MEMO: COVID-19 Testing Guidance for Primary Care 

TO:  Primary Care Professionals in Niagara

FROM:  M. Mustafa Hirji, MD, MPH, FRCPC, Medical Officer of Health & Commissioner (Acting)

REFERENCE: COVID-19 Testing Guidance for Primary Care 

DATE:  Nov. 1, 2021

The Ministry of Health updated COVID-19 Guidance: Primary Care Providers in a Community Setting on October 19, 2021. This guidance notes that COVID-19 testing should be offered to, or arranged for, all patients with new or worsening symptoms that are compatible with COVID-19 where possible and asymptomatic contacts of a confirmed case.

Locally in Niagara, numerous instances have now been documented where symptomatic persons were not tested for COVID-19 even after presenting to a health care provider, and subsequently spread infection to many others. A lower threshold to test could have prevented the spread of these infections.

To support access to testing for all residents across the Niagara region, Niagara Region Public Health (NRPH) encourages all Primary Care Providers to offer COVID-19 testing to their patients.

COVID-19 Testing Requirements for Primary Care

• Testing in office can be performed if the primary care provider is able to follow Droplet and Contact Precautions, has the appropriate tools and knowledge of how to test, and can ensure coordination of sample delivery to a laboratory providing COVID-19 testing
  • To order personal protective equipment go to Ontario Together: Help fight COVID-19 or review the Niagara PPE Provider Directory to find a provider
  • Supplies for COVID-19 testing can be ordered using the online West Region Swab Order Form
    • Allow up to 4 business days for delivery from requests
    • Order up to a 7-day supply
  • Preferred swab collection methods for COVID-19:
    • Nasopharyngeal (NP) swab
    • Combined swabbing of the oropharynx and bilateral anterior nares
    • Combined buccal and deep nasal swabbing
    • Deep nasal swabbing
    • Saliva (note: only a limited number of non-Public Health Ontario laboratories in Ontario are accepting saliva specimens for COVID-19 PCR testing)
    • Other preferred methods of specimen collection for COVID-19 PCR testing by Patient Characteristic
    • Use of Alternate Specimen Collection Methods for COVID-19 PCR Testing

Additional IPAC  Tips in Primary Care Settings

• Screen for COVID-19 – both passively with signage and actively with questions on the phone and/or when patients present to the clinic.
• Move patients who screen positive in office to a separate room and close the door, or instruct to return to vehicle or parking lot (if available or appropriate) to wait for a room to become available.
• Block off scheduled appointments towards the end of the day for patients with respiratory symptoms who may require COVID-19 testing
• Adapt clinic flow to support physical distance guidelines. Where this is not possible, primary care providers should use their clinical judgement to adapt patient flows based on their unique circumstances.
• Use floor markings to direct flow of traffic and to ensure spacing amongst patients
• Clean and disinfect examination bed/chair, horizontal surfaces and any medical equipment used during your clinical assessment
• Remove all non-essential items in the clinic setting
•  All patients should wear a surgical/procedures mask, with particular emphasis for patients who are symptomatic for COVID-19 or have had a recent exposure
• Optimize ventilation within the clinic setting such as changing filters regularly, continuously running the HVAC system to be exchanging air with the outside, and opening windows if possible
• Any symptomatic individual, regardless of vaccination status who is being tested or referred for testing must be told to isolate until a negative result is received
• Fully immunized, asymptomatic individuals who are a high-risk contact do not need to self isolate

Point-of-Care Testing Guidance

• Rapid antigen POC testing is not to be used for diagnosis of COVID-19 but can be used as an additional layer of screening within the primary care setting
• Rapid antigen POC testing is to be completed on those individuals who are asymptomatic and who are not a contact of a confirmed case
• Individuals who test positive on a rapid antigen POC test must be referred for confirmatory PCR testing
• Further information is available at: Interim guidance on the use of rapid antigen detection tests for the identification of SARS-CoV-2 infection - Canada.ca

Testing Referrals

• In the event it is necessary to refer patients to an external centre for testing, visit our website for testing locations in Niagara
• If making a testing referral, ensure that the patient is aware of the need for safe arrangements for travel to the hospital or testing location that maintains isolation of the patient (i.e. patient should wear a surgical/procedure mask and should avoid public transit if possible)

More Information

• Primary care providers should not delay assessment and treatment of issues which have symptoms that overlap with those of COVID-19 but are clinically evident of a different diagnosis
• PPE and Infection Control for In-office Assessments
• Continue to reference the COVID-19 Provincial Testing Guidance for testing guidance and the COVID-19 Reference Document for Symptoms for the COVID-19 symptom list, including exceptions related to underlying conditions
• Guidance for Primary Care Providers in Community Settings
• COVID-19 Polymerase Chain Reaction (PCR) Testing: Preferred Specimen Collection Methods
• Health Care Provider Frequently Asked Questions on Novel Coronavirus (COVID-19)
• Reporting Confirmed COVID-19 Cases or Positive Rapid Test Results