Ontario expands access to COVID-19 antivirals, 'strongly recommends' masking indoors

6th wave not likely to 'settle' until middle or end of May, top doctor says

Cbc.ca
April 12, 2022

Ontario is expanding access to COVID-19 antiviral treatments for high-risk people as officials "strongly recommend" wearing masks in all indoor settings.

"It is clear we are in a sixth wave," Ontario's chief medical officer of health, Dr. Kieran Moore, told reporters Monday during his first COVID-19 update in more than a month.

The current wave, Moore says, is driven by the BA.2 variant and will likely continue into the middle or end of May.

While Moore said the province will not be reintroducing a mask mandate in indoor settings at this time, he said Ontarians should be prepared for those measures to return if a new variant of concern emerges, if the health-care system is threatened due to rising cases, or potentially during the winter months.

In the meantime, he said it's important for people to self-screen, test for symptoms, and get vaccinated.

"We have the tools to mitigate [the wave]," Moore said.

Antiviral eligibility expanded
Paxlovid, an antiviral drug for treatment of COVID-19 made by Pfizer, was approved in Canada on Jan. 17.

Paxlovid is for adults who have mild to moderate symptoms of COVID-19 in the early days of infection and who have a high risk of deteriorating into severe illness and requiring hospitalization. The medication is in pill form, taken twice a day for five days.

A positive result on a PCR or rapid test is required to be assessed for antiviral treatment, and it must be started within five days of the onset of symptoms.

Since January, that treatment and PCR testing has been limited to immunocompromised adults, unvaccinated people aged 60 and over, and unvaccinated people aged 50 and over if they are First Nation, Inuit or Metis or have other risk factors.

Effective immediately, the province says the following groups are eligible to be tested and assessed for antivirals:

People aged 18 and over who are immunocompromised.
People aged 70 and over.
People aged 60 and over with fewer than three vaccine doses.
People aged 18 and over with fewer than three vaccine doses and at least one condition considered to be a risk.

Access to Paxlovid has largely been limited to clinical assessment centres and primary care providers, but the province says participating pharmacies will start dispensing it this week.

Bring back mask mandates, report says
The expanded eligibility comes on the heels of a report by Public Health Ontario that shows COVID-19 cases, test positivity rates and hospitalizations have gone up since March 21, when the province ended mandatory masking in most indoor spaces.

"The full impact of lifting masking and other measures may not yet be observable, given limited PCR testing eligibility and lagging hospitalization data," the report says.

It proposes bringing back indoor masking and extending masking mandates in high-risk settings as possible elements of a "layered" strategy to mitigate a surge in cases.

The province has set April 27 as the date it plans to eliminate all remaining COVID-19 restrictions including masking in long-term care homes, retirement homes, health-care settings, jails, shelters, congregate living settings and on public transit.

However, that date will likely be pushed back, Moore said Monday, adding that his team is drafting a proposal for an extension to be considered by the province.

Ontario will heed advice of top doctors on masks
Meanwhile, Health Minister Christine Elliott said Monday officials will also follow the lead of the province's top doctors on whether or not to reintroduce masks.

"Many people are choosing to continue wearing their masks, that is their own preference," Elliott said.

"That is something that we will await [the top doctors'] guidance on and if it's a requirement that they recommend that we return to mask wearing, we will."

The report also warns that the number of Ontario children experiencing severe illness from COVID-19 is likely to increase given the increased transmissibility of the BA.2 subvariant of the virus, the removal of public health measures and the limited vaccine eligibility and two-dose coverage in those under the age of 12.

Asked Monday about reintroducing masks in schools given the data outlined in the report, Moore said "we have not seen any significant threat to the health of children."

But it's not just the risk of severe illness that is raising concerns.

In a statement issued Monday, the Ontario Liberals cited Ministry of Health data from Friday that shows one in seven kids and teachers were absent from schools across the province last week.

Liberal house leader John Fraser says that's why the province should immediately mandate masks in schools and other indoor public settings. 

"We know that these aren't perfect, but they are a layer of protection that are going to help us," he said.

"We can't wait two or three weeks."

NDP Health critic France Gelinas agrees, saying she has heard from many public health units eager to see them reintroduced.

"[Moore] has the power to make it a directive, to make it happen province-wide," she said following Moore's announcement Monday.

"I would have liked him to take it a step further."

Daily cases hovering around 100,000 to 120,000
The BA.2 subvariant is now the dominant strain in the latest wave of the pandemic, the document says. The proportion of samples identified as BA.2 rose from 12.3 per cent the week of Feb. 13 to 54 per cent the week of March 13, it says.

Meanwhile, wastewater surveillance suggests cases have been on the rise since mid to late March.

The scientific director of Ontario's panel of COVID-19 advisers has said the latest wastewater data suggests daily case counts for the virus are hovering around 100,000 to 120,000.

Last week, the province expanded eligibility for fourth doses of a COVID-19 vaccine to those 60 and older, as well as Indigenous residents and adult members of their household.

Fourth doses were already available to long-term care and retirement home residents and immunocompromised people in Ontario.

This comes as Ontario is reporting 1,090 people in hospital with COVID-19 Monday, up from 977 the day before and 857 at this time last week.

Of that number, 184 patients are in intensive care, up from 173 a day earlier and 168 a week ago. Eighty-two patients are on ventilators due to the virus.

The province reported another 2,401 COVID-19 cases through limited PCR testing, with 12,149 tests completed the day before.

​The test positivity rate sits at 17.6 per cent.

Three more deaths linked to the virus were also reported, pushing the total death toll in the province to 12,566.