Clarification on COVID-19 symptoms and recommendations for testing

Posted Tuesday September 21, 2021

Posted By: Michelle Goulet

Category: General

To: Ottawa Physicians and Nurse Practitioners, CHCs and CRCs, Emergency Departments and Walk-in Clinics
Date: September 20, 2021
From: Dr. Michelle Foote, Associate Medical Officer of Health (Acting)

Dear Colleagues,

In recent months, the Delta variant of COVID-19 has become the dominant strain in Ottawa. The Delta variant is significantly more transmissible than the original variant of COVID-19. As schools resume, local case counts continue to increase, and children born after 2009 remain unvaccinated, OPH urges healthcare providers to continue to have a low threshold for recommending testing for patients with any symptom(s) consistent with COVID-19.

Ottawa Public Health would like to provide clarity that anyone with ANY of the symptoms listed in the chart on the next page is eligible for testing, and anyone (whether or not they are fully vaccinated) with a recent high-risk exposure to someone with COVID-19 who presents with any symptom listed is required to self-isolate and advised to get tested for COVID-19. If they do choose not to get tested, they must self-isolate for 10 days from symptom onset. More information about recommended testing is found on page 3 of this Public Health Alert.

Requests for Medical Notes:

OPH recommends that healthcare providers avoid providing notes or statements attesting to a clinical assessment that COVID-19 has been “ruled out” as a cause of symptoms. OPH recommends instead that healthcare providers support the parent/guardian to make appropriate declarations when completing the school screening self-assessment questionnaire and to help the parent declare that the child meets the criteria to return to school after an illness or contact with a confirmed case.

Medical notes or proof of negative tests are not required for staff or students to return to school or work following an illness or a high-risk exposure. Instead, parents/guardians are asked to complete an Attestation Form prior to returning to school.

Symptoms and COVID-19 Testing Requirements

Symptoms and COVID-19 Testing Requirements
 Symptoms

COVID-19 Symptoms requiring a test

Individuals, whether or not they are considered high-risk contacts, must get a COVID-19 test for the following symptoms (even if fully vaccinated).

Their household contacts who are not fully vaccinated must also stay home while they are awaiting test results.

Those who have one or more of these symptoms and choose not to get tested must self-isolate for 10 days.

  • Fever and/or chills
  • Cough or barking cough (croup)
  • Shortness of breath
  • New olfactory or taste disorder
In children (< 18 years old):
  • Nausea, vomiting and/or diarrhea, not related to other known causes or conditions
In adults (> 18 years old)
  • Myalgias (That is unexplained or unusual and not related to receiving a COVID-19 vaccine the past 48 hours).)
  • Extreme tiredness, lack of energy or feeling unwell (That is unusual or unexpected and not related to receiving a COVID-19 vaccine in the past 48 hours).

Other symptoms

High-risk contacts: Testing is required for any of the following symptoms, even if fully vaccinated.

Household contacts who do not have symptoms and are fully vaccinated* do not need to isolate. Household contacts who have symptoms OR who are not fully vaccinated need to isolate while awaiting test results.

Not high-risk contacts: Self-isolate (I.e. stay home except for medical emergencies or to seek COVID-19 testing) for at least 24 hours until
symptoms are improving without the use of fever reducing medications. Testing is not required prior to discontinuing isolation, though these individuals remain eligible for testing. Household contacts who do not have symptoms are able to attend work or school.

  • Sore throat
  • Rhinorrhea and/or nasal congestion
  • Conjunctivitis
  • Decreased or lack of appetite
  • Abdominal pain
  • Headache (New and persistent, unusual, unexplained, or long-lasting (not related to tension-type headaches, chronic migraines, receiving a COVID-19 vaccine in the last 48 hours).)

When do I recommend testing for COVID-19?

  • Healthcare providers may be consulted to determine whether a symptomatic child needs to be tested for COVID-19. This determination is based on the provider’s clinical judgment and there are no validated clinical tools available to differentiate COVID-19 from other illnesses with similar symptoms. OPH supports a low index of suspicion to test for COVID-19.
  • Asymptomatic persons who are identified as high-risk contacts (e.g., children in the same class as a lab confirmed case) are advised to go for testing no earlier than 7 days after last close contact with the case. Note that high-risk contacts may be tested prior to Day 7 if they present for testing sooner.
  • High-risk contacts who are not fully vaccinated and who test negative are notified that they are required to continue to self-isolate for 10 days and re-testing is advised if there are new or worsening symptoms

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