Coronavirus disease 2019 (COVID-19)

Key Messages:

The virus that causes COVID-19 (SARS-CoV-2) is primarily transmitted via exhaled respiratory droplets and particles that are propelled into the air after an infected person coughs, sneezes, talks, or breathes.
COVID-19 can cause illness ranging from a very mild, cold-like illness to severe infections. Presentations may be atypical, especially in older persons, children, and people living with a developmental disability.
It is important to note that people with COVID-19 can be asymptomatic while infected and transmission can still occur when infected people are asymptomatic or prior to developing symptoms.

Introduction

COVID-19 is a disease caused by the SARS-CoV-2 virus. COVID-19 most often causes respiratory symptoms similar to a cold, the flu, or pneumonia. Most people with COVID-19 have mild symptoms, but some people become severely ill. Vaccination can help prevent the development of severe illness.

Some people may develop Post-COVID Conditions – also known as “Long COVID.”

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Local Epidemiology

For the most up-to-date information and epidemiological data please visit:

Ottawa: Seasonal Respiratory Infections and Enteric Outbreaks Surveillance Dashboard
Ontario: Ontario Respiratory Virus Tool – Public Health Ontario
Canada: Summary: Canadian respiratory virus surveillance report (FluWatch+) — Canada.ca - Public Health Agency of Canada

Signs and symptoms

COVID-19 can cause illness ranging from a very mild, cold-like illness to a severe infection. Presentations may be atypical, especially in older persons, children and people living with a developmental disability. People with COVID-19 can be asymptomatic while infected; transmission can still occur when people are asymptomatic or prior to developing symptoms.

Refer to the Public Health Agency of Canada’s COVID-19 signs, symptoms and severity of disease: a clinician guide, for a full list of symptoms.

Diagnosis and laboratory testing

Clinicians play a vital role in helping patients navigate current testing resources, accessing antivirals or providing testing in their own clinical setting. Public Health Ontario (PHO) has best practices for the prevention of acute respiratory infection transmission in clinical settings.

Testing & Treatment

The Ministry of Health provides testing guidance, eligibility criteria for PCR testing, and information on COVID-19 testing locations. Those who have symptoms of COVID-19 and are at higher risk of severe outcomes from COVID‑19 may be eligible for antivirals, and are advised to seek testing (rapid antigen testing (RAT) or PCR) and care immediately.

Testing (RATs or PCR) and access to antiviral therapy is available through many local pharmacies, visit the province's website for more information.

Note that if you are collecting specimens that are part of a respiratory outbreak in a facility (e.g., long-term care or retirement home), please refer to instructions from Public Health Ontario.

Testing:

Rapid Antigen Testing (RAT): A positive rapid antigen test is highly indicative that a symptomatic individual has COVID-19. Therefore, individuals with a positive result on a rapid antigen test do not require a confirmatory PCR test in most settings and are managed as a case of COVID-19 and should follow recommendations on measures to take to limit transmission.

Molecular tests are preferred for some populations, such as symptomatic patients in hospital and for residents in highest risk settings, such as long-term care homes.
A single negative RAT does not rule out COVID-19, and these tests may be falsely negative, especially early in illness.
Two consecutive negative RATs, separated by 24-48 hours, mean COVID-19 infection is less likely. The individual is still recommended to self-isolate until they are afebrile, and symptoms have improved for 24 hours (or 48 hours for gastrointestinal symptoms).

Serology testing for COVID-19

There are limited clinical scenarios for which serology testing may be appropriate for diagnostic purposes, such as when assessing symptoms compatible with Multisystem Inflammatory Syndrome in Children (MIS-C). To date no studies have identified an immune marker that represents an absolute correlate of protection against SARS-CoV-2-infection (i.e., prevents an infection at a certain threshold), so serology is not useful in determining someone’s protection against future infection.

Management of staff returning to work in highest risk settings:

Individuals should follow any workplace guidance (as applicable) for return to work. Individuals returning to work in highest risk settings (e.g., acute care, long-term care homes, etc.) should follow any relevant workplace guidance on return to work. In general, return to work in highest risk settings after self-isolating as above, may occur while following measures to reduce the risk of transmission for 10 days after symptom onset/positive test date, including:
- Avoiding caring for patients/residents at highest risk of severe COVID-19 infection, where possible
- Ensuring well-fitting source control masking (e.g., a well-fitting medical mask or fit or non-fit tested N95 respirator or KN95)
- Reviewing PPE and IPAC practices, where possible
- Taking unmasked breaks in a separate breakroom, or with physical distancing, to avoid exposing coworkers
- Working on a single ward or area of the setting as much as possible
- Working in a single facility, as much as possible

Infection Prevention and Control in your office

There are IPAC resources available to support seeing symptomatic patients in clinic, including offering testing, Ottawa Public Health’s IPAC resources and information from Public Health Ontario.

Management

Pharmaceutical Therapies

The Ministry of Health provides information for patients on testing and antiviral eligibility and access. Ontario Health provides recommendation on the use of Paxlovid.

Additional resources:

Ontario Health guidance on Paxlovid for health care professionals: Access to Antiviral Therapy for COVID-19 in the community (Ontario Health)
Nirtmatrelvir/Ritonavir (PaxlovidTM): What Prescribers and Pharmacists Need to Know (University of Waterloo & University of Toronto)

Immunization

Supporting your patients to get vaccinated

For more information on vaccine clinics in Ottawa, including where your patients can get vaccinated, patients can visit our public COVID-19 Vaccine webpage.

Updated vaccine information and guidance for the public is available from the Ontario Ministry of Health: COVID-19 vaccines.

Contraindications to Vaccination

If a patient has a history of severe immediate allergic reaction (e.g., anaphylaxis) to the vaccine or any of the vaccine ingredients, health care practitioners are encouraged to refer patients to an allergist prior to administration of COVID-19 vaccine.

People who experienced a severe immediate allergic reaction after a dose of an mRNA COVID-19 vaccine can safely receive future doses of the same or another mRNA COVID-19 vaccine after consulting with an allergist/immunologist or another appropriate physician. For more information, please consult the Canadian Immunization Guide.

Resources for Healthcare professionals

Ontario’s Ministry of Health: COVID-19 Vaccine Program.
Government of Canada: COVID-19 vaccines and treatments
Canadian Immunization Guide (CIG): COVID-19 vaccines.

Prevention

Infection prevention and control (IPAC) measures protect healthcare professionals, staff, and patients from the spread of disease, including COVID-19. A risk assessment of your clinic and exam rooms prior to any interaction with patients will help to determine which IPAC measures are needed, depending on the specific setting and procedures being performed. The resources below may assist as you implement appropriate IPAC measures within your practice.

Provincial Infectious Diseases Advisory Committee (PIDAC): Best Practices for the Prevention of Acute Respiratory Infection Transmission in All Health Care Settings

Incorporates evidence to date on modes of transmission, effectiveness of personal protective equipment (PPE) in healthcare workers (HCWs).

Recommendations in the guidance include:

The recommended PPE when providing direct care for patients with acute respiratory infections includes a well-fitted medical mask* (surgical/procedure) or a fit-tested, eye protection, gown, and gloves.
N95 respirator (fit-tested, seal-checked) or medical mask* should be used with all other recommended personal protective equipment when aerosol generating medical procedures (AGMPs) are performed or anticipated to be performed on patients with suspect or confirmed COVID 19.
*A non-fit tested N95respirator (or equivalent) is considered an alternative to a medical mask.

Resources

Recommended Steps: Putting On Personal Protective Equipment (PPE), Public Health Ontario
Clinical Office Practice IPAC webpage, Public Health Ontario

For more information on Infection Prevention and Control, please see our page Infection Prevention and Control Resources for Healthcare Professionals.

Public Health Role

Using the Health Protection and Promotion Act, S.O. 2007, Ottawa Public Health (OPH) takes actions to protect the public and prevent the spread of COVID-19 in our community.
We collaborate with provincial and national public health partners, as well as local hospitals and community agencies, to conduct surveillance and assess the risk level in our community. We also work with partners to coordinate the response to outbreaks and make recommendations based on the local situation.
All deaths related to COVID-19 are reportable to OPH. Please see the Diagnosis and laboratory testing section of this web page for more details.

Patient resources

Respiratory Illness, Ottawa Public Health
Multilingual Resources for Diverse Communities, Ottawa Public Health

Physician Resources

COVID-19 guidance documents

The Ministry of Health’s Health Sector Resources.
Public Health Ontario has resources for physicians and primary care providers including respiratory virus surveillance data and Infection Prevention and Control (IPAC) resources.

Testing

Public Health Ontario: COVID-19 PCR testing information, including test methods and sample preparation and submission instructions.

Contact us:

Monday to Friday from 8:30 am to 4:30 pm: Call 613-580-2424, extension 24224, select your language of choice by pressing 1 or 2 and then leave a detailed, confidential message including your contact information.

After hours, on weekends, or holidays: Call 3-1-1 and ask to speak to Public Health on call. To have your call prioritized as a health care professional, please identify yourself and your reason for calling; your call will be prioritized for answer.

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