Hastings Prince Edward Public Health
Online Bulletin for Health Care Providers

November 2, 2020

From:
Dr. Piotr Oglaza
Medical Officer of Health
Hastings Prince Edward Public Health

In this Issue:

  1. HPEPH Management of COVID-19 Cases
  2. Health Care Provider Frequently Asked Questions
  3. Infection Prevention and Control Assessment for Primary Care, Specialty and Walk-in Clinics

HPEPH Management of COVID-19 Cases

When HPEPH receives notification of a case of COVID-19 in our region, Communicable Disease Investigators (CDIs) are currently taking the following steps:

  1. Contact the individual within 24 hours of receiving the positive result from the lab.
  2. Verify that the individual is in self-isolation:
    • Individuals with symptoms or who are a close contact of a case should receive instructions on how to self-isolate at the time of testing.
    • HPEPH also determines if the case needs support for self-isolation (e.g., food, housing).
  3. Interview the case, which includes asking about:
    • Symptoms (new or worsening)
    • Risk factors (occupational, sociodemographic, medical and behavioural)
    • Whether they work or spend time in high risk settings (e.g., long-term care & retirement homes, shelters & congregate settings, child care, schools)
    • Medical complications due to COVID-19 illness
    • Acquisition exposures (possible sources of infection)
    • Transmission exposures (possible infection of others from 48 hours prior to onset of symptoms, or date of specimen collection if asymptomatic, until date of self-isolation)
  4. Contact management:
    • Gather information on all possible contacts and perform risk assessments to determine who of the contacts are low risk and who are high risk.
      • The risk level of a contact is determine based on factors such as mask use (medical, cloth or no mask used), physical proximity to case (within 2 meters), and level/length of interaction with case (walking by vs. conversation).
    • Contact and inform any identified high risk contacts that they were in close contact with a COVID-19 positive case during their infectious period and provide instructions for isolation and testing.
    • Ensure any low risk contacts are notified of possible exposure to a COVID-19 positive case during their infectious period and provide instructions for self monitoring for symptoms.

Health Care Provider Frequently Asked Questions

How do I treat essential workers that regularly travel across the US-Canada border and who will screen positive as a result?

  • The College of Physicians and Surgeons of Ontario (CPSO) has clarified its policy on treating essential workers that regularly travel across the US-Canada border and who will screen positive as a result. The updated guidance summarized the COVID-19 FAQs for Physicians is as follows:
    • You may have some patients who are essential workers that are required to regularly travel across the US-Canada border as a part of their job. As a result, they will always screen positive when using the Ministry of Health’s screening tool simply because the nature of their work.
    • Recognizing that these individuals have been deemed essential workers and exempted from the quarantine and isolation rules set out by the federal government, the College is supportive of physicians exercising their clinical judgment regarding how to best care for these patients when they screen positive solely because of work related travel.
    • An immediate deferral of in-person care or redirection to another facility is not necessary in these instances provided appropriate safety precautions can be met. If there is no opportunity to see a patient following a 14-day window without travel across the border or a negative COVID-19 test, physicians can arrange to see the patient for any in-person care if they can satisfy the recommended precautions to do so safely (i.e., immediately isolating the individual upon arrival, use of appropriate PPE, etc.).

Where can I find clinical guidance for assessment of patients who have symptoms of COVID-19?

What should I inform my patient who receives a positive COVID-19 test result?

What if I am aware of a patient who is COVID-19 positive and not self-isolating?

  • HCPs can reinforce the requirements of the Medical Officer of Health's Class Order, including the need to self-isolate. HCPs can share a copy of the Class Order and Fact Sheet.
  • HCPs can also contact 613-966-5500 ext. 349 and provide HPEPH with information about the person who is not self-isolating for further investigation

I am aware of a COVID-19 positive patient who was in my clinic during their infectious period. Do I need to notify all of the patients and staff who were in my clinic that day?

  • If you determine that a staff or patient with COVID-19 has been at your clinical setting while infectious, primary care providers can conduct a preliminary assessment of which patients, regulated health professionals, and other health care workers may have been in close contact with the person with COVID-19 while infectious, and whether appropriate PPE and source protection were used.
  • If a case identifies that they were at a medical clinic in their infectious period, HPEPH will contact the clinic to conduct a risk assessment and to assess preventive measures in place such as screening procedures, PPE protocols, and environmental cleaning and disinfection.
  • If there is a need to contact staff and persons who may have been exposed at the clinic, HPEPH will work with the primary care provider to facilitate notification and provide these persons with further instructions.

My patient tells me they are a contact of a person with COVID-19, what should I advise them to do?

Infection Prevention and Control Assessment for Primary Care, Specialty and Walk-in Clinics

Public Health Ontario (PHO) has developed a comprehensive IPAC checklist for primary care, specialty and walk-in clinics during COVID-19. This document outlines a self-assessment checklist with embedded resources for the following areas of focus:

  • Clinic planning and preparation
  • Reception and waiting area(s)
  • Screening staff, patients and visitors
  • Positive screening: Providing care
  • Personal protective equipment (PPE)
  • Hazard controls
  • Physical capacity/environment
  • Critical supplies and equipment
  • Human resources/occupational health and safety
  • Environmental cleaning
  • Reprocessing of reusable medical equipment/devices
  • Heating, ventilation and air conditioning (HVAC)

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HPEPH is offering services by appointment only. We remain dedicated to protecting our community by providing local HCPs and community members with new information as it becomes available. Current information on COVID-19 specifically for health care providers can be found at hpePublicHealth.ca, Ontario Ministry of Health and at publichealthontario.ca.

Contact Information: 

To give us your comments: kkhani@hpeph.ca

To report communicable diseases:613-966-5500 x349

To report AEFI or DOPHS: Online / Fax - 613-966-1813 or CDCFAX1@hpeph.ca

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