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.”

Back to top

Local Epidemiology

For the most up-to-date information on the COVID-19 situation and epidemiological data please visit:

Ottawa: Seasonal Respiratory Infections and Enteric Outbreaks Surveillance Report
Ontario: Ontario Respiratory Virus Tool – Public Health Ontario
Canada: COVID-19 epidemiology update: Summary - 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.

With ongoing community transmission, consider COVID-19 as a potential diagnosis for all patients presenting with symptoms of acute respiratory infection, regardless of their travel or contact history.

Back to top

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) and the Ontario College of Family Physicians have resources on COVID-19 IPAC measures for the clinical office setting.

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.

Patients can be directed to our public-facing COVID-19 Testing and Care Information page for information on testing eligibility and when and how to seek testing (rapid antigen testing 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 COVID-19 outbreak in a facility (e.g., long-term care or retirement home), please ensure that the outbreak number is included on the requisition, as per the PHO Respiratory Outbreak Testing Prioritization Protocol (PDF).

Rapid Antigen 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. Results from RATs are not reportable to public health.

Individuals with symptoms may undergo rapid antigen testing if it is available to them. Non-routine, or ‘one-off’, testing is not recommended, as there are important limitations of the tests.
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 positive rapid antigen test is highly indicative that a symptomatic individual has COVID-19.
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 24-48hours, means 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). For additional information, please refer to: Public Health Ontario Coronavirus Disease 2019 – Serology. 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 and from Public Health Ontario and from the Ontario College of Family Physicians. COVID-19 testing must comply with provincial eligibility criteria in all settings. There are IPAC resources available to support seeing symptomatic patients in clinic, including offering testing, Ottawa Public Health’s IPAC resources and information and from Public Health Ontario, Ontario Health and from the Ontario College of Family Physicians. COVID-19 testing must comply with provincial eligibility criteria in all settings.

Results

It is the responsibility of the ordering physician or health care professional to communicate test results to their patients.

Patients can check their COVID-19 PCR test result the following ways if they have a valid Ontario photo health card:

On MyChart if the test was affiliated with The Ottawa Hospital
The Government of Ontario website

For information on isolation and supports for people who are tested for COVID-19, please see the Management section.

Management

Notification and management of contacts

Individuals should inform others of their exposure.

Individuals who test positive or who have symptoms of COVID-19 should notify their household members and similar close contacts that they are ill and refer them to additional precautions to take.

A close contact is anyone an individual was less than two metres away from for at least 15 minutes, or multiple shorter lengths of time, without measures such as masking, distancing, and/or the use of personal protective equipment in the 48 hours before symptoms began or a positive test result, whichever came first.

For more information please see guidance from the Ministry of Health.

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.

Please note that OPH does not coordinate access to pharmaceutical treatments for individuals with COVID-19. Provincially, pharmacotherapies are coordinated through Ontario Health.

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)
The eHealth Centre of Excellence digitized Paxlovid prescription form

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.

Even if your patient decides not to receive the COVID-19 vaccine, please continue to recommend they stay up to date with other vaccinations, including vaccination against influenza.

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 Ontario Ministry of Health’s COVID-19 Vaccine Guidance and the Canadian Immunization Guide.

Report an Adverse Event Following Immunization

Under the Health Protection and Promotion Act, S.O. 2007, all healthcare professionals are required to report Adverse Events Following Immunization (AEFIs) to local public health units. If you see a patient with symptoms that could possibly be related to a recent vaccination, you as the healthcare professional are required to report the AEFI. Submitting a report doesn’t mean that the vaccine caused the event, but this is a critical component of monitoring the safety of all vaccines.

In addition to AEFIs, health care professionals are asked to report Adverse Events of Special Interest (PDF) for COVID-19 vaccine safety surveillance. AEFIs and AESIs are reportable to the health unit of the patient’s residence. The reporting form (PDF) can be submitted by fax to OPH at 613-580-9660 or through our online form. If you are unsure, please be proactive and report.

Physician Billing

The Ontario Medical Association has outlined information pertaining to billing for COVID-19 vaccination (PDF). The Ministry of Health also publishes OHIP bulletins to update on billing issues. Physicians can also check the OMA portal for updates. Questions regarding submission of billing codes can be directed to the Ministry of Health's Service Support Contact Centre at SSContactCentre.MOH@ontario.ca.

Resources for Healthcare professionals

The Canadian Pediatric Society has an online module,
Moving to Acceptance: Strategies to address concerns about vaccines, that is eligible for MOC credit (Note – there is a cost to take the module).
The Government of Ontario’s Ministry of Health has a page dedicated to Ontario's COVID-19 Vaccine Program.
The Government of Canada has a list of authorized vaccines and treatments for COVID-19, which includes regulatory information such as product monographs.
The Canadian Immunization Guide (CIG) provides recommendations on the use of 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.

Public Health Ontario: IPAC Recommendations for use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19 (PDF).

Incorporates evidence to date on modes of transmission, effectiveness of personal protective equipment (PPE) in healthcare workers (HCWs) and the undetermined impact of the emergence of variants and their lineages. Recommendations will be updated as needed based on emerging information.

Recommendations in the guidance include:

The recommended PPE when providing direct care for patients with suspect or confirmed COVID-19 includes a well-fitted medical mask* (surgical/procedure) or a fit-tested, seal-checked N95 respirator (or equivalent), 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
COVID-19 Eye Protection Guideline (pdf - 139 KB), Ottawa Public Health
Clinical Office Practice IPAC webpage, Public Health Ontario (includes a practical IPAC checklist and video resources. Contact information for the Regional IPAC Support Team is available here as well).
COVID-19 Health Care Resources, Public Health Ontario
Focus on Heating, Ventilation and Air Conditioning (HVAC) Systems in Buildings and COVID-19 (PDF), Public Health Ontario
Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings (PDF), Provincial Infectious Diseases Advisory Committee (PIDAC)
Infection Prevention and Control – Online Learning, 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
Masks, 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 also has many useful resources for physicians and primary care providers including research syntheses, information on variants of concern and Infection Prevention and Control (IPAC) resources in relation to COVID-19.

Testing

Public Health Ontario has information on Testing for COVID-19 in Ontario, including who to test, test methods and sample preparation and submission instructions.
Please see OPH’s Testing page for information testing locations patient resources.

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.

Receive Email Updates...