Information on COVID-19 for Physician and Health Care Professionals

Information on COVID-19 is evolving rapidly. Please subscribe to Public Health Alerts for Health Care Professionals to receive regular updates via e-mail. You can also check this webpage frequently for updates or call Ottawa Public Health (OPH) at 613-580-6744 for advice.

Important Notes

  • 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. Expanded guidance for in-person care for essential visits can be found on the Ministry of Health (MOH) COVID-19 website. Another option is to refer your patients to the Kids Come First vaccine clinic at CHEO
  • 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.

On this page: 

Recent Changes to Recommendations 

Please refer to the Ministry of Health web page for recent changes to COVID-19 guidance.

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Recent Public Health Alerts Issued By Ottawa Public Health

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Latest Public Health Alerts Issued by Ottawa Public Health. To view previous Public Health Alerts please refer to COVID-19 OPH Blog Posts.

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Epidemiological Data

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Signs and Symptoms

Last update: August 21, 2020

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.

Please refer to the guidelines from the Ministry of Heath for reference to COVID-19 Signs and Symptoms outlined below:

Signs and Symptoms
  
Classic Symptoms of COVID-19 include:
  • Fever (37.8C or greater)
  • New or worsening cough
  • Shortness of breath (dyspnea)
Other Symptoms of COVID-19 include:
  • Sore throat
  • Difficulty swallowing
  • New olfactory or taste disorder(s)
  • Nausea/vomiting, diarrhea, abdominal pain
  • Runny nose or nasal congestion – in absence of underlying reasons for these symptoms such as seasonal allergies, post nasal drip, etc.

Atypical Symptoms of COVID-19 can include:

 

Particularly in children, older persons, and people living with a developmental disability
  • Unexplained fatigue/malaise/myalgias
  • Delirium (acutely altered mental status and inattention)
  • Unexplained or increased number of falls
  • Acute functional decline
  • Exacerbation of chronic conditions
  • Chills
  • Headaches
  • Croup
  • Conjunctivitis
  • Multisystem inflammatory syndrome in children (MIS-C)
    • Presentation may include persistent fever, abdominal pain, conjunctivitis, gastrointestinal symptoms (nausea, vomiting and diarrhea) and rash
Atypical Signs of COVID-19 can include:
  • Unexplained tachycardia, including age specific tachycardia for children
  • Decrease in blood pressure
  • Unexplained hypoxia (even if mild i.e. O2 sat <90%)
  • Lethargy, difficulty feeding in infants (if no other diagnosis)
Other Signs of COVID-19 can include:
  • Clinical or radiological evidence of pneumonia

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). 

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Testing for COVID-19

Last update: August 21, 2020

Guidance for Symptomatic Individuals

  • Any person presenting with at least one sign or symptom should be considered for testing.
  • Clinicians should continue to use their clinical judgement during patient assessment and test facilitation, considering local epidemiology and exposure risks.

Guidance for Asymptomatic Individuals

  • Asymptomatic contacts of a confirmed case should be considered for testing for COVID-19 as soon as possible after identification of the case and within 14 days from their last exposure.
  • If they test negative and the contact becomes symptomatic, they should be re-tested.
  • If the test result is negative, asymptomatic contacts must remain in self-isolation for 14 days from their last exposure to the case.

Note: Public Health Ontario (PHO) is not currently recommending routine testing of asymptomatic persons for COVID-19 outside of those recommended in Ministry guidance, or as directed by the public health unit for public health investigation. Please note that given an incubation period of up to 14 days for COVID-19 disease after exposure, a negative PCR test result in an asymptomatic person should not be used to rule out disease.

  • If the clinician would like to further 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.

If you have a patient who meets the criteria for attending the COVID-19 Assessment Centre (new or worsening cough and/or fever, recent travel history, contact with someone diagnosed with COVID-19), and you are unable to assess or test them in your clinic, please direct that patient to the Assessment Centre.

Please refer to the Ministry of Health testing guidance, COVID-19 Provincial Testing Guidance Update for guidelines regarding:

Guidance for Specific Settings

  1. Facility Transfers
  2. Hospitals
  3. Long-Term Care and Retirement Homes
  4. Other Congregate Living Settings and Institutions
  5. Remote/Isolated/Rural/Indigenous Communities
  6. Workplaces and Community Settings

Guidance for Priority Populations

  1. Healthcare Workers/Caregivers/Care Providers/First Responders/Emergency Childcare Centre Workers and Persons Living in Same Household
  2. Essential Workers
  3. Cross-Border Workers
  4. Schools (K-12, post-secondary)
  5. Other Priority Populations 

Specimen collection

Due to global shortages of NP swabs, the PHO Laboratory will accept other swab types and other liquid transport media (except gel or solid media) for COVID-19 testing. Please refer to the PHO Guidance on Specimen Collection and Handling, for information on alternative collection kits that are acceptable for COVID-19 testing. 

Collection and submission instructions for respiratory tract specimens for;

Note Precautions: 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.

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.
  • The Public Health Ontario Laboratory (PHOL) indicates that when swabs are available, the preferred specimen is a nasopharyngeal swab (NPS).
  • As an alternative during a shortage of NP swabs, PHOL supports the use of deep nasal swab or viral throat swab collected in universal transport medium (UTM).
  • Please refer to the PHO Specimen Requirements for additional alternative media accepted for COVID-19 specimen collection.

B) In-patients

  • The PHO Laboratory will accept multiple specimen submissions for in-patients. If performed, collection should be done in the various sites: 
  • Upper respiratory tract:
    • 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., bronchoalveolar 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.

Please refer to the CDC’s influenza specimen collection poster for instructions on upper respiratory specimen collection for healthcare professionals.

Please note: specimens are processed at the Public Health Ontario (PHO) Laboratory and other regional laboratories.

Testing Requisition

For more information on COVID-19 testing, specimen collection and handling, please refer to the Public Health Ontario website.

Testing Resources:

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Serology for COVID-19

Last update: August 21, 2020

As of August 6, 2020, Public Health Ontario indicates that serology testing should not be used for screening and diagnosis of acute COVID-19 infection. At the present time, serology testing for COVID-19 is only available for specific clinical use. 

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Results 

Last update: August 21, 2020

Follow up of lab 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.
    • To use this website, they will need a valid (green) Ontario photo health card.
  • OPH will directly contact only those who have tested positive as part of OPH case and contact management activities.

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Reporting to Ottawa Public Health

Last update: August 21, 2020

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:

  • 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 (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.

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Management

Management of symptomatic persons TESTED for COVID 19

Last update: August 21, 2020

Please see the OPH handout “COVID-19 Tested, What Now?” for guidance on what to do once an individual who is not a healthcare worker (HCW) has been tested for COVID-19. The following table can be found in the OPH handout, in English and French.

 Thumbnail of the Tested What Now handout

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

Management of symptomatic persons NOT TESTED for COVID 19

Last update: August 21 , 2020

Please note: Any Ontarian presenting with at least one symptom or sign of COVID-19 should be considered for testing. Clinicians should continue to use their clinical judgement during patient assessment and test facilitation, considering local epidemiology and exposure risks.

If the individual is asymptomatic and has no known exposure risk

If the individual is asymptomatic, but has an exposure risk (ex; an individual who has refused testing, but has a close contact who has confirmed COVID-19)

Who is a Close Contact?

A close contact is a person who has been in near physical proximity to a person who has tested positive for COVID-19. OPH identifies close contacts through a detailed review of factors such as the individual’s symptoms, where they have been, and who they have interacted with. Close contacts are directly contacted by OPH and receive further guidance.

The following people may be considered high risk or close contacts;  

  • A person who lived with someone who has tested positive, while that person was not self-isolating and infectious (includes congregate living settings where direct contact (<2 metres) is occurring in shared rooms/living spaces
  • A person who provided care for a person who has tested positive (bathing, toileting, dressing, feeding etc.) and/or had direct contact with infectious bodily fluids (e.g., coughed on or sneezed on) from up to 2 days (48 hours) before they became sick 
  • A person who had other similar close (<2 metres) unprotected contact, for more than 15 minutes (the longer they were within 2 metres the higher the risk*), from up to 2 days (48 hours) before the person who tested positive was sick
  • Any patient in a healthcare setting in the same room when the person who tested positive was not on droplet and contact precautions or other patients in waiting room/common areas (i.e., < 2 metres from person for any duration of time) when the person who tested positive was not wearing a surgical/procedure mask
  • Passengers or crew (e.g. aircraft, train, bus, taxi) seated within 2 metres of the person who has tested positive (approximately two seats in all directions) and/or had close prolonged contact (more than 15 minutes) and/or direct contact with infectious bodily fluids, while the person who tested positive was not wearing a surgical/procedure mask
  • Any person who has travelled outside of Canada in the past 14 days.

Other factors may impact the risk of the exposure such as whether the interaction occurred inside or outside or how long the interaction was. OPH will discuss these factors when speaking with people who have COVID-19.   

*Interactions where people briefly come within 2 metres (6 feet) of each other, such as walking by someone on the sidewalk, are generally not considered close or high-risk contacts. 

Management of health care workers

Last update: August 21, 2020

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.

  • 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 HCW develops any COVID-19 signs and symptoms, whether prior to or during a shift, they should put on a mask, wash their hands, maintain physical distance of 2 metres or more, go home, immediately notify their supervisor, and self-isolate immediately.
  • All symptomatic HCWs (regardless of care delivery setting, includes paramedics) and staff who work in health care facilities, should be tested for COVID-19 at a Care Clinic or Assessment Centre. 
  • For more information regarding testing criteria for HCWs, please refer to Testing for COVID-19.

HCWs awaiting test results:

  • Symptomatic HCWs awaiting test results must self-isolate and remain off work.
  • Asymptomatic HCWs awaiting test results may continue to work using the appropriate precautions recommended by their employer/Occupational Health.

Criteria for when to discharge someone with probable or confirmed COVID-19 from isolation

Last update: August 21, 2020

For each scenario, isolation after symptom onset should be for the duration specified, provided that the individual is afebrile, and symptoms are improving.

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

If an individual has tested positive but has never had symptoms, isolation recommendations should be based on date of specimen collection.

  • After an individual completes their isolation period, they should continue to practice physical distancing measures and be advised to wear a mask in indoor public spaces as recommended for everyone at this time.
Approaches to Clearing Cases
ApproachWhen to UseInstructions

Non-Test Based

Waiting 14 days from symptom onset (or 14 days from when swab was taken if persistently asymptomatic)

All cases may be cleared by a non-test based approach Can discontinue isolation at 14 days after symptom onset (or 14 days from positive test collection date if never had symptoms), provided that the individual is afebrile and symptoms are improving for at least 72 hours. Absence of cough is not required for those known to have chronic cough or who are experiencing reactive airways post-infection.  

Test Based

Two consecutive negative specimens collected at least 24 hours apart.

Not routinely recommended, but may by used at the discretion of a hospital to discontinue precautions for admitted patients

Continue isolation until 2 consecutive negative specimens collected at least 24 hours apart. 

  • Testing for clearance testing may begin after the individual has become afebrile and symptoms are improving for at least 24 hours. Absence of cough is not required for those known to have chronic cough or who are experiencing reactive airways post-infection. 
  • If swab remains positive, test again in approximately 3-4 days. If swab is negative, re-test in 1-2 days (and at least 24 hours apart). 
  • Tick the box labelled "For clearance of disease" on the PHO Laboratory COVID-19 Test Requisition, or clearly wrote this on the requisition if submitting to another laboratory. 

 Please see the Ministry of Health Quick Reference Public Health Guidance on Testing and Clearance (July 29, 2020) for further guidance, including the following;

  • Recommendations for Health Care Workers Return to Work
  • Work Self-Isolation in Non-Healthcare Settings

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

Last update: July 21, 2020

Coronaviruses are spread through contacts and droplets. As of May 3, 2020 Public Health Ontario recommends:

  • Droplet and Contact precautions are sufficient for providing direct care to patients with suspected 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 (AGMP) (e.g., endotracheal intubation, cardiopulmonary resuscitation, bronchoscopy)
  • Follow the recommended steps for putting on and taking off PPE.

To help protect yourself, your patients and your co-workers please refer to the PHO COVID-19 Health Care Resources for further guidance.

IPAC Resources

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Role of Ottawa Public Health 

Last update: July 21, 2020

  • Using the Health Protection and Promotion Act, S.O. 2007 Ottawa Public Health (OPH) is taking actions to protect the public and prevent the spread of COVID-19 in our community.
  • All people who have tested COVID-19 positive, whether clinically diagnosed or laboratory confirmed and potential suspects, are reportable to local public health under the Health Protection and Promotion Act. OPH actively follows up on all reported cases and people who may have come into close contact with them to prevent further spread in our community.
  • In collaboration with our provincial and national public health partners, and stakeholders that include local hospitals and community agencies, OPH assess the risk level 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 cases and contacts (e.g., self-isolation; monitoring of symptoms; or none required).
  • For cases and close contacts, public health provides instructions on management 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. Ottawa Public Health (OPH) has been working with all LTCHs/RHs to prevent and/or contain COVID-19 outbreaks. OPH is working with the Champlain Health Regional Incident Command to ensure that LTCH/RH are receiving the support they require.

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.

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Your Mental Health

The work that you are doing on the front lines of health care is so important, and this has never been more true as the COVID-19 pandemic evolves. It is normal to experience increased feelings of stress and anxiety under these conditions. Please reach out for support if needed. Protecting your Mental Health, what can you do as an essential worker?

Thank you for your ongoing work to keep our community safe and healthy.

You are not alone. We are all in this together.

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Additional Resources and Guidance Documents

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