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Guidance for Health Care Workers and Health Sector Employers on novel coronavirus associated with Wuhan, China (2019-nCoV)

Last reviewed February 7, 2020
Last updated February 7, 2020

This information is intended for use by health care workers and health sector employers in acute care settings. Guidance for other sectors will follow.

Case Definitions - Adapted from the Public Health Agency of Canada's National Case Definition

These case definitions are for surveillance purposes and they are current as of February 7, 2020. They are not intended to replace clinical or public health practitioner judgment in individual patient assessment and management.

Person under Investigation for 2019-nCoV

A person with fever and/or onset of cough or difficulty breathing,
AND any of the following:

  • Travel to mainland China in the 14 days before onset of illness

OR

  • Close contact with a confirmed or probable case of 2019-nCoV

OR

  • Close contact with a person with acute respiratory illness who has been to mainland China within 14 days prior to their illness onset

Probable Case for 2019-nCoV

A person:

  • with fever (over 38 degrees Celsius) and/or new onset of (or exacerbation of chronic) cough or breathing difficulty

AND any of the following:

    • Travel to mainland China in the 14 days before onset of illness

OR

    • Close contact with a confirmed or probable case of 2019-nCoV

OR

    • Close contact with a person with acute respiratory illness who has been to mainland China within 14 days prior to their illness onset

AND

  • in whom laboratory diagnosis of 2019-nCoV is not available, inconclusive, or negative (if specimen quality or timing is suspect)

Presumptive Confirmed Case for 2019-nCoV

A person in whom the laboratory screening test for 2019-nCoV was positive from the Public Health Ontario Laboratory but not yet confirmed by the National Microbiology Laboratory (NML).

Confirmed Case for 2019-nCoV

A person with laboratory confirmation of infection with 2019-nCoV which consists of positive real-time PCR on at least two specific genomic targets or a single positive target with sequencing AND confirmed by NML by nucleic acid testing.

Case Definition Footnotes

  1. The incubation period of 2019-nCoV is unknown. SARS-CoV demonstrated a prolonged incubation period (median 4-5 days; range 2-10 days) compared to other human coronavirus infections (average 2 days; typical range 12 hours to 5 days). The incubation period for MERS-CoV is approximately 5 days (range 2-14 days). Allowing for variability and recall error and to establish consistency with the World Health Organization’s 2019-nCoV case definition, exposure history based on the prior 14 days is recommended at this time.
  2. A close contact is defined as a person who provided care for the patient, including healthcare workers, family members or other caregivers, or who had other similar close physical contact OR who lived with or otherwise had close prolonged contact with a probable or confirmed case while the case was ill.
  3. Other exposure scenarios not specifically mentioned here may arise and may be considered at jurisdictional discretion (e.g. history of being a patient in the same ward or facility during a nosocomial outbreak of 2019-nCoV).
  4. There is limited evidence on the likelihood of 2019-nCoV presenting as a co-infection with other pathogens. At this time, the identification of one causative agent should not exclude 2019-nCoV where the index of suspicion may be high.
  5. Laboratory confirmation may not be available due to no possibility of acquiring samples for laboratory testing of 2019-nCoV.
  6. Inconclusive is defined as a positive test on a single real-time PCR target or a positive test with an assay that has limited performance data available.
  7. Laboratory tests are evolving for this emerging pathogen, and laboratory testing recommendations will change accordingly as new assays are developed and validated.

After PHO has identified a presumptive confirmed case, the sample will be sent to the NML for confirmation. In Canada, laboratory confirmation of infection with 2019-nCoV virus is done by the NML. Laboratory confirmation of infection with 2019-nCoV consists of positive real-time PCR on at least two specific genomic targets or a single positive target with sequencing AND confirmed by NML by nucleic acid testing.

Screening

The Ministry of Health (ministry) recommends that health care settings (acute care) continue to implement routine case finding/surveillance methods to identify individuals with acute respiratory infection, as per the Provincial Infectious Disease Advisory Committee's (PIDAC's) Annex B: Prevention of Transmission of Acute Respiratory Infection in all Health Care Settings. This activity - routine across the health system - is foundational to strong surveillance practices for 2019-nCoV.

Depending on the type of health setting, routine case finding/surveillance methods include passive and/or active methods.

Health care workers should follow appropriate occupational health & safety and infection prevention & control measures for individuals who fail the passive and/or active screening process.

Occupational Health & Safety and Infection Prevention & Control

At this time, consistent with the guidance in place for MERS-CoV, the ministry is recommending the following for acute care settings. Please note that the ministry is reviewing guidance for other settings and will provide further updates in the coming days.

The ministry recommends the use of Routine Practices and Additional Precautions (Contact, Droplet, Airborne). Place patient in a single room, preferably with negative pressure. Use N95 respirator for aerosol generating procedures including specimen collections. Health care workers at risk of exposure to a confirmed case, presumptive confirmed case, probable case or person under investigation (or PUI) and/or the patient's environment are to follow these precautions:

  • hand hygiene
  • use of airborne infection isolation rooms when possible
  • masking the patient with a surgical mask when outside of an airborne isolation room
  • use of gloves, gowns, fit-tested, seal-checked N95 respirators and eye protection by health care workers when entering the same room as the patient or when transporting or caring for the patient

For more information on Routine Practices and Additional Precautions, health care workers should refer to (PIDAC's) Routine Practices and Additional Precautions in All Health Care Settings and Annex B: Prevention of Transmission of Acute Respiratory Infection in all Health Care Settings.

The use of Airborne Precautions is a higher level of precaution than is being recommended by the Public Health Agency of Canada or the World Health Organization (WHO), or that is normally recommended for coronaviruses. The ministry is recommending that health care workers apply Airborne Precautions based on the application of the precautionary principle to this novel virus for which little information about transmission and clinical severity is available. These recommendations may change as more information is known about this virus.

Assessment

Health care workers should assess patients who have acute respiratory infection to determine if they meet any of the criteria of the PUI case definition for 2019-nCoV in addition to considering/testing for other common respiratory pathogens.

Health care workers considering the need to test a patient for 2019-nCoV should contact PHO's Customer Service Centre at 416-235-6556/ 1-877-604-4567 for advice and support. PHO may approve testing for 2019-nCoV in patients who do not fit the criteria in the PUI case definition. Requesting physicians should discuss the case with the on-call medical microbiologist at PHO.

Laboratory Testing

PHO conducts laboratory testing for 2019-nCoV. Health care workers should review PHO's Test Information Sheet for Novel Coronavirus (2019-nCoV) for more information on laboratory testing. As noted above, PHO Customer Service Centre should be contacted if 2019-nCoV testing is being considered (416-235-6556/ 1-877-604-4567).

Health care workers are to wear PPE including N95 respirator when obtaining specimens that may generate aerosols.

Reporting

Health care workers should contact their local public health unit to report a confirmed case, presumptive confirmed case, probable case or PUI.

Treatment

Medical care is supportive; there are no specific treatments targeting this virus. Health care workers should manage patients with 2019-nCoV based on their clinical presentation. Patients who do not require admission for clinical care may be discharged with instructions to isolate; this includes PUIs who are awaiting 2019-nCoV test results. For patients who are discharged, health care workers should work with their public health unit to make arrangements for clinical and public health follow-up.

The ministry has developed a fact sheet entitled Preventing 2019-nCoV from Spreading to Others in Homes and Communities to support health care workers to provide guidance and information for PUIs, probable cases, and confirmed cases who are discharged to be cared for at home. The fact sheet will be available in other languages shortly.

Case and Contact Management

Public health units may refer to novel coronavirus in Ontario  [document forthcoming] for guidance on conducting case and contact management for a confirmed, presumptive confirmed or probable case of 2019-nCoV, as well as PUIs who are close contacts of a presumptive confirmed, confirmed or probable case.

Further Information

For more information, call the ministry's Health Care Provider Hotline at 1-866-212-2272.

This information does not relieve employers from their legislated obligations.

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For More Information

Ministry of Health
Health System Emergency Management Branch
1075 Bay Street, Suite 810
Toronto, Ontario
Canada M5S 2B1
Fax : 416-212-4466
TTY : 1-800-387-5559
E-mail : emergencymanagement.moh@ontario.ca

 

Health workers and health sector employers can call the Healthcare Provider Hotline for more information
Toll free : 1-866-212-2272

CritiCall Ontario provides a 24 hour call centre for hospitals to contact on-call specialists; arrange for appropriate hospital bed access and facilitate urgent triage for patients
1-800-668-4357

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