COVID-19 Update: Expanding testing criteria

Posted Monday April 13, 2020

Posted By: Emily Ngo

Category: General

To: Ottawa Physicians, Nurse Practitioners, Walk-In Clinics, Travel Clinics, Community Health Centres, Emergency Departments, Infection Control, HEPCO, Long Term Care Homes, Retirement Homes
Date: April 13, 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

 

The Ministry of Health has released updated guidance on COVID-19 testing including expanding eligible signs and symptoms, expanding criteria for testing of certain priority groups, and testing asymptomatic individuals in certain situations.

COVID-19 presentations

Typical symptoms of COVID-19Fever, cough, OR difficulty breathing
Atypical signs and symptoms of COVID-19Atypical symptoms: Unexplained fatigue/malaise, delirium (acutely altered mental status and inattention), falls, acute functional decline, exacerbation of chronic conditions, digestive symptoms (including nausea, vomiting, diarrhea, abdominal pain), chills, headaches, croup, OR loss of taste/smell
Atypical signs: Unexplained tachycardia (including age specific tachycardia for children), decrease in blood pressure, unexplained hypoxia (even if mild, i.e., O2 sat <90%), lethargy, OR difficulty feeding in infants (if no other diagnosis)
New or worsening acute respiratory illnessFever (37.8°C or greater), new cough, shortness of breath (dyspnea), sore throat, runny nose or sneezing, nasal congestion, hoarse voice, difficulty swallowing, OR clinical or radiological evidence of pneumonia
AsymptomaticNo typical or atypical signs or symptoms of COVID-19

Definitions

  • Health Care Worker (HCW): Health professionals and any other workers in clinics, home and community care, health care facilities, and institutions, who may be in contact with patients, residents, inmates, or other co-workers.
    • Health care professionals: doctor, nurse, paramedics, dentist, dental hygienist, therapist, technician, public health staff, etc.
    • Other workers: reception staff, housekeeping staff, administrative staff, corrections staff, police officers, and fire personnel, etc.
  • Institutional settings: long-term care homes (LTCH), retirement homes (RH), correctional facilities, homeless shelters, mental health institution, hospice, and other congregate living settings.

OPH recommends the HIGHEST priority for COVID-19 testing to the following groups, based on their signs and symptoms:

 At least one typical symptom of COVID-19At least one atypical sign or symptom of COVID-19At least one symptom of a new or worsening acute respiratory illness
HCWs and staff who work in health care facilitiesRecommend testingRecommend testingRecommend testing
Household members (or similar close regular contact) of HCWs or staff who work in health care facilitiesRecommend testingRecommend testingRecommend testing
Residents in LTCH, RH, and other institutional settingsRecommend testingConsider testing, particularly in elderly personsRecommend testing
Staff in LTCH, RH, and other institutional settingsRecommend testingRecommend testingRecommend testing
Hospital inpatients and those requiring/likely requiring admissionRecommend testingConsider testing, particularly in elderly personsRecommend testing
Members of remote, isolated, rural and/or Indigenous communitiesRecommend testingConsider testing, particularly in elderly persons and childrenRecommend testing
Caregivers and care providersRecommend testingRecommend testingRecommend testing
First responders (i.e., firefighters, police; [paramedics are included in HCWs above])Recommend testingRecommend testingRecommend testing
Vulnerable healthcare priority population with frequent healthcare contact (i.e., patients with cancer/chemotherapy, dialysis therapy, pre-/post-transplant, pregnancy, and neonates)Recommend testingConsider testing, particularly in elderly persons and children (including those with developmental disability)Recommend testing

OPH recommends the NEXT HIGHEST priority for COVID-19 testing if supplies permit AND there is at least one typical symptom of COVID-19:

  • Close contacts of confirmed or probable cases
  • Returning international travellers who seek medical attention
  • Critical infrastructure workers – this includes grocery stores, food services, maintenance and transportation workers, and utilities. See the full list of Ontario’s essential workplaces

Generally, OPH does not recommend the testing of asymptomatic individuals for COVID-19 except in these specific circumstances:

ScenarioTesting Recommendation
Asymptomatic new admission or re-admission to a LTCH or RHRecommend testing within first 14 days after transfer
Asymptomatic patient transferred from a hospital admission to a LTCH †Recommend testing prior to transfer¶
Asymptomatic resident in an institution* living in the same room as a symptomatic resident‡Recommend testing
COVID-19 outbreak in LTCH or RH

Recommend testing of the following:

  • Asymptomatic residents that are close contacts of a confirmed case
  • All asymptomatic residents living in adjacent rooms
  • All asymptomatic staff working on the unit/care hub
  • All asymptomatic essential visitors that attended at the unit/care hub
  • Any other asymptomatic contacts deemed appropriate based on OPH risk assessment
Asymptomatic resident of a LTCH or RH on an outpatient visit (e.g., Emergency Department visit, dialysis, etc.)Testing is NOT recommended

† A pending test result is not a barrier to transfer. A negative result does not rule out the potential for incubating illness and all patients should remain under a 14-day self-isolation period following transfer.
¶Test as close to transfer as is reasonably achievable.
*An institution: long-term care facilities, retirement homes, correctional facilities, homeless shelters, mental health institution, correctional facility, hospice, and other congregate living settings.
‡ A negative result does not rule out the potential for incubating illness and all close contacts should remain under a 14-day self-isolation period following contact.

Please note that the Ministry of Health states: “Despite this [Ministry] guidance [on testing criteria], clinicians may continue to use their discretion to make decisions on which individuals to test.”

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