home

Information and Resources on COVID-19 Coronavirus

This page contains links to the Ministry of Health (MOH), and other reliable sources of information related to COVID-19 Coronavirus. These websites and this page will be updated with new information as it becomes available. Please check back regularly for updates.

The College is working with the Ministry of Health in monitoring the situation closely and making changes as necessary. Information related to the COVID-19 situation is subject to change quickly as the situation evolves.

Information for the Public

In a statement issued by the Chief Medical Officer of Health, all Ontarian over the age of 70 are strongly recommended to practice self-isolation. In addition, everyone regardless of age is asked to practice social distancing to help prevent the spread of COVID-19.

The Ministry of Health is providing daily updates on the status of the COVID-19 Coronavirus in Ontario on their dedicated web page for the public (updated every day).

If you are experiencing symptoms of COVID-19, contact your primary care provider, Telehealth Ontario at 1-866-797-0000 or your local public health unit.

Other Helpful Resources:

Public Health Ontario – Coronavirus COVID-19

Government of Canada – Coronavirus COVID-19

World Health Organization (WHO) Web Page on COVID-19

COVID-19 Fact Sheet: Resources for Ontarians Experiencing Mental Health and Addictions Issues During the Pandemic

Information for Members of CTCMPAO

Directive 2 allows for a gradual restart to practice. What is considered a gradual restart?

The Chief Medical Officer of Health has amended Directive 2. Directive 2 requires health care providers to restart their practice after a careful assessment of risks and resources. This will take time as the required planning and organization (described below) is thorough. Further, it is expected that health care providers will slowly open their practice (when all the considerations have been addressed) and expand their services once it has been determined that the measures put in place are keeping patients, staff and the health care provider safe. This is likely the requirement for a “gradual start” as opposed to a quick opening.

Directive 2 list 3 conditions that members must consider before returning to practice.The conditions are:

  1. Members must comply with the requirements set out in COVID-19 Operational Requirements: Health Sector Restart. This is a Ministry document that covers requirements for risk assessments, hierarchy of hazard controls, screening, health human resources, critical supplies and equipment, infection control and other important issues.
  2. Members should use telemedicine or virtual care where possible to avoid having patients physically come to the clinic. Health Care Providers must consider which services should be provided remotely and which services can safely resume in-person with appropriate hazard controls and sufficient PPE.
  3. Members should be sourcing personal protective equipment (PPE) through their regular supply chain. If you are experiencing difficulty sourcing PPE, the Government has made available a directory of PPE suppliers.

With respect to condition #2, members are in the best position to determine which services should resume in person, and which should resume virtually. However, members should consider the following when making this determination

  1. Your own ability to resume services at this time.
  2. The need to minimize harm to patients.
  3. The need to treat all patients with the same clinical needs equally unless relevant differences exist.
  4. The need to ensure that those who continue to be burdened by the limited capacity of the health care system have their health monitored, receive appropriate care, and be re-evaluated for emergent activities should they require them.

Again, members must first read the following documents before returning to practice to ensure that they are able to do so safely:

Directive 2

COVID-19 Operational Requirements: Health Sector Restart

Return to Practice Guidance

How can I ensure safe practice while conducting telepractice?

Members must read the College’s Telepractice Position Statement to understand the risks and responsibilities associated with telepractice and virtual care.

How should a practitioner determine whether it is time to resume in-person practice?

After reviewing all of the required information and considering the necessary issues, members should only resume in-person practice if they can resume practice safely and the anticipated benefits of providing that treatment (that the practitioner has determined the patient needs) clearly outweighs the risks of contracting COVID-19 to the patient, practitioner and/or clinic staff.

What are some scenarios where I as a practitioner should be cautious to restart?

  • If the practitioner does not have the necessary PPEs in place,
  • Consideration for patients (and/or the practitioner) that may have a compromised immune system,
  • Insufficient infection control policies in place at their clinic (particularly if it is a multi-discipline clinic),
  • Consideration of the practitioner themselves in whether they are comfortable to go back etc...

What PPE Should I wear in my practice to mitigate the risk of COVID-19?

Notice: This guide is based on the assumptions that patients have been pre-screened and do not exhibit any signs or symptoms of COVID-19. The Ministry’s COVID-19 Operational Requirements: Health Sector Restart must be adhered to.

With the announcement from the Chief Medical Officer of Health of the amendment to Directive 2, The College expects members to use their training and professional judgement to determine which personal protection equipment is appropriate to wear depending on the situation as it presents itself in your place of practice. Members may only begin providing in-person care only if all necessary precautions and protocols are in place to protect patients and themselves. This will include the necessary PPE provisions. The Provincial Government has produced guidance documents to help health care professionals to make this decision. To assist members, we have provided a summary of what would apply to members of this College. Review of this document is ongoing and the information will be amended as necessary.

The recommendations below are a starting point for PPE usage at this time, and members can increase their level of PPE as necessary:

Masks
Members are required to wear surgical, procedure, or medical masks at all times when they are in their place of practice. (As indicated in the Ministry’s COVID-19 Operational Requirements: Health Sector Restart) As per the guidance from Health Canada, our Members should, where possible, be using a surgical, procedural or medical mask that fall within one of the three classifications indicated.

Members are not required to change masks (between patients) unless any of the following apply:

    • The mask becomes visibly soiled
    • The mask makes contact with another person or their droplets or secretions (i.e. is coughed on)
    • The mask becomes damaged or compromised in any way
    • The mask becomes very moist to the point that the integrity becomes compromised

Please carefully assess your individual situation by reviewing the document “Routine Practices and Additional Precautions” prior to exercising your discretion.

Patients attending for treatment
In addition, it is the College’s recommendation that Members also have all patients wear masks when arriving for, or receiving treatment (including while patients are in a designated waiting area or room), as it becomes more difficult to maintain social distancing. Members should advise patients in advance (for example, at the time of booking an appointment), of the recommendation that they wear a mask when attending for treatment. Advise them that this is for the protection of the practitioner and the patient themselves. If the patient arrives without a mask, the member can provide a disposable mask for the patient to wear. If the patient is uncomfortable with wearing a mask, members may ask if the patient would be comfortable to wear some other form of face covering. If the patient remains uncomfortable with wearing a mask, a member would have to decide as to whether the anticipated benefits of treatment (to the patient) clearly outweigh the risks of COVID-19 to the patient and the practitioner.

Gloves
Practitioners may but are not required, to wear examination or surgical gloves for patient treatments. When used, gloves must be discarded after each treatment regardless of the condition of the glove. Members must also wash their hands before and after each treatment. It is important that members maintain hand hygiene even when using gloves.

A clear procedure for donning and removing PPE safely may be found here.

Gowns/Lab Coats
Members should be using regular lab coats or gowns that are often worn in TCM practice. Similar to masks, these do not need to be changed after each patient unless:

  • The lab coat becomes visibly soiled
  • The lab coat makes contact with the patient’s droplets or secretions
  • The lab coat becomes damaged or compromised in any way

In addition to aprons, gowns, and lab coats, the use of scrubs is a suitable alternative for practitioners to wear. As long as they are removed before leaving the clinic environment and can be laundered appropriately, practitioners may choose to wear scrubs at their discretion. The same consideration would apply if the scrubs become visibly soiled, make contact with the patient’s droplets or secretions, or become damaged or compromised in any way.

Please carefully assess your individual situation by reviewing the document “Routine Practices and Additional Precautions” prior to exercising your discretion.

Face shields or eye protection
Members of the College are not recommended to be treating COVID-19 patients, and so face shields or eye protection may not be required for daily practice but should be considered. Members are encouraged to maintain a small supply of eye protection or face shields available at their practice. Practitioners should ensure to consider situations where patients may not call in advance to book. Practitioners should carefully consider how to handle this situation and have policies in place at the clinic to ensure the safety of staff and practitioners.

Members are expected to use their professional judgement and conduct ongoing risk assessments to determine if additional PPE is required.

If you are having difficulty finding PPE supplies, please visit the Directory of PPE Suppliers for alternative options.

This reference guide has adapted the following information released from the Ministry. We recommend that you review each document carefully prior to exercising your discretion.

(These documents are curated to assist you on preparation and is not meant to be relied upon as independent of information provided by the various levels of public health and other authoritative sources. This guide does not replace the need for Members to keep aware of the latest developments, updates and changes to government materials which is subject and open to change from time to time.)

Additional information for clinics:

What happens if a member is found to be practicing contrary to government directives or College standards?

Contravening an order of the Chief Medical Officer of Health is a contravention of the Health Protection and Promotion Act. This can result in a provincial prosecution and significant financial penalties.

In addition, the College could commence an investigation that may result in a referral to the discipline committee.

If the member has created an unsafe working environment for their staff, they are subject to a complaint to the Ministry of Labour and a prosecution and/or fine under the Occupational Health and Safety Act. Further, if any employee died as a result of unsafe working conditions, the member could be subject to a charge under the Criminal Code.

If the member has transmitted, or abetted the transmission of COVID-19 to their patients, staff or anyone who comes to their clinic, the member could be the subject of a civil law suit or possibly a criminal charge under the Criminal Code.

If a patient arrives to an appointment without a mask, do I cancel the appointment?

It is recommended that members have patients wear a mask to their appointment. Members should advise patients in advance (for example, at the time of making the appointment). If the patient arrives without a mask, the member can provide a disposable mask for the patient to wear. If the patient is uncomfortable with wearing a mask, a Member would have to decide as to whether the anticipated benefits of treatment (to the patient) clearly outweigh the risks of COVID-19 to the patient and the practitioner.

What should I be doing to screen patients for COVID-19?

The Ministry of Health has provided a Patient Screening Guidance Document for health care providers to use in their practice. Members are required to use the screening questions in the guidance document to screen their patients for COVID-19. This screening should take place over the phone prior to the appointment, and when the patient arrives for the appointment.

If the patient screens positive for COVID-19, the member should not proceed with the appointment, and follow the steps outlined in the Return to Practice Guidance to have the patient tested for COVID-19.

Does the College require mandatory education on Infection Prevention and Control (IPAC) procedures before we return to practice?

Our expectation is that our members are knowledgeable about existing IPAC procedures, however, if members, their staff or their clinic partners (in a multidiscipline setting) are looking for a refresher to remind them of key fundamentals, you will find helpful information prepared by Public Health Ontario here. The information gathered provides helpful videos as well as step by step guides that practitioners could review for themselves and/or direct their staff to review prior to returning to practice.

What should I do if a patient’s chronic symptoms overlap with the symptoms listed on the COVID-19 screening?

If patients answer yes to any of the screening questions, it would be considered a positive screening. Based on the ministry guidance, patients who screen positive are recommended to complete the self-assessment tool. Based on how they respond, the tool will advise them if further testing is required. The Ministry’s Guidance on Testing and Clearance provides additional information on testing and clearance for individuals suspected or confirmed to have COVID-19.

The College’s guidance is that patients with signs and symptoms consistent with COVID-19 should not be seen in-person for clinical services during this time to minimize the risk for potential infection. However, TCM practitioners and acupuncturists are expected to use their professional judgment when making treatment decisions and to determine if the anticipated benefits of treatment outweigh the risks to the patient and the practitioner.

At this time, all practitioners are encouraged to implement a system for virtual and/or telephone consultations when and where possible. Members are in the best position to determine which services should resume in person, which should resume virtually. If, after careful assessment of risks and resources, a practitioner decides to provide in-person treatment, they must comply with the requirements set out in COVID-19 Operational Requirements: Health Sector Restart.

What can a practitioner do if a patient finds wearing a face mask uncomfortable?

Practitioners should instruct their patients to wear masks when for example, they arrive for, or receive treatment. If the patient cannot wear a mask (e.g., due to a medical condition or perhaps have difficulty breathing), the practitioner would be expected to ask if the patient would be comfortable to wear some other form of face covering, e.g., a face shield, if appropriate. However, if the patient remains uncomfortable, the member will have to use their professional judgment when making treatment decisions and to determine if the anticipated benefits of treatment outweigh the risks of COVID-19 to the patient and the practitioner. If the patient is exhibiting signs and symptoms consistent with COVID-19, they should not be seen in-person for clinical services during this time to minimize the risk for potential infection. The practitioner should also consider whether virtual care may be more appropriate to this patient at this time.

Members must screen patients based on the current case definition and determine if they fit the definition for a Probable Case for COVID-19. All members should undertake active screening and passive screening:

  • Active screening over the phone before scheduling appointments, when possible and upon entry to the clinic. Staff conducting screening should ideally be behind a barrier to protect from droplet/contact spread. A plexiglass barrier can protect reception staff from sneezing/ coughing patients.
  • Passive screening including signage at points of entry of the facility and at reception, using the latest case definition for COVID-19. Similar messaging can be communicated on voicemails and websites

Members must screen patients based on the current Screening Guidance.

If a patient screens positive over the phone, you must advise them to call their local public health unit, and/or contact Telehealth Ontario at 1-866-797-0000. Patients should not show up to hospitals unannounced.

A patient who screens positive at a member’s practice must be separated from other visitors and staff so that they are at least 2 metres apart (use a separate room where available) and given a surgical/procedure mask while health workers call their local public health unit and a plan for travel and further COVID-19 assessment is made.

It is important to note that the College’s code of ethics for members states that:

Members must provide the best care to patients, recognizing one’s own limitations and referring patients to other practitioners, or other health care providers when the level of care needed is beyond one’s competence.

COVID-19 Infection Prevention and Control for Regulated Health Professionals Webinar
A recording of the June 25, 2020 COVID-19: Infection Prevention and Control (IPAC) for Regulated Health Professionals webinar is now available. The webinar was a joint presentation from the College of Kinesiologists, Massage Therapists, Occupational Therapists and Physiotherapists. The webinar was led by representatives from Public Health Ontario and focuses on IPAC in the context of COVID-19.


Access materials from the webinar here :

Members should also regularly check the Ministry of Health’s web page for COVID-19 Guidance for the Health Sector. It contains the most up-to-date case definition, affected areas, guidance documents, signage for patients and visitors, and other related information.

CTCMPAO receives regular updates on COVID-19 from the Ministry of Health, and will update members with any relevant information as the situation progresses.

Return to Practice

On May 26, 2020, the Chief Medical Officer of Health updated Directive 2. Directive 2 requires health care providers to restart their practice after a careful assessment of risks and resources. This will take time as the required planning and organization (described below) is thorough. Further, it is expected that health care providers will slowly open their practice (when all the considerations have been addressed) and expand their services once it has been determined that the measures put in place are keeping patients, staff and the health care provider safe. This is likely the requirement for a “gradual start” as opposed to a quick opening.

Directive 2 lists 3 conditions that members must consider before returning to practice. The conditions are:

  1. Members must comply with the requirements set out in COVID-19 Operational Requirements: Health Sector Restart. This is a Ministry document that covers requirements for risk assessments, hierarchy of hazard controls, screening, health human resources, critical supplies and equipment, infection control and other important issues.
  2. Members should use telemedicine or virtual care where possible to avoid having patients physically come to the clinic. Health Care Providers must consider which services should be provided remotely and which services can safely resume in-person with appropriate hazard controls and sufficient PPE.
  3. Members should be sourcing personal protective equipment (PPE) through their regular supply chain. If you are experiencing difficulty sourcing PPE, the Government has made available a directory of PPE suppliers.

With respect to condition #2, members are in the best position to determine which services should resume in person, and which should resume virtually. However, members should consider the following when making this determination

  1. Your own ability to resume services at this time.
  2. The need to minimize harm to patients.
  3. The need to treat all patients with the same clinical needs equally unless relevant differences exist.
  4. The need to ensure that those who continue to be burdened by the limited capacity of the health care system have their health monitored, receive appropriate care, and be re-evaluated for emergent activities should they require them.

Below are College documents members are required to read before restarting their practice.

Return to Practice Guidance

Return to Practice Guidance

Telepractice Position Statement

Return to Practice Guidance – One Page Summary

Government of Canada – Financial Support

The College is mindful that this is a difficult time for R. TCMP’s and R. Ac’s, particularly with the recommendation from the Ministry to suspend their practice. We know that Individuals and businesses will no doubt be impacted during this time, for more information regarding how the Government may assist you, your practice or your employees during this time, please find the latest information regarding financial relief here.

Updates and Information from Ministry of Health

Case Definition

COVID-19 Guidance for Independent Health Facilities

Updated Infection Prevention and Control Measures for COVID-19

Self-Isolation Guidelines (English)

Self-Isolation Guidelines (French)

Self-Isolation Guidelines (Chinese)

FAQs on Access to Personal Protective Equipment for All Settings

MOH Poster - What You Need to Know to Help You and Your Family Stay Healthy (English)

MOH Poster - What You Need to Know to Help You and Your Family Stay Healthy (French)

Enhanced Public Health Measures for COVID-19

Patients Sign (English)

Patients Sign (French)

Patients Sign (Chinese)

Chief Medical Officer of Health Memo: Health Worker Illness and Return to Work

Chief Medical Officer of Health Directive #2

Ministry of Health Directives, Memos and Other Resources

COVID-19 Reference Document for Symptoms

COVID-19 Patient Screening Guidance Document

Updates and Information from Government of Canada

Community-Based Measures to Mitigate the Spread of Coronavirus Disease (COVID-19) in Canada

Risk-Informed Decision-Making for Mass Gatherings During COVID-19 Global Outbreak