Information on COVID-19 for Physician and Health Care Professionals

Routine immunizations for children should be kept up to date to reduce the risk for common and serious childhood infections, such as pneumococcal disease, measles, and pertussis. Reserving specific times or days for this task may become a priority.

Maintain physical distancing measures during routine care, place patients at least 2 metres apart in the waiting room, and have alcohol hand rub constantly available. Inform families prior to a visit that minimizing the number of people accompanying patients as much as possible is recommended.

COVID-19 is reportable under Ontario's public health legislation. If you suspect an individual may be infected with COVID-19, report the suspected case to Ottawa Public Health immediately by either:
  1) Using the Online COVID-19 Reporting Tool. If you use the reporting tool, you do NOT need to call OPH to report the same concern.
  OR
  2) Calling 613-580-6744 (24 hours per day).
Laboratory confirmation is not required to report a suspected COVID-19 case.

Last update: May 19, 2020 

Information on COVID-19 is evolving rapidly. Please check this webpage frequently for updates or call Ottawa Public Health (OPH) at 613-580-6744 for advice.

 Key Messages
  • Ottawa Public Health (OPH) has laboratory confirmation of community spread of COVID-19. Statistics on COVID-19 in Ottawa are updated daily and special statements from Medical Officer of Health, Dr. Vera Etches, are posted here
  • Updates about the status of cases in Ontario, including Ottawa, are available on the Ministry of Health webpage.
  • COVID-19 can cause illness ranging from a very mild, cold-like illness to a severe lung infection. Symptoms can include fever, cough, sore throat, muscle ache, headache, and difficulty breathing (shortness of breath). Atypical symptoms can also be seen including: unexplained fatigue/malaise, delirium (acutely altered mental status and inattention), falls, acute functional decline, exacerbation of chronic conditions, chills, headaches, croup, and loss of sensation of taste/smell.
  • Any Ottawa resident who has COVID-19 symptoms is recommended to go for testing (see COVID-19 Testing Criteria for details on who to test).
    • Routine testing of asymptomatic persons for COVID-19 is not recommended.
    • Health care workers (HCW) with acute respiratory illness should self-isolate and be tested regardless of exposure or travel history (see Health Care Workers with Symptoms for details).
      • Symptomatic health care workers should self-isolate while awaiting test results.
      • Testing for health care workers is being prioritized by the laboratory.
  • Droplet and Contact Precautions are sufficient for providing direct care to patients with suspect or confirmed COVID-19, including nasopharyngeal and oropharyngeal swab collection (see Infection Prevention and Control section for details)
  • Airborne precautions, including the use of N95 respirators, are only required for Aerosol-generating medical procedures (e.g., endotracheal intubation, cardiopulmonary resuscitation, bronchoscopy, surgery)
  • Laboratory testing for COVID-19 is being conducted at the Public Health Ontario Laboratory (PHOL) and other regional sites. Complete the mandatory information using the COVID-19 Virus Test Requisition (PDF)
  • COVID-19 is reportable under Ontario's public health legislation.
    • Report the suspected case to OPH using the Online COVID-19 Reporting Tool OR by calling 613-580-6744 (24 hours per day)
    • If the patient requires a sick note from their employer, OPH has created a letter on our website that can be provided to patients on self-isolation.
 Recent Changes to Recommendations 

1) Revised sections on criteria for testing (May 13th, 2020)

Ottawa Public Health has updated their testing recommendations: any resident of Ottawa with COVID-19 symptoms is recommended to go for testing.

2) Revised sections on criteria for testing (May 4th 2020)

Ottawa Public Health has updated their testing recommendations to include any resident of Ottawa with COVID-19 symptoms aged 60 years or older.

3) Revised sections on criteria for testing and management of health care workers (April 21, 2020)

To highlight, the testing of symptomatic household contacts of a HCW for COVID-19:

  • Updated testing priorities for COVID-19 now include symptomatic individuals (e.g., children, partners, or other household members) living with HCWs. A HCW whose symptomatic household contact is tested should remain in self-isolation until test results are available. 

4) Section on symptomatic health care workers (April 2, 2020)

New section to outline different criteria for testing and return to work for Health Care Workers with Symptoms.

5) Updates on testing (March 27, 2020)

Updated recommendations are provided with further details in the Testing section:

  • Changes to specimen collection to address the local shortage of NP swabs
  • Changes to laboratory requisition including prioritizing testing of health care workers

 Recent Public Health Alerts Issued By Ottawa Public Health

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 Local Epidemiology

 Signs and Symptoms

  • With community-spread in Ottawa, COVID-19 must be considered as a potential diagnosis for all patients presenting with symptoms of acute respiratory infection, regardless of their travel or contact history. 
  • COVID-19 can cause illness ranging from a very mild, cold-like illness to a severe lung infection, including atypical presentations especially in older persons, children, and people living with a developmental disability.

Classic COVID-19 symptoms: fever (37.8°C or greater), new or worsening cough and/or shortness of breath (dyspnea)

Other symptoms of COVID-19: sore throat, difficulty swallowing, new olfactory or taste disorder(s), nausea/vomiting, diarrhea, abdominal pain, runny nose*, or nasal congestion*

*In the absence of underlying reason for these symptoms such as seasonal allergies and post nasal drip

Signs of COVID-19 can include: clinical or radiological evidence of pneumonia

Atypical signs and symptoms should be considered particularly in children, older persons, and people living with a developmental disability.

  • Atypical symptoms include: Unexplained fatigue/malaise, delirium (acutely altered mental status and inattention), unexplained or increased number of falls, acute functional decline, exacerbation of chronic conditions, chills, headaches, conjunctivitis, croup or multisystem inflammatory vasculitis in children 
  • Atypical signs include: 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)

Complications of COVID-19 include: pneumonia, kidney failure, and in severe cases, death.

Information around incubation period and period of communicability are still emerging:

  • Current estimates of COVID-19 incubation period range from 1-14 days with median estimates of 5-6 days between infection and the onset of clinical symptoms of the disease.
  • The accepted period of communicability begins 48 hours prior to symptom onset (possible range of presymptomatic transmission: 1 to 3 days before symptom onset). The end of the period of infectivity is currently not clearly defined. In a single study of 9 patients who fully recovered from mild to moderate illness (i.e., that would not ordinarily have required hospitalization), of the virus recovered in successive samples, none was viable after 8 days from symptom onset.
  • However, most health authorities build in an extra buffer, such as the completion of 14 days from symptom onset and afebrile and symptoms improving. Ontario provides non-test based criteria to indicate when a non-hospitalized person can be considered recovered: Quick Reference Public Health Guidance on Testing and Clearance.

Criteria for Testing Symptomatic Individuals

As of May 13, 2020, OPH is recommending that any individual in Ottawa, regardless of age, with any symptoms compatible with COVID-19 should receive testing. Please see the signs and symptoms tab for presentations of COVID19. Recommendations for testing of the general public may continue to change. However, the priority groups below should still be prioritized for testing, should demand for testing exceed assessment and/or lab capacity. 

OPH recommends the HIGHEST priority for COVID-19 testing to the following groups:

  • Symptomatic health care workers* (regardless of care delivery setting, includes paramedics) and staff who work in health care facilities
  • Symptomatic residents and staff in Long Term Care and Retirement Homes and other institutional settings** (homeless shelters, prisons, correctional facilities, day care for essential workers, group homes, community supportive living, disability-specific communities/congregate settings, short-term rehab, hospices, other shelters) 
  • Symptomatic caregivers (e.g. volunteers, family members of residents in a hospital, long terms care, retirement home, other congregate or institutional setting)
  • Symptomatic care providers (e.g. employees, privately-hired support workers)
  • Symptomatic first responders (i.e. firefighters, police)
  • Symptomatic household members of HCWs, care providers or first responders
  • Symptomatic members of remote, isolated, rural and/or Indigenous communities
  • Symptomatic people in priority populations with frequent contact with the healthcare system (e.g. undergoing cancer treatment/chemotherapy, dialysis, pre-/post-transplant, pregnant persons*, neonates*)
  • Hospital inpatients and those likely requiring admission
  • Individuals referred for testing by Ottawa Public Health

*If the individual being tested is a breastfeeding mother: the case should wear a medical mask (or, if not available, a cloth mask) or loosely cover the baby with a blanket or towel. The mother should adhere to respiratory etiquette and perform hand hygiene before and after close contact with the baby. 

*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.

  • Examples of health professionals include: nurse, doctor, paramedic, therapist, dentist, public health, OT, PT, RT and PSW
  • Examples of non-health professionals include: reception, housekeeping, administrative, facilities, security, corrections staff, police and fire personnel
  • Examples of clinics, health care facilities, and institutions include: dental clinic, primary care office, hospitals, LTC facilities, retirement homes, group homes, correctional facilities, homeless shelters, public health units and emergency services stations.

**An institution or congregate living setting: long-term care facilities, retirement homes, correctional facilities, homeless shelters, mental health institution, hospice, day care for essential workers, group homes, community supported living, disability-specific communities/congregate settings, short-term rehab, and other congregate living settings. 

OPH recommends the NEXT HIGHEST priority for COVID-19 testing (if supplies and lab capacity permits). 

  • Symptomatic close contacts*** of confirmed or probable cases
  • Symptomatic returning travelers who seek medical attention
  • Symptomatic essential workers – (e.g. grocery stores, food services, maintenance and transportation workers, and utilities. See the full list of Ontario’s essential workplaces)
  • Symptomatic cross-border workers (i.e. workers who reside in Ontario, but who cross the Canadian border for work)
  • Symptomatic Ottawa residents 60 years or older

***A close contact is defined as:

  • Those in the same household and anyone else who had close contact when the case was sick and not self-isolating, and up to 2 days (48 hours) before the patient’s symptom onset. 
  • This may include:
    • members of an extended family, roommates, boarders, guests, etc. 
    • people who provided care for the case (e.g. bathing, toileting, dressing, feeding, etc.).
    • people living in congregate settings (e.g. dormitories, shelters, group homes, detention centres, child/daycare centres) where contacts shared communal living areas (e.g. kitchen, bathroom, living room) with the case. 

Criteria for Testing Asymptomatic Individuals

Generally, OPH does NOT recommend the testing of asymptomatic individuals for COVID-19 except in these specific circumstances as per the Ministry of Health COVID-19 Provincial Testing Guidance Update of April 15, 2020:

Scenario Testing Recommendation
Asymptomatic new admission or re-admission to a LTCH or RH (i.e. not from hospital) Recommend testing within first 14 days after transfer

Asymptomatic patient transferred from a hospital admission to a LTCH, retirement home, or hospice 

 

Note: As of April 15, 2020 the Ministry has asked hospitals to temporarily stop transferring patients to LTCH/RH. However, these recommendations apply in the unlikely event that a transfer is still required.
Recommend testing; results must be received 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 

  • 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

Recommend testing

Asymptomatic resident of a LTCH or RH on an outpatient visit (e.g., Emergency Department visit, dialysis, etc.) Testing is NOT recommended
Newborns born to mothers with suspected COVID-19 at the time of birth Recommend testing within 24 hours of delivery, regardless of symptoms

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. Given test results take 24-48 hours at the moment, you would want to test the patient within a few days of the intended transfer date, as close to that 48 hour window as possible. 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.

An institution: long-term care facilities, retirement homes, correctional facilities, homeless shelters, mental health institution, correctional facility, hospice, and other congregate living settings

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.”

If a clinician would like to discuss the role for testing, the PHO Microbiologists on-call are available and can be contacted through the PHO Laboratory's Customer Service Centre at 416-235-6556 / 1-877-604-4567 or the After-Hours Emergency Duty Officer at 416-605-3113.

 Specimen Collection

  • Specimens are processed at the Public Health Ontario (PHO) Laboratory and other regional laboratories. 
  • All health care providers should wear appropriate personal protective equipment (PPE) for Contact and Droplet Precautions – including eye protection – when collecting upper respiratory tract specimens.
  • Airborne precautions – including N95 respirators – are required for any aerosol-generating procedure, including bronchoscopy.
  • Please note that serology for COVID-19 is not available.

A differential approach to specimen collection is recommended:

A) Patients not admitted to hospital (including those in the Emergency Department)

  • A single upper respiratory tract specimen will be accepted for COVID-19 testing. As per the Public Health Ontario Laboratory (PHOL), a nasopharyngeal (NP) swab is the preferred specimen for COVID-19 testing. 

  • As an alternative during a shortage of NP swabs, PHOL supports the use of a viral throat swab for COVID-19 testing in most symptomatic individuals with mild illness and those not requiring hospitalization, including health care workers (HCWs).

B) Patients admitted to hospital or under consideration for admission

  • For symptomatic individuals admitted to hospital, PHOL recommends the submission of one upper respiratory tract specimen and, when possible, one lower respiratory tract specimen for COVID-19 testing.
  • The recommended upper respiratory tract specimen in patients admitted to hospital or under consideration for admission is an NP swab.

C) Residents in Long-Term Care Homes and Retirement Homes

  • For symptomatic residents in Long-Term Care Homes and Retirement Homes, the recommended upper respiratory tract specimen is an NP swab.
  • Additional details on specimen requirements:

  • Upper respiratory tract: 
    • Upper respiratory tract specimens include:
      • Nasopharyngeal specimen: NPS (Virus Respiratory Kit order #390082) with pink universal transport media (i.e., same swab used to test for influenza or respiratory syncytial virus).

      • Throat specimen: viral swab (Virus Culture Kit order #390081) containing pink universal transport media (i.e., the same swab used to test for herpes simplex virus).

  • Lower respiratory tract specimens: (e.g., bronchoaveolar lavage, bronch wash, pleural fluid, lung tissue). Submit when possible for in-patients. For these specimens, use a Tuberculosis Kit (order #390042) containing a 90mL sterile container.
  • Sputum: Collect if patient has a productive cough. Do not induce. Submit for in-patients only. For these specimens, use a Tuberculosis Kit (order #390042) containing a 90mL sterile container.
  • Alternative specimen collection kits:
  • Submission and Collection Notes

  • PHO Laboratory pre-approval for COVID-19 testing is not required, provided that all fields are filled accurately on the requisition (PDF)
  • To facilitate priority testing of a HCW specimen, please check the HCW box under “Patient Setting/Population”

Storage and Transport Requirements

  • Place specimen in biohazard bag and seal.
  • Store specimens in a refrigerator at 2–8°C following collection and ship to the PHO Laboratory on ice packs.
  • Additional details on how to test for COVID-19 is available on the Public Health Ontario (PHO) website.

 Follow-up Laboratory results

  • It is the responsibility of the ordering physician or healthcare provider to communicate test results to their patients.
  • Patients can now check to their COVID-19 test result on the Government of Ontario website
  • OPH will directly contact only those who have tested positive as part of OPH case and contact management activities.

Reporting to Ottawa Public Health

COVID-19 is reportable under Ontario's public health legislation. If you suspect an individual may be infected with COVID-19, report the suspected case to Ottawa Public Health immediately by either:

Laboratory confirmation is not required to report a suspected COVID-19 case.

Because COVID-19 is contagious, the sooner local public health can be involved in a suspected case, the sooner control measures and contact tracing can begin to reduce the spread to the public, particularly the most vulnerable.

 Management of symptomatic persons TESTED for COVID-19

Please see the OPH handout on “Instructions for those with COVID-19 symptoms who are tested”.

In brief, key instructions for symptomatic persons tested for COVID-19 include:

  • The patient must self-isolate at home until they meet criteria to discontinue self-isolation (see below)
  • The patient must notify all close contacts that they must self-isolate for 14 days from their last contact with the patient tested. This includes anyone who has close contacts up to 2 days (48 hours) prior to onset of symptoms. Self-isolation of close contacts can be discontinued if the patient’s test result is negative for COVID-19.
  • Please provide your close contacts a copy of the Ottawa Public Health “Instructions for those who may have been in close contact with a case of COVID-19
  • The patient should monitor their COVID-19 symptoms and seek emergent care if symptoms are worsening.
  • OPH will only directly contact individuals who test positive. After self-isolation is discontinued, the patient should continue to practice physical distancing.
  • Criteria to discontinue self-isolation for those tested for COVID-19

  • Discontinuing self-isolation depends on if you have travelled and on your COVID-19 test result. Please refer to the following table for your situation: 

 

 COVID-19 Test Positive COVID-19 Test Negative 
Returning from travel   Fourteen (14) days since your return to Canada OR fourteen (14) days after your symptoms started, whichever is longer 
AND you have no fever  
AND your symptoms are improving 
AND you are not currently admitted to hospital or a health care worker* 
Fourteen (14) days since your return to Canada OR fourteen (14) days after your symptoms started, whichever is longer 

AND you have no fever  
AND your symptoms are improving 
AND you are not a health care worker* 
No travel history   Fourteen (14) days after symptoms started 
AND you have no fever  
AND your symptoms are improving 
AND you are not currently admitted to hospital or a health care worker* 
24 hours after symptoms resolve

* Please note: hospitalized patients and health care workers have different criteria for discontinuing self-isolation. 

 Management of symptomatic persons NOT tested for COVID-19

Please see the OPH handout on “Instructions for those with COVID-19 symptoms who are NOT tested”.

In brief, key instructions for symptomatic persons NOT tested for COVID-19 include:

  • The patient must self-isolate at home until they meet criteria to discontinue self-isolation (see below)
  • The patient must notify all close contacts that they must self-isolate for 14 days from their last contact with the patient tested. This includes anyone who has close contacts up to 2 days (48 hours) prior to onset of symptoms.
  • Please provide your close contacts a copy of the Ottawa Public Health “Instructions for those who may have been in close contact with a case of COVID-19.” 
  • The patient should monitor their COVID-19 symptoms and seek emergent care if symptoms are worsening.
  • OPH will only directly contact individuals who test positive.
  • After self-isolation is discontinued, the patient should continue to practice physical distancing
  • Criteria to discontinue self-isolation for those NOT tested for COVID-19

  • Discontinuing self-isolation depends on your travel history. Please refer to the following table for your situation: 
   
Returning from travel   Fourteen (14) days since your return to Canada OR 14 days after your symptoms started, whichever is longer 
AND you have no fever  
AND your symptoms are improving 
AND you are not a health care worker* 
No travel history   Fourteen (14) days after your symptoms started 
AND you have no fever  
AND your symptoms are improving 
AND you are not a health care worker* 

* Please note: health care workers have different criteria for discontinuing self-isolation. 

 Management of persons who may have been in close contact with a case of COVID-19 

Please see the OPH handout on “Instructions for those who may have been in close contact with a case of COVID-19”.

A close contact is:

  • A person who lives with the case of COVID-19, OR 
  • A person who provided care for the case of COVID-19, including family members or other caregivers, from up to 2 days (48 hours) before the case of COVID-19 was sick until they self-isolated, OR 
  • A person who had other similar close physical contact, for more than 5 minutes, from up to 2 days (48 hours) before the case of COVID-19 was sick until they self-isolated. 

In brief, key instructions for close contacts include:

  • They must self-isolate at home until they meet criteria to discontinue self-isolation (see below)
  • Monitor for COVID-19 symptoms and if symptoms develop, please use the Government of Ontario COVID-19 self-assessment tool to find out how to get further care.
  • After self-isolation is discontinued, continue practicing physical distancing.
  • Criteria to discontinue self-isolation for those who may have been in close contact with a case of COVID-19

  • Discontinuing self-isolation depends on whether or not you are still in contact with a case of COVID-19. 
  • Please refer to the following table for your situation: 
   

No longer in contact with a case of COVID-19 

(e.g., lives in different household OR lives in same household and can separate by using a separate bedroom and bathroom) 
Fourteen (14) days since the last day you had contact with a case of COVID-19 
 
AND you have not developed any symptoms of COVID-19  
(e.g. fever, cough, or difficulty breathing)  

Ongoing contact with a case of COVID-19 

(e.g., lives in same household and unable to separate because you continue to share the same bedroom and/or bathroom 
Fourteen (14) days from the end of the case of COVID-19’s last day of self-isolation 
 
AND you have not developed any symptoms of COVID-19  
(e.g. fever, cough, or difficulty breathing) 

 

 General resources for management

  • If the patient requires a sick note from their employer, OPH has created a letter on our website that can be provided to patients on self-isolation.

 Management of Health Care Workers 

Who is a Health Care Worker?

A Health Care Worker (HCW) includes 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 include but are not limited to: nurse, doctor, therapist, paramedics, dentist, and dental hygienist, technician, public health inspector, public health staff
  • Other workers include but are not limited to: reception staff, housekeeping staff, administrative staff, corrections staff, police officers and fire personnel
  • Examples of clinics, health care facilities, institutions and professional organizations include but are not limited to: primary care offices, hospitals dental clinics, LTC facilities, retirement homes, group homes, correctional facilities, homeless shelters, police stations, fire departments, and public health units

Self-monitor for symptoms of COVID-19

Initial management of symptomatic HCWs:

  • If a healthcare worker develops any typical and/or atypical COVID-19 signs and symptoms, whether prior to or during a shift, they should put on a mask, wash their hands, go home, immediately notify their supervisor, and self-isolate immediately.

Testing of HCWs

  • All symptomatic HCWs (regardless of care delivery setting, includes paramedics) and staff who work in health care facilities, with a single typical and/or atypical COVID-19 sign or symptom should be tested for COVID19 at the Brewer Assessment Centre (they will be triaged appropriately, and their test will be expedited).
  • All HCWs who are tested should remain in self-isolation until test results are available, unless instructed otherwise by OPH and/or Occupational Health and Safety Department of their employer.

Criteria for discharge from self-isolation and return to work for HCWs

The Ministry of Health has released updated guidance on COVID-19 testing for clearance on April 19, 2020. Please consult the original Ministry document for the full text. Below is a summary.

Please note the various scenarios below. Durations of isolation in the scenarios below are minimum durations, which may have to be extended if symptoms persist beyond or to near the end of the isolation period. For each scenario, isolation after symptom onset should be for the duration specified provided that the individual is afebrile, and symptoms are improving – OPH recommends that the person should feel well for 24 hours before returning to work. Absence of cough is not required for those known to have chronic cough or who are experiencing reactive airways post-infection.

Criteria for when to discharge a Health Care Workers (HCWs) from isolation
ApproachCriteria 
Test-based approach HCWs who have tested positive for COVID-19 should remain off work until they receive 2 consecutive negative specimens at least 24 hours apart (OPH recommends that if the first test is positive a second test should wait for another 7 days.)
Non test-based approach HCWs may return to work 14 days after symptom onset (or as directed by their employer/Occupational Health and Safety department)

Work self-isolation (Note: see the table below for various scenarios for managing return to work for HCWs critical to operations under work self-isolation):

  • For HCWs that are agreed to be CRITICAL to operations by all parties, earlier return to work may be permitted under work-self-isolation.
  • Maintain self-isolation outside of work until 14 days after symptom onset (or until 2 negative swabs 24 hours apart).
  • Do not work in multiple locations.
  • Continue to follow strict self-isolation instructions when you are not at work including not going into the community or leaving your place of isolation unless it’s to get medical attention.
Recommendations for HCWs critical to operations for return to work under work self-isolation
Presentation at time of testTest resultRecommendation
At least one typical or atypical sign or symptom of COVID-19  Positive

May return to work as soon as 24 hours after symptom resolution

AND Continue with appropriate PPE at work until:

  1. Two consecutive negative tests or
  2. Until 14 days after symptom onset and asymptomatic
Negative

May return to work 24 hours after symptom resolution.

If the HCW was self-isolating due to an exposure at the time of testing, return to work should be under work self-isolation until 14 days from last exposure

Not tested* May return to work 14 days after symptom onset
OR
May return to work 24 hours after symptom resolution with appropriate PPE AND under work self-isolation until 14 days from symptom onset
Never symptomatic at time of test Positive May return to work 14 days after positive specimen collection date
OR
May return to work if remain asymptomatic 72 hours from test AND Continue with appropriate PPE at work until: 1. Two consecutive negative tests or 2. Until 14 days after symptom onset and asymptomatic

*Not tested because the test was not available – NB: symptomatic HCWs are recommended to be tested

Criteria for when to discharge non-HCWs from isolation
GroupCriteria
For individuals in self-isolation at home

Fourteen (14) days after symptom onset

AND no fever

AND symptoms are improving**
For hospitalized patients If currently hospitalized, isolate until 2 negative tests (single NP swab) at least 24 hours apart
If previously hospitalized but now discharged home within 14 days of symptom onset, follow advice for individuals in self-isolation at home (above)
If previously hospitalized but now discharged to a long-term care home/retirement home, maintain isolation (droplet and contact precautions) until 2 consecutive negative tests, obtained at least 24 hours apart
If testing for clearance is not possible in this situation, maintain isolation until 14 days after symptom onset and patient is afebrile with symptom improvement.

**Absence of cough is not required for those known to have chronic cough or who are experiencing reactive airways post-infection

 Infection Prevention and Control (IPAC) Measures for COVID-19

Coronaviruses are spread through contacts and droplets. As of March 12, 2020 Public Health Ontario recommends:

  • Droplet and Contact precautions are sufficient for providing direct care to patients with suspect or confirmed COVID-19, including nasopharyngeal and oropharyngeal swab collection:

  • Airborne precautions, including the use of N95 respirators, are only required for Aerosol-generating medical procedures (e.g., endotracheal intubation, cardiopulmonary resuscitation, bronchoscopy, surgery) 

Specific IPAC measures include:

  • Ensure that you have appropriate access to personal protective equipment (PPE) and other infection prevention and control supplies including gloves, gown, surgical/procedure masks, eye protection, hand hygiene supplies and N95 respirators for aerosol-generating medical procedures.
  • Performing hand hygiene (i.e., using alcohol-based hand rub or washing hands with soap and water) before entering and after exiting the patient’s room, and after taking off and disposing of personal protective equipment;

  • Conducting examination procedures that minimize contact with droplets (i.e., sitting next to rather than in front of a coughing patient);

  • Cleaning and disinfecting communal or shared equipment after use;

  • Wearing eye protection when within two meters of the patient;

  • Wearing gloves and gown to enter the patient’s room;

  • Instructing the patient to wear a mask when outside his or her room and to perform hand hygiene on exiting the room.

 Cleaning the office/healthcare environment:

  • Ensure that any patient-occupied areas are being cleaned and disinfected with an approved hospital-grade disinfectant.
  • Patient-contact surfaces (i.e. areas within 2 metres of the patient who has screened positive), treatment areas including all horizontal surfaces, and equipment should be cleaned and disinfected before another patient is brought into the treatment area or used on another patient.

 Resources

  • Refer to Provincial Infectious Diseases Advisory Committee’s Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings for more information about environmental cleaning. 
  • Please see Public Health Ontario's COVID-19 IPAC Recommendations for more details (April 6, 2020 update).

 Public Health Role

OPH actively follows up on all reported cases and their close contacts to prevent further spread in our community.

  • As per provincial guidelines and based on the assessed level of risk, OPH recommends the type of follow-up that is required for all contacts (e.g., self-isolation; monitoring of symptoms; or none required).
  • For cases and close contacts, public health provides instructions on restrictions of activities and how to protect others.
  • OPH also advises on what changes in health should prompt follow-up with us and/or a healthcare facility.

The Ethical Framework for Pandemic Response was developed by the Public Health Ethics Working Group to support Ottawa Public Health during the COVID-19 pandemic.

Resources

Clinical Tools and Handouts

Guidance Documents

Physician and Health Care Professional Resources

Patient Information

If a front line health service provider would like to contact a psychologist, click here

Frequently Asked Questions (FAQs) by Healthcare Professionals

1. If I suspect a patient has COVID-19, how do I report it to Ottawa Public Health? 

If you suspect an individual may be infected with COVID-19, report the suspected case to Ottawa Public Health immediately by either:

 

a. Using the Online COVID-19 Reporting Tool. If you use the reporting tool, you do NOT need to call OPH to report the same concern.

OR

b. Call 613-580-6744 (24 hours per day).

 

Laboratory confirmation is not required to report a suspected COVID-19 case.

2. Who should be tested for COVID-19?

OPH recommends prioritizing testing to the following populations (based on Ministry of Health guidance dated April 15, 2020):

HIGHEST priority for testing:

  • Symptomatic health care workers (regardless of care delivery setting, includes paramedics) and staff who work in health care facilities
  • Symptomatic residents and staff in Long Term Care and Retirement Homes and other institutional settings (homeless shelters, prisons, correctional facilities, day care for essential workers, group homes, community supported living, disability-specific communities/congregate settings, short-term rehab, hospices, other shelters) 
  • Symptomatic caregivers (e.g. volunteers, family members of residents in a hospital, long terms care, retirement home, other congregate or institutional setting)
  • Symptomatic care providers (e.g. employees, privately hired support workers)
  • Symptomatic first responders (i.e. firefighters, police)
  • Symptomatic household members of HCWs, care providers or first responders
  • Symptomatic members of remote, isolated, rural and/or Indigenous communities
  • Symptomatic people in priority populations with frequent contact with the healthcare system (e.g. undergoing cancer treatment/chemotherapy, dialysis, pre-/post-transplant, pregnant persons, neonates)
  • Hospital inpatients and those likely requiring admission
  • Individuals referred for testing by Ottawa Public Health

NEXT HIGHEST priority (should be tested if supplies permit):

  • Symptomatic close contacts of confirmed or probable cases
  • Symptomatic returning travelers who seek medical attention
  • Symptomatic critical infrastructure workers – (e.g. grocery stores, food services, maintenance and transportation workers, and utilities. See the full list of Ontario’s essential workplaces)

3. For the purposes of testing, who is considered a health care worker?

A “health care worker” (HCW) includes health professionals and non-health professionals in clinics, health care facilities, and institutions, who may be in contact with patients, residents, inmates, or other co-workers.

  • Examples of health professionals include: nurse, doctor, paramedic, therapist, dentist, public health, OT, PT, RT and PSW
  • Examples of non-health professionals include: reception, housekeeping, administrative, facilities, security, corrections staff, police and fire personnel
  • Examples of clinics, health care facilities, and institutions include: dental clinic, primary care office, hospitals, LTC facilities, retirement homes, group homes, correctional facilities, homeless shelters, public health units and emergency services stations.

4. Where can health care workers get their results?

  • If you are tested at the Brewer Assessment Centre, they will provide you with instructions to access your test results online through MyChart. There is also a COVID-19 lab result viewer available here. Please note that this website displays results through the provincial lab repository, Ontario Laboratory Information System (OLIS). At this time, not all labs submit their COVID-19 results through OLIS, so your results may not be available.
  • It is the responsibility of the ordering physician/healthcare provider to communicate test results to their patients. Public health units will directly contact only those who have tested positive as part of their case and contact management activities.

5. What should I do after I know my test result?

If you are a health care professional that is not critical to operations (symptomatic or asymptomatic, including people with a travel history in the past 14 days outside of Canada) please see below for test-based and/or non-test-based approaches for returning to work in a healthcare setting:

  
Test-based approach HCWs who have tested positive for COVID-19 should remain off work until they receive 2 consecutive negative specimens (single NP swab) at least 24 hours apart**
Non test-based approach HCWs may return to work 14 days after symptom onset (or as directed by their employer/Occupational Health and Safety department)
**OPH or Occupational Health will advise when and where swabs will be collected. Example: If a sample is collected at 8:00 a.m. on March 10, the next swab cannot be collected until after 8:00 a.m. on March 11. 

If you are a health care professional that is critical to operations determined by all partners (symptomatic or asymptomatic, including people with a travel history in the past 14 days outside of Canada) please see below for test-based and/or non-test-based approaches for returning to work in a healthcare setting under work self-isolation*: 

Work Self-isolation* Instructions
 

 

Outside of work

If previously symptomatic: Maintain self-isolation outside of work until 14 days after symptom onset (or until 2 negative specimens at least 24 hours apart**)

If never symptomatic: Maintain self-isolation outside of work until 14 days after specimen collection date. Continue self-monitoring for symptoms and immediately self-isolate should symptoms develop. 

At work

If previously symptomatic: Must be a minimum of 72 hours after illness resolving (resolution of fever and improvement in respiratory and other symptoms) before returning to work, must NOT work in multiple locations

If never symptomatic: Must be a minimum of 72 hours after specimen collection date before returning to work, must NOT work in multiple locations 

 *Work Self-Isolation = maintaining self-isolation measures outside of work for 14 days from symptom onset (or 14 days from positive specimen collection date if asymptomatic) to avoid transmitting household members or other community contacts. While at work, the HCW should adhere to universal masking recommendations, maintain physical distancing (>2m) except for providing direct care, and performing meticulous hand hygiene. These measures at work are required to continue until test-based or non-test based clearance.

**OPH or Occupational Health will advise when and where swabs will be collected. Example: If a sample is collected at 8:00 a.m. on March 10, the next swab cannot be collected until after 8:00 a.m. on March 11. 

If your test came back negative:

SymptomsTest ResultRecommendations for HCW Return to work 
Yes Negative
  • If you were self-isolating due to a non-household exposure at the time of testing, you may return to work 24 hours after full symptom resolution AND you should be under work-self-isolation (see above table) until 14 days from last exposure.
  • If you were self-isolating due to a household exposure at the time of testing, you may return to work 24 hours after full symptom resolution AND 14 days from last exposure to the household case, whichever is longer. OPH does not recommend work-self-isolation
  • If you were not self-isolating due to an exposure, you may return to work 24 hours after symptom resolution.
No Negative
  • If you were self-isolating due to a non-household exposure at the time of testing, return to work should be under work-self-isolation until 14 days from the exposure.
  • If you were self-isolating due to a household exposure at the time of testing, return to work should 14 days from last exposure to the household case. OPH does not recommend work-self-isolation
  • If you were not self-isolating due to an exposure, you may return to work immediately.

 

6. My patient was tested for COVID-19. What should I advise patients while waiting for results?
  • It is the responsibility of the ordering physician/healthcare provider to communicate test results to their patients.
  • While awaiting results, patients should self-isolate.
  • Patients tested at the Brewer Assessment Centre can access their results through MyChart
  • Ottawa Public Health will directly contact those who have tested positive as part of OPH case and contact management activities.

7. If I am a healthcare worker (HCW) and I develop symptoms of COVID-19, what should I do? 

  • As a HCW, if you develop any respiratory symptoms or fever (including mild symptoms) or atypical symptoms (see COVID-19 signs and symptoms), whether prior to or during a shift, you should put on a mask, wash your hands, go home, immediately notify your supervisor, and self-isolate.
  • Respiratory symptoms can include cough, sputum production, difficulty breathing, sore throat, or rhinorrhea. 
  • All HCWs with typical or atypical COVID-19 symptoms should be tested for COVID-19 at the Brewer Assessment Centre. You will be triaged, and your test will be expedited.
  • All HCWs who are tested should remain in self-isolation until test results are available. 
8. What should we tell patients who have symptoms of an acute respiratory illness, but who do not meet the criteria for testing?
  • If the patient only has mild symptoms that can be managed at home, (e.g. they do not have shortness of breath), they should not present to a COVID-19 assessment center.
  • The symptomatic patient should be recommended to self-isolate for 14 days from the first day of symptoms OR until 24 hours AFTER their symptoms have FULLY resolved, whichever is the longer timeframe.
    • For example, if symptoms last 8 days then they should self-isolate for 14 days.
    • For example, if symptoms last 15 days then they should self-isolate for a total of 16 days.
  • Direct patients to the OPH patient handout on Home Isolation in EnglishFrench and Simplified Chinese (PDFs). Public Health Ontario has prepared Home Isolation handouts in FarsiItalian, and Korean (PDFs).

9. When should I be self-monitoring for symptoms of COVID-19?

  • Health care workers (HCWs) should regularly self-monitor for symptoms of COVID-19.
  • OPH recommends testing HCWs with any of the following new respiratory symptoms: fever, cough, sputum production, difficulty breathing, sore throat, or rhinorrhea.
  • OPH recommends a low threshold to test HCWs for COVID-19 given that the consequences of an infected HCW spreading this virus to colleagues or vulnerable patients is significant.

10. Where should a patient go if they are experiencing symptoms of a respiratory distress from COVID-19?

  • There is no designated hospital for COVID-19 patients at this time.
  • If a patient has severe symptoms and feels that they should go to the hospital, they can call 9-1-1 or proceed to the nearest hospital using a private vehicle.  They should wear a medical mask over their mouth and nose during transport if possible.
  • An individual with confirmed COVID-19 should alert first responders and hospital staff of their status as soon as possible.
11. What advice should we give to family members and/or caregivers of someone who has confirmed COVID-19?

Individuals who live with a confirmed COVID-19 case and have had prolonged close contact should be advised to self-isolate for 14 days after break of contact and to self-monitor for the development of symptoms. 

12. If I’m a health care worker and one of my family members is self-isolating due to recent travel, what do I need to do?
You should continue to practice physical distancing if:
  • Your family member is self-isolating because they have returned from travel outside of Canada in the past 14 days AND is asymptomatic

You should self-isolate if your family member has:

  • Tested positive for COVID-19 OR
  • Is suspected to have COVID-19 OR
  • Has respiratory symptoms (e.g. fever, cough, or shortness of breath) that started within 14 days travel outside of Canada 
13. How do I protect myself as a health care professional and my household contacts (i.e. partner at home, young children, older adults)? 
  • Ensure that you have appropriate access to PPE and other infection prevention and control supplies including gloves, gown, surgical/procedure masks, eye protection, hand hygiene supplies and N95 respirators for aerosol-generating medical procedures.
  • Follow the recommended steps for putting on and taking off personal protective equipment.
  • Ensure your hands are clean before contact with your face.
  • Ensure that any patient-occupied areas are being cleaned and disinfected with an approved hospital-grade disinfectant.
  • For interactions with a suspected or confirmed case of COVID-19, it is sufficient to use contact and droplet precautions (gloves, gown, and facial protection with medical/surgical mask).
  • Regularly self-monitor for symptoms (i.e. fever and/or new or worsening cough) and obtain testing and self-isolate as needed. 

14. How do I clean my office after seeing a suspected or confirmed COVID-19 patient?

  • Patient-contact surfaces (i.e. areas within 2 metres of the patient who has screened positive), treatment areas including all horizontal surfaces, and equipment should be cleaned and disinfected before another patient is brought into the treatment area or used on another patient.
  • Refer to Provincial Infectious Diseases Advisory Committee’s Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings for more information about environmental cleaning. 

15. Should we be seeing patients with respiratory symptoms without PPE?

  • As per routine practices, health care providers should always use appropriate precautions for patients with respiratory symptoms.

16. Where can I access Personal Protective Equipment (PPE)?

  • The Ontario Ministry of Health has requested that any clinic with concerns about PPE availability to connect with them here via email: EOClogistics.moh@ontario.ca.

17. Why were recommendations for personal protective equipment changed from airborne precautions to droplet and contact precautions?

  • On March 12, 2020, Public Health Ontario released updated infection prevention and control recommendations for use of personal protective equipment for care of individuals with suspect or confirmed COVID-19.

    • Droplet and Contact precautions are recommended for the routine care of patients with suspected or confirmed COVID-19.
    • Airborne precautions should be used when aerosol generating medical procedures (AGMPs) are planned or anticipated to be performed on patients with suspected or confirmed COVID-19 including, but not limited to:
      • Cardio-pulmonary resuscitation
      • Endotracheal intubation
      • Bronchoscopy
18. Should I wear a cloth mask?

We know that asymptomatic and pre-symptomatic transmission can occur, but it is unclear how big a factor this is to the overall picture.

As a health care provider:

  • Droplet and contact precautions are recommended when caring for suspected or confirmed cases of COVID-19.
  • Homemade masks should not be worn as a replacement for appropriate personal protective equipment (PPE) in healthcare settings when medical masks are available.
  • Cloth masks are not medical devices and are not regulated. Use caution if you choose to wear one.
  • Cloth masks may not be effective in blocking virus particles that may be transmitted by coughing, sneezing, or certain medical procedures.

In the community:

  • Medical masks must be reserved for the healthcare setting so that they are available when you need them for patient care.
  • Per Health Canada, cloth masks have not been proven to protect the person wearing them. Strict hygiene and public health measures, including frequent hand washing and physical distancing, will reduce your chance of exposure to the virus in the community.
  • Cloth masks may be used as an added precaution in the community to protect those around you (similar to covering your mouth with your sleeve when coughing).
  • Cloth masks) may be considered in situations where physical distancing is hard to keep, such as in public transportation or in grocery stores.
  • Use caution when wearing cloth masks and follow Health Canada’s guidance on fitting, washing, and removal.

19. Is CPR considered an aerosol-generating medical procedure?

  •  The World Health Organization currently lists cardio-pulmonary resuscitation (CPR) as an aerosol-generating medical procedure (AGMP). However, compressions alone do not generate aerosols whereas the airway management (intubation) does. Public Health Ontario’s guidance makes this distinction, listing – “cardio-pulmonary resuscitation during airway management” as an AGMP.

20. What is the risk of transmission from clothing and uniforms exposed to respiratory droplets from patients who have or may have COVID-19 to subsequent patients I care for?

  • At this time, there are no reports of transmission through uniforms or other fomites. The viability of the coronavirus on clothing is not yet clear. Droplet and contact precautions are recommended when caring for a patient with COVID-19. This includes the use of a disposable gown over your uniform in addition to gloves, mask, and face-shield. 

21. Where can I find updated information on the number of COVID-19 cases in the Ottawa community?

  • Information on the status of COVID-19 cases in Ottawa can be found on the OPH statistics page.
22. Is there community/local transmission in Ottawa, and what does this mean?
  • Ottawa Public Health has declared that there is local transmission of COVID-19 in Ottawa.
  • Community or local transmission means that there are undetected COVID-19 cases in the community that have gone on to cause transmission of the virus in Ottawa, and the source of transmission cannot be linked back to travel outside of the community and/or being a close contact of a previously confirmed case. 

23. How is Ottawa Public Health determining who is a close contact? How are you connecting with these close contacts?

  • A close contact is someone who has been physically close to a suspected or confirmed case of COVID-19. OPH connects with these close contacts by phone calls, often provided by details from the individual themselves or from an employer, institution, or department. Close contacts may include:
    • A person who provided care for the patient, including family members or other caregivers, or who had other similar close physical contact (e.g., healthcare workers without appropriate personal protective equipment) OR
    • A person who lived with or otherwise had close prolonged contact with a probable or confirmed case while the case was symptomatic.

24. When Ottawa Public Health learns of a new case, what is their role in managing the case and contacts?

25. Where can I find information about treatment recommendations for COVID-19?

  • The Ontario Ministry of Health webpage has a section related to treatment of COVID-19. There are currently no specific treatments or vaccines for coronaviruses. 
26. Is it safe to use ibuprofen when COVID-19 is suspected?
  • Some concern was raised on social media and in a letter to the Lancet that the use of ibuprofen may facilitate and worsen COVID-19 infections through up-regulation of ACE2 receptor expression.
  • On March 20, 2020 Health Canada published an Information Update highlighting that there is no scientific evidence that establishes a link between ibuprofen and the worsening of COVID-19 symptoms. 
27. What if a patient requires a sick note?

You can provide your patient with this note, created by Ottawa Public Health for your convenience. 

28. Should children still receive routine vaccinations during the COVID-19 pandemic? 

  • Yes, the Canadian Pediatric Society recommends that routine vaccinations for children should be kept up-to-date during the COVID-19 pandemic.
  • Any change to scheduled vaccines puts children at risk for common and serious childhood infections, such as pneumococcal disease, measles, and pertussis.
  • Consider reserving specific times or days to accomplish this.
  • Keeping accurate, up-to-date health records, and having follow-ups for missed vaccines is essential for children. 

29. Can pets and other animals get COVID-19?

  • The Canadian Food Inspection Agency states that although there are reports of animals becoming infected with COVID-19, they are not aware of any reports suggesting that animals develop symptoms. The Public Health Agency of Canada recommends that if you have COVID-19 symptoms, or if you are a close contact with a COVID-19 case, you follow similar precautions around animals as you would around humans (e.g. avoid close contact, have other household members care for the animals if possible, limit your animal’s contact with people and animals outside of your household until your illness is resolved). If you have concerns about your pet’s health, you should contact your veterinarian.
  • Testing animals for COVID-19 is not currently recommended.

 

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