MEDICAL ADVISORY: Novel Coronavirus (COVID-19) Update #9

Issued by:  Gayane Hovhannisyan, MD, MPH, PhD, FRCPC, Associate Medical Officer of Health (Acting)

Niagara Public Health Novel Coronavirus (COVID-19) Info Line

Public Health (PH) nurses are available to work with you and your patients seven days a week from 9:15 a.m. to 7:30 p.m. Monday through Friday and 9:15 a.m. to 4:15 p.m. Saturday and Sunday.

• 905-688-8248 ext. 7428 for health care professionals
• 905-688-8248 ext. 7019 for your patients

Niagara Health COVID-19 Assessment Sites

Niagara Health has set up COVID-19 assessment centres in Niagara Falls and St. Catharines. The assessment centres are by appointment only.

• Call the PH health care professional line (905-688-8248 ext. 7428) and a PH nurse will work with you to determine if your patient qualifies for testing and will create the referral to the Niagara Health assessment centre
• Due to the existing global shortage of swabs, the following patients will be prioritized (priority groups):
  1. Health care workers with direct patient care and Paramedics (includes minor respiratory symptoms or sore throat)
  2. Older adults (60 or older)
  3. Those with underlying medical conditions
  4. Residents of Long-term care homes, retirement homes and supportive housing
• A Niagara Health staff member will schedule your patient for testing

Self-Isolation Recommendations (*Significant Change)

Anyone who travelled outside of Canada and has mild respiratory symptoms that DO NOT require hospitalization;

AND

DO NOT meet the testing priority groups (listed above), should be sent home on self-isolation for 14 days *from the onset of symptoms

OR

 24 hours after cessation of symptoms, whichever is longer

Specimen Collection and Transport

Please notify Public Health if you are testing a patient. Please ensure you then send the patient home to self isolate and manage prescription(s) or other needs in a way that assumes the patient has COVID-19.

• A single upper respiratory tract specimen will be accepted for COVID-19 testing. Upper respiratory tract specimens include a nasopharyngeal swab (NPS) OR viral throat swab collected in universal transport medium (UTM). NP is the preferred specimen.

Alternative specimen collection kits

Public Health Ontario (PHO) Laboratory has done a limited evaluation on the following specimen collection kits, which can be used for collection of nasopharyngeal specimens for COVID-19 testing:

• Chlamydia trachomatis Culture - Female Kit order #: 390083
• Chlamydia trachomatis Culture - Male Kit order #: 390084
• Mycoplasma pneumoniae/Chamydophila pneumoniae PCR Kit order #: 390085
• Roche PCR Media Uniswab Kit order #: 300295 (vendor catalogue 07958021190)
• Bordetella pertussis BP Kit order #: 390052
  • The pertussis kits have 500ul of fluid (buffered saline) and that is enough for the lab to test for COVID-19 PCR

Note: Nasal or naso-pharyngeal swabs are preferred but a throat swab is accepted. For more information on specimen collection, contact the lab or refer to the Public Health Ontario testing guidelines.

Specimen Transport

• Niagara Region Public Health cannot provide specimen pick up and transport at this time
• Please work with your local lab to co-ordinate specimen pickup based on the transportation of dangerous good criteria
  • Please ensure process for specimen transport is in place prior to specimen collection
  • Prior to preparing for transport of the specimen, ensure that at least two unique identifiers are located on the specimen containers and the lab test requisition is placed in the exterior pocket of the plastic biohazard bag
  • The specimen must be placed in a sealed biohazard bag

  • The closed container is then placed inside the specimen transport bag with an absorbent pad in the bottom of the bag

  • Specimens are to be stored at 2-8 degrees Celsius following collection

Physician Services during a Public Health Emergency

• We are reminding physicians to continue to provide medical care that addresses the urgent and emergent needs of their patients
• It is important that patients with acute respiratory illness or other acute symptoms not be denied care
• If you are not able to provide them care, please make the appropriate referral or coverage arrangements
• Public Health does not provide primary care services
• Physicians are encouraged to use the new OHIP billing codes for telephone or video assessments

Dr. Hirji’s COVID-19 Response and Preparedness Webinar (Tuesday March 17, 2020)

• The recording is available online

Niagara Region Website for Health Care Professionals

A list of frequently asked questions to support primary care professionals is now on our website. We will be updating the FAQ section as new questions arise throughout this evolving pandemic.