Easing Public Health and Workplace Safety Measures – Updated March 16, 2022

The province is easing public health and workplace safety measures. According to the Ministry of Health’s Living with and Managing COVID-19: Technical Media Briefing, a process is now underway to gradually revoke all Chief Medical Officer of Health Directives by the end of April. They will be replaced with operational guidance or recommendations from the Chief Medical Officer of Health. As Directives are revoked, individual organizations will continue to have the authority to keep requirements in place.

Directive #6 on Vaccine Policies Revoked

Effective March 14, 2022, the Chief Medical Officer of Health revoked Directive #6, which required certain organizations to implement mandatory COVID-19 vaccination policies. Public hospitals, home care and community service provider organizations, Home and Community Care Supports Services organizations, and paramedic services are no longer required to implement mandatory COVID-19 vaccination policies for their employees, staff, contractors, volunteers, and students.

Mask Mandates

The Chief Medical Officer of Health announced that mask mandates would be lifted in most public spaces in Ontario on March 21, 2022. This guidance does not apply to high-risk settings including hospitals, long-term care, retirement homes, and other health care settings.

Physiotherapists working in community settings such as private practice clinics should continue to follow the guidance from the Ministry of Health’s Primary Care Providers in a Community Setting document, which provides guidance on in-person and virtual care, screening, and occupational health and safety, including PPE requirements, infection prevention and control measures, and self-isolation and return to work.

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COVID-19 Directives and Guidance – Updated February 23, 2022

Effective since February 10, The Chief Medical Officer of Health revoked Directive #2 to allow for a gradual resumption of non-urgent and non-emergent surgeries and procedures in hospitals. The Directive applied to public hospitals, private hospitals, and independent health facilities and was initially issued to help maintain health system capacity and health human resources as a result of pandemic pressures.

Read the supporting Q&A for more information on the revocation of Directive #2.

The Ministry also updated COVID-19 Interim Guidance: Omicron Surge Management of Critical Staffing Shortages in Highest Risk Settings. This document outlines considerations in response to critical staffing shortages for otherwise ineligible staff for early return to work based on different risk levels and applies to:

• Hospitals with complex continuing care facilities and paramedic services;
• Congregative living settings, including long-term care, retirement homes, and others; and,
• Home and community care.

The Ministry of Health updated COVID-19 Guidance: Primary Care Providers in a Community Setting. There are updated recommendations in various sections including:

• Deciding how to provide in-person versus virtual care;
• Active and passive screening requirements;
• PPE requirements when caring for patients with suspected or confirmed COVID-19;
• Testing and case management; and,
• Self-isolation and return to work for health care workers.

With regard to COVID-19 vaccination and testing, primary care providers should not require patients to have a negative COVID-19 test prior to an in-person visit. Access to necessary in-person care should be available to all patients regardless of COVID-19 vaccination status. Primary care providers and their office/clinic staff are strongly recommended to be fully vaccinated and should also consider implementing staff vaccination policies for their practice.

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Directives #2 and #6 – February 9, 2022

The Chief Medical Officer of Health updated Directive #2, effective February 1. This Directive enables regulated health professionals or those who operate a group practice of regulated health professionals in Public Hospitals, Pediatric Specialty Hospitals, Private Hospitals, and Independent Health Facilitates to continue certain restrictions and resume certain clinical activities.

In Public Hospitals, ambulatory clinics may gradually resume as long as the increase in activity does not lead to insufficient staffing in other areas of the hospital. The requirement to cease non-emergent or non-urgent surgeries and procedures is still in effect, with the exception of diagnostic imaging and cancer screening, which may gradually resume.

In the other settings, non-emergent or non-urgent surgeries and procedures may gradually resume in consideration of system capacity and the need to maintain the health and human resources to deliver essential and urgent health services. In Pediatric Specialty Hospitals specifically, ambulatory clinics may gradually resume so long as the increase in activity does not lead to insufficient staffing in other areas of the hospital.

Read more about Directive #2 and the accompanying Q&A.

The Chief Medical Officer of Health re-issued Directive #6, effective on February 2. This Directive applies to Public Hospitals (within the meaning of the Public Hospitals Act), Service Providers (within the meaning of the Home Care and Community Services Act), Local Health Integration Networks (within the meaning of the Local Health System Integration Act), and Ambulance Services (within the meaning of the Ambulance Act). These organizations must establish and implement a COVID-19 vaccination policy that requires its employees, staff, contractors, volunteers and students to provide:

• Proof of full vaccination against COVID-19; or
• Written proof of a medical reason for not being fully vaccinated against COVID-19;
• Proof of completing an educational session approved by your organization about COVID-19 vaccination; or
• Documentation that confirms current participation in a COVID-19 vaccine clinical trial authorized by Health Canada.

The Directive enables organizations to decide to remove the option for completing an educational session and require all of their employees, staff, contractors, volunteers and students without written proof of medical exemption to be fully vaccinated against COVID-19. Those individuals without vaccination will be required to undergo regular antigen point of care testing at intervals determined by their organization and submit negative test results.

Read more about Directive #6.

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Directive #1, #2, and #5 – January 12, 2022

The Chief Medical Officer of Health (CMOH) updated various Directives due to growing information on the transmission of the Omicron variant. The Ministry of Health (MOH) has also developed Q&As to support understanding of some of these Directives.

Directive #1, in effect since December 22, outlines required precautions for all health care providers and health care entities to optimize protection against Omicron. It has recently been updated to provide direction around PPE to health care workers who are awaiting fit-testing.

Required precautions for health care workers who are providing direct care to or interaction with a suspect, probable, or confirmed case of COVID-19 are:

• A fit tested, seal-checked N95 respirator (or approved equivalent);
• Eye protection (goggles, face shield or safety glasses with side protection); and
• Gown and gloves.

For those who are providing direct care to or interacting with a suspect, probable, or confirmed case of COVID-19 but are not yet fit-tested for an N95 respirator they are required to use:

• A well-fitted surgical/procedure mask;
• A KN95 respirator or a non-fit tested N95 respirator (or equivalent)
• Along with the other PPE requirements outlined above.

Directive #5, in effect on December 22, outlines required precautions and procedures that all public hospitals, long-term care homes, and retirement homes must implement. Regulated health professionals (RHPs) in these settings providing direct care or interacting with suspected, probable or confirmed COVID-19 patients or residents must use appropriate PPE, which includes:

• Fit-tested, seal-checked N95 respirators (or an approved equivalent);
• Gloves, eye protection (face shield, safety glasses with side protection, or goggles); and
• Isolation gowns.

Furthermore, these organizations cannot deny access to a fit-tested, seal-checked N95 respirator (or approved equivalent). The MOH developed Q&As to accompany Directive #1  and Directive #5, which outlines the revisions made for each Directive, along with more information on areas including:

• What is known about the modes of transmission of the COVID-19 Omicron variant;
• How to use a point-of-care risk assessment;
• Precautions taken when performing an Aerosol Generating Procedure (AGMP);
• Accessing fit testing; and
• The difference between a suspect and probable case of COVID-19.

Directive #2, in effect since January 5, outlines steps required to preserve hospital and human health resource capacity. This Directive applies to RHPs or persons who operate a group practice of RHPs in a hospital, private hospital, or independent health facility (within the meaning of the Independent Health Facilities Act). This directive does not change or add any restrictions currently applicable to community based physiotherapy clinics.

It specifies that:

• All non-emergent or non-urgent surgeries or procedures should be ceased; and
• All non-emergent or non-urgent diagnostic imaging and ambulatory clinical activity should be ceased, unless directly related to the provision of emergent or urgent surgeries and procedures or to pain management services.

It notes that RHPs are in the best position to determine what are urgent or emergent surgeries and procedures, diagnostic imaging, and ambulatory clinical activity in their specific health practice and should rely on evidence and guidance where available.

For more information on the impact on health care professionals in those settings, please read the Q&A that accompanies Directive #2.

Find the Directives on the Ministry website.  The MOH notes that if any questions about the interpretation of these directives, please write to EOCoperations.moh@ontario.ca.

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Directive #1 and # 5 – December 21, 2021 Update

The Chief Medical Officer of Health for Ontario has updated guidance outlined in Directive #1 for Health Care Providers and Health Care Entities, and Directive #5 for Hospitals and Long-Term Care Homes as an interim change in current practices due to the uncertainty on the transmissibility of the COVID-19 Omicron variant. Please review the updates on the directives when they are posted on the Ontario government website.

Effective December 22, 2021, Directive #1 outlines the required precautions that should be taken by all health care providers and health care entities to optimize protection against the Omicron variant, which includes:

• Performing a point-of-care risk assessment before every patient interaction.
• Airborne precautions when aerosol generating medical procedures (AGMPs) are planned or anticipated to be performed on patients with suspected or confirmed COVID-19, based on a point of care risk assessment and clinical and professional judgement.
• Required precautions for all health care workers providing direct care to or interacting with a suspected, probable or confirmed cases of COVID-19 are a fit-tested, seal-checked N95 respirator (or approved equivalent), eye protection (goggles or face shield), gown and gloves.

Effective December 22, 2021, Directive #5 outlines the required precautions and procedures that all public hospitals and long-term care homes must implement. The Directive outlines that public hospitals and long-term care homes must ensure the conservation, stewardship, and ongoing supply of personal protective equipment (PPE), and develop contingency plans if a shortage is to occur. The Directive also outlines that:

• Regulated health professional and other health care workers are provided with information and training on the safe use of all PPE (e.g., don and doff) by their organization;
• A point-of-care risk assessment (PCRA) must be performed before every patient or resident interaction;
• Droplet and Contact Precautions must be used for all interactions with suspected, probable or confirmed COVID-19 patients or residents, which includes gloves, face shields or goggles, gowns, and well-fitted surgical/procedure masks.
• Required precautions for providing direct care to or interacting with a suspected, probable or confirmed cases of COVID-19 are a fit-tested, seal-checked N95 respirator (or approved equivalent), eye protection (goggles or face shield), gown and gloves.
• All providing direct care to or interacting with suspected, probable or confirmed COVID-19 patients or residents shall have access to appropriate PPE. The public hospital or long-term care home will not deny access to a fit-tested, seal-checked N95 respirator (or approved equivalent).
• Fit-tested, seal-checked N95 respirators (or approved equivalent), must be used by all in the room where Aerosol Generating Medical Procedures (AGMPs) are being performed, are frequent or probable.

Please review and adopt the updated IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19, which outlines foundational infection prevention and control and occupational health and safety strategies, including the role of PPE within the Hierarchy of Hazard Controls and a description of what PPE should be used in different settings and for different activities.

COVID-19 Vaccine Booster Eligibility Expansion – Updated November 4, 2021

The Ministry of Health has updated their COVID-19 third dose vaccination recommendations to align with the recommendations made by the National Advisory Committee on Immunization (NACI). The updated recommendations have expanded to include more groups, including health care workers given that they:

1. are at an increased risk of COVID-19 infection due to their ongoing interactions and exposure to patients that may be infected with COVID-19;
2. pose an increased risk of transmission to vulnerable populations if they are infected; and,
3. are essential in maintaining health system capacity throughout this pandemic.

At this time, a booster dose of a COVID-19 vaccine will be offered to health care workers who received their second dose of the COVID-19 vaccine at least 6 months (168 days) ago. This includes:

• Any regulated health professionals and any staff member, contract worker, student/trainee, registered volunteer, or other designated essential caregiver currently working in-person in a health care organization, including workers that are not providing direct patient care and are frequently in the patient environment (i.e., cleaning staff, research staff, other administrative staff); and,
• Workers providing healthcare service or direct patient service in a congregate, residential or community setting outside of a health care organization.

For more information on how to get a third dose of the COVID-19 vaccine, please discuss this with your organization and/or contact your local public health unit.

Access the news release.

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Learn more about the Ontario Vaccine plan.

Access vaccine educational documents.

The CPA and OPA have been advocating for health care professionals, including physiotherapists and physiotherapist assistants, working in all settings of our health system to have priority access to the COVID-19 vaccine.

Access CPA’s statement.

Physiotherapists may choose to bill their usual and customary rates for virtual visits. However, some funders may have established policies regarding a different fee for virtual visits (e.g. home care sector).

It is important to be transparent with funders and this includes indicating on all documentation for care, including your invoice that care was provided through a virtual visit.

At all times, all standards of practice including those for charting and billing and fees must be met. The College of Physiotherapists of Ontario has resources to help you.

Several extended health benefits insurers have publicly indicated that they will cover physiotherapy virtual care visits.

Access a list of insurers paying for virtual visit claims. The WSIB is also allowing for a variety of their programs and services to be delivered through virtual care for those with workplace injuries.

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For auto insurance, it is up to each individual insurer, however, there is no prohibition in the SABS on the provision of virtual care. If an auto insurer denies a treatment plan or places barriers to care provided virtually without good reasons then this may be a reason for a complaint to FSRAO. Learn more about Statutory Accident Benefit Claims during COVID-19, including an interpretation of the legislation as it relates to the use of virtual care provided to a claimant.

If you have any questions about virtual care and coverage, you are welcome to reach out to the insurer to ask for clarification, however, the policy holder (i.e., the patient) should also contact their insurance company to confirm coverage.

OPA and CPA are continuing to advocate for coverage to ensure access to care across all funding streams.

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What is tele-rehab/virtual care?

A physiotherapist must use their professional judgement to determine whether it is appropriate, effective, and safe to deliver care through virtual means for each patient.

Factors such as competence with technology, language barriers, and cognitive or physical impairments must be considered in all cases, and informed consent must be given to participating in virtual care. The College has listed the type of interventions and modalities that can be provided virtually.

Health authorities continue to recommend the use of virtual care where possible. Consider offering a blended or hybrid model of in person and virtual care where appropriate.

CPA has developed a webinar series to address member questions concerning telehealth services. Additional resources for accessing telehealth platforms have also been available at discounted rates to members. Find more information.

The Rehab Care Alliance (RCA) has additional resources on implementing and evaluating tele rehab programs.

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Providing virtual care to people outside of Ontario

The Canadian Alliance of Physiotherapy Regulators has published a detailed guideline to assist physiotherapists interested in providing cross border care.

The College has also addressed this in their FAQs.

Members must implement infection control practices and measures including the use of PPE that are consistent with provincial and jurisdictional public health recommendations, Ministry of Health guidelines and the College of Physiotherapists of Ontario standards of practice and guidance in this area. It is important that members stay up to date on public health recommendations and monitor for changes.

The guidance document for primary care providers in a community setting and the COVID-19 Operational Requirements: Health Sector Restart document both provide information on risk reduction measures for those providing in person care. It also provides PPE guidance for those who screen positive or negative for COVID 19 and routine PPE practices for the safety of yourself and others.

The College has developed an FAQ page that covers variety of questions regarding PPE.