Updated COVID-19 recommendations
March 16, 2020
To: Local Health System Partners
Re: Updated COVID-19 recommendations
Due to changes in case definitions, infection control and implications with patient management, we are providing updated guidance to assist you in the care of your patients. Given these changes, specifically, the change in precautions from airborne to contact/droplet for routine patient care, providers who have appropriate IPAC measures in place can safely care for patients with probable or confirmed COVID-19.
Updated case definition
The updated case definitions are found on the Ontario Ministry of Health and Long-Term Care website and are attached to this Alert. The two definitions currently in use are “probable case” and “confirmed case”. Please be sure to read the footnotes such as the definition of a “close contact”.
Please note the following:
- Public Health Sudbury & Districts is currently including the following as “impacted areas”: all travel outside of Canada and, until March 18, attendance at the Prospectors & Developers Association of Canada (PDAC) convention that took place in Toronto from March 1-4, 2020.
- A probable case will include those who meet the symptom and exposure criteria who are awaiting testing.
Updated infection prevention and control measures
| Precaution type | Contact/droplet | Airborne |
|---|---|---|
| Personal protective equipment | Gloves, protective eyewear, isolation gown + Surgical/procedure mask | Gloves, protective eyewear, isolation gown + N95 respirator |
| Room type for patient care | Single patient room | Airborne infection isolation room (or single room with a closed door) |
| Settings where indicated | 1. Providing direct care to probable or confirmed case 2. Triage or preliminary screening not involving patient contact 3. Entering room of a probable or confirmed case, including cleaning** after and between consultations | Conducting aerosol-generating medical procedures (AGMP) for probable or confirmed case* |
*AGMP includes: intubation, CPR, open airway suctioning, bronchoscopy, sputum induction, non-invasive positive pressure ventilation for acute respiratory failure, high-flow oxygen therapy. DOES NOT INCLUDE collection of a nasopharyngeal or throat swab for COVID-19 testing.
**Contact/droplet cleaning procedures: ensure all horizontal surfaces in exam room that have been in contact with the patient, as well as equipment used to examine the patient (ex. stethoscope), are disinfected with a low-level disinfectant, or a wipe impregnated with a low-level disinfectant. Refer to the “Infection Prevention and Control for Clinical Office Practice” available on the Public Health Ontario website for additional guidance on
environmental cleaning and other infection prevention and control measures. Additional guidance is also available for other healthcare settings including guidance on airborne precautions.
To reduce the probability of transmission of COVID-19 in in-patient, ambulatory and outpatient healthcare facilities, ensure patients with probable or confirmed COVID-19 to:
- Wear a surgical/procedure mask if tolerated
- Maintain a two metre distance or separation by a physical barrier and
- Perform hand hygiene
Updated patient management
Managing ASYMPTOMATIC patients:
NOTE: testing of ASYMPTOMATIC individuals is NOT indicated.
| Risk | Management |
|---|---|
| No travel to impacted area, no close contact with probable or confirmed case or person with acute respiratory illness who has been to an impacted area | Counsel patient on protecting themselves from COVID-19 exposure. Resources are available on our website on preventing the spread of illness, facts on COVID-19 and preparedness measures. Posters are available for you to print for your office. -Patient can continue to receive routine healthcare. |
| Travelled to an impacted area | Voluntary self-isolation is recommended for 14 days for travelers returning from outside of Canada (see website for information and printable poster on how to self-isolate). Otherwise, self-monitor for symptoms (see website for information and printable poster on how to self-monitor). If symptoms develop, manage as probable case. -Patient can continue to receive routine healthcare – recommend that patient call beforehand to be screened for symptoms. |
| Close contact with confirmed case | Self-isolate for 14 days since last exposure. If symptoms develop, manage as probable case. -Patient can continue to receive routine healthcare – recommend that patient call beforehand to be screened for symptoms. |
| Close contact with probable case or person with acute respiratory illness who has been to an impacted area | Self-monitor for 14 days since last exposure. If symptoms develop, manage as probable case. -Patient can continue to receive routine healthcare – recommend that patient call beforehand to be screened for symptoms. |
Managing SYMPTOMATIC patients:
| Risk | Management |
|---|---|
| No travel to impacted area, no close contact with probable or confirmed case or person with acute respiratory illness who has been to an impacted area | Counsel patient on protecting themselves from COVID-19 exposure. Resources are available on our website on preventing the spread of illness, facts on COVID-19 and preparedness measures. Posters are available for you to print for your office. -Patient can continue to receive routine healthcare – recommend applying relevant precautions according to patient’s symptoms. |
| Travelled to an impacted area or close contact with confirmed or probable case or person with acute respiratory illness who has been to an impacted area | Probable case. Testing is indicated, though is subject to local availability. Advise patient to self-isolate. If your clinic does not offer testing, please refer to local hospital or assessment centre to arrange for testing. Other COVID-19 questions can be referred to Public Health Sudbury & Districts. If probable case cannot receive testing, self-isolate until 24 hours symptom-free and at least 14 days since last exposure. -Patient can continue to receive routine healthcare – apply precautions as outlined in Alert if receiving in-person care. |
| As above and positive COVID-19 result. | Confirmed case. Public Health Sudbury & Districts will follow-up with all confirmed cases. -Patient can continue to receive routine healthcare – apply precautions as outlined in Alert if receiving in-person care. |
Thank you for your attention to these important matters. Should you have questions or comments, or for immediate reporting of COVID-19, please contact the Control of Infectious Diseases Program at 705.522.9200, ext. 301 (toll-free 1.866.522.9200) or after hours at 705.688.4366.
Sincerely,
Dr. Penny Sutcliffe
Medical Officer of Heath and Chief Executive Officer
and
Dr. Ariella Zbar
Associate Medical Officer of Health
This item was last modified on March 19, 2020