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 8:30 a.m. to 4:30 p.m., Monday to Friday, and is provided for health care providers to ensure your inquiries can be answered quickly. Messages received over the weekend will be responded to as soon as possible, in the order they were received and based on urgency the next business day. Urgent inquiries will be triaged to our after-hours line through our Answering Service.

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. Mackenzie Health has opened an additional Assessment Centre located at 9401 Jane Street in the City of Vaughan. 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.

Testing is available for anyone:

  • Showing COVID-19 symptoms
  • Exposed to a confirmed case of COVID-19, as informed by York Region Public Health or an exposure notification through the COVID Alert app
  • Who lives or works in a setting that has a COVID-19 outbreak
  • Eligible for testing as part of a targeted testing initiative directed by the Ministry of Health or the Ministry of Long-Term Care

As of Sunday, October 4, 2020, COVID-19 Assessment Centres will discontinue walk-in testing services. Beginning, Tuesday, October 6, 2020, you must make an appointment at a COVID-19 Assessment Centre.

Asymptomatic patients that do not meet the criteria above can get tested for COVID-19 at select pharmacies. To find the closest pharmacy or assessment centre, please visit Ontario.ca/covidtest

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

For up-to-date guidance and requirements for your health sector with respect to screening, infection prevention and control measures, personal protective equipment, and other sector-specific needs, visit the Ministry of Health COVID-19 Guidance for the Health Sector page.

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 4:30 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 is available for anyone:

  • Showing COVID-19 symptoms
  • Exposed to a confirmed case of COVID-19, as informed by York Region Public Health or an exposure notification through the COVID Alert app
  • Who lives or works in a setting that has a COVID-19 outbreak
  • Eligible for testing as part of a targeted testing initiative directed by the Ministry of Health or the Ministry of Long-Term Care

Asymptomatic patients that do not meet the criteria above can get tested for COVID-19 at select pharmacies. To find the closest pharmacy or assessment centre, please visit Ontario.ca/covidtest

For an up-to-date list of symptoms, refer to the Ministry of Health’s COVID-19 Reference Document for Symptoms.

For up-to-date testing guidelines, refer to the Ministry of Health’s COVID-19 Provincial Testing Guidance Update.

Clinicians should continue to use their clinical judgement during patient assessment and test facilitation, considering local epidemiology and exposure risks.

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Children and COVID-19

Epidemiology

Locally, cases are rising in children aged 0-19 years. Visit york.ca/covid19data to access up-to-date interactive data from York Region. 


Clinical disease presentation and severity

Parents may request your support in interpreting symptoms based on the Ontario COVID-19 Screening Tool for Children in School and Child Care. 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

Critical illness

  • Respiratory failure requiring mechanical ventilation (acute respiratory distress syndrome (ARDS), persistent hypoxemia)
  • Septic shock
  • Organ failure requiring invasive monitoring and mechanical ventilation
    • Myocardial injury/heart failure
    • Liver injury/coagulation dysfunction
    • Kidney injury

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.

For more information on the management of a child with COVID-19, options include:

  • Contact the Pediatrics Department at your local hospital
  • Page Pediatric Infectious Diseases at the Hospital for Sick Children
  • And/or send a referral to the Hospital for Sick Children’s virtual COVID clinic (Infectious Diseases rapid access clinic) through EpicCare Link

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 August 25, 2020, Ontario's Ministry of Health issued Guidance for Immunization Services 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

It is now mandatory to wear a non-medical mask or facial covering in all indoor public spaces in York Region such as businesses, facilities and workplaces, with limited exemptions, including corrections and developmental services. It is also recommended by York Region Public Health to wear a non-medical mask or facial covering when physical distancing with people outside of your household/social bubble is not possible. School aged children from Grades 4 and up must wear a non-medical mask or face covering while in class at school and school-aged children from Grade 3 and under are strongly encouraged to wear a non-medical mask or face covering while in class at school. 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 on 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

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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 (without the use of fever-reducing medication) 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. Once a case is discharged from isolation, their case status should be updated to 'resolved'.

In general, a time-based approach is taken and only in some scenarios can a test-based approach be considered. All cases may be cleared using a time-based approach.

Note: Contacts who have had an exposure to a case must still self-isolate for 14 days from their last exposure. This is based on the incubation period which has not been changed provincially. While 10 days applies to clearance of cases as outlined below, 14 days applies to contacts self-isolating after an exposure.

Non test-based approach for mild and moderate illness with no severe immune compromise:

  • Can discontinue isolation after 10 days from symptom onset (or 10 days from positive test collection date if never had symptoms), provided that the individual is afebrile (without the use of fever-reducing medications) 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
  • Mild to moderate illness includes the majority of cases of COVID-19, and includes all those who do not meet the definition of severe illness or severe immune compromise (below)

Non test based approach for severe illness (requiring ICU level of care) OR severe immune compromise (regardless of symptoms and their severity):

  • Can discontinue isolation 20 days from symptom onset (or 20 days from positive test collection date if asymptomatic and severe immune compromise), provided that the individual is afebrile (without the use of fever-reducing medications) 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
  • Studies informing this approach did not have a consistent definition of severe illness or severe immune compromise. For the purposes of a clearance assessment:
    • Severe illness is defined as requiring ICU level of care for COVID-19 illness (e.g., respiratory dysfunction, hypoxia, shock and/or multi-system organ dysfunction)
    • Examples of severe immune compromise include cancer chemotherapy, untreated HIV infection with CD4 T lymphocyte count <200, combined primary immunodeficiency disorder, taking prednisone >20 mg/day for more than 14 days and taking other immune suppressive medications
    • Factors such as advanced age, diabetes and end-stage renal disease are generally not considered severe immune compromise impacting non-test based clearance

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 tested by a nucleic acid amplification test (NAAT) and collected at least 24 hours apart
  • Testing for clearance 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 to 4 days. If swab is negative, re-test in 1 to 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
  • Serological testing cannot be used for test based clearance
  • Test based clearance should not be used in an attempt to reduce the length of isolation

Health care workers:

  • Health care workers (HCWs) should follow isolation and clearance with a non-test based approach (10 days following symptom onset) unless they have required hospitalization during the course of their illness, in which case a test-based approach may be used at the discretion of the hospital while they are admitted
  • 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
  • Contact York Region Public Health at 1-877-464-9675 ext. 77280 if additional information is required

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Past Communications from York Region Public Health

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Community Health Care Provider Webinars

York Region Public Health hosts interactive webinars with community-based health care providers to provide updates on COVID-19. To receive an invitation or submit questions for future webinars, please subscribe to York Region’s Public Health Matters.

COVID-19 Briefing: September 23, 2020

Hosted by Dr. Alanna Fitzgerald-Husek and Dr. Richard Gould, Associate Medical Officers of Health, York Region Public Health

COVID-19 Briefing: August 19, 2020

Hosted by Dr. Fareen Karachiwalla, Associate Medical Officer of Health, York Region Public Health & Dr. Rebecca Shalansky, Medical Resident, York Region Public Health

Please note that this webinar was recorded prior to the release of the COVID-19 Guidance: School Outbreak Management document from the Ontario Ministry of Health. If there are any discrepancies between what was said in the video with respect to school outbreak management and the Ministry Guidance document, the Guidance document prevails.

COVID-19 Briefing: July 16, 2020

Hosted by Dr. Fareen Karachiwalla, Associate Medical Officer of Health, York Region Public Health

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Resources

External Resources for Health Professionals

Access to Personal Protective Equipment (PPE)

Ontario Health, together with the Ministry of Health, has implemented a new temporary process called Pandemic PPE Transitional Support (PPTS). This new process provides access to a dedicated supply of PPE from the provincial stockpile to all community-based physicians – both primary care providers and community-based specialists – free of charge.

Eligible practitioners can make requests through the Ontario Health Regional Online Remedy Intake Form.

In addition, the Ministry of Health requests that primary care providers and community-based specialists continue to update their PPE inventory levels twice a week. This is an eligibility requirement to receive PPE through PPTS.

For more information, see Transitional PPE Support.

Resources for Patients in Different Languages


 


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