COVID-19 (2019-nCoV)

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Reporting Obligations

Persons under investigation or probable cases who meet the case definition below must be reported by phone or fax. During business hours 8:30am–4:30pm Monday to Friday and ask for the Infectious Diseases Team at extension 2222. After hours and weekends ask for on call.

Phone: 613-345-5685 or 1-800-660-5853
Fax: 613-345-5777

The Public Health Agency of Canada COVID-19 case definitions include fever and/or respiratory symptoms along with possible exposure to the virus through travel to an affected area, close contact with a confirmed or probable case, or close contact with a person with acute respiratory disease who had been to an affected area, within 14 days before the onset of the illness.

Epidemiology

Aetiologic Agent

Coronaviruses are large, enveloped ribonucleic acid (RNA) viruses named after their corona- or crown-like surface projections observed on electron microscopy. A novel coronavirus is a new strain that has not been previously identified in humans. Coronaviruses are zoonotic, as they transmit between animals and people. There are at least seven known coronaviruses that infect humans.

On December 31 2019, the World Health Organization (WHO) China Country Office was informed of cases of pneumonia of unknown etiology (unknown cause) detected in Wuhan City, Hubei Province in China. A novel coronavirus (2019-nCoV) was identified as the causative virus by Chinese authorities on January 7, 2020.

On February 11, 2020, the WHO released the official name for the disease caused by the novel coronavirus (2019-nCoV) as COVID-19.

Clinical Presentation

Ministry of Health COVID-19 Reference Document for Symptoms

Common symptoms of COVID-19 include:

Fever (temperature of 37.8°C or greater)
New or worsening cough
Shortness of breath (dyspnea)

Other symptoms of COVID-19 can include:

Sore throat
Difficulty swallowing
New olfactory or taste disorder(s)
Nausea/vomiting, diarrhea, abdominal pain (of particular concern in children)
Runny nose, or nasal congestion – in absence of underlying reason for these symptoms such as seasonal allergies, post nasal drip, etc.

Other signs of COVID-19 can include:

Clinical or radiological evidence of pneumonia

Atypical symptoms/signs of COVID-19 should be considered, particularly in children, older persons, and people living with a developmental disability. Atypical symptoms can include:

Unexplained fatigue/malaise
Delirium (acutely altered mental status and inattention)
Unexplained or increased number of falls
Acute functional decline
Exacerbation of chronic conditions
Chills
Headaches
Croup
Conjunctivitis
Multisystem inflammatory vasculitis in children
- Presentation may include persistent fever, abdominal pain, conjunctivitis, gastrointestinal symptoms (nausea, vomiting and diarrhea) and rash.

Atypical signs can include:

Unexplained tachycardia, including age specific tachycardia for children
Decrease in blood pressure
Unexplained hypoxia (even if mild i.e. O2 sat <90%)
Lethargy, difficulty feeding in infants (if no other diagnosis)

Modes of Transmission

Evidence to date suggests that COVID-19 is spread by droplets from an infected person via a cough, sneeze or talking. Droplets typically travel about 2 metres (6 feet) and can live on hard surfaces. While there is evidence of the virus in feces, there is no evidence to date that it can be spread this way. Respiratory etiquette and regular environmental cleaning are important to decrease the risk of spread of infection.

Incubation Period

The mean incubation period appears to be 5 days with a range of 1 to 14 days. The World Health Organization’s COVID-19 case definition includes exposure to a case within the previous 14 days.

Period of Communicability

(as per Management of Cases and Contacts of COVID-19 in Ontario)

The period of communicability is not well understood. Detailed information from people infected is needed to characterize onset and duration of viral shedding and determine the infectious period of COVID-19. It is possible that people infected with COVID-19 may be infectious before showing significant symptoms. However, based on currently available data, the people who have symptoms are causing the majority of virus spread. (reference).

As early symptoms of COVID-19 may be mild and non-specific, and there have been early reports of potential asymptomatic transmission, contact tracing should extend from 48 hours prior to symptom onset to 10 days after symptom onset.
For individuals who have never had symptoms at the time of testing, the period of communicability extends from 48 hours prior to the positive specimen collection date.

For individuals with mild infection that do not require hospitalization, it is assumed that they are no longer communicable 14 days after onset of illness, as long as they are afebrile at that time and have improved symptoms. Absence of cough is not required for those known to have chronic cough or who are experiencing reactive airways post-infection. (reference).

Risk Factors/Susceptibility

Risk Factors:

Travel Outside Canada in the last 14 days (more information below)
Close physical contact with someone:
- who tested positive for COVID-19.
- who is currently sick with a new cough, fever, or difficulty breathing.
- who returned from outside of Canada in the last 2 weeks.

Close physical contact means:

a face-to-face conversation for 15 minutes
being in the same room for 2 hours
living in the same home

The Ontario Self-Assessment tool identifies the following at-risk groups:

70 years old or older
getting treatment that compromises (weakens) your immune system
(for example, chemotherapy, medication for transplants, corticosteroids, TNF inhibitors)
having a condition that compromises (weakens) your immune system
(for example, lupus, rheumatoid arthritis, other autoimmune disorder)
having a chronic (long-lasting) health condition
(for example, diabetes, emphysema, asthma, heart condition)

Other risk factors/populations that need to be considered include: Priority populations within Leeds, Grenville and Lanark and access to the social determinants of health.

Diagnosis and Laboratory Testing

Before testing, review the Public Health Ontario direction about testing.

If you have any questions regarding the updated COVID-19 Test Requisition, please contact [email protected] or 1-877-604-4567.

Treatment and Case Management

Individuals who are positive for COVID-19 and do not require hospitalization for medical reasons can be self-isolated at home under public health follow-up if the home setting is appropriate. Public health is responsible for the contact tracing of all positive cases, and will require that individuals with significant contact self-isolate for a 14 day period.

Directives/Guidance Documents

COVID-19 Guidance for the Health Sector – Ministry of Health

Directives:

Guidance Documents:

Long-Term Care/Retirement Homes:

Requirements for Specific Populations

Travel history outside of Canada in the past 14 days:

Asymptomatic travelers should be advised to stay home/self-isolate for 14 days and contact their local public health unit (613-345-5685 or 1-800-660-5853) for further direction on activity restrictions.
If patients develop a fever and/or onset of a new cough or have difficulty breathing within 14 days of their travel date, call local public health unit (613-345-5685 or 1-800-660-5853) or telehealth (1-800-797-0000) for advice. Refer to guidance documents above for more information.

Travel history to impacted area,

Asymptomatic travelers:
- With known close contact with a case: self-isolate for 14 days from last known exposure.
- With known non-close contact with a case: self-monitor for symptoms for 14 days from last known exposure.
If patients develop a fever and/or onset of a new cough or have difficulty breathing within 14 days of their travel date, call your local public health unit (1-800-660-5853) or telehealth (1-800-797-0000) for advice. Refer to guidance documents above for more information.

How to Self-Isolate

Self-isolation: Guide for Caregivers, Household Members and Close Contacts