Information on Novel Coronavirus (COVID-19) for Physician and Health Care Professionals

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: March 31, 2020

Novel coronavirus (COVID-19) is reportable under Ontario's public health legislation. Ottawa Public Health (OPH) should be notified regarding any individuals being tested for COVID-19.

The novel coronavirus (COVID-19) situation and Ontario Ministry of Health recommendations for health care professionals are evolving rapidly. Please check this webpage frequently for updates or call Ottawa Public Health at 613-580-6744 for the most recent recommendations.

Key Messages

  • Ottawa Public Health 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.
  • Novel coronavirus 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).
  • Not every patient with respiratory symptoms requires testing for COVID-19 (see Laboratory Testing for details on who to test).
    • Routine testing of asymptomatic persons for COVID-19 is not recommended.
    • Health care workers 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)
  • Novel coronavirus 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)
    • Advise patients to self-isolate. 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).
    • 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) Updates on testing (March 27, 2020)

Updated recommendations are provided in the 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

2) Section on symptomatic health care workers (March 27, 2020)

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

Recent Public Health Alerts Issued By Ottawa Public Health

To ensure OPH can reach you using our automated messaging system, please register for communications from Ottawa Public Health.

Register for Communications from Ottawa Public Health

 

Local Epidemiology

Signs and Symptoms

  • Novel coronavirus 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).
  • Complications of COVID-19 include pneumonia, kidney failure, and in severe cases, death can be an outcome.
  • Information around incubation period and period of communicability are still emerging.
  • Some people such as the elderly and those who are immunocompromised may not develop a fever. For these individuals, the presence of new/worse cough or difficulty breathing may be enough to trigger further precautions.

Laboratory Testing

  • If you suspect an individual may be infected with COVID-19, report the suspected case to Ottawa Public Health immediately by:
    • 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.
    • Calling 613-580-6744 (the Ottawa Public Health Information Centre)
    • Laboratory confirmation is not required to report a suspected COVID-19 case.
    • Advise patients to self-isolate. 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).
    • 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.
  • Additional details on how to test for COVID-19 is available on the Public Health Ontario (PHO) website.
  • If the 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.

Which patients should be tested?

OPH recommends prioritizing testing to the following populations with fever, cough, or difficulty breathing*: 

HIGHEST priority for testing:

  • Health care workers (HCW) and staff who work in health care facilities*
  • Residents and staff in long-term care facilities, retirement homes, and other institutional settings (e.g., correctional facilities, homeless shelters)
  • Hospitalized patients admitted with respiratory symptoms (new or exacerbated)
  • Members of remote, isolated, rural and/or indigenous communities

*Note: Testing is indicated in HCWs even with mild respiratory symptoms (i.e., fever, cough, sputum production, difficulty breathing, sore throat, rhinorrhea). 

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

  • Close contacts of confirmed or probable cases
  • Individuals (e.g., children, partners, or other household members) living with HCWs or with staff who work in health care facilities
  • 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

A close contact is defined as:

  • 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.

Testing for COVID-19 is NOT recommended if a person has no symptoms, regardless of their travel or exposure history. 

Follow-up of COVID-19 Laboratory results

As a reminder, it is the responsibility of the ordering physician or healthcare provider to communicate test results to their patients. OPH will directly contact only those who have tested positive as part of OPH case and contact management activities.

Lab testing background

Specimens are processed at the Public Health Ontario (PHO) Laboratory and other regional laboratories. More details on how to test for COVID-19 is available on the PHO website.

Collecting Specimens

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. In addition, 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.

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 shipped to the PHO Laboratory on ice packs.

Reporting to Ottawa Public Health

Novel coronavirus 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.
  2. Calling 613-580-6744 (24 hours per day)

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

This section is currently being updated. Please refer to the Resources section for management information from the Ministry of Health.  

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:

  • 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.

Please see Public Health Ontario's COVID-19 IPAC Recommendations for more details

Long-Term Care Homes and Retirement Homes

The long-term care home (LTCH) and retirement home sectors are critical stakeholders in the response to COVID-19. Residents of these institutions are particularly vulnerable to severe illness and death from COVID-19. Efforts to keep COVID-19 out of these institutions and early detection of COVID-19 cases in institutions are vital to COVID-19 control.      

On March 9, 2020, the Ontario Ministry of Long-Term Care advised the LTCH Sector to:

  • Initiate active screening for COVID-19 for all residents, staff, contracted staff, volunteers and visitors,

  • Consult local public health if exposure to or transmission of COVID-19 to determine any additional public health actions.

For the full memorandum, please see the link in the resources section below dated March 9.

Public Health Ontario Laboratory has announced that as of March 9, 2020, all specimens submitted from institutions for standard outbreak respiratory testing will also be tested automatically for COVID-19.

On March 13, 2020 the Ontario Ministry of Health (together with the Ministry of Long Term Care) advised the LTCH Sector to:

  • Strongly recommend that only essential* visitors be allowed to enter their home.

*The Ministry of Health is identifying essential visitors as those who have a loved one in the home who is very ill or at end of life

For the full memorandum, please see the link in the resources section below dated March 13.

On March 16, Ottawa Public Health sent an ERMS to Long-term Care Homes and Retirement Homes stating that:

  • OPH recommends COVID-19 testing regardless exposure or travel history for individuals with acute respiratory illness who reside in long-term care homes and retirement homes.

  • To obtain nasal pharyngeal (NP) swabs to conduct COVID-19 testing please call 613-580-2424 ext. 26325  

For the full ERMS, please see the link below. 

If you have any additional questions about COVID-19 or would like to report an exposure in a LTCH or a Retirement Home, please call 613-580-6744.

To report an outbreak for any other disease during regular business hours, or for more information, call 613-580-2424 ext. 26325, or in the evening, on weekends or holidays, call 3-1-1 and ask to speak with the Public Health Inspector on-call. 

Resources for LTCH and Retirement Homes:

For information on donning and doffing PPE, visit Public Health Ontario's website.

Prevention

This section is currently being updated.

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.

Resources

Clinical Tools and Handouts

Guidance Documents

Physician and Health Care Professional Resources

Patient Information

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 with fever, cough, or difficulty breathing*: 

HIGHEST priority for testing:

  • Health care workers (HCW) and staff who work in health care facilities*
  • Residents and staff in long-term care facilities, retirement homes, and other institutional settings (e.g., correctional facilities, homeless shelters)
  • Hospitalized patients admitted with respiratory symptoms (new or exacerbated)
  • Members of remote, isolated, rural and/or indigenous communities

*Note: Testing is indicated in HCWs even with mild respiratory symptoms (i.e., fever, cough, sputum production, difficulty breathing, sore throat, rhinorrhea).

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

  • Close contacts of confirmed or probable cases
  • Individuals (e.g., children, partners, or other household members) living with HCWs or with staff who work in health care facilities
  • 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

These guidelines are created based on guidance from the Ontario Ministry of Health and are updated based on their definitions.

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. 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).
5. 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. 

6. 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 
7. 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.

8. 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. 
9. 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. 
10. 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
11. Where can I access Personal Protective Equipment (PPE)?
The Ontario Ministry of Health has requested any clinics with concerns about PPE availability to connect with them here via email: EOClogistics.moh@ontario.ca
12. 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
13. 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.
14. 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. 
15. 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. 
16. What if a patient requires a sick note?

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

17. 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
 18. 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. 
 19. 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.

·         Ottawa Public Health 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.

 

o    PHO Laboratory will accept other swab types (except cotton-tipped swabs) and other liquid transport media (except gel or solid media) for COVID-19 testing; however, if the submitted swab and/or media type were not validated at PHO Laboratory for COVID-19 testing, the results will be reported with a disclaimer. Further information on alternative collection kits is available here.

In order to decrease transmission of COVID-19 in Ottawa, Ottawa Public Health is now recommending that all residents of Ottawa practice physical distancing. The above Youtube video explains what is physical distancing. 

Read video script

With more cases of COVID-19 confirmed in Ottawa, we are asking that all people in Ottawa practice physical (social) distancing 

What is physical distancing?

  • Physical distancing involves taking steps to limit the number of people you come into close contact with.
  • Through physical distancing, we can flatten the curve. That means, decrease the number of people ill all at once, so that the healthcare system can keep up and continue to provide life-saving care.

How can you  practice physical distancing?

Here are a few examples:

  • Limit non-essential trips out of the home
  • work to maintain a distance of about 2 meters from other people, as much as possible. 
  • Work from home if you can
  • Avoid visits to long-term care homes, or retirement homes unless the visit is absolutely essential
  • Avoid non-essential trips in the community
  • Limit or cancel group gatherings, including play-dates for children
  • Older adults should avoid gathering in groups of 5 or more at this time

Why you need to maintain a distance of about 2 meters from others:

The human coronaviruses cause infections of the nose, throat and lungs. They are most commonly spread from an infected person through:

  • respiratory droplets that come out when you cough or sneeze
  • close, prolonged personal contact, such as touching or shaking hands
  • touching something with the virus on it, then touching your mouth, nose or eyes before washing your hands

Our collective efforts are needed as a community. The actions you take will affect not only you, but your loved ones, and our most vulnerable. Stay home if you are able to.

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