Annexes - CDS/DM Directive on DND/CAF Operating and Reconstituting in a Persistent COVID-19 Environment

Annex A – Glossary – Lexicon

1. Close Contact. Exposure to an infected person (laboratory-confirmed or a clinical diagnosis) for a cumulative total of 15 minutes or more over a 24-hour period, without respecting PHMs (physical distancing of at least two metres and mask wearing).
2. Cluster. A group of COVID-19 cases identified as being closely linked in time or space through a specific event, location, or common exposure.
3. Cohort. Groups that are sub-divided (into cohorts) to simplify contact tracing or to reduce potential transmission of an infection.
4. Contact. Someone who has had contact with a COVID-19 case during the infectious period.
5. Contact Tracing. Contact-tracing (CT) for the DT will be performed to interrupt ongoing transmission and reduce the spread of an infection such as COVID-19. It alerts contacts to the possibility of infection, provides an opportunity for education, and determines what additional PHMs need to be taken to limit the transmission of COVID-19:
   1. CT of DT members is normally performed by local public health authorities; and
   2. If authorized by the MND, and only to the extent authorized by MND, the CAF may perform CT for DND employees, other Government of Canada (GC) employees, and CFMWS employees who are part of the DT. This would only happen in an OUTCAN/deployed situation.
6. Contact Tracer. A member of the Health Services team who has been trained to conduct interviews and follow up with COVID-19 Cases and Contacts.
7. COVID-19. COVID-19 is the clinical symptomatic disease caused by the SARS COV-2 virus.
8. COVID-19 Case. A person with a confirmed diagnosis of COVID-19 identified by a positive test result. Prior to receiving the results of testing, a person who is thought to have COVID-19 may be considered a “probable case.” A probable case will be treated as a COVID-19 case.
9. COVID-19 Protective Zones. The following zones will categorize exposure risk and help DND/CAF establish appropriate Public Health Measures (PHMs) and Personal Protective Equipment (PPE) priorities for DT members based on your work environment:
   1. Home Zone. Place of duty is at home or in quarantine;
   2. PHM Zone. Duties and work environments, where two metre physical distancing can be maintained;
   3. PHM Zone – Enhanced. Duties and work environments where two metre physical distancing cannot be maintained;
   4. PPE Zone. Duties and work environment that involves coming in contact with known COVID-19 infected or symptomatic individuals, their belongings or environment; and
   5. PPE Zone – Medical. Healthcare providers and first responders who provide patient care to known COVID-19 infected or symptomatic individuals.
10. Domestic Travel. Travel within the boundaries in the country of duty.
11. Isolation. A preventive measure against the spread of an infectious disease involving the separation of an infected person from non-infected people during the communicable period of the disease.
12. Layered Risk Mitigation Strategy. Layered Risk Mitigation is a strategy to reduce the risk of COVID-19 Cases from infecting a DND/CAF group by applying a number of risk reduction tools. This always begins with PHMs but includes additional tools such as screening questionnaires, quarantine, operational testing, rapid antigen detection tests, masks, contact tracing, and the sequestering of forces. Each layer in the strategy reduces risk in an attempt to minimize the chance of an infected person adversely affecting a mission and limiting the impact if they do.
13. Non-Medical Mask. A non-medical mask is a mask that fully covers the nose and mouth to prevent respiratory droplets from contaminating people or things in the immediate vicinity of the wearer. The wearing of a non-medical mask is considered a PHM that will protect others from you in the course of your normal activities.
14. Onboarding. The action or process of integrating a new employee into an organization.
15. Operational Testing. Operational testing refers to any testing of asymptomatic individuals for COVID-19 that is not required for clinical reasons, including but not limited to, deployments, taskings, or as part of an alternate quarantine protocol. For the purposes of this directive, operational testing is considered separate from Rapid Antigen Detection Testing.
16. Outbreak. An epidemic limited to a localized increase in the incidence of a disease.
17. Polymerase Chain Reaction (PCR) Testing. A polymerase chain reaction (PCR) test is performed to detect genetic material from a specific organism, such as a virus. The test detects the presence of a virus if you are infected at the time of the test. A PCR test for COVID-19 is used to diagnose people who are currently infected with SARS-CoV-2, the coronavirus that causes COVID-19. The PCR test is the “gold standard” test for diagnosing COVID-19 because it is the most accurate and reliable test and is the most common type of test required for crossing of borders and for confirmation of diagnosis of COVID-19.
18. Personal Protective Equipment (PPE). All PPE referred to throughout this directive is related to the use of PPE in the COVID-19 context. There are two categories of PPE: medical-grade PPE and non-medical PPE. The wearing of non-medical PPE is considered a PHM that will help protect the wearer as well as other people from COVID-19. Medical-grade PPE is for the sole purpose of protecting the wearer from infection when performing higher risk healthcare tasks. Medical-grade PPE is used in conjunction with PHMs. Users of medical-grade PPE are normally restricted to members on operations, first responders and health care workers where specific guidance on its allocation and use is already provided in separate policies, directives, and orders. Medical-grade PPE includes equipment such as: surgical and N95 masks, eye protection, face shields, gloves, and gowns. Medical-grade PPE will not be issued to the majority of DT personnel.
19. Physical Distancing. This means making changes in your everyday routines in order to minimize close contact with others, including keeping a distance of at least 2 arms lengths (approximately 2 metres) from others, as much as possible.
20. Prevalence. This refers to an epidemiological concept of the frequency of an exposure or an outcome such as the number of cases of an infection that is occurring in a defined population of individuals/people at one point in time (point prevalence) or within a specified period of time (period prevalence).
21. Public Health Measures (PHMs). PHMs are behaviours, actions, or the wearing of non-medical equipment which may help reduce the risk of transmission of infectious diseases. Some PHMs provide limited protection from others, but their most important feature is they protect others from you in the course of your duties in the DND/CAF workplace and in the community. Judicious application of PHMs is all that is needed for most members of the DT and should be the default for all settings.
22. Quarantine. A measure to prevent the spread of an infectious disease in which a healthy person who may have been in contact with an infected person is separated from others for the during the incubation period of the disease. This type of quarantine must be distinguished from quarantine that applies to travellers returning from abroad and is imposed under the Quarantine Act, and constitutionally is within the exclusive authority of the federal government.
23. Rapid Antigen Detection Testing (RADT). A rapid antigen detection test (RADT) is test suitable for point-of-care diagnostic testing. It detects the presence of proteins (antigens) expressed by the virus, bacteria, or parasite for which the test has been specifically designed. If the target antigen is present in sufficient concentrations in the sample, it will bind to specific antibodies fixed to a paper strip enclosed in a plastic casing and generate a visually detectable signal, typically within 30 minutes. RADT for the COVID-19 virus requires a sample from the respiratory tract of a person.
24. Re-onboarding. Occurs in the context of bringing people back into the workplace or into the work environment with potentially different/redefined expectations or requirements.
25. Resurgence. A clear and sharp increase in the number of COVID-19 cases that occur in a specific geographic location, which has experienced a peak and a subsequent plateau or decline. Resurgences can arise from the sum of multiple clusters.
26. Self-Isolation. This is the term that has been used in CAF orders and DND direction throughout the early months of the COVID-19 response, but is to be replaced with the term quarantine going forward.
27. Sequester. Separation of a Cohort of asymptomatic CAF members/DND employees from their friends, families and other members of the DT. Used for the purpose of reducing the potential spread of COVID-19 from the communities in which they live or work into the DND/CAF Cohort or Training Establishment, for the duration of the sequestration.
28. Wave. An uncontrolled spread of cases in multiple geographic locations, which have experienced a peak and a subsequent plateau or decline in cases. A wave is distinguished from a resurgence or cluster by its extensive involvement across multiple regional jurisdictions and prolonged period (weeks to months) of transmission, and may arise from a resurgence.

Annex B – PHM Qualitative Comparison Framework

PHM	Most effective (++++)	More effective (+++)	Effective (++)	Less effective (+)	Least effective
Vaccination - boosters	Fully vaccinated + booster		Fully vaccinated w/o booster	Partially vaccinated	Unvaccinated
Ventilation	Outdoor with good airflow	Indoor - open windows/doors with optimized HVACFootnote *	Indoor – with optimized HVACFootnote *	Indoor – open windows/doors w/o optimized HVACFootnote *	Indoor – poor air exchange
Quarantine	Perfect quarantine x 14 days	Perfect quarantine x 10 days	Perfect quarantine x 7 days	Imperfect quarantine	No quarantine
Cohorting	Individual	Small group	Large group – no mixing	Large group – some mixing	No cohorting
Testing (asymptomatic)Footnote **	PCR – lab-based	Other molecular tests	Rapid antigen Testing - repeated	Rapid antigen Testing x 1	No testing
Physical Distancing	At least 2 m distancing		At least 1 m distancing		No intentional distancing
Masking	Fit-test N95 Respirator	Medical Mask	Non-Medical Mask (snug- fit)	Non-Medical Mask (poor- fit)	No masking
Isolation	10 day isolation	7 day isolation, then mask for 10 days total	5 day isolation, then mask for 10 days total	Masking for asymptomatic; symptomatic isolation until symptoms resolve	Masking only
Notes: PHMs across each row is intended to illustrate the order of relative effectiveness of each variation. PHMs down each column should not be interpreted as being of equivalent effectiveness. This information is presented as a qualitative reference. Footnote * Consult RP Ops to confirm HVAC status. Where ventilation is confirmed to be suboptimal and unable to be improved through the existing HVAC system, additional air purifiers may be considered following a risk assessment in consultation with the SMA and RP Ops Return to footnote * referrer Footnote ** Type and frequency of testing is context specific. In general, 1-2 RADT/wk could be indicated in lower risk settings; 2-3 RADT/wk could be indicated in higher risk situations. Return to footnote ** referrer

Annex C – Mask Framework

Risk Matrix: Mask Considerations in Example Settings

Mask Type	Example Setting
	Standard/ community or office setting, 2-m spacing possible, good ventilation	Closed meeting rooms or classrooms where distancing/ ventillation/ other control measures are adequate; consider time spent in this setting	Meeting rooms or classroms where distancing/ ventillation/ other control measures may not be adequate; consider time spent in this setting	Clinical patient care (worn by health care provider)
Non-medical mask (NMM), 3-layer	Appropriate	Appropriate	Consider additional mitigation levels	Not appropriate
Medical/ disposable/ surgical mask	Consider	Consider	Consider based on the length of time in the setting, and what other risk control measures are possible	Appropriate in some health care settings; facility and situation dependent
NMM over medical mask	Consider	Consider	Consider based on the length of time in the setting, and what other risk control measures are possible	Increased risk depending on additional mitigation measures
N95 non-medical, KN95 or FFP2	Unlikely to be necessary	Unlikely to be necessary	Consider if unable to implement other control measures	Possible use in lower-risk clinical settings; facility-dependent
Fit-tested N95, medical	N/A	N/A	N/A	Appropriate
The most effective mask is a mask that is worn properly – especially when speaking Masking is only one step in the layered risk mitigation strategy 3-layer cloth masks are the standard recommendation and acceptable for all settings except clinical care; chain of command may choose different mask types as setting risk increases

Mask Types

Annex D – RADT Framework

COVID-19 Rapid Antigen Detection Testing Risk Matrix Assessment

Factor	Risk
	Less effective (+)	Effective (++)	More effective (+++)	Most effective (++++)
Ability to maintain other PHMs: e.g. Distancing, mask use, vaccination status,	No constraints on other PHMs E.g. DT members who are present in the workplace; however, follow all other PHMs and have minimal to no contact with other workers	PHMs constrained but reliable E.g. DT members whose work require them to physically work with others	System level PHMs unreliable but individual PHMs remain in place E.g. DT members who are constrained to work in close proximity and cannot maintain safe physical distancing due to their work environment	System and individual level PHMs unreliable E.g. DT members whose essential duties preclude individual PHMs such as masking
Type of Work Environment	DT members who can fully work from home DT members who interact with vaccinated personnel or regularly tested personnel	DT members who have controlled interactions with population of unknown status	DT members who primarily interact with the public DT members involved in congregate living facilities	DT members at risk of actual or likely exposure to cases, where mitigation measures are unreliable DT members in close proximity to a work cluster.
Possible RADT strategy	Unlikely to be necessary	Unlikely to be necessary	Consider in concert L1 Gen Safety sections, ADM (HR-Civ) and their SMA. Site and unit selection should be prioritized in terms of mission risk and criticality and limited to those sites and situations where: the diminished ability to fully implement PHMs is resulting in exceedingly high levels of risks to the mission. Evidence suggests that existing PHMs may be less effective and create undue risk to personnel.	Consider in concert L1 Gen Safety sections, ADM (HR-Civ) and their SMA. Site and unit selection should be prioritized in terms of mission risk and criticality and limited to those sites and situations which will best benefit from the implementation of the test capability. Cluster response testing should be considered under the advice of CFHS/local SMA.

RADT Kit Request Process

• Requests for RADT’s for CFHS clinics and deployed Ops requirements will go through existing medical supply request process. These are considered “clinical requests”
• For all other non-clinical requests, irrespective of their use (high-risk settings, large-scale operational testing, accommodated individuals (approved/pending), in between vaccine doses, etc.), will follow the new process detailed below.
• All non-clinical RADT requests must capture the following:
  1. Number of tests (individuals tests, not boxes) requested for a 30 day period.
  2. Rationale for testing requirements (essential workers unable to perform duties from home and in a high risk environment, outbreak prevention in training environment, etc.).
  3. Outline of testing protocol (voluntary, mandatory, frequency, at work/controlled or self-tested at home).
  4. Confirmation that testing request and protocol has been reviewed by SMA/OHS Rep and name of this POC.
  5. Local POC for receipt of test kits.
• Requests can be made by SMA, OHS Rep at Formation/Base/Wing or L1/Command Rep.
• Requests sent to : +D Safe G Rapid Test Kits – Trousse de test rapide DSG@VCDS D Safe G@Ottawa-Hull
• Once request is received, RADT Requirements Committee (SJS/DHSO/D Safe G) will assess the requirement, supply availability and confirm release of tests.
• VCDS/D Safe G will act as the release authority to CJOC for movement of test kits; requestor informed of decision.

Annex E – Travel Testing Framework

COVID-19 Travel Testing Decision Tool

Applicable to most individual and small group travel (<10)

Common to all

Perform self screen before departure^{Footnote *} DO NOT TRAVEL IF SICK Adhere to PHM’s throughout your travel