Respiratory Illness: Tools and Resources for Doctors

Updated respiratory illness resources:

• Common Respiratory Illnesses in Children: Tip Sheet for Family Doctors (OCFP PDF, updated October 2025)
• Screening tool (PDF) to help front office identify patients at high risk for serious illness/outcomes from respiratory illness (OCFP, updated October 2025)
• Ontario Respiratory Virus Tool (external link) – epidemiological information on virus activity, including COVID-19, flu, RSV and other respiratory viruses (PHO)

Updates on vaccination, testing and treatment:

Vaccines

• Starting in late September, high-risk and priority populations may get their COVID-19 vaccine and flu shot as supply becomes available in hospitals, long-term care homes, and other congregate care settings, followed by primary care providers and participating pharmacies.
• Free COVID-19 vaccines will be available for all individuals 6 months of age and older who live, work or go to school in Ontario starting on October 27, 2025.
• Learn more about vaccines approved by Health Canada.
• The vaccine may be given at the same time, or at any time before or after any other vaccine.
  • Unless contraindicated, previously vaccinated individuals can receive a dose if it has been at least three months since their last dose. Note that children younger than four with no previous COVID-19 vaccine may require a two-dose series.
  • One’s history of COVID-19 infection does not affect when to get vaccinated, (i.e., same principle as for flu and other vaccines.
• Vaccination available primarily at participating pharmacies (external link) and public health units (PHUs). If you are vaccinating, continue to order vaccines from your local PHU.

Testing

• Test to treat – publicly funded testing is available for those eligible for treatment (i.e., at higher risk of severe illness)
  • They are, in general:
    • people aged 65 years of age and older
    • people aged 18 years of age and older who have at least one condition that puts them at higher risk of severe COVID-19 disease
    • people who are immunocompromised
    • residents and patients in certain high-risk settings including hospitals and congregate living settings with medically and socially vulnerable individuals (for example, in long-term care and other specific populations and settings)
    • people in the context of suspected or confirmed outbreaks, as directed by the local public health unit
• Continue to order rapid antigen tests (RATs) via the PPE Supply Portal (note: username and password required) to provide to eligible patients.
• PCR tests may be requested for eligible patients through Public Health Ontario.
• Patients may also access testing, including PCR for eligible patients, via participating community pharmacies and some local Public Health Units.

Treatment

Eligible patients include those who:

• have symptoms and test positive for COVID-19 (positive PCR or rapid antigen test)
• are at increased risk for severe outcomes from COVID-19 because you are either:
  • 65 years of age or older (regardless of vaccine status and any other risk factors)
  • Immunocompromised (regardless of age, vaccine status or prior COVID-19 infections), for example:
    • recipient of solid organ transplant
    • treatment for a malignant hematologic condition
    • bone marrow–, stem cell transplant–, or transplant-related immunosuppressant use
    • receipt of anti-CD20 drugs or B cell– depleting drugs (such as rituximab) in the past 2 years
    • severe primary immunodeficiencies
    • treatment for cancer, including solid tumours
    • treatment with significantly immunosuppressing drugs (for example, a biologic in the past 3 months, oral immune-suppressing medication in the past months, oral steroid [20 mg/day of prednisone equivalent taken on an ongoing basis] in the past month, or immune-suppressing infusion or injection in the past 3 months)
    • advanced HIV infection (treated or untreated)
    • moderate primary immunodeficiencies
    • renal conditions (such as hemodialysis, peritoneal dialysis, glomerulonephritis and dispensing of a steroid, eGFR<15mL/min/1.73m²)
  • At increased risk to due to a combination of age and other medical conditions or risk factors based on an assessment by your health-care provider
• Use clinical discretion in prescribing antiviral medications.
• Consider treatment with Paxlovid (first-line therapy) or, if contraindicated/not feasible, with remdesivir; usually treatment must begin within 5-7 days of symptoms starting or a positive test result.
• Paxlovid is covered under the Ontario Drug Benefit plan for eligible patients and may also be covered by private insurance plans.
• Advise patients with Paxlovid prescription to reach out to their community pharmacy about availability.

Resources:

• Recommendations for Antiviral Therapy for Adults with Mild to Moderate COVID-19 (PDF), including treatment algorithm (Ontario Health, April 2024)
• COVID-19 testing and treatment (MOH External link) | Find COVID-19 PCR testing locations (External link)
• COVID-19 vaccine – find participating Ontario pharmacies (External link)
• PPE supply portal for healthcare providers (External link – register for Provincial Antigen Testing Program to sign in)
• PCR test requisition form (PHO PDF, August 2024)
• Access to remdesivir in the community,(PDF) including downloadable referral form (Ontario Health atHome, June 2024)

Highlights of Ontario’s RSV program:

• Publicly funded prevention programs are focused on infants and high-risk adults aged 60 years or older.
• The publicly funded adult RSV prevention program, covers Ontario residents who have not previously received a publicly funded RSV vaccine and are:
  • Infants born April 1 or after and who are less than 8 months of age at the time of immunization.
  • Children up to 24 months of age who meet the following high-risk criteria for severe RSV disease through their second RSV season:
    • chronic lung disease of prematurity (CLD), including bronchopulmonary dysplasia, requiring ongoing assisted ventilation, oxygen therapy or chronic medical therapy in the 6 months prior to the start of RSV season
      • Note: Children who were less than 12 months of age and approved for coverage in the previous RSV season for chronic lung disease and bronchopulmonary dysplasia remain eligible.
    • hemodynamically significant congenital heart disease (CHD) requiring corrective surgery or are on cardiac medication for congestive heart failure or diagnosed with moderate to severe pulmonary hypertension
    • severe immunodeficiency
    • Down Syndrome / Trisomy 21 with recurrent pulmonary exacerbations requiring hospitalization, deteriorating pulmonary function and/or severe growth delay
    • cystic fibrosis with respiratory involvement and/or growth delay
    • neuromuscular disease impairing clearing of respiratory secretions
    • severe congenital airway anomalies impairing the clearing of respiratory secretions
  • Adults aged 75 and older
  • Adults aged 60–74 and meet one of the following criteria:
    • resident of a long-term care home, Elder Care Lodge, or retirement home including similar settings (for example, co-located facilities)
    • patient in hospital receiving alternate level of care (ALC) including similar settings (for example, complex continuing care, hospital transitional programs)
    • patient with glomerulonephritis (GN) who is moderately to severely immunocompromised
    • patient receiving hemodialysis or peritoneal dialysis
    • recipient of solid organ or hematopoietic stem cell transplants
    • individual who is homeless
    • individual who identifies as First Nations, Inuit, or Métis
• Monoclonal antibody Beyfortus® is recommended for universal immunization of newborns and high-risk infants up to 24 months old.
• Infants born during RSV season (November 2025-April 2026) are to be immunized before hospital discharge; infants born in 2025 out of RSV season or outside hospital may be immunized in primary care, hospital clinics, or through local Public Heath Units.
• High-risk older adults (as described above) are eligible to receive the Abrysvo® or Arexvy® vaccine. Studies show multi-year protection from vaccination – those who received a dose last RSV season do not require a dose this season.
• Counsel pregnant individuals about the effectiveness of Beyfortus® in prevention – Abrysvo® may be offered in pregnancy if Beyfortus® is declined.
• RSV immunization may be given at the same time or at any time before or after other vaccines.
• Order Beyfortus® through your local Public Health Unit. Timelines for availability of 100 mg infant doses may vary.

Resources:

• RSV Prevention Program Summary (OCFP, Updated October 2025)
• Summary of the RSV immunization program (external link), including billing information (OMA)
• Provider factsheet: Protecting Infants and High-Risk Children during RSV Season (Provincial Council for Maternal and Child Health PDF, August 2025)
• Older Adult High-Risk Respiratory Syncytial Virus (RSV) Vaccine Program Fact Sheet – Vaccine Recipients (MOH PDF, August 2025)

Key Updates:

• Effective November 3, 2025, Ontario Health has developed clinical recommendations for antiviral therapy of seasonal influenza. Review here.
  • This document provides guidance on the appropriate prescribing antivirals, incorporating the latest evidence. This includes new recommendations for the appropriate prescrbing of oral baloxavir, intravenous zanamivir, and intravenous peramivir that are currently not included in the existing Association of Medical Microbiology and Infectious Disease (AMMI) Canada influenza treatment guidelines.
• Individuals aged six months and older who have no contraindications or precautions can receive any age-appropriate quadrivalent or trivalent vaccine.
• For children, there is no preference for quadrivalent over trivalent flu vaccine formulations (NACI recommendation– external link).
• Adults aged 65+ should get an enhanced flu vaccine – high-dose or adjuvanted are considered equivalent. If not available, offer any available age-appropriate vaccine.
• Children six months to nine years old who have not previously received a seasonal flu vaccine should receive two doses, at least four weeks apart.

Resources:

• Recommendations for Antiviral Therapy of Seasonal Influenza (Ontario Health, updated November 3, 2025)
• 2025-26 Universal Influenza Immunization Program (MOH external link)
• Health Care Provider Fact Sheet: Influenza Immunization for Individuals 6 months to 64 years of age (MOH PDF, 2025-26)
• Health Care Provider Fact Sheet: Influenza Immunization for Individuals ≥65 years of age (MOH PDF, September 2025)

Key information:

• High number of cases in 2024 may be attributed to waning immunity/missed doses.
• Tdap doses at:
  • ages two, four and six months.
  • ages four years and 14 years.
  • every pregnancy, one dose ideally between 27 and 32 weeks of gestation.

Resources:

• Publicly funded Immunization Schedules for Ontario (MOH PDF, June 2022)
• DFCM-OCFP Community of Practice sessions:
  • Sept. 6, 2024 (external link – discussion starts at 36:34); Preparing for Fall and Practice Management
  • Sept. 20, 2024 (external link – discussion starts at 46:47) Managing Respiratory Illness in Kids & COPD

Key information:

• Masking policies are set by individual practices – continue to take steps needed to minimize transmission risk.
• Continue to order PPE from the PPE Supply Portal. (External link)

Resources:

• Safely providing in-person care for community-based practices (a summary of PHO comprehensive guidance, OMA PDF, June 2025)
• Printable office signs (PDF) to encourage masking in clinic (OCFP)

Resources to share with patients:

• Family Doctor Tips on Caring for Children with Respiratory Symptoms (OCFP PDF, updated October 2025)
• If You Get Sick: Managing Colds, Flus, RSV and COVID-19 (OCFP PDF, updated October 2024)
• Protection from Respiratory Illnesses (Ministry of Health external link)