Ontario Updates COVID-19 Provincial Testing Guidance
Date: April 9, 2020
In its “COVID-19 Quick Reference Public Health Guidance on Testing and Clearance” of March 27, 2020, the Ontario Ministry of Health (MOH) stated that only symptomatic individuals should be tested.
As the government builds its testing capacity, the MOH has updated its testing guidance (“COVID-19 Provincial Testing Guidance Update”, April 8, 2020) to expand the testing of asymptomatic individuals in certain groups. The MOH has also updated its testing guidance for situations of resource shortages. It anticipates releasing additional guidance in the next few days to further expand the list of those who should be tested.
Set out below are highlights from the April 8, 2020 update (as well as information from a Directive issued by the Chief Medical Officer of Health on April 10, 2020).
1. Hospital Inpatients (Patients) and Long-Term Care Home and Retirement Home Residents (Residents)
Patients and Residents should be tested if they have one of the following symptoms: (i) a temperature of 37.8 degrees Celsius or greater; (ii) new or worsening respiratory illness symptoms; or (iii) clinical or radiological evidence of pneumonia (COVID-19 Symptoms).
Patients and Residents with an atypical presentation of COVID-19 should also be considered for testing, particularly if they are elderly. Atypical symptoms include unexplained fatigue or malaise, delirium, falls, acute functional decline, exacerbation for chronic conditions, digestive symptoms such as nausea, vomiting, diarrhea and abdominal pain, chills, headaches, croup, unexplained tachycardia, decrease in blood pressure, unexplained hypoxia, lethargy and unexplained feeding difficulty in children.
Patients transferred from a hospital to a long-term care home should be tested before being transferred, even if they are asymptomatic.
Asymptomatic Residents should be tested if they live in the same room as a symptomatic Resident. Asymptomatic Residents should also be tested within the first 14 days of their admission or readmission to a long-term care home or retirement home (unless they are transferred from a hospital in which case they would have already been tested). All newly admitted or readmitted Residents must self-isolate for 14 days, even if they test negative.
In the event of an outbreak of COVID-19 in a long-term care home or retirement home, all Residents living in adjacent rooms of the positive case and every non-Resident in that unit or care hub, including staff and visitors, should be tested, subject to local public health’s discretion. Local public health also has the discretion to test additional people.
This does not change the guidance of the MOH dated March 27, 2020 regarding when Patients can be discharged.
2. Healthcare Workers, Caregivers, Care Providers and First Responders
All healthcare workers, first responders, care providers and caregivers, including family members and volunteers, should be tested as soon as feasible if they develop any COVID-19 symptoms or atypical symptoms.
This does not change the guidance of the MOH dated March 27, 2020 regarding when health care workers can return to work.
3. Remote, Isolated, Rural or Indigenous Communities (Remote Communities)
Individuals living in Remote Communities should be tested if they experience any COVID-19 symptoms. They should also be tested if they experience atypical symptoms, particularly if they are elderly persons or children.
4. Priorities in Situations of Resource Limitations
Where there is a shortage of testing supplies, symptomatic individuals and staff in institutional settings, symptomatic healthcare workers and first responders, Patients admitted with respiratory symptoms, symptomatic members of Remote Communities, symptomatic travelers and individuals referred by local public health are prioritized for testing.
5. New Directive Regarding Personal Protective Equipment for Hospitals and Long-Term Care Homes
On April 10, 2020, the Chief Medical Officer of Health issued a revised Directive #5 respecting Personal Protective Equipment (PPE) for Hospitals and Long-Term Care Homes.
The key aspects of the revised Directive #5 are:
- It references the challenges of adequate PPE supplies and calls for contingency plans in the event of PPE shortages.
- It specifies that all Regulated Health Professionals (but not for example PSWs) must complete a Point of Care Risk Assessment prior to providing care to patients/residents in order to assess appropriate PPE, which may or may not include an N95 respirator.
- In the Long-Term Care Sector, staff and visitors must wear surgical masks at all times (with the exception of break times, during which social distancing must be maintained).
Editor’s Note: Section 5 of this post was added on April 11, 2020.
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