MEDICAL ADVISORY: Novel Coronavirus (COVID-19) Update #6

Issued by:  Dr. Andrea Feller, MD, MS, FAAP, FACPM, Associate Medical Officer of Health

As new questions arise throughout this fluid and rapidly evolving pandemic, we will be posting them on our health care professional’s webpage.

I have a patient with respiratory symptoms who travelled but not to an impacted country, what should I do with this patient?

• Put a mask on them
• Assess for other illness
• Review the prioritization of COVID-19 testing
• Ask to stay home until symptom-free

I have a patient who is asymptomatic, no travel history, but they had contact with someone who travelled. What should I do with this patient?

Public Health Ontario is not currently recommending routine testing of asymptomatic persons for COVID-19. 

Did you know there is a new billing code for telephone COVID-19 assessments?

Ontario has also approved new physician billing codes for telephone assessments, enabling doctors to conduct more assessments over the phone rather than in their clinic. We do not have any further information at this time and we do not know if it can be delegated.

Do all patients tested for COVID-19 need to be self-isolated for 14 days?

Yes. If patient is positive for COVID19, they must self-isolate for 14 days from their last exposure to an affected area until receipt of two negative results, 24 hours apart.

Yes. If patient is negative for COVID-19 then the patient remains in self-isolation until the patient receives a phone call from Public Health that their results for COVID-19 are negative. Self-isolation may need to continue even when results are negative based on the level of risk of their exposure.    

What is the test for COVID-19?

• Only a single upper respiratory tract specimen will be accepted for COVID-19 testing  from an outpatient setting
• Nasopharyngeal swab (NPS) is preferred since information available to date suggest that a NPS has higher sensitivity than a throat swab for COVID-19 detection
• PCR testing is performed for COVID-19. Serology for COVID-19 is not available

What personal protective equipment do I need to test for COVID-19?

Droplet/Contact precautions:

• Use of gloves, gowns, surgical mask and eye protection (face shield or goggles are acceptable as eye protection)
• Hand hygiene

What is the turnaround time on testing for emergency rooms vs. primary care?

• According to the most current Labstract for Coronavirus Disease 2019 (CoOVID-19) the turnaround time will vary according to geographical location and proximity to PHO Laboratory Hamilton or Toronto 
• Results take longer if the sample goes in an alternate route vs. a direct route

Can I send people for testing other than the hospital emergency room?

Preparations for testing sites are underway for the near future. Public Health is working closely with Health system partners.

Do I need to collect a separate swab for COVID-19 and influenza?

Influenza testing is reserved for sentinel physicians, hospitals and long-term care homes. 

Do I need to notify Niagara Region Public Health and Emergency Services when I test someone for COVID-19? 

Yes. COVID-19 is a disease of public health significance and it is reportable to Public Health. Notify Public Health immediately of your testing so we can follow up with your patient to review self-isolation guidelines

Primary Care Providers only are requested to call 905-688-8248 extension 7554 or toll-free 1-888-505-6074.

What is required by the health care professional to test for COVID-19?

The health care professional will need:

• Surgical mask(s)
• A room to isolate patient (does not need to be a negative pressure room)
• Personal Protective Equipment
• NP swabs
• COVID-19 Virus Test Requisition
• Coronavirus Labstract
• Hand hygiene facilities available
• Cleaning supplies

If I test someone for COVID-19, do I need to keep the room empty for two hours?

No. Dr. Michelle Murti from Public Health Ontario stated, “there is no airborne transmission of the COVID-19 virus and therefore no need to apply the two-hour clearance generally recommended for measles.”

How do I clean my clinic room if I have tested someone for COVID-19?

• Clean and disinfect all equipment and surfaces in contact with the patient or potentially contaminated with bodily fluids (i.e. from coughing/sneezing) between each patient
• High touch items/surfaces should be cleaned and disinfected at least twice daily and when potential contamination has occurred or the surfaces are visibly soiled
• Disinfect using a hospital grade disinfectant (low level disinfectant) that has virucidal and bactericidal properties and a drug identification number (DIN)
• Follow manufacturer’s instructions for use of the disinfectant including contact time and pre-cleaning requirements
• Equipment covered by a barrier is to be removed and discarded between patients; if equipment is contaminated, clean and disinfect prior to replacing a new barrier on the equipment
• Items that cannot be easily cleaned and disinfected should be removed (e.g. magazines and plush toys)

For more detailed information on cleaning and disinfection refer to the:

• Best Practices for Prevention, Surveillance and Infection Control Management of Novel Respiratory Infections in All Health Care Settings – pg. 19
• Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings, 3rd Edition – pg. 27 – 33

Is Niagara Region Public Health Department testing for COVID-19?

No. At this time, we are sending all inquiries to the hospital or health care professionals willing and able to do the testing.

Signage

Please remove old signs and replace with the poster included below. Colour copies are available for order or download at niagararegion.ca/health/professionals.

Additional Resources 

• COVID-19 Response and Preparedness Webinar for Health Professionals (poster below)
• COVID-19 Directive #1 for Health Care Providers and Health Care Entities Issued under Section 77.7 of the Health Protection and Promotion Act (HPPA), R.S.O. 1990, c. H.7
• Updated IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19

Further Information

The Infectious Disease program can be reached at 1-888-505-6074 or 905-688-8248 ext. 7330 Monday to Friday 8:30 a.m. – 4: 30 p.m., after hours 905-984-3690.  As information is evolving daily, please refer to Infectious Disease Information for Health Professionals.