MEDICAL ADVISORY: Novel Coronavirus (2019 -nCoV) UpdateIssued by: Gayane Hovhannisyan, MD, MPH, PhD, FRCPC, Acting Associate Medical Officer of Health Updated Case Definition for
2019-nCoV - On January 31, 2020, the Ministry of Health released Version 2 of the guidance document for Novel Coronavirus (2019-nCoV) for Primary Care Providers in a Community Setting
- All primary care settings should undertake active screening (asking questions) and passive screening (signage) of patients for
2019-nCoV
- Patients should be screened over the phone before scheduling appointments
- The primary care provider or Walk-in clinic should contact Public Health to report a suspect case and discuss the most appropriate setting for testing
Case Definition (Updated) - Fever, and/or new onset of cough or difficulty breathing, AND any of the following:
- Travel to Hubei Province (includes Wuhan), China in the past 14 days before the onset of illness OR
- Close contact with a confirmed or probable case of 2019-nCoV OR
- Close contact with a person with acute respiratory illness who has been to Hubei Province (includes Wuhan) within 14 days prior to their illness onset
Infection Prevention and Control - Testing requires the ability to take appropriate airborne/droplet/contact precautions during specimen collection. Only primary care providers who can safely use and have access to N95 respirators are able to conduct detailed clinical assessment, examination and testing (as indicated) in their clinics.
- Below is a list of mask fit questions to review with your staff to determine if N95 respirators can be safely used in your clinic setting
Testing & Understanding Lab Results - Primary care providers or Walk-in Clinics that can safely test a patient with a clinical and travel exposure history consistent with the above case definition
- For patients that meet case definition, a public health nurse will call the Public Health Ontario Laboratory (PHOL) to obtain approval for testing on your behalf
- For patients that do not meet case definition, the primary care provider or Walk-in Clinic who is considering testing will need to contact PHOL directly to obtain approval
- Ensure your office has NP swabs (Virus Respiratory Kit order #390082) and throat swabs (Virus Culture Kit order #390081) in stock or place an order with PHOL
- Turnaround time for test results will vary depending on the volume in the PHOL and National Microbiology Lab (Winnipeg)
Requirements for N-95 Respirator Use Prior to 2019-nCoV Specimen Collection - Please check with your occupational health & safety and infection prevention & control for workplace policies and procedures around N-95 respirator use
- Fit testing must be performed initially (before the employee is required to wear the N-95 respirator in the workplace) and
must be repeated at least every two years
- Fit testing must be conducted whenever respirator design or facial changes occur, that could affect the proper fit of the N-95 respirator. This may occur as a result of:
- A change in weight (either 10% weight loss or gain)
- Dental changes
- Facial scarring
- Cosmetic surgery
- Any changes to facial hair from when baseline test was conducted, because
facial hair interferes with proper seal
- Anything that may interfere with proper facial seal e.g. personal head coverings, garments or facial jewelry. If the head coverings do not come between the N-95 respirator and the face, (e.g. hijab, turban, yarmulke) then it does not interfere with a proper seal.
- There are certain health conditions that may impact an employee’s ability to wear an N-95 respirator even if they are fit-tested, such as:
- Heart disease
- Severe asthma/COPD
- General
anxiety or claustrophobia
- Unstable severe hypertension
- Uncontrolled seizure disorder
- Any condition that may affect your ability to safely use a respirator
- Note: Check to ensure N-95 respirators are not expired.
For Further Information: - Ministry of Health guidance documents, medical advisories and memos, and other 2019-nCoV
resources are available online
- Contact Niagara Region Public Health & Emergency Services, Infectious Disease program at 1-888-505-6074 or 905-688-8248 ext. 7330 Monday to Friday 8:30 a.m. to 4:30 p.m., after hours 905-984-3690.
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