The Regional Municipality Of York

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COVID-19 Information for Health Professionals

York Region Public Health continues to provide support for health professionals related to COVID-19. The York Region Public Health phone line for health care professionals 1-877-464-9675 ext. 77280 is staffed from 8:30a.m. to 8:00 p.m., seven days a week and is provided for health care providers to ensure your inquiries can be answered quickly. After this time you may leave a message and our staff will respond on the following day.

Assessment Centres in York Region

Mackenzie Health, Southlake Regional Health Centre and Markham-Stouffville Hospital have opened their own COVID-19 Assessment Centres, located in or adjacent to each of the respective hospitals. COVID-19 Assessment Centres facilitate testing for individuals with symptoms of COVID-19 or anyone who feels they might have been exposed to COVID-19. These COVID-19 Assessment Centres allow local hospital emergency departments to focus on treating people who are critically ill and have life-threatening illnesses or injuries.

Patients who are not experiencing symptoms, but may have been exposed to a case of COVID-19 or are concerned about exposure to COVID-19, can go to a COVID-19 Assessment Centre to be tested.

Please note: testing criteria for assessment centres and the case definition may change.

York Region Public Health offices do not provide COVID-19 testing.

For current information regarding the status of positive cases identified in York Region, refer to york.ca/covid19data.

York Region Public Health continues to collaborate with local hospitals and health care providers, emergency services, COVID-19 Assessment Centres and other partner agencies to ensure prompt reporting and follow up of individuals who may require testing or have tested positive for COVID-19.


Alert:

Health Canada is asking health professionals to avoid prescribing or dispensing larger supplies of medication than necessary, unless there is a specific medical reason to do so as increasing demand can lead to local shortages.

Consider talking to your patients about plans for serious illness and end-of-life care options. Please see this resource from the Public Health Agency of Canada to assist.

Please update your College of Physicians and Surgeons of Ontario (CPSO) address and fax number to ensure you are receiving all ENS messaging as it relates to COVID-19.

You can also reach out to surveillance@york.ca if you continue to experience issues receiving ENS updates.


For Health Professionals


Sector-Specific Guidance Documents

Health care settings are being requested to conduct passive and active screening, as detailed in the following guidance documents for:

We are available 24/7 for health care providers. Call our dedicated COVID-19 line for health professionals at 1-877-464-9675 ext. 77280 between 8:30 a.m. and 8:00 p.m., seven days a week. After hours call 905-953-6478.

Review the updated case definition from the Ministry. Updates to the case definition are likely to be ongoing given the evolving evidence. We suggest checking this link regularly as the situation and case definition evolves.

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Infection Prevention and Control (IPAC) Recommendations

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Important Information to Gather from Suspect Cases

Please collect the following information from anyone you believe may meet the COVID-19 case definition to help with an assessment:

  • Signs, symptoms, onset and your clinical assessment
  • Travel details if applicable (dates and exact location(s) of travel and date of return to Canada)
  • Full patient demographics (including phone number)
  • Confirmation of infection prevention and control measures put in place following assessment and testing for COVID-19 (if testing was carried out)
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Testing for COVID-19

Who should be tested for COVID-19?

Testing for COVID-19 should be based on clinical assessment, and not based on the case definition. At this time, there are no criteria for testing and all specimens will be tested if submitted to PHOL.

Updated provincial guidance on testing was provided on June 2, 2020.

Symptomatic testing:

1. All people with at least one symptom of COVID-19, even for mild symptoms.

Asymptomatic, risk-based testing:

2. People who are concerned that they have been exposed to COVID-19. This includes people who are contacts of or may have been exposed to a confirmed or suspected case.

3. People who are at risk of exposure to COVID-19 through their employment, including essential workers (e.g., health care workers, grocery store employees, food processing plants).

  •  No Ontarian who is symptomatic or who is concerned they have been exposed to COVID-19 will be declined a test at an Assessment Centre (either through appointment or walk-in, per the processes of each individual Assessment Centre) 
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Children and COVID-19

Epidemiology

Though rare, paediatric cases of COVID-19 have been reported. However, there are relatively fewer cases of COVID-19 among children compared to cases among adult patients.


Clinical disease presentation and severity

Consistent with prior data, reports continue to indicate that children have mild disease compared with adults. However, there are reports of severe disease in children. Paediatric patients with COVID-19 may experience the following signs or symptoms based on illness severity, as identified by the Canadian Paediatric Society:

Mild Disease

  • Asymptomatic infection or upper respiratory tract symptoms (e.g., pharyngeal congestion, sore throat, or fever) for a short period (i.e., less than 7 days)
  • No oxygen support required
  • No abnormal radiographs or evidence of sepsis

Moderate Disease

  • Fever, cough, fatigue, headache, vomiting, diarrhea, abdominal pain, myalgia, anosmia (loss of smell) or ageusia (loss of taste)
  • Signs of increased work of breathing and increased respiratory rate, but no hypoxemia (no oxygen required)
  • Pneumonia on chest x-ray
  • No evidence of sepsis

Severe Disease

  • Respiratory distress or organ dysfunction, such as
    • Tachypnea
    • Hypoxemia
    • Cardiovascular effects (e.g., myocardial injury)
    • Central nervous system effects (e.g., decreased level of consciousness, depression, seizures, or coma)
    • Gastrointestinal effects (e.g., dehydration, difficulty feeding, elevated liver enzymes)
    • Coagulation dysfunction, rhabdomyolysis, or other vital organ dysfunction

Acute Inflammatory Syndrome in Children

An acute inflammatory illness has recently been reported in a small number of children worldwide, thought to be associated with COVID-19. Clinical presentations include persistent fever and features suggestive of Kawasaki disease (complete or incomplete), toxic shock-like syndrome, euvolemic shock states and severe gastrointestinal illness. Severe myocardial dysfunction and multiple organ failure have also been reported. While rare, clinicians should be aware of this potential syndrome and maintain a high index of suspicion to identify cases. No Kawasaki-like disease has been reported in York Region. For more information, please see the Public Alert from the Canadian Paediatric Surveillance Program.


Disease transmission in children

Person-to-person spread was demonstrated very early in this pandemic and has been well described in children. Contact tracing in various countries has determined that the major risk factor for acquiring COVID-19 infection in childhood is currently household exposure.


Managing children and youth infected with symptomatic COVID-19

No treatment for COVID-19 is proven to be effective at the present time. Treatment remains largely supportive and includes prevention and management of complications. Several Canadian universities, research centres and medical organizations have recommended against use of off-label, investigational therapies and antivirals, outside of clinical trials to treat COVID-19. Hospitalized paediatric patients may soon have the opportunity to participate in clinical trials, which are beginning to evaluate antivirals and convalescent plasma, such as the trial being conducted by the Canadian Blood Services.


Surveillance

The Canadian Paediatric Surveillance Program is currently performing a study on COVID-19-related conditions, such as paediatric inflammatory multisystem syndrome (Kawasaki Disease like syndrome) as well as cutaneous manifestations. Please report any COVID-19-related symptoms observed within patients to the Canadian Paediatric Surveillance Program.


Immunization

While COVID-19 is currently a primary focus for health care providers, there are vaccine preventable diseases that still pose a risk to the York Region community. On April 20, 2020, Ontario's Ministry of Health issued Guidance for Immunization Service Providers during COVID-19. The guidance indicates that routine immunization services should still be provided, as long as proper infection prevention and control measures are in place. Please see York Region Public Health’s message on Interim Guidance issued by the National Advisory Committee on Immunization (NACI).


Facial coverings

The Public Health Agency of Canada recommends that individuals wear non-medical face coverings for periods of time when physical distancing is not possible, such as when in public spaces. When discussing the use of face coverings with parents, the following considerations should be discussed:

  • Non-medical face coverings should never be placed on a child under the age of 2, or those individuals who have trouble breathing
  • Facial coverings work best when used in correlation with other public health measures, such as physical distancing, hand hygiene, and respiratory etiquette. These actions should continue, even when wearing a mask
  • While face coverings do help to protect the person wearing it, they provide the most benefit to others in case the mask-wearer is pre-symptomatic or asymptomatic
  • Hand hygiene should always be performed before putting on and after taking off a mask
  • Face coverings should never be shared between individuals. They should be changed as soon as possible if damp or dirty
  • Reusable face coverings should be washed after every use. Disposable masks should only be used once and be placed in the proper disposal unit after use

Links

Canadian Paediatric Society - Update on COVID-19
Canadian Paediatric Surveillance Program – Public Health Alert Acute Inflammatory Illness
Centre for Disease Control - Information for Paediatric Healthcare Providers
European Centre for Disease Prevention and Control – Rapid Risk Assessment

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Recommendations for Isolation

Criteria for when to discharge someone from isolation after being diagnosed with COVID-19

For each of the scenarios below, isolation after symptom onset should be for the duration specified and provided that the individual is afebrile and symptoms are improving. Absence of cough is not required for those known to have chronic cough or who are experiencing reactive airways post-infection. Once a case is discharged from isolation, their case status should be updated to 'resolved'.

Non Test-based Approach: Waiting 14 days from symptom onset (or 14 days from when swab was taken if persistently asymptomatic)

  • All cases may be cleared by a non-test based approach
  • Can discontinue isolation at 14 days after symptom onset (or 14 days from positive test collection date if never had symptoms), provided that the individual is afebrile and symptoms are improving for at least 72 hours. Absence of cough is not required for those known to have chronic cough or who are experiencing reactive airways post-infection.

Test Based Approach: Two consecutive negative specimens collected at least 24 hours apart

  • Not routinely recommended, but may be used at the discretion of a hospital to discontinue precautions for admitted patients
  • Continue isolation until 2 consecutive negative specimens collected at least 24 hours apart.
    • Testing for clearance testing may begin after the individual has become afebrile and symptoms are improving for at least 24 hours. Absence of cough is not required for those known to have chronic cough or who are experiencing reactive airways post-infection.
    • If swab remains positive, test again in approximately 3-4 days. If swab is negative, re-test in 1-2 days (and at least 24 hours apart).
    • Tick the box labelled ‘For clearance of disease’ on the PHO Laboratory COVID-19 Test Requisition, or clearly write this on the requisition if submitting to another laboratory.

Health care workers:

  • Health care workers (HCWs) should follow isolation and clearance with a non-test based approach (14 days following symptom onset) unless they have required hospitalization during the course of their illness, in which case a test-based approach is preferred (2 consecutive negative specimens collected at least 24 hours apart).
  • Some HCWs may be directed to have test based clearance by their employer/Occupational Health and Safety.
  • Symptomatic HCWs awaiting testing results must be off work
  • Asymptomatic HCWs awaiting testing results may continue to work using the appropriate precautions recommended by the facility, which will depend on the reason for testing
  • In exceptional circumstances where clinical care would be severely compromised without additional staffing, an earlier return to work of a COVID-19 positive HCW may be considered under work self-isolation recognizing staff still may be infectious.


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Past Communications from York Region Public Health

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Resources

External Resources for Health Professionals

Access to Personal Protective Equipment (PPE)

On March 28, the Ministry of Health provided a Minister’s Order that requires health care provider organizations to provide information related to their PPE inventories to Ontario Health on a daily basis. The Ministry of Health memo outlines a process for organizations to request supply and equipment requests.

Support accessing PPE can be obtained through the province at: Ontario.ca/PPE

Resources for Patients in Different Languages


 


York Region,Public Health,support,health professionals,novel,coronavirus COVID-19 The Regional Municipality of York en-US Novel Coronavirus COVID-19 Information for Health Professionals York Region Public Health continues to provide support for health professionals related to COVID-19 (formerly referred to as novel coronavirus or 2019-nCoV)

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