Infectious Diseases

Algoma Public Health

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Health Professionals Q&A for COVID-19

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  1. What special precautions should be taken when assessing a patient who may have COVID-19 in the primary care setting?

  2. Who decides whether a patient can get tested for COVID-19?

  3. When should a patient get tested for COVID-19?

  4. If local capacity to conduct testing becomes challenged by high volumes and/or limited resources, how should testing be prioritized?

  5. When should a patient NOT get tested for COVID-19?

  6. Can I test a patient for COVID-19 in my clinic?

  7. How can I order specimen collection kits in order to do COVID-19 testing?

  8. Where can patients get tested for COVID-19 in Algoma?

  9. What is the role of Algoma Public Health when there is a person under investigation for COVID-19?

  10. What is the turnaround time for COVID-19 testing?

  11. How should the patient be managed following COVID-19 testing?

  12. Are there any special actions to take for environmental cleaning?

  13. What is the current guidance for health care workers returning from international travel?

  14. If I assess a patient and determine that they should be tested for COVID-19 based on both symptoms and exposure risk being present, does everyone who has been in contact with the patient need to self-isolate for 14 days?

  15. How should I manage a symptomatic patient who is not tested for COVID-19?

  16. How should I manage asymptomatic individuals who have not been tested for COVID-19?

  17. When can individual with a probable or confirmed COVID-19 be discharged from isolation?

 

1. What special precautions should be taken when assessing a patient who may have COVID-19 in the primary care setting?

  • Droplet and Contact precautions are required for the routine care of patients with suspected or confirmed COVID-19.
  • Airborne precautions are required when aerosol generating medical procedures (AGMPs) are planned or anticipated to be performed on patients with suspected or confirmed COVID-19.
    • The collection of a nasopharyngeal swab or throat swab is NOT considered an AGM.
  • For a summary of PPE recommendations for inpatient and outpatient ambulatory settings, including at triage, reception, waiting areas, and consultation rooms, please consult Public Health Ontario’s Updated IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-1
  • Signage for patients are available in EnglishFrench, and additional languages from the Ministry of Health website for the health sector. 

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2.Who decides whether a patient can get tested for COVID-19?

  • The decision whether to test a patient for COVID-19 ultimately rests with the clinician and should be guided by a clinical assessment of the individual’s symptoms, risk of exposure and an awareness of the local region’s current capacity to conduct testing.
    • Health professionals may contact Algoma Public Health at 705-759-5404 for public health guidance on whether COVID-19 testing is recommended for specific patients. 

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3. When should a patient get tested for COVID-19?

  • Testing for COVID-19 should be based on clinical assessment to determine the presence of symptoms compatible with COVID-19, and the presence of exposure risk.
    • Symptoms compatible with COVID-19 range from mild flu-like respiratory symptoms, to severe symptoms, and can include fever, cough and difficulty breathing.  Serious complications include pneumonia, kidney failure, and death.
    • Exposure risk to COVID-19 for Algoma residents is still highest for those who have travelled internationally, and those who have been in close contact with a confirmed or probable case, or in close contact with a symptomatic returning traveller.  As the situation evolves, exposure risk may also include domestic travel to regions of Ontario and Canada with evidence of community transmission.
    • Health professionals may contact Algoma Public Health at 705-759-5404 for public health guidance on whether COVID-19 testing is recommended for specific patients. 

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4. How should testing be prioritized, if local capacity to conduct testing becomes challenged by high volumes and/or limited resources??

  • If local capacity to conduct testing becomes very limited, testing should be prioritized for individuals who are more acutely ill, who are at higher risk of spreading the illness to many individuals or to vulnerable individuals, or who are health care workers.  These groups include:
    • Symptomatic health care workers (regardless of care delivery setting) and staff who work in health care facilities
    • Symptomatic residents and staff in long term care facilities and retirement homes and other institutional settings (e.g. homeless shelter)
    • Hospitalized patients admitted with respiratory symptoms (new or exacerbated)
    • Symptomatic members of remote, isolated, rural and/or Indigenous communities
    • Symptomatic travellers identified at a point of entry to Canada

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5. When should a patient NOT get tested for COVID-19?

  • Routine testing of asymptomatic persons for COVID-19 is not recommended.
  • Being in close contact with someone who does not have COVID-19, but was exposed to someone with COVID-19, is not an indication for testing; i.e. do not test “contacts of contacts”

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6. Can I test a patient for COVID-19 in my clinic?

 

  • COVID-19 testing may be conducted in a primary care office setting, with appropriate contact and droplet precautions. 
  • Additional guidance for COVID-19 testing is available in the Ministry of Health’s COVID-19 Guidance for Primary Care Providers in a Community Setting.
  • Instructions for testing from the Public Health Ontario laboratory are available here.

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7. How can I order specimen collection kits in order to do COVID-19 testing?

 

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8. Where can patients get tested for COVID-19 in Algoma?

  • The following hospitals have capacity to conduct COVID-19 testing in the Algoma region:
    • Sault Area Hospital, Sault Ste. Marie
    • Lady Dunn Health Centre, Wawa
    • North Shore Health Network, Blind River
    • St. Joseph’s General Hospital, Elliot Lake

  • The following family health teams have some limited capacity to conduct COVID-19 testing for their patients:
    • Group Health Centre, Sault Ste. Marie
    • Elliot Lake Family Health Team, Elliot Lake

  • All patients being tested for COVID-19 must be reported to public health.  Public health follow-up to assess exposures, support self-isolation, and conduct any necessary contact tracing is vital to identifying and disrupting any local chains of transmission.  Please notify Algoma Public Health as follows:

Phone

705-759-5404 or 1-866-892-0172, ext. 5404 (Mon-Fri, 8:30am to 4:30pm)

705-254-6611 (after hours line for physicians reporting a disease of public health significance)


Fax

A fully completed COVID-19 reporting form may be faxed to 705-541-7309.

 

For hospitals and other facilities that are conducting a larger volume of COVID-19 testing, reporting may be batched.

 

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9. What is the role of Algoma Public Health when there is a person under investigation for COVID-19?

  • Public health management includes
    • Guidance on testing decisions based on assessment of exposure risk and knowledge of local testing capacity
    • Assistance in liaising with the local hospital that is conducting the testing
    • Advising the patient on how to appropriately self-isolate at home until results are available
    • Identifying potential sources of exposure from which the patient may have become infected
    • Identifying any close contacts and providing instructions on how to self-monitor for symptoms and take any additional precautions, depending on the level of risk

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10. What is the turnaround time for COVID-19 testing?

 

  • At this time, COVID-19 turnaround time is about 24-48 hours for positive results in priority groups (see above).  Turnaround times may increase as volumes rise and may be longer for notification of negative results.

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11. How should the patient be managed following COVID-19 testing?

  • Treatment for COVID-19 is supportive.  There are no specific therapies at this time.
  • If clinically well enough to be discharged, people who have been tested for COVID-19 should be instructed to self-isolate at home while results are pending. 
  • Once notified, Algoma Public Health will call the patient to provide self-isolation instructions and complete additional public health follow-up, including any necessary contact tracing.

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12. Are there any special actions to take for environmental cleaning?

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13. What is the current guidance for health care workers returning from international travel?

  • Health care workers who have travelled outside of Canada within the last 14 days should self-isolate for a period of 14 days starting from their arrival in Ontario.
  • Health care workers should not attend work if they are sick.
  • If there are particular workers who are deemed critical, by all parties, to continued operations, these workers should undergo regular screening, use appropriate PPE for the 14 days and undertake active self-monitoring, including taking their temperature twice daily to monitor for fever, and immediately self isolate if symptoms develop and self-identify to their occupational health and safety department.
  • Full recommendations from the Ministry of Health are available here.

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14. If I assess a patient and determine that they should be tested for COVID-19 based on both symptoms and exposure risk being present, does everyone who has been in contact with the patient need to self-isolate for 14 days?

 

No.  All local public health units in Ontario use a consistent approach to identify potential contacts and we recommend specific actions based on an assessment of risk. 

  • E.g. If the individual being tested has a very low pre-test probability of having COVID-19, identified contacts may be asked to self-monitor for symptoms, rather than to self-isolate. 

  • E.g. If the patient and care providers were wearing appropriate PPE, or had no interaction that put them within 2 metres of one another, individuals in such a scenario may not be considered “contacts” because there would have been minimal exposure to risk of droplet/contact transmission.

When testing a patient for COVID-19, please notify Algoma Public Health, so that we can follow up with the patient to (i) assess who meets criteria as a contact, and (ii) notify contacts and give them specific guidance based on risk level.  APH can also help communicate risk to concerned coworkers in the health care setting.

 

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15. How should I manage a symptomatic patient who is not tested for COVID-19?

  • Due to testing prioritization by clinicians, not all individuals with respiratory symptoms compatible with COVID-19 and a risk of exposure will be tested for COVID-19.
  • Please notify Algoma Public Health of all probable cases of COVID-19, where you suspect COVID-19 in a patient who is not receiving testing.  APH public health nurses will follow-up with appropriate isolation instructions, contact identification and tracing, and further monitoring as required.
  • These individuals should have ready access to information on worsening signs and symptoms that should prompt urgent medical attention.
  • These individuals should self-isolate for 14 days from symptom onset.  After 14 days, if they are afebrile and their symptoms are improving, they may discontinue self-isolation.
  • If symptoms or fever persist, individuals should follow up with their health provider.
  • The above guidance from the Ministry of Health is based on current evidence regarding viral shedding and viability after symptom onset in outpatients, and will be updated as additional information on the period of infectiousness becomes available.

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16. How should I manage asymptomatic individuals who have not been tested for COVID-19?

 

  • If an individual is asymptomatic and has no exposure risk, provide reassurance and general information on COVID-19.
  • If an individual is asymptomatic but has exposure risk (e.g. recent international travel), provide information on self-monitoring and self-isolation for 14 days from last exposure.
    • Resources for the public are available from Public Health Ontario here.

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17. When can an individual with probable or confirmed COVID-19 be discharged from isolation?

 

  • For each scenario, isolation after symptom onset should be for the duration specified and provided that the individual is afebrile and symptoms are improving.

  • For individuals at home:
    • 14 days following symptom onset
    • This applies to individuals whether they were confirmed by testing, and individuals who were not tested but have symptoms compatible with COVID-19

  • For hospitalized patients:
    • Isolate in hospital until 2 negative tests, obtained at least 24 hours apart
    • If discharged home within 14 days of symptom onset, follow advice for individuals at home

  • For health care workers:
    • For return to work, 2 negative tests are required, obtained at least 24 hours apart
    • If critical for operations, health care workers may return to work 14 days after symptom onset while wearing appropriate PPE, and continuing use of appropriate PPE until 2 negative specimens at least 24 hours apart

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