Niagara Region Public Health and Emergency Services is closely monitoring the COVID-19 pandemic. This is an evolving situation and we'll continue to update information as it becomes available.
If you have questions, call our COVID-19 Primary Care Info-Line Monday to Friday, 8:30 a.m. - 4:15 p.m. Call 905-688-8248, press 7, then press 1 for physicians.
Updated Nov. 18
Niagara Regional Council passed a temporary face covering by-law (By-law 2020-46) to require residents to wear mandatory face coverings in enclosed public places, and on Regional and municipal transit during the COVID-19 pandemic.
The by-law aligns with face covering orders issued by the province under the Reopening Ontario Act. The by-law will automatically expire when those Provincial requirements are no longer in effect.
Learn more about the face covering by-law. There is no requirement for people to prove their condition or disability.
Yes. Public Health is reporting on Niagara's vaccination statistics, including daily and active. Updates to reports are made each day at around noon.
You can also view:
Review the self-monitoring sheet for individuals who are asymptomatic.
Due to the COVID-19 pandemic, Regional headquarters is closed to the public. Many of our programs have shifted to online platforms, been cancelled or are postponed until further notice.
Check our website for a list of up-to-date service closures and disruptions.
Ontario is looking for people with experience in providing health care to help provincial efforts to prevent and control the spread of COVID-19.
If you're a health care provider working part-time, a former health care provider who is retired or on inactive status, or a health care provider in training, and you would like to be matched to positions and opportunities where services are needed most, sign up on the Workforce Matching Portal.
Full vaccination is the greatest protection patients can have against COVID-19 and its variants.
The Government of Canada is working with provinces and territories to allocate COVID-19 vaccines across Canada. See important updates about COVID-19 vaccine availability in Ontario.
We have also created the Public Health COVID-19 FAQ page dedicated to the COVID-19 vaccines. We'll continue to share updates as we receive more information from the province as it relates to Niagara. Learn about COVID-19 vaccination in Niagara.
The Ministry of Health has created a COVID-19 vaccine-relevant information and planning resources webpage for health care providers.
According to National Advisory Committee on Immunization, the optimal interval between the first and second dose of a two-dose COVID-19 vaccine series is:
For more information and to learn about what health care providers should consider when recommending this interval to patients, refer to our Nov. 12 Memo: Optimal Interval Between First and Second Doses of COVID-19 Vaccine.
While an mRNA vaccine is now preferred as the second dose for individuals who received a first dose of AstraZeneca, a viral vector vaccine may be offered to start a vaccine series when an mRNA vaccine is inaccessible or contraindicated.
The benefits of vaccines authorized in Canada continue to outweigh the risks. Use the following emerging information to counsel patients to help them make an informed decision around COVID-19 vaccination with a viral vector vaccine.
All cases of vaccine-induced immune thrombotic thrombocytopenia, capillary leak syndrome and Guillain-Barré Syndrome following COVID-19 vaccination need to be reported to Public Health.
Patients who have either started or completed their COVID-19 vaccine series outside of Ontario or Canada with a vaccine NOT currently authorized by Health Canada are recommended to restart their COVID-19 vaccine series with a Health Canada authorized COVID-19 vaccine. Patients would be eligible to restart their COVID-19 vaccine series 28 days after their last vaccine.
A completed vaccine series from outside of Canada is currently considered valid by the Ontario government, but there's no guarantee that this will remain the case, nor that other jurisdictions and organizations will recognize it. Not all vaccine series elsewhere in the world are as effective as the vaccines approved by Health Canada.
As a practical matter to ensure patients are recognized as vaccinated in the future, and as an ethical matter to ensure all persons have opportunity to receive equivalent protection against COVID-19, a Health Canada approved vaccine series is recommended to anyone who hasn't already been vaccinated with one.
Patients who have received a partial or full dose of a COVID-19 vaccine series can report their vaccination using our online form.
Health care providers should:
The Ministry of Health has created a COVID-19 vaccine-relevant information and planning resources webpage for health care providers which includes a section on general immunization documents for immunizers and vaccine clinics as well as consent for COVID-19 vaccination documents.
Be sure to review information on how to become a COVID-19 vaccine administration site.
Public Health has a training video on how to draw up an extra dose from the vial for Pfizer-BioNTech vaccine (see the approximate six minute mark).
If someone experiences an adverse event following immunization they should report it to a healthcare professional, such as a family doctor. Healthcare professionals are asked to report adverse events to Public Health.
Public Health surveillance of adverse events following immunizations is important for timely detection of rare vaccine safety issues. Expected side effects for each vaccine product are listed on the vaccine product monograph.
To support the rollout of COVID-19 vaccinations across the province, the Ontario eConsult of Excellence, Public Health Ontario, OMA, Ontario MD, Ontario Health, and the Ministry of Health have created a COVID-19 - Allergy / Immunology BASETM Managed Specialty Group. This new eConsult service offers allergy advice related to the COVID-19 vaccine.
Physicians and nurse practitioners will be able to submit electronically both patient-specific and general questions about COVID-19 vaccine allergies. Within a few days, allergy and clinical immunology specialists will provide a response.
To learn more or to register, visit the Ontario eConsult service.
For information on side effects (including after a second dose of a COVID-19 vaccination) and the long-term safety of mRNA vaccines, visit the Public Health COVID-19 FAQ page.
If you're a health care worker who received the vaccine, refer to COVID-19 Guidance for Health Care Settings: Managing Health Care Workers with Symptoms within 48 Hours of Receiving COVID-19 Vaccine.
Encourage patients to visit COVID-19 Vaccination: Fertility, Pregnancy and Breastfeeding to get up-to-date information.
Since all Health Canada authorized COVID-19 vaccines are not live vaccines, they're considered safe in these groups, however there is limited data on efficacy.
The National Advisory Committee on Immunization preferentially recommends that a complete COVID-19 vaccine series with an mRNA COVID-19 vaccine should be offered to individuals in the authorized age group who are immunosuppressed due to disease or treatment. Informed consent should include discussion about the possibility that individuals who are immunosuppressed may have a diminished immune response to any of the authorized COVID-19 vaccines. If they're not able to receive an mRNA vaccine, another authorized COVID-19 vaccine should be offered.
The COVID-19 vaccine recommendations for special populations document contains recommendations based on the best available evidence for COVID-19 vaccination in special populations and expert clinician advice.
National Advisory Committee on Immunization recommends that the following groups should not be offered COVID-19 vaccination at this time:
In Ontario, most people who completed a series of a COVID-19 vaccine authorized by Health Canada (even if administered outside of Ontario), are not eligible for additional doses at this time. Health Canada and other international experts continue to review data to determine if additional doses for the general population may be needed in the future.
Niagara Region Public Health cannot provide additional doses of COVID-19 vaccine for travel purposes. The decisions about vaccine restrictions, requirements and guidance for travel are directed by the federal government.
The province has announced that select vulnerable populations are eligible for a third dose of COVID-19 vaccine. Refer to the Ministry of Health COVID-19 Vaccine Third Dose Recommendations.
For details on this process in Niagara, see Expanded Third Dose Eligibility - Immunosuppressant Medications, released Oct. 25, 2021.
The National Advisory Committee on Immunization recommends that COVID-19 vaccines may be given at the same time as, or any time before or after, other vaccines, including live, non-live, adjuvanted or unadjuvanted vaccines.
Vaccines administered during the same visit should be administered at different injection sites.
Read our medical advisory for more information on concomitant administration of COVID-19 vaccine with other vaccines.
Yes, people who have previously tested positive for COVID-19 can still be vaccinated as long as they're out of self-isolation. The National Advisory Committee on Immunization continues to recommend that a complete series of a COVID-19 vaccine may be offered to individuals who have had confirmed SARS-CoV-2 infection. People don't need COVID-19 testing before vaccination.
Studies of COVID-19 vaccines have shown that they're very effective at preventing people from becoming sick with COVID-19. However, as of right now, whether someone who has been given a COVID-19 vaccine can develop an asymptomatic (no symptoms) COVID-19 infection and pass it to others hasn't been carefully studied.
While there is early evidence suggesting that the vaccine may also reduce COVID-19 transmission, National Advisory Committee on Immunization is recommending that everyone continue to practise public health measures, such as wearing a face mask and physical distancing, regardless of whether or not they received a COVID-19 vaccine. More information on the vaccine's ability to reduce COVID-19 transmission is expected in the future once this has been studied further.
This means the vaccines will protect those who receive it from getting sick, but it's possible that someone who has been vaccinated could still carry the virus and pass the virus on to others, although it would likely be at a much lower rate.
Please view our COVID-19 Vaccines - Primary Care webpage for resources to support in building vaccine confidence among your patient population.
To support access to testing for all Niagara residents, Niagara Region Public Health encourages all primary care providers to offer COVID-19 testing to their patients. For more information on testing options, read the COVID-19 testing guidance for primary care.
If it's necessary to refer patients to an external centre for testing, see testing locations in Niagara. Niagara Region Public Health offices don't provide COVID-19 testing.
If testing your own patients in the office, confirmed PCR tests, probable cases and positive rapid molecular tests are required to be reported to Public Health online. Positive rapid antigen test results are also recommended to be reported to Public Health. For individuals who are known contacts of a positive COVID-19 case (symptomatic or asymptomatic), negative antigen results should be confirmed through a PCR test. See Case Definition - Coronavirus Disease (COVID-19) for full details.
Reporting online is the preferred method for timely follow up from Public Health. However, cases can be reported through our COVID-19 Primary Care Info-Line at 905-688-8248, press 7, then press 1 for physicians. Public Health will notify all patients with positive COVID-19 tests. Patients may access their own results online, or contact their primary health care provider for results.
Get information on:
Rapid antigen point of care tests are most often used in surveillance on asymptomatic individuals - not to be used on high-risk contacts. If the antigen result is positive, it must be confirmed by a molecular point of care test or PCR test.
Positive antigen test results are recommended to be reported to Public Health.
Molecular point of care tests are used on symptomatic individuals and high-risk contacts of a case (either symptomatic or asymptomatic). If an individual tests negative on a molecular point of care test but is a high-risk contact, it must be confirmed with a PCR test. Asymptomatic individuals who are not a high-risk contact of a case that test positive on molecular point of care must be confirmed by a PCR test.
For more information, visit the provincial algorithm.
If you have a patient who tests positive with a Positive Rapid Antigen Test, have them book a confirmatory PCR test within 24 hours. For details, see guidance documents. Scroll down to the Symptoms, Screening, and Testing Resources section for:
The province has provided the definition of a probable case with footnotes.
For patients who meet the definition of a probable case: If your patient meets the definition of a probable case they should be reported to Public Health. Someone identified as a probable case should be tested, but if they refuse, they and their unvaccinated household members must self-isolate, and will receive further direction from Public Health. If a probable case refuses to isolate, this should also be reported to Public Health.
If you recommend a COVID-19 test for a patient, and it is declined for any reason, we must assume they have COVID-19. They are to self-isolate for 10 days from the day of their symptom onset (away from household members, when possible). If self-isolation away from household members isn't possible, household members are to remain in self-isolation for the duration of the individual's illness AND then an additional 10 days from the last exposure to the symptomatic individual.
Household members that are fully vaccinated do not need to self-isolate, unless they develop symptoms. Household members that were previously positive for COVID-19 within the last 90 days and have since been cleared also do not need to self-isolate, unless they develop symptoms. If household members become symptomatic, they should consult their health care provider and / or go for testing, even if they are fully vaccinated or previously positive for COVID-19.
Asymptomatic testing is not recommended by Public Health, unless under the direction of Public Health on a case-by-case basis. Anyone with respiratory symptoms, other mild symptoms, or fever that you suspect may have COVID-19 or anyone concerned that they may have been exposed to COVID-19 should be referred to the Niagara Health COVID-19 Assessment Centre for testing, if you're not testing in your office.
The turnaround time on receiving test results depends on the current volume of tests being processed. It can take up to seven days for patients to receive their COVID-19 lab test results, but typically it's within 48 hours. It's important that symptomatic patients or asymptomatic high-risk contacts that are not fully vaccinated remain in self-isolation while they wait for their test results.
Public Health doesn't have earlier access to your patients' COVID-19 test results and is unable to respond to callers on our COVID-19 Info-Line that are asking for laboratory results. If patients are having difficulty accessing results or need a paper copy, have them call 905-378-4647 and ask for the Release of Information Office.
If your patient receives an indeterminate result from their online search for results, this may mean that results are not completed by the lab. Tell the patient to continue to check back in a day or two for their results if they haven't been contacted by the testing site / provider.
If the result is a true indeterminate result for COVID-19 from the laboratory, the testing site / provider will contact the patient regarding repeating the test.
Public Health will follow-up with anyone who tests positive.
Some patients who are tested may not have access to their test results through the online portal, specifically those without OHIP, with a red-white OHIP card, without internet access or language barriers. If you're testing your patient, confirm before, or at the time of testing, that they're able to access the online portal. Any individual without access to the online portal must be informed by telephone of their result as soon as reasonably possible.
Anyone concerned that they may have been exposed to COVID-19 or anyone with respiratory symptoms, other mild symptoms, or fever that you suspect may have COVID-19 can be referred for testing. For more information on who should be tested, visit the COVID-19 Provincial Testing Guidance Update.
Get more information on Public Health Ontario's ongoing viral detection and repeat positives review.
Yes. Public Health recommends that high-risk contacts (regardless of vaccination status or if they were previously positive for COVID-19) get tested on day seven from the last exposure to the positive case. If testing was completed on day zero to six, repeat testing is recommended.
If a contact of a case becomes symptomatic, testing is recommended earlier. Public Health works directly with the close contacts of all laboratory confirmed COVID-19 cases in Niagara to provide close contacts with medical direction and instruction for testing and self-isolation.
Symptomatic patients that are sent for testing need to self-isolate until they get their results, regardless of their vaccination status or if they were previously positive for COVID-19.
Asymptomatic patients sent for testing because they are a high-risk contact also need to self-isolate for the full 10 days from their last exposure to the positive case. Asymptomatic high-risk contacts that are fully vaccinated or previously positive for COVID-19 within the past 90 days and have since been cleared do not need to self-isolate, unless they develop symptoms.
If your patient has no symptoms, has not had known close contact with a positive case of COVID-19 and no travel history but decided to get a COVID-19 test, they are not required to self-isolate.
A COVID-19 test is only a snapshot of your patient's health on the specific date and time the swab was taken. No testing is perfect and a negative result doesn't mean that they haven't been exposed to COVID-19. Individuals can still develop symptoms days after a test was taken.
Important: If you're testing for COVID-19, refer to the Public Health Ontario Updated IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19.
Make sure the patient is sent home with instructions to self-isolate and manage prescription(s) or other needs in a way that assumes the patient has COVID-19.
You will also need:
A single upper respiratory tract specimen will be accepted for COVID-19 testing.
Testing for COVID-19 is done by real-time PCR using protocols validated by PHO Laboratory and the NML. Public Health Ontario has provided information on testing for COVID-19 and to support the interpretation of lab results. View their information on test methods.
One serological test for antibodies to the virus has been approved by Health Canada but is not yet available for widespread use. Review the Ministry’s COVID-19 Provincial Testing Guidance Update for more information on serology testing (page 2).
Niagara Region Public Health cannot provide specimen pick-up and transport at this time. Work with your local lab to coordinate specimen pick-up based on the transportation of dangerous goods criteria.
With the increased transmissibility of variants of concern, more intensive efforts are important to prevent further spread, including the need to provide immediate testing for those individuals who have even mild COVID-19 symptoms.
See Niagara's daily case count for more on these variants.
More information at:
Follow the Ministry of Health's COVID-19 Guidance: Primary Care Providers in a Community Setting for in-person care and essential visits.
The Chief Medical Officer of Health's Directive #2, limiting the provision of non-essential in-person care, has been amended to support the gradual resumption of non-essential health care. The direction isn't to have you return to normal practice, but rather move towards a 'new normal'. To support this, the Ontario Ministry of Health has made available COVID-19 Operational Requirements for Health Sector Restart.
As the gradual restart of services continues, you're in the best position to determine which services can continue to be offered virtually, such as phone consultations, virtual assessments, and which services can safely resume in-person. As a reminder, Ontario approved new physician billing codes for telephone assessments, enabling doctors to conduct more assessments over the phone rather than in their clinic.
You will also need to be cautious and resume practice in a controlled and gradual manner while taking steps to protect yourself, your staff, the patient and the public. Review the measures that must be in place to meet public health guidelines and promote a safe environment for the provision of in-person health services by health care providers.
No. The National Advisory Committee on Immunization states that if post-exposure prophylaxis (PEP) is required (for example measles, hepatitis A, hepatitis B, rabies, meningococcus and varicella), it should be given without delay to all patients who need it.
It's important that your patients are informed in advance about your new office practices, the safety precautions you're taking, and how you're keeping each other safe.
Active and passive screening of patients is extremely important during this time. Patients and essential visitors should be screened over the phone for symptoms of COVID-19 before their appointments or when patients present to the clinic. If screening over the phone, patients can be told what to expect when they come into the office for their appointment.
If they screen positive in person, you can direct patients to a different room in the office or ask them to wait in their vehicle until a room becomes available. For more information about IPAC Tips in Primary Care Settings, see Ministry of Health’s COVID-19 Guidance for Primary Care Providers.
As an additional precautionary measure, on the day of the appointments, patients and essential visitors should be screened again on site, with staff taking proper precautionary measures to protect against the possible spread of COVID-19.
Your office may consider posting signage to inform patients of the specific measures being taken to ensure the safety of patients and clinical staff during this time, such as screening of patients and essential visitors, cleaning and disinfecting frequency of examination rooms and high-touch surfaces, and use of personal protective equipment.
You can order the Novel Coronavirus (COVID-19) Screening Poster for Primary Care Providers and other Infection Prevention and Control print material on Public Health's resources order page.
Public Health is committed to identifying and working collaboratively with Niagara's school boards and the community on reopening concerns as well as advising on communication and outbreak guidance for schools. We're sharing best evidence with school boards around:
Resources are being shared with the schools directly. If you or your practice are advising teachers or parents, or providing resources, let us know what's being shared so that we can ensure consistent communication. Email the primary care and stakeholder engagement advisor.
For more information around schools and COVID-19, see schools, child care and camps during COVID-19.
For information on the recommendations for symptomatic children who fail the COVID-19 school / child care screening and for self-isolation, see symptoms and frequently asked questions about school / child care.
Employers and employees have a role to play to reduce the community spread of COVID-19. Find recommendations and information that apply to all workplaces and businesses, except health care settings, to help prevent the spread of COVID-19.
For any workplace, if you're concerned about an employee's risk due to their medical status, all employees should connect with their occupational health, and have their occupational health connect with you.
For more information visit:
Encourage workers to speak with their health care provider.
Refer to the COVID-19 Quick Reference Public Health Guidance on Testing and Clearance guidance document (page 14) for information on when health care workers can return to work. Public Health may extend isolation based on your case investigation or status of an outbreak.
Niagara Region Public Health recommends testing for individuals who are symptomatic or have been recommended by a health care provider or public health to get tested.
If your patient still declines a COVID-19 test, refer to the question: "My patient declined a COVID-19 test. What are the next steps?" for information on self-isolation requirements.
In general, asymptomatic individuals without exposure to a confirmed case should not be referred for testing.
People with a household member who has been referred for testing or is awaiting test results should self-isolate until the result is received. If the result is negative, they can discontinue isolation. If the test is positive, they should remain in self-isolation and will be advised further by Public Health. Household members who are (a) fully vaccinated and not showing symptoms or (b) had tested positive for COVID-19 in the past 90 days but have since been cleared and not showing symptoms don't have to self-isolate.
If an asymptomatic individual has had close contact with someone with symptoms of COVID-19 who is awaiting test results, but is not in their household, they should self-monitor.
Public Health Ontario’s Infection Prevention and Control Assessment for Primary Care, Specialty and Walk-in Clinics during COVID-19 checklist provides guidance, supports and resources for
Review key elements of environmental cleaning in healthcare settings from Public Health Ontario.
You can order the Novel Coronavirus (COVID-19) screening poster for health care professionals under "COVID-19".
You can order the COVID-19 screening poster and signage to support proper cough and hand hygiene practices on the health care professionals resource order page.
Additional signage to support physical distancing and masking in the office is also available for download and print. Visit COVID-19 information for health care professionals.
Before every patient interaction, health care workers must conduct a point-of-care risk assessment to determine the level of precautions required. Due to asymptomatic spread and breakthrough cases, it's strongly advised that you wear a medical mask and goggles when within two metres of a patient to prevent any high-risk exposure. For information on different types of interactions and exposure risk, review the Health Care Worker Risk Assessment tool.
The proper use of personal protective equipment is critical to keeping both clinicians and patients safe. At a minimum, all health care providers are to wear a surgical / procedural mask for interactions with and within two metres of patients who screen negative. Contact / droplet precautions are to be used for interactions with and within two metres of patients who screen positive. Contact / droplet precautions include:
Follow the Ministry of Health's COVID-19 Guidance for Primary Care Providers in a Community Setting (page 10) for a summary of required precautions.
To order personal protective equipment go to Ontario Together: Help fight COVID-19 or review the Niagara PPE Provider Directory to find a provider. You can also order personal protective equipment from Healthcare Materials Management Services.
For more detailed information on cleaning and disinfection, refer to the: