Information on COVID-19 for Physician and Health Care Professionals

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State of emergency in effect. Stay at home except for essential travel and follow the restrictions and public health measures. We are currently updating our pages to reflect the new provincial measures. City updates how Province’s stay-at-home measures will impact some in-person services and facilities.

 

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

  • Due to the nature of COVID-19 which spreads quickly through clusters and outbreaks, we may see further rapid surges of COVID-19 in Ottawa. Healthcare providers can assist in the community response by reinforcing the self-isolation requirements for any persons diagnosed with COVID-19 and their contacts.
  • For the most up-to-date information on the situation in Ottawa please visit OPH’s interactive dashboard: https://www.ottawapublichealth.ca/en/reports-research-and-statistics/daily-covid19-dashboard.aspx
  • When notified of a case, OPH takes the following steps:
    1. Contact the individual within 24 hours of receiving the positive result from the lab.
    2. Verify that the individual is in self-isolation and review isolation requirements.
      • OPH will also determine if the case needs support for self-isolation (e.g., food, housing) and has partnered with the Ottawa Health Team to help those who need additional support.
    3. Initiate case investigation:
      • Through a structured interview process, case managers determine whether a person who has tested positive for COVID-19 works or spends time in high risk settings (e.g., long-term care & retirement homes, shelters & congregate settings, child care, schools) for referral to the appropriate OPH team for follow-up.
      • Collect information on where and from whom the person most likely acquired the infection.
    4. Conduct contact tracing:
      • Identify and notify directly all household contacts and those in high-risk settings (e.g., schools, long-term care facilities and congregate living settings).
      • Attempt to reach a broader group of contacts through the person diagnosed with COVID-19 or via third parties where outbreaks/cluster events have occurred.

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

To ensure OPH can reach you using our automated messaging system, please register for communications from 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: December 2, 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.

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. WHO recommends that the follow-up of contacts of confirmed cases is 14 days.
  • 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: December 2, 2020

All individuals who are waiting for COVID-19 test results must self-isolate.

Guidance for Symptomatic Individuals

  • Any person presenting with at least one sign or symptom should be considered for testing and be directed that they must self-isolate and self-monitor until they receive their test result. They must not return to child care/school or work in-person.
  • If the person presenting symptoms is a child, please consult the OPH Return to School guidance for further information.
  • Clinicians should advise individuals to tell their household contacts to also self-isolate for fourteen days from their last contact with the individual and to notify them once the test results are received;
  • 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 need to self-isolate for 14 days since last day of exposure to the person who tested positive for COVID-19 and monitor for signs and symptoms of COVID-19.
  • Testing is recommended if the individual develops any signs or symptoms of COVID-19.
  • If a contact of a confirmed case has a negative test result, they 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 below for attending the COVID-19 Assessment Centre Centre and are unable to assess or test them in your clinic, please direct that patient to the Assessment Centre.

  1. Showing COVID-19 symptoms. OR
  2. Has been exposed to a confirmed case of the virus, as informed by OPH or exposure notification through the COVID Alert app. OR
  3. Is a resident or works in a setting that has a COVID (outbreak, as identified and informed by OPH. OR
  4. Is eligible for testing as part of a targeted testing initiative directed by the Ministry of Health or the Ministry of Long-Term Care.

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

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: December 2, 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: December 2, 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: December 2, 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

New self-isolation periods have changed. Please see the COVID-19 Quick Reference Public Health Guidance on Testing and Clearance (Version 10) for more details. Significant changes in Version 10 include moving from a 14-day isolation period for all cases, to a 10-day isolation period for the majority of cases with mild to moderate illness and a 20-day isolation period for cases with severe illness (requiring ICU-level support) or with immune compromise

All individuals must self-isolate while waiting for COVID-19 test results. 

Management of symptomatic persons TESTED for COVID 19

Last update: December 2, 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. 

Management of symptomatic persons NOT TESTED for COVID 19

Last update: December 2 , 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.

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

Last update: December 2, 2020

Please see the Ministry of Health Quick Reference Public Health Guidance on Testing and Clearance (Version 10, October 1, 2020) for further guidance, including the following;

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

Last update: December 2, 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: December 2, 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 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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