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COVID-19
Health Care Provider
      Briefing
Middlesex and London Region
       June 18, 2021

Welcome
          Presenter:
    Dr. Alex Summers
Associate Medical Officer of Health
  Middlesex-London Health Unit

         @alexsummers4

Surveillance Report
As of June 18th:
• Over 177 million COVID-19 cases and over 3.8 million deaths have
   been reported worldwide.
• Over 2.5 billion vaccine doses administered worldwide
• 548,745 cases of this illness confirmed in Ontario, including 8,984
   deaths
• Local:

Data source: Ontario Ministry of Health (Ministry) Public Health Case and Contact Management Solution (CCM), extracted
2021-06-18. Data current as of the end of day 2021-06-17.

Variant of Concern (VOC) update

Cases by Reported Date

Data source: Ontario Ministry of Health (Ministry) Public Health Case and Contact Management Solution (CCM), extracted
2021-06-18. Data current as of the end of day 2021-06-17.

Outbreaks
Outbreaks (as of June 18, 2021):
• Congregate Setting = 0
• LTCH/RH/Hospital = 1

Schools/Child Care/Post-secondary in Outbreak:

COVID-19 Vaccine Update

COVID-19 Vaccine Coverage

Temporary halt to MLHU programs

The Middlesex-London Health Unit will be receiving a 70% increase in its
allocation of COVID-19 vaccine over the next several weeks

This will allow for the acceleration of second dose delivery. Protection against the
new Delta variant first identified in India is much better after two doses (in the
range of 90% after two doses, as opposed to 30-40% after one dose).

In order to meet the challenge of delivering this vaccine as quickly as possible, the
Health Unit needs to temporarily increase its staffing capacity at the mass
immunization clinics immediately.

The Health Unit will be suspending almost all non-COVID-19 programming and
services temporarily between June 17th and July 7th.

COVID-19 Vaccine Eligibility
Who is currently eligible to get the vaccine?
  ➢ Anyone over age 12

COVID-19 Vaccine Eligibility:
               Second dose schedule
•   Shortened interval guidance for MLHU region:
              o   Adults aged 70 and over
              o   Listed healthcare workers (list on healthunit.com)
              o   Listed health conditions (list on healthunit.com)
              o   Individuals who received a first dose on or before May 9
              o   Individuals who received first dose of AstraZeneca (8-12 week
                  interval)
•   Eligible individuals who need to re-book their second dose for a
    shortened-interval appointment:
         ✓ Call the COVID-19 Vaccine Booking Line:
           (226)289-3560 (8:00 a.m. – 7:30 p.m. Monday to Sunday)
         ✓ Visit covidvaccinelm.ca

New AZ Guidance from NACI
• An mRNA vaccine is now preferred as the second dose
  for individuals who received a first dose of the
  AstraZeneca/COVISHIELD vaccine
•   Emerging evidence from studies in Germany suggests a potentially better
    immune response, including against variants of concern, when a first dose of
    the AstraZeneca vaccine is followed by a second dose of the Pfizer-BioNTech
    mRNA vaccine, compared to two doses of the AstraZeneca vaccine.
•   Evidence continues to suggest a first dose of the AstraZeneca vaccine
    followed by a second dose of the Pfizer-BioNTech mRNA vaccine has a good
    safety profile.
•   Receiving an mRNA vaccine as a second dose also mitigates the rare risk of
    VITT that is associated with viral vector vaccines. The rate of VITT after the
    second dose of the AstraZeneca/COVISHIELD vaccine appears to be lower
    than with the first dose but has increased over time, with current estimates
    of approximately 1 per 600,000 people vaccinated.

Second dose information
•   Cancelling appointments
     o If you booked only one appointment with the same contact
        information:
         • Go to covidvaccinelm.ca, Gate 6: Option 1
     o If you booked multiple appointments with the same contact
        information:
         • Email covidcancel@mlhu.on.ca, and provide the following:
              • First and last name of the person holding the appointment
              • Email address OR cell phone number used to book the
                 appointment
              • Date, time and location of appointment needing to be
                 cancelled
                  • Please provide this information for each
                     person/appointment being cancelled
         • Starting Monday, June 21, individuals can also call: 519-963-4136
             (new cancellation phone line)

Second dose information
•   Booking multiple second dose appointments online
     o Anyone who used the same email address or cell phone number to
          book a first dose appointment for more than one person can now re-
          book shortened-interval appointments for multiple individuals online
          at covidvaccinelm.ca using Gate #4: I need to re-book my scheduled
          second dose, or by calling the Appointment Booking Phone Line at
          226-289-3560.
•   According to their eligibility, individuals that are homebound and received
    a first dose COVID-19 from the mobile clinic team will be contacted to
    arrange a second dose appointment.

School-based COVID-19
        vaccination pop-up clinics
• On June 21, the Middlesex-London Health Unit will start
  hosting school-based Pop-Up Community Clinics
   • Select London and Middlesex County schools
   • Will provide a first dose COVID-19 vaccine to people who
     have not been able to attend one of the mass vaccination
     clinics in the region, whether due to transportation
     challenges or other barriers.
   • For more information please visit
     www.healthunit.com/covid-19-vaccine.

Provincial Updates: Accelerated second doses
Monday, June 21, anyone who received their first dose on or before May
9th will be eligible to book or rebook their second dose appointment at a
shortened interval.

Wednesday, June 23, anyone who received their first dose on or before
May 30th and who live in the catchment area of one of the 10 Delta hot
spots (Durham, Halton, Hamilton, Peel, Porcupine, Simcoe-Muskoka,
Toronto, Waterloo, Wellington-Dufferin-Guelph, and York) will be eligible to
book or rebook their second dose appointment at a shortened interval.

The week of June 28, all Ontarians 18+ who have received their first dose
of an mRNA COVID-19 vaccine will be eligible to book their second dose
appointment (at least 28 days after the first dose, as per the recommended
interval guidelines)

Vaccine Receipts
• After being vaccinated, individuals can log in to the provincial
  portal to download or print an electronic COVID-19 vaccine
  receipt for each dose received no matter where they were
  vaccinated (e.g., mass vaccination clinic, hospital, pharmacy
  or primary care setting).
   o Individuals will need the following to obtain a vaccination
      receipt;
       ▪ Their green photo health (OHIP) card for the numbers
          on the front AND the back of the card,
           • Please Note: Expired cards will be accepted
       ▪ Their date of birth, and
       ▪ Their postal code

Interchangeability of mRNA Vaccines
• Moderna and Pfizer are interchangeable COVID-19 mRNA
  vaccines. This means that individuals can receive either
  vaccine as their second dose, regardless of which vaccine they
  received as their first dose.
• Large shipments of Moderna are anticipated in the next few
  weeks, allowing more people to receive a second dose at a
  shorter interval.
• At the mass vaccination clinics in Middlesex-London, this also
  means that some people who received Pfizer as a first dose
  may receive Moderna as a second dose, or vice versa.

Moderna Updates
• Moderna vials from US differ from vials from EU used
  previously:
       ▪   Each vial will contain 14 doses (max 15) vs. 10 doses
       ▪   Each carton will contain 140 doses (max 150) vs. 100 doses
       ▪   Each vial has a larger fill volume of 8mL in vials vs. 6mL
       ▪   Expiration dates are NOT printed on cartons or vials, this info is
           found on Moderna’s Canadian website (6 lots expire Dec 2021)
   • Health Canada has also approved a revision to Moderna’s
     COVID-19 Product Monograph for the storage of
     punctured vials.
       ▪    Once the vial has been entered (needle-punctured), it can be
            stored at room temperature or refrigerated (2°C to 25°C OR 36°F
            to 77°F) but must be discarded after 24 hours.

Out of Province/International Vaccinations
    •  COVID-19 vaccinations received outside of Ontario or outside of
       Canada
        o report this information to the Middlesex-London Health Unit
        o MLHU will assist with either completing your vaccination
            series and/or validating your vaccination record in the
            Provincial COVID-19 reporting system (COVAXon).
    • The Health Unit is currently working on a process for individuals
       to submit their COVID-19 vaccine records electronically for
       assessment and entry into the Provincial COVID-19 reporting
       system (COVAXon).
    • The latest ministry guidance on individuals vaccinated outside
       Ontario/Canada can be found on the Middlesex London Health
       Unit’s website
Please Note: Currently, COVID-19 vaccination records cannot be
submitted or viewed using Immunization Connect Ontario (ICON).

Travel Restrictions
• International:
   • According to the Government of Canada , exemptions
      for fully vaccinated travellers who are eligible to enter
      Canada are expected in early July
• Provincial
   • On June 16, restrictions on travel from Manitoba and
      Quebec into Ontario were lifted.
       • You can leave home to travel. If you are ill, you
          should not travel even if your symptoms are mild.

COVID-19 Vaccine Hesitancy
•   PHAC highlights the following strategies for building vaccine confidence through
    communication with patients:
     o   Use presumptive statements when initiating a discussion with patients about
         vaccines that convey the social norm of vaccination and the expectation that patients
         will vaccinate.
     o   Cultivate a "safe space" for discussions about vaccination.
     o   Open up about your own experiences getting vaccinated, vaccinating other patients
         and/or how you have chosen or encourage vaccination for your loved ones.
     o   Activate the "right" emotions.
     o   Be transparent during a discussion on the risks and benefits of vaccination and inform
         patients of the risks of not getting vaccinated.

Employment Opportunity
• The Middlesex-London Health Unit has issued an immediate
  call for Clinical Supervisors and Managers, as well as
  vaccinators and administrative staff to expand the local
  vaccination effort at mass vaccination clinics and community-
  based mobile clinic sites.
• Physicians interested in working at a mass vaccination clinic
  can email scheduling@mlhu.on.ca.

Questions?
• Ask using chat function now, or after the webinar at:
  healthcareproviders@mlhu.on.ca
• For urgent matters please call the Health Unit’s main line at
  519-663-5317.
• For more information www.healthunit.com/healthcare-
  providers