What's new?

Change in testing guidance

Either nasopharyngeal (NP) or throat swab are now suitable for COVID-19 testing (NP preferred)

Change in MHO notification

No requirement to notify MHO for suspect cases

New patient-facing document

Document provides self-isolation instructions and information on obtaining test results

Focus on discharge instructions

Ensure patients being tested are provided self-isolation instructions and handout

Clarification of Personal Protective Equipment (PPE) needed

Wear a gown, gloves, surgical mask and eye protection/face shield during specimen collection. N95 masks are not required unless Aerosol Generating Medical Procedures are involved.

Situation Update:

As the epidemiology of COVID-19 changes, the affected areas will change. As of March 4, 2020, affected areas are: China, Hong Kong, Iran, Japan, Italy, Singapore, and South Korea.

The United States is also reporting increased numbers of COVID-19 cases. Seattle, Washington is reported as having high activity of COVID-19. As of March 4, 2020, 21 confirmed cases and 8 deaths have been reported with 62% of cases over the age of 60. At the present time, routine testing of travelers returning from Washington State is not recommended.

It is important to note that most people infected with COVID-19 have mild disease and recover. Approximately 80% of lab-confirmed patients have mild to moderate disease, 14% have more severe disease (e.g., dyspnea, tachypnea), and 6% have critical presentations. People with COVID-19 generally develop mild respiratory symptoms and fever an average of 5-6 days after infection (mean incubation period 5-6 days, range 1-14 days).

Screening:

We have created a screening algorithm for Medical Office Assistants (MOA). MOA should ask patients:

Do you have a fever OR cough OR shortness of breath? (If yes, to any symptoms, proceed to #2. If no, follow usual procedures) In the 14 days before you had symptoms did you: travel to an area known to have COVID-19 OR come in close contact with an ill person who travelled to an area known to have COVID-19 OR have contact with a person with COVID-19? (If yes, to any exposure history, proceed to ACTIONS. If no, follow usual procedures)

ACTIONS: Have patient clean their hands with alcohol-based rub, put on a surgical mask, and move to a private room (if a private room is unavailable, seat the patient at least 2 metres away from others) AND notify a health care clinician to assess the patient promptly.

Evaluation:

Consider testing for novel coronavirus for:

Patients with compatible symptoms (e.g., fever, cough, or difficulty breathing) AND

History of travel to an affected area (as of Mar. 4, 2020, affected areas include: China, Hong Kong, Iran, Japan, Italy, Singapore, and South Korea) within 14 days prior to illness onset OR other index of suspicion (e.g., contact with an ill person with travel to affected areas, contact with a confirmed or probable case of COVID-19).

We do not recommend COVID-19 testing in asymptomatic patients. We have developed a patient-facing document that provides information to asymptomatic patients requesting testing, which is available here.

Testing:

Physicians can test for COVID-19 without consulting a Medical Health Officer. (**new**) To facilitate prompt testing, the BCCDC will now accept either a nasopharyngeal (NP) or throat swab for COVID-19 testing (NP swab preferred). Community physicians can order NP swabs directly via the BCCDC Lab using this form.

How to test:

Use contact and droplet precautions (Required PPE includes: gloves, gowns, surgical mask and eye protection/face shield) particularly during sample collection (**new**) Obtain a NP swab OR throat swab (NP swab preferred) (red top or blue top COPAN with UNIVERSAL TRANSPORT MEDIA (UTM)) and send the swab to the BCCDC Provincial Laboratory. Ensure that the requisition indicates testing for “novel coronavirus” (for testing consultation, call the BCCDC Lab Medical Microbiologist on-call at 604-661-7033)

As per the BCCDC, as of February 27, 2020 specimens sent to the Provincial Lab for Influenza A/B and RSV testing will also automatically be tested for COVID-19. The BCCDC will notify Public Health in the event of a positive COVID-19 result. Public Health will follow-up on all confirmed COVID-19 results.

Discharge:

(**new**) Advise the patient to self-isolate and provide “Home Isolation” instructions – Home Isolation instructions are available here.

Inform the patient that they can call the BCCDC Coronavirus Hotline (1-833-707-2792) for testing results

If swabs results are positive, Public Health will provide follow-up.

Clinic Cleaning and Disinfecting in Community Clinics and Settings: (including community clinics, physician offices and long term care facilities)

As per Provincial Infection Control Network of BC (PICNet) guidance, clean patient/resident care areas to remove any organic matter on surfaces. Follow with disinfection using either 0.5% accelerated hydrogen peroxide wipes or 1,000 ppm bleach wipes. Consider cleaning and disinfecting shared equipment and other horizontal surfaces. In Fraser Health we do not recommend that cleaners mix their own cleaning solutions, as that can pose a health hazard to the worker.

Pandemic Planning and Preparation:

As we identify more cases, offices should start preparing for potential community transmission of the disease, and we encourage beginning to consider:

Preparing specific patient guidance (particularly instructions for having enough medications on-hand, when to visit the clinic)

Ensuring continuity of clinical operations

We will provide more information regarding pandemic planning and preparation in upcoming MHO alerts.