Updated: Public health management of cases and contacts associated with COVID-19
Updated September 4, 2020
This page is continually under review and will be updated as this situation evolves. Please visit the provincial and territorial resources for COVID-19 page for updated guidance specific to your province or territory.
On this page
- Case management: confirmed, probable and suspect cases (with and without COVID-19 symptoms)
- Contact management (of probable and confirmed cases)
- Appendix 1: Instructions for isolating in the home or co-living setting
- Appendix 2: Core personal public health practices
The Public Health Agency of Canada (PHAC), in collaboration with Canadian public health experts, has developed this guidance for federal/provincial/territorial (FPT) public health authorities (PHA) to support the management of cases and contacts of COVID-19 within their jurisdictions.
The strategy outlined in this guidance is intended to focus on case and contact management to mitigate the health impacts of COVID-19 on Canadians. This guidance is set in the Canadian context and is based on the available scientific evidence and expert opinion. In interpreting and applying this guidance, it is important to recognize that the health, disability, economic, social, or other circumstances faced by some individuals and households may limit their ability to follow the recommended measures. This may necessitate adapted case management and contact responses in some situations.
COVID-19 has evolved in different ways across Canada. The FPT Special Advisory Committee has recommended a strategic approach to lifting restrictive public health measures (PHM) that can be tailored by jurisdictions based on their local circumstances. Provincial and territorial (PT) PHAs have implemented the lifting of restrictive public health measures based on the epidemiology of COVID-19 in their jurisdictions, taking into consideration other important indicators, such as the capacity of their health systems. Among the agreed upon criteria and indicators to help inform government decisions on lifting PHM is having the capacity to test, trace and isolate all cases and quarantine all contacts. This guidance is subject to change as new information on transmissibility and epidemiology becomes available. It should be read in conjunction with relevant P/T and local legislation, regulations and policies. For information regarding COVID-19, refer to outbreak updates.
Case management: Confirmed, probable and suspect cases (with and without COVID-19 symptoms)
Reporting and notification
The interim national case definitionReference 1 for COVID-19 provides surveillance case definitions for confirmed, probable and suspect cases of COVID-19, as well as associated surveillance reporting requirements.
It is important for front line health care providers to notify PHAs of any cases (for example, confirmed, probable or suspect) and individuals who have symptoms consistent with COVID-19, but do not meet the currently identified exposure criteria for infection, in accordance with jurisdictional reporting requirements. PHAs need to provide overall co-ordination with health care providers and provincial laboratories for the management of cases and to establish communication links with all involved health care providers for the full duration of illness. PHA should report confirmed and probable cases of COVID-19 nationally to PHAC within 24 hours of receipt of their own notification.
Laboratory testing strategies have evolved over time. Each PT has modified their approach (for example, who is being tested) based on factors such as new evidence, laboratory capacity and local epidemiological circumstances. Appropriate laboratory testing for COVID-19 infection should be accessible by the health care providers through community-based, hospital or reference laboratory services (for example, a provincial public health laboratory (PHL) running a validated assay, or the National Microbiology Laboratory. Laboratory testing for COVID-19 consists of detection of at least one specific gene target by a NAAT assay (for example, real-time PCR or nucleic acid sequencing). The Respiratory Virus Infections Working Group of the Canadian Public Health Laboratory Network has developed laboratory testing best practices for COVID-19 and has updated its protocol on microbiological investigation of emerging respiratory pathogens, including severe acute respiratory infections. Reference 2 Reference 3.
Clinical management of the case (whether in the home or in an acute care setting) is based on the case's condition and at the discretion of the primary health care provider. Remdesivir (Veklury) is the only drug currently authorized in Canada for treatment of cases of COVID-19. Canadian guidance on the clinical management of patients with moderate to severe COVID-19 is available.Reference 4
Health care workers providing home care for a case should follow relevant guidance developed for infection prevention and control including Routine Practices and Additional PrecautionsReference 5, and COVID-19-specific infection prevention and control (IPC) guidance.Reference 6 Any aerosol-generating medical procedures (AGMP), such as nebulized medications, should be avoided in the home environment. If an AGMP is required, consideration should be given to transferring the case to hospital due to the need for Additional Precautions.
Case management in the home and co-living settings (isolation)
Epidemiologic evidence suggests that the majority of people who develop COVID-19 have mild illness and may not require care in a hospital. Reference 7 It is important that people who do not require hospital-level care convalesce in a suitable environment where effective isolation and appropriate monitoring (for example, for worsening of illness) can be provided. Considerations for a suitable environment will depend on individual or household living situations and may vary depending on the sex, gender, or other socioeconomic or identity factors of cases. Cases should be isolated away from others in the home or co-living setting, including household members (for example, not to go out unless directed to do so to seek medical care, not to take public transportation to seek medical care and to avoid contact with others).
The location where a person will be isolated will be determined by their healthcare provider and the PHA. There are several factors to consider when determining the suitability of an isolation location:
- Ability to self-manage: Symptomatic and asymptomatic cases should be able to monitor themselves for symptoms, maintain proper personal hygiene practices (for example, hand hygiene, respiratory etiquette, clean and disinfect high-touch surfaces) and isolate away from others (See Appendix 1), which will be impacted by:
- Household social and economic circumstances such as insecurity, violence or abuse;
- Inadequate housing conditions (for example, lack of access to clean water and appropriate supplies), economic barriers (for example, inability to purchase larger quantities of needed supplies at one time, unstable employment or inflexible working conditions);
- Individual skills, abilities and vulnerabilities such as difficulty reading, speaking, understanding or communicating, physical or psychological difficulty undertaking preventive activities and using protective equipment, need for assistance with personal or medical care activities or supplies, or need for ongoing supervision. COVID-19 guidance on considerations for people with disabilities in Canada is available;
- Social or geographic isolation such as lacking family or community contacts for support Reference 8 or residing in an area with reduced access to services or supports;
- The ability for the case to access plain-language instructions in the appropriate languages on: proper personal hygiene practices, how to self-isolate away from others, how to self-monitor symptoms, and when to seek help. Note that male gender cases are more likely to live alone and may be less likely to seek help.Reference 9 Reference 10
- Household configuration: Cases will be in varying household configurations that may hinder their ability to isolate themselves. This includes single-parent households, and multi-generational households with shared child care and elder care responsibilities. It also includes situations where child care is shared between two homes. In this context, the children should remain in the household that does not have a case for the duration of the self-isolation.
- Access to care: Some circumstances may require care from a household member (for example, the case is a child). The caregiver should be willing and able to provide the necessary care and monitoring for the case.
- Clinical condition: The case's clinical condition can be managed as an outpatient and does not require hospitalization, taking into consideration their baseline health status and the presence of risk factors for severe disease or outcomes, including:
- older adults (increasing risk with each decade, especially over 60 years of age),
- people with chronic medical conditions including lung disease, heart disease, high blood pressure, diabetes, kidney disease, liver disease, or cerebrovascular disease,
- people who are immunocompromised due to an underlying medical condition (for example, cancer), or due to taking medications which lower the immune system (for example, chemotherapy), or
- people with obesity (BMI of 40 or higher).
- Suitable home environment: In the home, the case should stay in a separate room so that they can be isolated from other household members. If residing in a dormitory (for example, at a post-secondary institution) or housing that is overcrowded, the preferred option is to provide the case with a single room with a private bathroom, which may require relocating the case or household members/roommates to another location.
- For Indigenous peoples, mandatory isolation away from home due to COVID-19 may trigger re-traumatization based on the history of forced removals and there is the potential for new trauma if their ability to practice their respective cultural and/or spiritual activities is limited. To avoid relocation of cases outside of their community, many Indigenous communities have re-purposed facilities or set up temporary structures to be used as isolation sites so that community members may safely isolate in situations where their home setting is not suitable. In these circumstances, processes need to be in place for cleaning and disinfection.
- If the case is not able to self-isolate within the home, ensure that shared spaces are well ventilated (for example, windows open, as weather permits) and that there is sufficient room for other members of the home setting to maintain a two-metre distance from the case. If the case cannot be isolated in their own room, separating the case from others with dividers such as curtains is appropriate. If the ill person is sleeping in the same room as others, it is important to maintain at least 2 metres distance (for example, separate beds and have people sleep head-to-toe). If a separate bathroom is not available, the bathroom should be cleaned and disinfected frequently.
- Co-living settings (for example, university dormitories, shelters, overcrowded housing): Special consideration is needed to support cases in these settings when self-isolating. If it is not possible to provide the case with a single room and a private bathroom, or to relocate the case outside of the home, efforts should be made to cohort confirmed cases together. For example, if two cases reside in a co-living setting, and single rooms are not available, they could share a double room. Specific guidance has been developed on the considerations for people experiencing homelessness and for post-secondary institutions.
- Access to supplies and necessities: The case should have access to food, running water, drinking water, and supplies (see Supplies for the home when isolating) for the duration of isolation. Those residing in remote and isolated communities may wish to consider stockpiling the needed supplies, as well as food and medications usually taken, if it is likely that the supply chain may be interrupted or unreliable. A case who does not have access to adequate food or necessary supplies could contact local leadership, public health or organizations that provide direct support. Guidance is available for hand washing in the absence of running or clean water.
- Risk to others in the home: Household members with risk factors for severe disease or outcomes (for example, older adults, chronic medical conditions, immunocompromised, or obesity should not provide care for the case and alternative arrangements may be necessary. This could include temporarily relocating these individuals or the case outside of the home to a location determined by public health, such as a designated hotel.
- If the case is a breastfeeding mother: Considering the many health benefits of breastfeeding and that the virus has not been found in breastmilk, breastfeeding can continue. Reference 11 The mother should wear a medical mask, or if not available, a non-medical mask or cloth face covering (for example, constructed to completely cover the nose and mouth without gaping, and secured to the head by ties or ear loops) when in close contact with the baby, especially during feeding. She should also adhere to respiratory etiquette and perform hand hygiene before and after close contact with the baby.
- Never place a mask on a child under two years of age.
- Travellers entering Canada: Symptomatic people entering Canada are subject to legal orders for mandatory isolation and are not permitted to isolate in a place where they will have contact with vulnerable people. The PHAC's Chief Public Health Officer will designate a facility for travellers who do not have an appropriate place to isolate.
Instructions should be provided on self-monitoring of symptoms and when/how to seek medical care.
PHAs should encourage individuals, families and communities to create a supportive environment for people who are isolating to take care of their mental health, and minimize stress and hardship associated with isolation as the financial, social, and psychological impact can be substantial. Obtaining and maintaining public trust are key to successful implementation of these measures; clear messages about the criteria and justification for and the role and duration of isolation and ways in which persons will be supported during the isolation period will help to generate public trust. To help to build public trust, messaging should be sensitive to different support needs of populations confronting social, economic, cultural or other vulnerabilities. Additional information on the psychological impacts of COVID-19 is available.
Public health monitoring of cases
It is recommended that PHAs provide active daily monitoring of cases (confirmed, probable and suspect) as long as feasible based on available resources. The parameters of active daily monitoring will vary by PHA, but generally should include:
- providing public health instructions to the case and household/ co-living setting contacts on public health measures including self-monitoring, infection prevention and control, and environmental cleaning of the home setting,
- daily contact with the case for symptom monitoring, to assess for symptom resolution, or to assess for progression of illness,
- Appendix 1: Instructions for isolating a case in the home or co-living setting provides specific advice.
It is recommended that cases be monitored until they have met the criteria set by the PHA for discontinuing isolation.
Discontinuation of home isolation
The PHA should direct the discontinuation of home isolation. Criteria could include:
- For symptomatic cases:
- at least 10 days or up to 14 days, depending on the situation and PHA direction, have passed since onset of first symptom,
- the case did not require hospitalization,
- the case is afebrile and has improved clinically,
- absence of cough is not required for those known to have chronic cough or for those who are experiencing reactive airways post infection.
- For asymptomatic cases:
- at least 10 days or up to 14 days, depending on the jurisdiction, have passed since the date their positive specimen was collected.
- In general, repeat laboratory testing (for example, a negative test result) as the basis for discontinuing home isolation is not recommended.
Close contacts of confirmed and probable casesFootnote a occurring in Canada should be identified and managed as per the recommendations in this document to the extent possible. It is recognized that the level and intensity of public health actions may vary among jurisdictions as they each manage the situation they are experiencing at a given time. For suspect cases, most PHAs have self-assessment tools and information on how cases should inform their contacts.
Contact tracing effortsFootnote b should consider all individuals with whom a case had contact while potentially infectious. Given that both pre-symptomatic and asymptomatic transmission can occur, contact tracing should include:
- identifying people who were in contact with a symptomatic case starting 48 hours prior to the case developing a symptom consistent with COVID-19.
- identifying people who were in contact with a laboratory confirmed asymptomatic case starting 48 hours prior to the day their positive specimen was collected. Reference 12
An individual risk assessment conducted by the PHA will identify each contact's exposure risk level and determine the required level and parameters of quarantine (self-isolation), and PHA actions for the 14-day monitoring period.
The purpose of contact management is twofold:
- to facilitate rapid identification of new cases and to reduce community spread by:
- identifying and isolating any symptomatic contacts as quickly as possible; and
- reducing the opportunity for transmission to others in the community from those without symptoms or with mild symptoms that may go unnoticed, and by providing contacts with information regarding infection prevention and control measures they should follow, and what to do if they develop symptoms.
- to gain a better understanding of the epidemiology of this coronavirus.
Depending on exposure risk level, there are three categories of contacts (high, medium or low).
A contact who develops symptoms compatible with COVID-19 within the monitoring period should be managed as a suspect case.
- If laboratory testing is conducted and the test results are negative for SARS-CoV-2, consider continuing to manage the individual as a contact for the duration of the monitoring period, based on individual risk assessment. The contact may be considered for re-testing if they have worsening /progression of symptoms.
- If laboratory testing is not conducted, after the individual completes at least 10 days of home isolation, consider continuing to manage as a contact until 14 days from last exposure, based on an individual risk assessment, since they are still a contact of a case and not a lab confirmed case themselves.
|Risk Level||Description of Risk LevelFootnote d||Isolation Level/ Contact actions||Public health authority (PHA) actions|
Close contact(s) of a case:
Self-monitor for symptoms for 14 days following their last contact.
Follow core personal public health practices(Appendix 2) recommended for the entire population
Avoid close contact with individuals at higher risk for severe illness
Low/No known risk
Only transient interactions (for example, walking by the case or being briefly in the same room) or unknown but possible transient interaction due to the occurrence of local community transmission.
Persons possibly exposed through travel
As of March 25, 2020, all travellers incoming to Canada are subject to mandatory quarantine enforceable through an emergency order under the Quarantine Act: Minimizing the Risk of Exposure to COVID-19 in Canada - Order (Mandatory Isolation). This means that all incoming travellers without symptoms are required to quarantine at home (or another designated location) where they will have no contact with vulnerable people for 14 days following their arrival to Canada and:
- Wear a non-medical mask or face covering while travelling to the place of quarantine,
- Self-monitor for symptoms consistent with COVID-19,
- Isolate within the quarantine location as quickly as possible should symptoms develop, and
- contact a health care professional or PHA,
- follow their instructions,
- Arrange to have someone pick up essentials like groceries or medication, or order deliveries,
- Not have visitors,
- Stay in a private place (for example, yard or balcony) for fresh air,
- Keep a distance of at least 2 metres from others,
- According to the Order, asymptomatic travellers who develop symptoms while in the 14 day quarantine period must extend quarantine to 14 days following the appearance of symptoms.
Exemptions from the mandatory quarantine requirement due to travel outside of Canada have been made for certain individuals who provide essential services as long as they are asymptomatic. Included are individuals who cross the border regularly to ensure the continued flow of goods and essential services, or those who provide other essential services to Canadians (for example, health care workers, truck drivers, airplane crews). Required actions for these workers include wearing a non-medical mask or face covering while in public settings if physical distancing cannot be maintained, continually monitoring self-monitoring for symptoms of COVID-19, and respecting the public health guidance and instructions of the area where the person is travelling and prevention measures from their workplace.
Any traveller who develops symptoms consistent with COVID-19 within the 14-day mandatory quarantine period should be considered and managed as a suspect case.
- If laboratory testing is conducted and the results are negative for SARS-CoV-2, the individual is no longer considered a suspect case but must continue their mandatory quarantine for the remainder of the 14-day monitoring period as per the emergency order. The traveller may be considered for re-testing if they have worsening /progression of symptoms.
- If laboratory testing is not conducted, the symptomatic traveller should extend their quarantine 14 days from the appearance of symptoms (as per the Mandatory Isolation Order). On day 14, if they still have a fever or have not clinically improved, their eligibility to discontinue home isolation should be assessed by the local PHA.
- If the symptomatic traveller requires transfer to acute care or further medical assessment, they should call ahead to the receiving facility to ensure the appropriate IPC measures are in place.
Contact tracing for airplane passengers and flight crew
Decisions related to contact tracing individual air travellers/crew who may have been exposed to a confirmed case of COVID-19 on a flight should be made based on a risk assessment conducted by the PHA to which the case is notified, considering the:
- type and severity of symptoms during the flight,
- current messaging to all international travellers - specifically that they must enter into a legally mandatory 14 day quarantine period starting the day they enter Canada
- timing of notification and likelihood of getting sufficient passenger contact information (for example, within 14 days of flight),
- incremental benefit of individual communication to those seated within 2 metres of the case versus public communication of the flight number (with or without identification of the section of the plane where the case was seated).
There is no direct evidence at present that contacting individual air travellers has facilitated early case finding. Nor is there evidence regarding transmission risk in relation to flight duration.
Should the PHA determine that contact tracing individual air travellers is warranted, the PHAC's Interjurisdictional Notices team can assist the PHA in obtaining a flight manifest; however, it should be noted that flight manifests are not kept indefinitely and do not contain contact information on all travellers. The PHA will be required to provide a letter citing their authorities under their Public Health Acts in order to obtain the manifest. If contact tracing is not feasible, a public advisory to notify the public of the potential exposure may be considered by the PHA.
Contact tracing efforts should focus on those seated within a 2-metre radius of the case, as this is the accepted exposure risk area for droplet transmission.
Contact tracing efforts oriented towards individual air travellers/crew should, at a minimum, focus on:
- passengers seated within two metres of the index case and
- crew members serving the section of the aircraft where the index case was seated and
- persons who had close contact with the index case, for example, travel companions or persons providing care.
PHAs may wish to request the aircraft seat map from airlines to best target the contact tracing efforts. If the seat map is not available, PHAs may wish to trace economy class passengers seated in the 5 seats surrounding the case in all directions, up to and including 3 rows in front and 3 rows behind the case. In business class, due to seat spacing this may only involve tracing passengers in the 2 surrounding rows due to the space between seats. PHAs may also wish to confirm that the case sat in the assigned seat for the duration of the flight, and ask about the case's movements during the flight.
PHAs could consider expanding the scope of their contact tracing for individual travellers if the case had severe symptoms, such as persistent coughing and sneezing, or had diarrhea or vomiting, during the flight. Alternatively, the PHA could consider publicly communicating the flight number and possibly the section of the plane where the case was seated, as long as it does not reveal the identity of the case. In the event that a crew member is a confirmed case of COVID-19 and was symptomatic during the flight, passengers seated in the area served by that crew member, as well as the other crew members, should be included in any individually-oriented contact tracing efforts. If the province or territory reports the flight to PHAC, it can be posted on the Travel advice webpage.
Appendix 1: Instructions for isolating a case in the home or co-living setting
- Isolating in the home setting
- Personal protective measures for infection prevention and control
- Self-care while convalescing
- Precautions for household members (for example, caregivers, roommates) to prevent transmission to others in the home
- Supplies for the home when isolating
Isolating in the home setting
The following instructions are intended for a case (symptomatic or asymptomatic), for whom home isolation has been deemed appropriate, and their household members (caregivers, roommates). Additional advice is available on:
- How to isolate at home when you may have COVID-19
- How to care for a person with COVID-19 at home: Advice for caregivers
- How to care for a child with COVID-19 at home: Advice for caregivers
- Pregnancy, childbirth and caring for newborns: Advice for mothers during COVID-19
Stay at home
Individuals who need to isolate themselves include:
- Confirmed cases with symptoms
- Confirmed cases without symptoms (asymptomatic)
- Probable cases
- Suspect cases
The case should isolate themselves in the home setting, away from other household members, for a minimum of 10 days or up to 14 days from the onset of symptoms as directed by the PHA. The criteria for discontinuing home isolation includes:
For symptomatic cases:
- at least 10 days or up to 14 days, as directed by the PHA, have passed since first symptom onset,
- the case did not require hospitalization,
- the case is afebrile and has improved clinically,
- absence of cough is not required for those known to have chronic cough or for those who are experiencing reactive airways post infection.
For asymptomatic cases:
- at least 10 days or up to 14 days, as directed by the PHA, have passed since laboratory confirmation,
- if symptoms appear, the individual should continue to isolate for 10 days or up to 14 days from the onset of the first symptom, as directed by the PHA.
Staying at home means:
- Not going out unless directed to do so (for example, to seek medical care with use of appropriate infection prevention and control measures)
- Not going to school, work, or other public areas
- Not using public transportation (for example, buses, subways, taxis)
Personal protective measures for infection prevention and control
The case should adhere to good respiratory etiquette and hand hygiene practices at all times.
Respiratory etiquette describes a combination of measures intended to minimize the dispersion of respiratory droplets when coughing, sneezing and talking.
- Cover coughs and sneezes with a medical mask, or if not available, a non-medical mask or face covering (for example, constructed to completely cover the nose and mouth without gaping, and secured to the head by ties or ear loops) or a tissue. Dispose of tissues in a lined waste container and perform hand hygiene immediately after a cough or sneeze or
- Cough/sneeze into the bend of the arm, not the hand.
Hand hygiene refers to hand washing or hand sanitizing and actions taken to maintain healthy hands and fingernails. It should be performed frequently with soap and water for at least 20 seconds:
- Before and after preparing food;
- Before and after eating;
- After using the toilet;
- Before and after putting on, adjusting or taking off a mask
- After disposing of waste or handling contaminated laundry;
- Whenever hands look dirty.
Handwashing with plain soap and water is the preferred method of hand hygiene, since the mechanical action is effective at removing visible soil and microbes.
If soap and water are not available, hands can be cleaned with an alcohol-based hand sanitizer (ABHS) that contains at least 60% alcohol, ensuring that all surfaces of the hands are covered (for example, front and back of hands as well as between fingers) and rub them together until they feel dry. For visibly soiled hands, remove soiling with a wipe first, followed by use of ABHS.
When drying hands, disposable paper towels are preferred, but a dedicated reusable towel may be used and replaced when it becomes wet.
Avoid touching the eyes, nose, and mouth with unwashed hands.
The case should monitor self for symptoms and immediately report worsening of symptoms to a health care provider or PHA for further assessment.
If it is determined that transfer to an acute care facility is required, the case will be provided with instructions regarding transportation (for example, by ambulance or private vehicle).
- If calling an ambulance, the dispatcher should be notified that the case might have COVID-19.
- If the person is transferred by private vehicle, the receiving facility should be notified to ensure that appropriate infection prevention and control measures are in place.
- During travel, the ill person should wear a medical mask, or if not available, a non-medical mask or cloth face covering (for example, constructed to completely cover the nose and mouth without gaping, and secured to the head by ties or ear loops), if tolerable, or cover their nose and mouth with a tissue.
- Those transporting the ill person should use appropriate personal protective equipment when within 2 metres of the ill person (details below).
Limit contact with other people
The case should avoid being in close proximity (within 2 metres) of other people, including household members and visitors who do not have an essential need to be in the home, with the exception of individuals providing care or delivering supplies or food.
The case should stay in a separate room of their own so that they can be isolated from other household members.
- If a separate room is not feasible, consider relocating the case or household members/roommates to another location.
- Ensure that shared spaces are well ventilated (for example, windows open, weather permitting).
- If relocation is not possible and the ill person is sleeping in the same room as other persons, it is important to maintain at least 2 metres distance from others (for example, separate beds and have people sleep head-to-toe, if possible). Hanging a sheet from the ceiling to separate the ill person from others could be considered.
- If a separate bathroom is not available, the case should always lower the toilet lid before flushing to prevent contamination of the environment and the bathroom should be cleaned and disinfected frequently.
When interactions within 2 metres are unavoidable (for example, case is a single-parent with young children), they should be as brief as possible, and the case should wear a medical mask, or if not available, a non-medical mask or cloth face covering (for example, constructed to completely cover the nose and mouth without gaping, and secured to the head by ties or ear loops). If possible, the ill person or caregiver should arrange to have supplies dropped off at their front door to minimize direct contact. If the case must leave the home setting, a mask should be worn.
Medical masks provide a physical barrier that helps to prevent the transmission of the virus from an ill person to a well person by blocking large particle respiratory droplets propelled by coughing, sneezing and talking. However, using a mask alone is not enough to stop transmission and must be combined with other prevention measures including physical distancing, respiratory etiquette and hand hygiene.
The following steps will help to ensure masks are used effectively:
- Medical masks are recommended for cases of COVID-19 and for any household member providing direct care to a case; the coloured side of the mask should be worn facing out.
- N95 respirators must be reserved for healthcare workers and should not be used for by a case or household caregivers.
- If medical masks are not available for home use, a non-medical mask or face covering (for example, constructed to completely cover the nose and mouth without gaping, and secured to the head by ties or ear loops) worn by the ill person, if tolerable, to cover their mouth and nose may prevent respiratory droplets from contaminating others or landing on surfaces. Children under 2 years of age should not wear a mask. Children ages 2 years and above should wear a child-sized medical mask or if not available, a non-medical mask or cloth face covering adapted to their size where feasible.
- Non-medical masks may also be worn by any household member providing care to a case.
- Before putting on a mask, wash hands with soap and water or ABHS.
- Cover mouth and nose with mask and make sure there are no gaps between the face and the mask, press the mask tight against the face using fingers to secure along the perimeter of the mask, pressing firmly over the bridge of the nose. After putting on a new mask, wash hands again with soap and water or ABHS.
- Avoid touching the mask while using it. If the mask is touched, clean hands with soap and water or ABHS.
- Replace the mask with a new one as soon as it is damp or dirty with secretions. Do not re-use single-use masks.
- Non-medical masks should be carefully removed and replaced when soiled or damp and laundered in hot water and then dried thoroughly.
- To remove the mask, remove straps from behind the ears or untie from behind head. Do not touch the front of mask, and ensure that the front of the mask does not touch the skin or any surfaces before discarding it in a waste container or placing it in a hamper for laundering. Wash hands with soap and water or ABHS.
Limit contact with pets and other animals
There have not been any reports of pets transmitting the SARS-CoV-2 virus to humans. Reference 13 However, there have been several reports of infected humans spreading the virus to their pet dog or cat. It is still not clear how often this happens and under what circumstances. From the limited information available, it appears that some animals can get sick, therefore, it is recommended that the case also refrain with close contact with pets and, if possible, have another member of the household look after them. If this is not possible, practice good hand hygiene before and after touching animals, and their food/supplies, as well as good respiratory etiquette. Restrict the pet's contact with other people and animals outside the household while the case is in isolation.
Avoid sharing personal household items
The case should not share personal items with household members or others, such as toothbrushes, towels, washcloths, bed linen, cigarettes, unwashed eating utensils, drinks, phones, computers, or other electronic devices.
In the event that the case must prepare food for others (for example, single parent with young children), the case should perform hand hygiene before and after, adhere to respiratory etiquette, including wearing a mask, during meal preparation.
Clean and disinfect all high-touch surfaces
Disinfectants can kill the virus making it no longer possible to infect people. High-touch areas such as toilets, sink faucets, bedside tables, light switches and door handles should be cleaned and disinfected frequently using approved hard-surface disinfectants that have a Drug Identification Number (DIN). A DIN is an 8-digit number given by Health Canada that confirms the disinfectant product is approved and safe for use in Canada.
- While most disinfectants will work against coronavirus, Health Canada has created a list of hard-surface disinfectants that are supported by evidence demonstrating that they are likely to be effective and may be used against SARS-CoV2.
- Always read and follow the directions on the label to ensure safe and effective use, including information about how long the surface should be visibly wet to be disinfected.
- You can also find more information on all other approved disinfectants and other drug products on Health Canada's searchable Drug Product Database.
When approved hard surface disinfectants are not available, a diluted bleach solution can be prepared in accordance with the instructions on the label, or in a ratio of 5 millilitres (mL) of bleach per 250 mL of water OR 20 mL of bleach per litre of water. This ratio is based on bleach containing 5 % sodium hypochlorite, to give a 0.1 % sodium hypochlorite solution. Follow instructions for proper handling of household (chlorine) bleach. Be sure to prepare the solution fresh, when you are intending to use it, and only dilute bleach in water (and not with additional chemicals). Check the labelled intended use- some bleaches, such as those designed for whitening laundry, may not be suitable for disinfection. Ensure the product is not past its expiration date. Disinfectants, household cleaners, and bleach are meant to be used to clean and disinfect surfaces. Never use these products on the skin or internally (for example, by swallowing or injecting these products) as this could cause serious harm.
Find more information on Health Canada's website about using household chemicals safely and protect yourself and your family from poisonings when using disinfectants, household cleaning products and bleaches.
If they can withstand the use of liquids for disinfection, high-touch electronics such as smartphones, computers and other devices may be disinfected with alcohol (for example, alcohol prep wipes). Reference 14
Disposable gloves should be used when cleaning or handling surfaces, clothing, or linen soiled with body fluids. Dormitories and co-living settings where ill persons are convalescing should be cleaned and disinfected daily.
Toys and other objects children may have contact with that may have been contaminated by a case should be cleaned and disinfected daily.
All used disposable contaminated items should be placed in a lined container before disposing of them with other household waste.
Self-care while convalescing
The case should rest, eat nutritious food, stay hydrated with fluids like water, and manage their symptoms. Over the counter medication can be used to reduce fever and aches. Vitamins and complementary and alternative medicines are not recommended unless they are being used in consultation with a licensed healthcare provider.
Monitor temperature regularly
The case should monitor their temperature daily, or more frequently if they have a fever (for example, sweating, chills), or if their symptoms are changing. Temperatures should be recorded and reported to the PHA as per their instructions. If the case is taking acetaminophen (for example, Tylenol) or ibuprofen (for example, Advil), the temperature should be recorded at least 4 hours after the last dose of these fever-reducing medicines.Footnote h
Maintain a suitable environment for recovery
The environment should be well ventilated and free of tobacco or other smoke. Ventilation can be improved by opening windows and doors to the outside, as weather permits.
Staying at home and not being able to do normal everyday activities outside of the home can be socially isolating. PHAs can encourage people who are isolating themselves at home to connect with family and friends by phone or computer.
Precautions for household members (for example, caregivers, roommates) to reduce risk of transmission to others in the home
For others in the home, it is important to take appropriate steps to protect themselves against COVID-19.
- Perform regular hand hygiene. The case and the household members should perform hand hygiene regularly.
- Practice good respiratory etiquette followed by hand hygiene.
- Limit the number of caregivers. Ideally, the case should be able to care for themselves. Contact within 2 metres of the case should be limited to one person. Household members with risk factors for severe disease or outcomes (for example, older adults, chronic medical conditions, immunocompromised, or obesity) should not provide care for the case and should stay elsewhere if feasible.
- Prevent exposure to contaminated items and surfaces. Do not use personal items that belong to the case. (see Avoid sharing personal household items)
- Frequent cleaning and disinfecting. Refer to Clean and disinfect all high-touch surfaces
- Disposing of waste. All used disposable contaminated items should be placed in a lined container before disposing of them with other household waste.
- Use precautions when doing laundry. Contaminated laundry should be placed into a laundry bag or basket with a plastic liner and should not be shaken. Gloves and a mask should be worn when in direct contact with contaminated laundry. Clothing, linens, and non-medical masks and cloth face coverings belonging to the ill person can be washed together with other laundry, using regular laundry soap and hot water (60-90°C). Laundry should be thoroughly dried. Hand hygiene should be performed after handling contaminated laundry. If the laundry container comes in contact with contaminated laundry, it can be disinfected using approved hard-surface disinfectants or if not available, a diluted bleach solution can be used. Refer to Clean and disinfect all high-touch surfaces for instructions on diluting bleach.
- Use of personal protective equipment. Household members, who have direct contact with the case, should wear a medical mask, or if not available, a non-medical mask or cloth face covering (for example, constructed to completely cover the nose and mouth without gaping, and secured to the head by ties or ear loops) and eye protection when within two metres and should perform hand hygiene after contact. Caregivers should wear disposable gloves, if available, when in direct contact with the ill person, or when in direct contact with the ill person's environment as well as soiled materials and surfaces. Hand hygiene should be performed before putting gloves on and after removing them.
Eye protection is recommended to protect the mucous membranes of the eyes during case care or activities likely to generate splashes or sprays of bodily fluids including respiratory secretions.
- Eye protection should be worn over prescription eyeglasses. Prescription eyeglasses alone are not adequate protection against respiratory droplets.
- Protective eye wear should be put on after putting on a mask.
- After applying eye protection, gloves should be donned (see below).
- To remove eye protection, first remove gloves and perform hand hygiene. Then remove the eye protection by handling the arms of goggles or sides or back of face shield. The front of the goggles or face shield is considered contaminated.
- Discard the eye protection into a plastic lined waste container. If the eye protection is not intended for single use, clean it with soap and water and then disinfect it with approved hard-surface disinfectants or if not available, a diluted bleach solution, being mindful not to contaminate the environment with the eye protection. Refer to Clean and disinfect all high-touch surfaces for instructions on diluting bleach.
- Perform hand hygiene.
Disposable single use gloves, if available, should be worn when in direct contact with the ill person, cleaning contaminated surfaces, and handling items soiled with bodily fluids, including dishes, cutlery, clothing, laundry, and waste for disposal. Gloves are not a substitute for hand hygiene; caregivers must perform hand hygiene before and after putting on and taking off gloves.
- Gloves should be removed, hand hygiene performed, and new gloves applied when they become soiled during care.
- To remove gloves safely, with one of your gloved hands pull off your glove for the opposite hand from the fingertips, as you are pulling, form your glove into a ball within the palm of your gloved hand. To remove your other glove, slide your ungloved hand in under the glove at the wrist and gently roll inside out, and away from your body. Avoid touching the outside of the gloves with your bare hands.
- Gloves must be changed and hand hygiene performed when they are torn.
- Discard the gloves in a plastic-lined waste container.
- Perform hand hygiene.
- Double-gloving is not necessary.
Reusable utility gloves may be used; however, they must be cleaned with soap and water then disinfected after each use with approved hard-surface disinfectants, or if not available, a diluted bleach solution. Refer to Clean and disinfect all high-touch surfaces for instructions on diluting bleach.
Supplies for the home when isolating
- Medical mask, or if not available, a non-medical mask or cloth face covering (for example, constructed to completely cover the nose and mouth without gaping, and secured to the head by ties or ear loops) for case and caregiver in the home
- Disposable Gloves
- Eye protection
- Fever-reducing medications
- Hand soap
- Alcohol based hand sanitizer containing at least 60% alcohol.
- Waste container with plastic liner
- Regular household cleaning products
- Approved hard-surface disinfectants that have a Drug Identification Number (DIN) or if not available, household chlorine bleach (containing 5 % sodium hypochlorite, if available), and a container for dilution
- Alcohol prep wipes or cleaners suitable for cleaning high- touch electronics (for example, phones)
- Regular laundry soap
- Dish soap
- Disposable paper towels
Appendix 2: Core personal public health practices
With no targeted therapies or vaccine currently available, core personal public health practices are recommended for the entire population for the duration of the pandemic to help to reduce the spread of COVID-19 in Canada. These practices include:
- Staying informed, being prepared and following public health advice;
- Practicing good hygiene (for example, frequent hand hygiene, avoid touching face, respiratory etiquette, disinfect frequently touched surfaces);
- Maintaining a physical distance of at least 2 metres from others as much as possible when outside of the home (for example, from non-household members);
- If symptomatic/feeling ill, staying at home and away from others - not going to school/work and following jurisdictional/local public health advice;
- If at higher risk of severe disease or outcomes, staying at home as much as possible;
- Wearing a medical mask if experiencing symptoms and in close contact with others in the home setting or if going out to access medical care; if a medical mask is not available, a non-medical mask (NMM) or cloth face covering should be worn;
- Wearing NMM or cloth face covering for periods of time when it is not possible to consistently maintain a two-metre physical distance from others, particularly in crowded public settings Footnote i
- Reducing personal non-essential travel.
- Reference 1
PHAC. Interim National Case Definition: Novel Coronavirus (2019-nCoV). [Online] 2 April 2020. [Accessed on 11 June 2020]
- Reference 2
Respiratory Virus Infections Working Group. Canadian Public Health Laboratory Network Best Practices for COVID-19. Can Commun Dis Rep 2020;46(5):113-20. [Accessed June 1, 2020]
- Reference 3
Respiratory Virus Infections Working Group. The Canadian Public Health Laboratory Network protocol for microbiological investigations of emerging respiratory pathogens, including severe acute respiratory infections. Can Commun Dis Rep 2020;46(6):205-9. [Accessed June 4, 2020] https://doi.org/10.14745/ccdr.v46i06a09
- Reference 4
COVID-19 Clinical Care Guidance Working Group. Clinical Management of patients with moderate to severe COVID-19 - Interim Guidance. [Online] April 2, 2020. [Accessed on 11 June 2020]
- Reference 5
Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings [Online] September 2017[Accessed on 11 June 2020] www.canada.ca/en/public-health/services/publications/diseases-conditions/routine-practices-precautions-healthcare-associated-infections.html
- Reference 6
PHAC. Infection prevention and control for COVID-19: Interim guidance for home care settings. [Online] April 24, 2020. [Accessed 11 June, 2020]
- Reference 7
Government of Canada. Coronavirus disease 2019 (COVID-19): Epidemiology update. June 22, 2020.
- Reference 8
Leigh-Hunt N, Bagguley D, Bash K, et al. An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health. 2017;152:157-171.
- Reference 9
Statistics Canada. Jackie Tang, Nora Galbraith and Johnny Truong. Insights on Canadian Society. Living alone in Canada. [Online] March 6, 2019. [Accessed 17 June 2020].
- Reference 10
Thompson, A.E., Anisimowicz, Y., Miedema, B. et al. The influence of gender and other patient characteristics on health care-seeking behaviour: a QUALICOPC study. BMC Fam Pract 17, 38 (2016). https://doi.org/10.1186/s12875-016-0440-0
- Reference 11
World Health Organization. Home care for patients with suspected novel coronavirus (nCoV) infection presenting with mild symptoms and management of contacts. [Online] 17 March 2020. [Accessed on 11 June, 2020]
- Reference 12
World Health Organization. Contact tracing in the context of COVID-19. [Online] 10 May 2020. [Accessed on 31 July 2020]
- Reference 13
Canadian Veterinary Medical Association. COVID-19 and Animals. Frequently asked questions for veterinarians. [Online] 30 April, 2020 [Accessed June 23, 2020] https://www.canadianveterinarians.net/documents/new-covid-19-and-animals-frequently-asked-questions-for-veterinarians
- Reference 14
Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and its inactivation with biocidal agents, Journal of Hospital Infection https://doi.org/10.1016/j.jhin.2020.01.022
- Reference 15
WHO. Global surveillance for COVID-19 caused by human infection with COVID-19 virus Interim guidance. [Online] 20 March, 2020. [Accessed on 11 June, 2020]. https://www.who.int/publications-detail/global-surveillance-for-human-infection-with-novel-coronavirus-(2019-ncov)
- Reference 16
US Centers for Disease Control and Prevention. Public Health Guidance for Community-Related Exposure. [Online] June 5, 2020. [Accessed on 19 June, 2020] https://www.cdc.gov/coronavirus/2019-ncov/php/public-health-recommendations.html
- Reference 17
Wahba H. The antipyretic effect of ibuprofen and acetaminophen in children. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2004 Feb;24 (2):280-4.
- Footnote a
The recommendations for contact management may also be applied to contacts of suspect cases where feasible based on public health resources
- Footnote b
Where feasible based on public health resources
- Footnote c
Adapted from Public Health Ontario. At-a-Glance Risk Levels and Precautions for COVID-19. February 2020.
- Footnote d
Adapted from Public Health Ontario. Public health management of cases and contacts of novel coronavirus (COVID-19) in Ontario April 15, 2020 (version 7.0).
- Footnote e
The PHA should consider the type of mask worn by the contact in its risk assessment. The appropriate use of personal protective equipment assumes the use of a medical mask by the contact who provided direct care. The effectiveness of non-medical masks or cloth face coverings in preventing infection has not been proven.
- Footnote f
Available evidence is insufficient for precision on defining the length of time required for prolonged exposure. For public health follow up purposes, prolonged exposure is defined for as lasting for more than 15 minutes. Reference 15 Reference 16
- Footnote g
In general, quarantine (self-isolation) means that a contact stays in their home and does not go out, and avoids contact with others and practices physical distancing within the home setting.
- Footnote h
The peak effect of temperature reduction was found to be 2.5-3.0 hours after ingestion for both acetaminophen and ibuprofen treatments in a systematic review of antipyretic effect of ibuprofen and acetaminophen in children. Reference 17
- Footnote i
These situations could include public transportation, stores and shopping areas. Non-medical masks or cloth face coverings may also be recommended in some group living situations (for example, group homes, correctional facilities, dormitories or group residences). Advice or direction regarding the wearing of masks may vary from jurisdiction to jurisdiction based on local epidemiology.
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