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Ontario family docs limited to pilot call for more involvement in vaccine effort – KitchenerToday.com

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TORONTO — Ontario family doctors called Tuesday be more involved in the COVID-19 vaccination effort, saying they could boost uptake, but the government said their participation would be limited to a supply-dependent pilot project for now. 

The president of the Ontario Medical Association said the time is right for broader involvement of family doctors, who have only been participating in select public health units, now that Ontario is expecting more vaccines that don’t require extreme cold storage.

“I think it’s time to significantly empower family doctors to protect their patients,” Dr. Samantha Hill, president of the Ontario Medical Association said in an interview. “We do that by sending significant quantities of all of the non-Pfizer vaccines, whatever comes to our doors next, to primary care doctors so that they can meet this next phase of demand.”

Hill said family doctors are well-positioned to help people who are unable to travel to mass clinics, vaccine hesitant people and people at higher risk of infections. 

The Ontario College of Family Physicians said primary-care doctors could push overall participation in the province’s immunization program to nearly 90 per cent. 

In making its case, the group said it had conducted a survey that found 60 per cent of vaccine-hesitant respondents were more likely to get immunized if a family doctor endorsed and administered their shot. 

Some family physicians in six regions are currently offering Oxford-AstraZeneca shots to patients aged 60 and older as part of a pilot project. As of Tuesday, the government said those doctors had used about half of the 29,000 doses they had been sent.

The program is currently operating in Toronto, Peel Region, Hamilton, Guelph, Peterborough and Simcoe-Muskoka, with doctors calling eligible patients to schedule appointments. 

Solicitor General Sylvia Jones said the program will expand, but she couldn’t specify to where or when because the government doesn’t yet know when more doses of the Oxford-AstraZeneca vaccine will arrive. 

Jones didn’t rule out eventually having family doctors administer the Moderna vaccine as well, but said the Oxford-AstraZeneca shot was best suited for primary care physicians for now. 

“It is frankly a little easier vaccine to be able to move around, to store, so that is why we have put it with the primary care practitioners,” she said. “As we see supplies increase, then those conversations can continue, but right now it is AstraZeneca.”

The U.S. is expected to send 1.5 million Oxford-AstraZeneca shots to Canada before the end of the month.

Opposition politicians criticized the government for failing to fully involve family doctors in the vaccination effort.

“They’ve been left on the on the sidelines and I think that was a miscalculation by the government,” said NDP Leader Andrea Horwath.  

Liberal health critic John Fraser said the government shouldn’t still be running pilot projects at this point. 

“You need a plan and you need to execute it,” he said. 

At least one Ontario health unit said Tuesday that it will have some family doctors administer the Moderna vaccine as part of a local pilot project. Four primary care groups in Lambton Public Health will receive a total of 2,600 doses that will go to patients with high-risk chronic health conditions. 

Ontario’s supply of the Moderna vaccine is expected to increase in the coming weeks. The province says 97,000 doses are coming this week, and between 220,000 and more than 440,000 weekly doses are expected over the next three weeks. 

Jones said some of the incoming Moderna supply will go to pharmacies in the Toronto, Kingston and Windsor regions that are currently offering the Oxford-AstraZeneca vaccines to people 60 and older. 

The pharmacies in that pilot project have used more than 70 per cent of the 165,000 Oxford-AstraZeneca doses they received earlier in the month, the government said Tuesday.

Jones said the province still plans to expand the pharmacy project, although the government has not yet specified which other regions it will grow to. 

The government also reminded residents Tuesday not to show up for vaccination appointments far ahead of schedule. 

Lineups at some mass vaccination sites were reported in Toronto as the city vaccinates residents aged 75 and older. Local officials have urged those with appointments to show up only shortly before their time-slot, a call Jones repeated.

“People are excited to get the vaccine, they want to have that first shot and I can’t blame them,” she said. “We have regularly asked people not to arrive two or three hours early for your vaccine.”

The government also pledged on Tuesday to spend $3.7 million to help seniors and Ontarians with disabilities get vaccinated by helping transport them to immunization sites and, in some cases, bringing shots to them. 

Ontario outlined strategies for vaccinating priority groups in the next phase of the rollout set to begin in April. The phase will offer shots to people who are considered at risk due to their age, job, neighbourhood or health condition.

A document shared with health units and clinics broke down categories of people who can’t work from home. It encouraged workplace vaccinations and said employers should consider letting workers use paid time off to get their shots.

The government advised health units to work with communities to make vaccines accessible in hot spot neighbourhoods.

It also advised clinics to develop lists of backup recipients for remaining doses if people don’t show up to appointments.

This report by The Canadian Press was first published March 23, 2021.

Holly McKenzie-Sutter, The Canadian Press

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Canada will not restrict AstraZeneca COVID-19 vaccine, says benefits outweigh risk

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OTTAWA (Reuters) – Canada‘s health ministry said on Wednesday it would not restrict use of AstraZeneca Plc’s COVID-19 vaccine after a review showed the benefits outweighed the very rare risk of blood clots.

A separate advisory council had earlier recommended Canada stop offering the vaccine to people under 55. The panel is now reviewing that advice, the health ministry said in a statement.

Denmark on Wednesday became the first country to stop using the vaccine altogether over a potential link to the rare blood clots. Other nations have imposed limits on its use.

But Health Canada, the federal health ministry, said in a statement that a review of data from Europe, Britain and AstraZeneca had not identified specific risk factors.

“Therefore, Health Canada is not restricting the use of the vaccine in any specific populations at this time … The potential risk of these events is very rare, and the benefits of the vaccine in protecting against COVID-19 outweigh its potential risks,” it said.

Canada on Tuesday said it had recorded its first case of blood clotting with low platelets after someone received the AstraZeneca shot. The patient in question, a woman from Quebec, is recovering. (Graphic on vaccines: https://tmsnrt.rs/3tUM8ta)

COVID-19 cases are surging in Canada with the country reporting a near-record number of new cases recently. (Graphic on cases: https://tmsnrt.rs/34pvUyi)

 

(Reporting by David Ljunggren in Ottawa and Allison Martell in Toronto; Editing by Lisa Shumaker)

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Factbox-Some countries limit AstraZeneca vaccine use, US pauses J&J shot

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(Reuters) -Some countries are restricting use of the AstraZeneca COVID-19 vaccine to certain age groups or suspending use after European and British regulators confirmed possible links to rare blood clots.

Denmark became the first country to stop using the vaccine altogether, as it said results of investigations showed “real and serious side-effects”.

Johnson & Johnson’s single-shot vaccine has also been hit by concerns over blood clots, with European regulators reviewing such cases and U.S. federal health agencies recommending pausing its use for a few days. J&J noted no clear causal relationship had been established between the clots and its vaccine.

The developments pose a risk to vaccination plans in Europe.

Regulators have said the benefits of the AstraZeneca shot outweigh risks.

Anglo-Swedish drugmaker AstraZeneca said it was working with regulators to list the possible brain blood clots as “an extremely rare potential side effect” on the vaccines labels.

As of April 4, the European Medicines Agency had received reports of 169 cases of a rare brain blood clot known as cerebral venous sinus thrombosis (CVST), after 34 million doses had been administered in the European Economic Area. Most cases were in women under 60 years of age.

ASTRAZENECA VACCINE BEING USED, WITH OR WITHOUT RESTRICTIONS

AUSTRALIA

Said on April 8 it recommends people under 50 should get Pfizer’s COVID-19 vaccine in preference to AstraZeneca’s shot.

AUSTRIA

Has resumed use.

BRAZIL

Authorities said they would not limit use of the AstraZeneca vaccine, saying benefits outweigh risks.

BRITAIN

The Joint Committee on Vaccination and Immunisation has said an alternative to the vaccine should be given for people under 30 where possible, but people should continue to have a second shot if they have received a first dose.

BULGARIA

Resumed inoculations from March 19.

CYPRUS

Resumed inoculations on March 19.

CANADA

Authorities said in early April they would pause offering the vaccine to people under 55 and require a new analysis of the shot’s benefits and risks based on age and gender. On April 13, the country said it had recorded its first case of blood clotting with low platelets.

ESTONIA

Suspended use of the vaccine for people under 60 on April 7.

FRANCE

Approved resumption of the vaccine on March 19 but said it should be given only to people aged 55 and over. On April 9, recommended that recipients of a first dose of the AstraZeneca shot who are under 55 should receive a second dose with a messenger RNA vaccine.

FINLAND

Resumed using the AstraZeneca vaccine from March 29, but only for people aged 65 and over.

GEORGIA

Has limited use of the vaccine following the death of a nurse from anaphylactic shock, and vaccinations will continue only in full-fledged medical centres, Russian news agency TASS reported on March 19.

GERMANY

Sticking to its guidance from March 31 to limit use of the vaccine to those aged over 60. On April 1, Germany’s vaccine commission recommended people under 60 who have had a first shot of the vaccine should receive a different product for their second dose.

HUNGARY

Continuing the vaccine’s rollout.

ICELAND

Resumed use on March 25 after suspending it on March 11.

INDONESIA

Resumed using the vaccine on March 22 but warned against its use in people with a low blood platelet count.

IRELAND

On April 12, the country said it was restricting use of the vaccine to those over 60.

ITALY

Has recommended the vaccine be used only for people over 60, the country’s top health adviser said.

LATVIA

Announced it was restarting administering the shots from March 19.

LITHUANIA

Restarted use on March 19.

MEXICO

Drug regulator Cofepris said on April 7 it did not “at this time” plan to limit the vaccine’s use but was investigating the information raised by Britain.

NETHERLANDS

Limited use of the vaccine to people over 60, the Dutch government said on April 8.

NORTH MACEDONIA

Health minister said on March 31 the vaccine would be limited to people aged over 60 as a precautionary measure.

PHILIPPINES

Suspended use of the vaccine for people under 60 on April 8.

ROMANIA

Has resumed use of the vaccine after temporarily stopping vaccinating people with one batch of the vaccine on March 11.

SOUTH KOREA

Resumed use of the shot for people aged 30 or older on April 12. On April 7, it had suspended providing the AstraZeneca shot to people under 60.

SPAIN

From April 8, it was giving the vaccine only to people over 60.

SWEDEN

Resumed use of the vaccine on March 25 for people aged 65 and older.

THAILAND

Began use on March 15 after delaying rollout the week before.

COUNTRIES WHERE ASTRAZENECA VACCINE USE SUSPENDED

CAMEROON

Suspended administration of the vaccine it was scheduled to receive on March 20 as part of the global vaccines sharing scheme COVAX, the health ministry said.

DENMARK

In a world first, Denmark decided to stop using the AstraZeneca vaccine altogether after initially suspending use of the shot.

NORWAY

Authorities said on March 26 Norway would delay a decision on use of the vaccine, with a decision expected by April 15.

J&J VACCINE DELAYS AND RESTRICTIONS

UNITED STATES

On April 13, U.S. federal health agencies recommended pausing use of J&J’s COVID-19 vaccine for at least a few days after six women under the age of 50 developed rare blood clots after receiving the shot.

EUROPEAN UNION

The company said it would delay the rollout of the vaccine to Europe, after regulators said they were reviewing rare blood clots.

Widespread use in the EU had not yet started after the company began delivering the doses in the week beginning April 12. The European drug regulator recommended storing doses already received until its safety committee issues an expedited recommendation

SOUTH AFRICA

Suspended use of J&J’s vaccine on April 13.

(Reporting by Pushkala Aripaka, Yadarisa Shabong, Manas Mishra, Vishwadha Chander, Amruta Khandekar and Mrinalika Roy in Bengaluru; editing by Josephine Mason, Alison Williams, Timothy Heritage, Larry King, Barbara Lewis)

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Ontario hospitals may have to withhold care as COVID-19 fills ICUs

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By Allison Martell and Anna Mehler Paperny

TORONTO (Reuters) – Doctors in the Canadian province of Ontario may soon have to decide who can and cannot receive treatment in intensive care as the number of coronavirus infections sets records and patients are packed into hospitals still stretched from a December wave.

Canada‘s most populous province is canceling elective surgeries, admitting adults to a major children’s hospital and preparing field hospitals after the number of COVID-19 patients in ICUs jumped 31% to 612 in the week leading up to Sunday, according to data from the Ontario Hospital Association.

The sharp increase in Ontario hospital admissions is also straining supplies of tocilizumab, a drug often given to people seriously ill with COVID-19.

Hospital care is publicly funded in Canada, generally free at the point of care for residents. But new hospital beds have not kept pace with population growth, and shortages of staff and space often emerge during bad flu seasons.

Ontario’s hospitals fared relatively well during the first wave of the pandemic last year, in part because the province quickly canceled elective surgeries.

The College of Physicians and Surgeons of Ontario told doctors last Thursday that the province was considering “enacting the critical care triage protocol,” something that was not done during earlier waves of the virus. Triage protocols help doctors decide who to treat in a crisis.

“Everybody’s under extreme stress,” said Eddy Fan, an ICU doctor at Toronto’s University Health Network. He said no doctor wants to contemplate a triage protocol but there are only so many staff.

“There’s going to be a breaking point, a point at which we can’t fill those gaps any longer.”

In a statement, the health ministry said Ontario has not activated the protocol. A September draft suggested doctors could withhold life-sustaining care from patients with a less than 20% chance of surviving 12 months. A final version has not been made public.

Ontario’s Science Advisory Table had been forecasting the surge for months, said member and critical care physician Laveena Munshi. During a recent shift she wanted to call the son of a patient only to discover he was in an ICU across the street.

“The horror stories that we’re seeing in the hospital are like ones out of apocalyptic movies,” she said. “They’re not supposed to be the reality we’re seeing one year into a pandemic.”

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