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:

• 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:

• 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)