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

Last update February 14, 2020

Recent Public Health Alerts

The novel coronavirus situation and Ontario Ministry of Health recommendations are evolving rapidly. Please check this webpage frequently for updates or call OPH at 613-580-6744 for the most recent recommendations.

New Recommendations (Feb 11, 2020):

1)  Travelers returning from affected areas

Currently the Ontario Ministry of Health is recommending a differential approach between Hubei province and the rest of mainland China.

Travellers who have returned from Hubei province, including Wuhan City, should:

  • Call Ottawa Public Health at 613-580-6744 within 24 hours of arriving in Canada if they plan on travelling or returning to Ottawa.
  • Self Isolation is recommended – Individuals should stay at home and avoid close contact with others, including those in their home, for a total of 14 days from the date they left Hubei province.
  • Ottawa Public Health has prepared a patient handouts on Home Isolation for Novel Coronavirus in English, French and Simplified Chinese.
  • Call Ottawa Public Health at 613-580-6744 if they experience symptoms of the novel coronavirus.

Travellers who have returned from mainland China should:

  • Self-monitor for symptoms of fever, cough and difficulty breathing for a total of 14 days.
  • Ensure they can easily separate themselves from others if they become ill.
  • Call Ottawa Public Health at 613-580-6744 if they experience symptoms of the novel coronavirus.

Other scenarios may diverge from the above because of additional risk factors (e.g., exposure history). If you have questions about a specific individual, please call Ottawa Public Health at 613-580-6744.

2)  Close Contacts of Persons Under Investigation

Ottawa Public Health assesses each situation individually and determines appropriate interventions for close contacts of persons under investigation (PUI). Interventions may include recommendations for self-isolation or for daily monitoring.

Close contacts may include:

  • Anyone who lives in the same household (e.g., family members, roommates, guests);
    • This may include individuals in congregate settings (e.g., dormitories, shelters, group homes) who share a communal area (e.g., kitchen, bathroom, living room);
    • Anyone who provided care for the PUI (e.g., bathing, toileting, dressing, feeding);
    • Healthcare workers and/or support staff who provided care for the case or who had other similar close physical contact WITHOUT consistent and appropriate use of personal protective equipment

If you have any questions concerning close contacts or their identification, please call Ottawa Public Health at 613-580-6744.  

Key Messages

  • On December 31, 2019, a cluster of cases of pneumonia in Wuhan, China was reported to the World Health Organization, and the cause has been confirmed as a new coronavirus that has not previously been identified in humans (novel coronavirus or COVID-19).
  • The current situation around COVID-19 is evolving. More information is expected to emerge in the coming days and weeks. New information is becoming available daily and a clearer picture is being formed as this information is analyzed by provincial, national and international health agencies.
  • Updates about the status of cases in Ontario is available on the Ministry of Health webpage.
  • Currently, persons considered at most risk for novel coronavirus infection are:
    • Persons who become ill with fever and/or respiratory symptoms within 14 days of having visited mainland China; or,
    • Persons having been in close contact with someone who has a respiratory illness who has been to mainland China within 14 days prior to their illness onset; or,
    • Persons who become ill with fever and/or respiratory symptoms after being in close contact with a confirmed or probable case of COVID-19.  
  • Common symptoms of COVID-19 infection include fever, cough and respiratory symptoms such as shortness of breath and breathing difficulties.
  • Coronaviruses are spread through contacts and droplets. The Ontario Ministry of Health is recommending a precautionary approach that combines Airborne Precautions and Droplet/Contact Precautions in addition to Routine Practices for any patient with suspected COVID-19 (see Management section for more details).
    • The Ontario Ministry of Health has provided Guidance for Primary Care Providers in a Community Setting that reflects a number of options primary care providers may take to assess and test patients depending on their capacity to safely use N95 respirators and eye protection.
    • If patients are referred to the emergency department, the primary care provider should coordinate with the hospital, local public health unit, and the patient to make safe arrangements for travel that maintains isolation of the patients. Private vehicle (i.e., personal car, avoid public transit) to hospital is preferred if an ambulance is not required. Where the patient is able, they can drive themselves to the hospital. Where a private vehicle is not available, private hired vehicle (e.g., taxi, Uber) may be used while wearing a mask and sitting in the rear passenger seat with the window open (weather permitting).
  • Laboratory testing for COVID-19 is being conducted at the Public Health Ontario Laboratory (PHOL). In order to expedite testing, as of February 10, 2020, PHO Laboratory pre-approval for COVID-19 testing is no longer required, provided that the mandatory information is included on the requisition (see Laboratory Testing section for more details)
  • Novel coronavirus is now 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:
    • Calling 613-580-6744 (the Ottawa Public Health Information Centre)
    • Laboratory confirmation is not required to report a suspected COVID-19 case.
Introduction
  • If you suspect an individual may be infected with COVID-19, report the suspected case to Ottawa Public Health immediately by:
    • Calling 613-580-6744 (the Ottawa Public Health Information Centre)
    • Laboratory confirmation is not required to report a suspected COVID-19 case.
  • Coronaviruses can cause diseases ranging from the common cold to more severe diseases such as Severe Acute Respiratory Syndrome (SARS). Some human coronaviruses spread easily between people, while others do not.
  • On December 31, 2019, a cluster of cases of pneumonia in Wuhan, China was reported to the World Health Organization, and the cause has been confirmed as a new coronavirus that has not previously been identified in humans (COVID-19).
  • Currently, persons considered at most risk for novel coronavirus infection are:
    • Persons who become ill with fever and/or respiratory symptoms within 14 days of having visited mainland China; or,
    • Persons having been in close contact with someone who has a respiratory illness who has been to mainland China within 14 days prior to their illness onset; or
    • Persons who become ill with fever and/or respiratory symptoms after being in close contact with a confirmed or probable case of COVID-19.
  • Common symptoms of COVID-19 infection include fever, cough and respiratory symptoms such as shortness of breath and breathing difficulties.
Local Epidemiology
  • As of February 10, 2020, there have been no confirmed cases of COVID-19 in Ottawa.
  • There have been confirmed cases of COVID-19 outside of Ottawa in Ontario. Updates about the status of cases in Ontario is available on the Ministry of Health webpage.
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.
  • Currently, persons considered at most risk for novel coronavirus infection are:
    • Persons who become ill with fever and/or respiratory symptoms within 14 days of having visited Mainland China; or,
    • Persons having been in close contact with someone who has a respiratory illness who has been to Mainland China within 14 days prior to their illness onset; or,
    • Persons who become ill with fever and/or respiratory symptoms after being in close contact with a confirmed or probable case of COVID-19. 
  • 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:
    • Calling 613-580-6744 (the Ottawa Public Health Information Centre)
    • Laboratory confirmation is not required to report a suspected COVID-19 case.
  • Laboratory testing of persons under investigation (PUIs) for infection with COVID-19 may be considered for patients with:
    • Fever and/or acute respiratory illness, or with pneumonia; AND
    • Presence in Mainland China within 14 days prior to symptom onset.
  • Details on how to test for COVID-19 is available on the Public Health Ontario (PHO) website. Testing protocols will be revised as more information becomes available.
  • In order to expedite testing, as of February 10, 2020 PHO Laboratory pre-approval for COVID-19 testing is no longer required, provided that the following mandatory information is included on the requisition:
    1. Whether the individual meets criteria for a person under investigation (yes/ no)
    2. Travel history (country and dates)
    3. Contact of case or probable case (yes/no); if no, other sick contacts (yes/no; if yes, describe)
    4. Symptom onset date
    5. Patient symptoms (fever, cough, runny nose, pneumonia)
    6. Patient setting (ICU, hospitalized, ER or outpatient)
  • This mandatory information can be included in the specific PHO 2019-nCoV Test Requisition (PDF).
  • 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.

Lab testing background

  • Specimens are processed at the PHOL in Toronto, which is working collaboratively with the National Microbiology Laboratory in Winnipeg. More details on how to test for COVID-19 is available on the Public Health Ontario website.

Collecting Specimens

All health care providers should wear appropriate personal protective equipment (PPE) for Contact, Droplet, and Airborne Precautions – including a N95 respirator and eye protection – when collecting specimens.

Collection of multiple specimens from both the upper and lower respiratory tract, where possible, is recommended:

  • Upper respiratory tract: submit both a nasopharyngeal swab (NPS) AND viral throat swab.
  • Lower respiratory tract specimens (e.g., BAL, bronch wash, pleural fluid, lung tissue): submit when possible.
    • 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.
    • For these specimens, use a Tuberculosis Kit (order #390042) containing a 90mL sterile container.

Submission and Collection Notes

Complete all fields of PHO 2019-nCoV Test Requisition (PDF)

  1. Whether the individual meets criteria for a person under investigation (yes/ no)
  2. Travel history (country and dates)
  3. Contact of case or probable case (yes/no); if no, other sick contacts (yes/no; if yes, describe)
  4. Symptom onset date
  5. Patient symptoms (fever, cough, runny nose, pneumonia)
  6. Patient setting (ICU, hospitalized, ER or outpatient)

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 Public Health Ontario laboratory on ice packs.
Reporting to Ottawa Public Health
  • Novel coronavirus is now a 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:
    • Calling 613-580-6744 (the Ottawa Public Health Information Centre)
    • Laboratory confirmation is not required to report a suspected COVID-19 case.
  • Ottawa Public Health will refer testing to the Public Health Ontario Laboratory and explain requirements for isolation of the patient. We will need the patient’s travel history, symptoms and date of onset of, and other exposure history.

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

Who to suspect for COVID-19 infection

  • For all persons with acute respiratory infection, please include a travel history as part of routine practice.
  •  Currently, persons considered at most risk for novel coronavirus infection are:
    • Persons who become ill with fever and/or respiratory symptoms within 14 days of having visited mainland China; or,
    • Persons having been in close contact with someone who has a respiratory illness who has been to mainland china within 14 days prior to their illness onset; or,
    • Persons who become ill with fever and/or respiratory symptoms after being in close contact with a confirmed or probable case of COVID-19. 
  • While this infection originated in Hubei Province (Wuhan), China, confirmed cases have also been reported in other Chinese cities, countries in Asia and around the globe. Health care providers should apply a degree of clinical suspicion based on the patient’s travel and exposure history. 

Management of an asymptomatic person who has travelled to mainland China

Currently the Ontario Ministry of Health is recommending a differential approach between Hubei province and the rest of mainland China.

Travellers who have returned from Hubei province, including Wuhan City, should:

  • Call Ottawa Public Health at 613-580-6744 within 24 hours of arriving in Canada if they plan on travelling or returning to Ottawa.
  • Self Isolation is recommended – Individuals should stay at home and avoid close contact with others, including those in their home, for a total of 14 days from the date they left Hubei province.
  • Ottawa Public Health has prepared a patient handouts on Home Isolation for Novel Coronavirus in English, French and Simplified Chinese.
  • Call Ottawa Public Health at 613-580-6744 if they experience symptoms of the novel coronavirus.

Travellers who have returned from mainland China should:

  • Self-monitor for symptoms of fever, cough and difficulty breathing for a total of 14 days.
  • Ensure they can easily separate themselves from others if they become ill.
  • Call Ottawa Public Health at 613-580-6744 if they experience symptoms of the novel coronavirus.

Other scenarios may diverge from the above because of additional risk factors (e.g., exposure history). If you have questions about a specific individual, please call Ottawa Public Health at 613-580-6744 to discuss recommendations.

Management of a symptomatic individual you suspect may have COVID-19 for primary care providers in a community setting

Please note the Ontario Ministry of Health has provided Guidance for Primary Care Providers in a Community Setting that reflects a number of options primary care providers may take to assess and test patients depending on their capacity to safely use N95 respirators and eye protection.

  • Follow Routine Practices for infection prevention and control plus Droplet and Contact precautions (additional details below).
  • Undertake passive screening (signage) and active screening (asking questions) of patients for COVID-19.
    • Passive screening: Signs should be posted on entry to the office and at reception areas for patients with symptoms to self-identify, perform hand hygiene, and wear a procedure mask.
    • Active screening: Screen all patients over the phone before scheduling appointments and in person at reception areas using a screening tool such as:
      • Is the patient presenting with:
        • Fever, new onset of cough, or difficulty breathing; AND any of the following:
          • Travel to/from mainland China in the 14 days before the onset of illness OR
          • Close contact with a confirmed or probable case of COVID-19 OR
          • Close contact with a person with acute respiratory illness who has been to/from mainland China in the 14 days before their symptom(s)
  • If a patient screens positive, primary care providers should assess their capacity to safely conduct a clinical examination and collect specimens for a patient at risk of having COVID-19.
    • Primary care settings in which providers can safely use N95 respirators and eye protection may conduct detailed clinical exams and collect lab specimens on patients with clinical and travel/exposure history as described in the guidance document.
    • Providers in settings that do not have this capability should arrange for the patient to be assessed in hospital or contact Ottawa Public Health at 613-580-6744 for assistance with arrangements for further assessment and testing.
    • If patients are referred to the emergency department, the primary care provider should coordinate with the hospital, local public health unit, and the patient to make safe arrangements for travel that maintains isolation of the patients.
    • Private vehicle (i.e., personal car, avoid public transit) to hospital is preferred if an ambulance is not required. Where the patient is able, they can drive themselves to the hospital. Where a private vehicle is not available, private hired vehicle (e.g., taxi, Uber) may be used while wearing a mask and sitting in the rear passenger seat with the window open (weather permitting). Patients should be kept in a separate room with the door closed until the private transport is ready. The patient should be instructed to wear a procedure mask at all times (if tolerated) – including while waiting for and during the transfer – until he or she is assessed in a hospital setting.
  • Report the suspected case to Ottawa Public Health immediately by:
    • Calling 613-580-6744 (the Ottawa Public Health Information Centre).
    • Laboratory confirmation is not required to report a suspected COVID-19 case.

Ottawa Public Health will work to track people who may have been exposed to COVID-19 to prevent further spread.

Infection Prevention and Control (IPAC) Measures for COVID-19
  • Most respiratory infections are droplet/contact spread. The Ontario Ministry of Health is recommending a precautionary approach that combines Airborne Precautions and Droplet/Contact Precautions in addition to Routine Practices for any patient with suspected COVID-19. Specific IPAC measures include:
    • Performing hand hygiene (i.e., using alcohol-based hand rub or washing hands) 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/aerosols (i.e., sitting next to rather than in front of a coughing patient);
    • Cleaning and disinfecting communal or shared equipment after use;
    • Wearing a fit-tested, seal-checked N95 respirator covering the nose and mouth when enter the patient’s room or when within two meters of the patient;
      • Testing must take place in an appropriate setting – one that supports the safe use of N95 respirators and eye protection during specimen collection.
    • 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.
    • Patients with suspected or confirmed COVID-19 should ideally be placed in airborne infection isolation room. If no such room is available in a community office setting, patients should be placed immediately in a separate room with the door closed.
Prevention

For Patients

  • Members of the public are advised to take the usual measures to reduce the risk of transmission of the flu and respiratory illness, which include:
    • Wash your hands often with soap and water, or use hand sanitizer
    • Avoid touching your eyes, nose, and mouth unless you have just washed your hands
    • Cover your coughs and sneezes with a tissue or your arm, not your hand
    • Stay home if you are sick
    • If you are ill and must visit a healthcare provider, call ahead or tell them right away when you arrive that you have a respiratory illness and wear a mask while waiting to be seen
    • Avoid visiting people in hospitals or long-term care centres if you are sick
    • Get your flu shot
  • More tips on how to stop the spread of germs including the flu and the novel coronavirus is available on this website.
  • Residents who return from recent international travel with history of travel to affected area and become ill with respiratory signs and symptoms such as cough and fever should report their travel history to any health professional, or emergency department staff, when they visit.
  • If you are planning to travel to another country:

For Health Care Workers (HCWs)

  • The Ontario Ministry of Health is recommending a precautionary approach that combines Airborne Precautions and Droplet/Contact Precautions in addition to Routine Practices for any patient with suspected COVID-19. Specific IPAC measures include:
    • Performing hand hygiene (i.e., using alcohol-based hand rub or washing hands) 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/aerosols (i.e., sitting next to rather than in front of a coughing patient);
    • Cleaning and disinfecting communal or shared equipment after use;
    • Wearing a fit-tested, seal-checked N95 respirator covering the nose and mouth when enter the patient’s room or when within two meters of the patient;
      • Testing must take place in an appropriate setting – one that supports the safe use of N95 respirators and eye protection during specimen collection.
    • 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.
    • Patients with suspected or confirmed COVID-19 should ideally be placed in airborne infection isolation room. If no such room is available in a community office setting, patients should be placed immediately in a separate room with the door closed.
  • Ottawa Public Health recommends that health care providers become familiar with PIDAC’s “PIDAC Best Practices for Prevention, Surveillance and Infection Control Management of Novel Respiratory Infections in All Health Care Settings
  • Section 3.2 “Personal Protection Equipment and Practices” describes specific infection prevention and control (IPAC) measures for health care providers at risk of direct exposure to patients with suspect or confirmed infection with a novel respiratory agent.

 

 

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