COVID-19: Updates to Testing, testing and clearance, symptoms guidance

Posted Thursday May 07, 2020

Posted By: Emily Ngo

Category: General

To: Ottawa Healthcare Providers and Partners
Date: May 7 2020
From: Dr. Monir Taha, Associate Medical Officer of Health, Ottawa Public Health (OPH)

For COVID-19 information see OPH’s Physician and Health Care Professionals Coronavirus website, visit www.ottawapublichealth.ca/ncov), or call 613-580-6744

Ministry of Health Guidance Updates

The Ministry of Health released the following three updated documents:

  1. Quick Reference Public Health Guidance on Testing and Clearance V6.0: http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/2019_testing_clearing_cases_guidance.pdf
    • This 4-page document is divided into the following sections (updates are italicized):
      • Diagnosing COVID-19
      • Management for individuals who have not been tested
      • Criteria to discharge someone from isolation and consider “resolved”
      • Approaches to clearing cases
        • Updated to consider the observation that some people with more severe illness may have prolonged detection of viral RNA which may indicate the potential for longer viral shedding. Specifically, a non-test-based approach is appropriate for most individuals who have recovered from mild to moderate illness, while a test-based approach should be considered for individuals who have had severe illness.
      • Recommendations for Health Care Workers Return to Work
        • Guidance is updated regarding when work self-isolation may be considered based on exposure history
  2. COVID-19 Reference document for Symptoms: V2.0: http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/2019_reference_doc_symptoms.pdf
    • Additions: Conjunctivitis is added to the list of atypical symptoms.
    • Clarifications:
      • Runny nose, sneezing or congestion should only be considered in absence of underlying reason for these symptoms such as seasonal allergies and post-nasal drip
      • Unexplained or increased number of falls is an atypical symptom
  3. COVID-19 Provincial Testing Guidance V.3.0: http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/2019_covid_testing_guidance.pdf
    • The 15-page document is divided into the following sections (italicized sections include new additions from the Ministry):
      1. Hospital inpatients
      2. Residents living in long-term care and retirement homes
        • Additional guidance for transfer from hospital to long-Term Care Homes
      3. Residents of other congregate living settings and institutions
      4. Persons working in congregate living settings and institutions
      5. Healthcare workers/caregivers/care providers/first responders
      6. Persons living in same household of healthcare workers/care providers/first responders
      7. Remote/isolated/rural/Indigenous communities
      8. Specific priority populations
        • Additional guidance for testing newborns
      9. Essential workers
      10. Cross-border workers

Note: Consideration should be given for other underlying reasons for patients presenting with ONLY runny nose, sneezing or congestion, such as seasonal allergies and post-nasal drip

Reminders:

  • Testing of asymptomatic patients, residents or staff is generally not recommended.
  • Clinicians should continue to use their discretion to make decision on which individuals to test.

Appendix: Atypical symptoms/signs of COVID-19: Including addition of conjunctivitis to atypical symptom list
Appendix B: Testing Asymptomatic Cancer Patients
Appendix C: Testing for Hemodialysis Patients

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