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TORONTO — COVID-19 cases and hospitalizations are on the rise, the flu season is on the horizon and many other respiratory viruses are circulating again, Ontario's top doctor said Thursday as he warned the coming months could be tough. 

Chief Medical Officer of Health Dr. Kieran Moore urged people to get their COVID-19 and flu shots when eligible – the latter being available for the general public Nov. 1 –  and said he's hoping for the highest level of uptake possible because the flu vaccine is normally quite effective at reducing the risk of hospitalization.

"We really need it this year of all years because it's going to be a complicated year, as we try to get back to normal living with all respiratory viruses this fall and winter," he said in an interview Thursday.

Early this year, the Ontario government – in consultation with Moore – eased and then removed restrictions such as gathering and capacity limits, proof of vaccination requirements and mask mandates, except in long-term care homes. This fall and winter are set to be the first since the beginning of the pandemic without those public health measures in place.

The province is seeing a "slow and progressive rise" this week in the number of COVID-19 cases, test positivity, and the number of people in hospital and intensive care units with COVID-19, Moore said. 

Moore is not ready to declare an eighth wave just yet, but said the increase in COVID-19 activity in Ontario is partly being driven by Omicron subvariants BA.2.75 and BQ.1.1. They each make up about five per cent of cases in Ontario, but appear to be more transmissible and infectious.

If the hospital system is strained to a point where the ability to reduce the surgical backlog is being affected, Moore said he would first suggest the government make a "recommendation" on masking in settings such as post-secondary institutions, malls and public transit. 

If there are further knock-on effects from the virus, Moore says at that point he would recommend reinstating some mask mandates.

There is currently enough ICU capacity, Moore said. However, emergency departments have reported strain and long wait times in recent weeks.

In August, the most recent month for which data is available, ER patients waited 1.9 hours on average until first being assessed by a doctor and the average time emergency patients spent in hospital if admitted was 20.7 hours. 

But an Ontario Health report leaked this week by the Liberals said that in August, 90 per cent of ER patients waited up to 4.2 hours to first see a doctor and if admitted, stayed in hospital for up to 44.1 hours. That's despite patient volumes being lower than in August 2021.

Ontario Health said the average times are more meaningful, but Liberal health critic Adil Shamji said the 90th percentile figures are useful because they reveal the longest waits and the most dangerous scenarios. 

To prepare for the upcoming flu season, Ontario has ordered more than six million flu shots, Moore said, which is considerably less than last year. 

In 2021, Ontario ordered 7.6 million flu shots – 1.4 million more doses than the previous year – after large uptake in 2020. But there was lower interest last year due to a decrease in flu activity over the past couple of years, Moore said. This year's order size is more "realistic," he said.

The Ministry of Health said flu shot uptake for several seasons pre-pandemic stood at about 30 per cent. It increased to nearly 39 per cent when COVID-19 hit in 2020, but dropped to 29 per cent last season. 

Moore said he hopes in particular that at least 80 per cent of older Ontarians get immunized against the flu this year.

Ontario also announced Thursday that the Pfizer bivalent vaccine, which targets the Omicron variant, will be available starting next week to people 12 and over.

This report by The Canadian Press was first published Oct. 13, 2022.

Allison Jones, The Canadian Press