Public health management of cases and contacts associated with novel coronavirus disease 2019 (COVID-19)

March 13, 2020

Note

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

The Public Health Agency of Canada (PHAC), in collaboration with Canadian public health experts has developed this guidance for federal/provincial/territorial (F/P/T) public health authorities (PHA) in the event that a case of novel coronavirus disease (COVID-19) is suspected or confirmed within their jurisdictions.

The strategy outlined in this guidance is containment (i.e. to reduce opportunities for transmission to contacts in the community) and is based on the Canadian context and public health assumptions that reflect the currently available scientific evidence and expert opinion. It 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, visit the Canada.ca and WHO web site.

In the context of the COVID-19 response, there will be incoming travellers whose management will fall under the Quarantine Act and who will be managed in quarantine facilities. The considerations for these individuals is beyond the scope of this guidance document.

Case management - confirmed cases, probable cases and Persons Under Investigation (PUI)

Reporting and Notification

An interim national case definitionReference 1 for COVID-19 has been developed, specifically for confirmed cases, probable cases and Persons Under Investigation (PUI), as well as associated surveillance reporting requirements. P/T public health authorities (PHA) should report confirmed and probable cases of COVID-19 nationally to the PHAC within 24 hours of receipt of their own notification.

It is important for front line health care providers to notify PHAs of any cases (i.e. confirmed or probable), PUI and individuals who do not fulfill the case definition, in accordance with jurisdictional reporting requirements. PHAs will need to provide overall coordination with health care providers and provincial laboratories for the management of cases/PUI and to establish communication links with all involved health care providers for the full duration of illness.

Laboratory Testing

Facilitate appropriate laboratory testing by the health care provider in consultation with the provincial Public Health Laboratory (PHL). As per relevant laboratory guidance and identified protocols, ensure that appropriate specimens from a case are forwarded to the respective PHL. The PHL will then coordinate the submission of specimens to the National Microbiology Laboratory for further testing, as necessary. Include exposure/travel history with specimens being sent. Refer to Protocol for Microbiological Investigations of Severe Acute Respiratory Infections (SARI)Reference 2 for details on specimen collection and handling, and consultation with the PHL microbiologist on-call. Refer also to additional laboratory guidance provided by PHLs

Clinical Management/Treatment

The treating health care provider (whether in the home or in an acute care setting) will provide individual clinical management of the case/PUI based on their condition and at the discretion of the health care provider. At this time, there is no specific treatment (e.g. antivirals) for cases of COVID-19. Guidance on the clinical management of severe acute respiratory infection (i.e. in a hospital) when a case of COVID-19 is suspected is available from the WHO.Reference 3

Health care workers providing care for a case/PUI should follow relevant guidance developed for infection prevention and control including Routine Practices and Additional PrecautionsReference 4, and COVID-19-specific infection prevention and control (IPC) guidanceReference 5. Any aerosol-generating medical procedures should be avoided in the home environment. If an AGMP is required, consideration should be given to transferring the case/PUI to hospital due to the need for Additional Precautions.

Case Management in the Home and Co-Living Settings (isolation)

Early epidemiologic evidence suggests that the majority of people who develop COVID-19 will have mild illness and may not require care in a hospital. It is important that people who do not require hospital-level care convalesce at home as long as effective isolation and appropriate monitoring (i.e. for worsening of illness) can be provided.

Cases/PUIs should be isolated in the home setting while symptomatic (i.e. not go out unless directed to do so to seek medical care) until symptoms have resolved and the person is feeling well enough to resume normal activities, and has met the clinical and laboratory criteria set by the PHA for discontinuing isolation.Footnote a Refer to Appendix 1: Instructions for isolating in the home or co-living situation.

The location where a person will be isolated will be determined by their healthcare provider and the PHA. When determining the location, several factors to determine the suitability of the home setting are described below.

Public Health Monitoring of Cases and PUI:

It is recommended that PHAs provide active daily monitoring of cases and PUIs. The parameters of active daily monitoring will vary by PHA, but generally includes having daily contact with the case/PUI for symptom monitoring, to assess for symptom resolution, or to assess for progression of illness.

Case: conduct active daily monitoringFootnote b of the case's health status for duration of illness (and until they have met the criteria set by the PHA for discontinuing isolation).

PUI: conduct active daily monitoring of the PUI's health status until laboratory investigation has confirmed or ruled out COVID-19. If COVID-19 confirmed, follow the advice for a case.

Public Health Advice for Cases/PUI in the home or co-living setting:

Provide public health instructions to the case/PUI and household co-living setting contacts on public health measures including self-monitoring, infection prevention and control, and environmental cleaning of the home setting. See Appendix 1: Instructions for isolating in the home or co-living setting for specific advice.

Contact management (of probable and confirmed cases)

Considering the context for this guidance is containment of the virus, close contacts of confirmed and probable casesFootnote c occurring in Canada should be identified and managed as per the recommendations in this document until the containment objective is achieved or a new objective becomes necessary (e.g., if sustained person to person transmission is occurring in the community). An individual risk assessment conducted by the PHA will identify the contact's exposure risk level and to determine the required level and parameters of isolation, and PHA actions for the 14-day monitoring period.

The purpose of contact management is twofold:

  1. to facilitate rapid identification of new cases and to support containment by:
    • identifying and isolating any symptomatic contacts as quickly as possible; and
    • reducing the opportunity for transmission to others in the community from those with mild symptoms that may go unnoticed, and by providing contacts with information regarding infection prevention and control measures they should follow, as well as what to do if they develop symptoms
  2. to gain a better understanding of the epidemiology of this novel coronavirus.

Depending on exposure risk level, there are three categories of contacts (high, medium or low). Table 1 Categories of contacts by exposure risk level describes the risk level, provides isolation and contact management advice as well as associated PHA actionsFootnote d:

Table 1. Categories of contacts by exposure risk level
Risk Level Description of Risk LevelFootnote e Isolation Level/ Contact actions Public health authority (PHA) actions
High

1) Close contact(s) of a case:

  • provided care for the case (including health care workers, family members or other caregivers), or who had other similar close physical contact (e.g. intimate partner) without consistent and appropriate use of recommended personal protective equipment, OR
  • who lived with or otherwise had close prolongedFootnote f contact (within 2 metres) with a case while the case was symptomatic and not isolating, OR
  • had direct contact with infectious body fluids of a case (e.g., was coughed or sneezed on) without the appropriate use of recommended personal protective equipment.
  1. Self-isolateFootnote g at home for 14 days from last unprotected exposure
  2. Follow good respiratory etiquette and hand hygiene practices.
  3. Self-monitor for the appearance of symptoms, particularly fever and respiratory symptoms such as coughing or shortness of breath.
  4. Take and record temperature daily and avoid the use of fever reducing medications (e.g., acetaminophen, ibuprofen) as much as possible. These medications could mask an early symptom of COVID-19; if these medications must be taken, advise the PHA.
  5. Isolate within the home setting as quickly as possible should symptoms develop, and contact the local public health authority for further direction, which will include:
    • where to go for care,
    • appropriate mode of transportation to use, and
    • IPC precautions to be followed.
  • Conduct an individual risk assessment
  • Active daily monitoring of contacts for symptoms
  • A close contact who develops symptoms compatible with COVID-19 within the monitoring period should be considered a PUI and from an IPC perspective should be managed as a case.
  • If laboratory testing is negative for the virus that causes COVID-19, the individual is no longer a PUI, but should continue to self-isolate until 14 days from last exposure.
  • If transferring the symptomatic person from the community to an acute care facility, notify the receiving facility prior to arrival to ensure appropriate IPC measures are in place.
Medium

1) Non-close contact:

  • provided care for the case, (including health care workers, family members or other caregivers) or who had other similar close physical contact with consistent and appropriate use of personal protective equipment OR
  • who lived or otherwise had prolonged contact but was not within 2 metres of a case while the case was symptomatic and not isolating.

Self-monitor for symptoms for 14 days following their last contact.

  1. Self-isolation is not required.
  2. Self-isolate as quickly as possible should symptoms develop, and contact the local PHA for further direction, which will include where to go for care, the appropriate mode of transportation to use, and IPC precautions to be followed
  3. Avoid crowded public spaces and places where rapid self-isolation upon onset of symptoms may not be feasible. Examples of crowded public spaces and places include mass gatherings, such as concerts and sporting events
  4. Avoid close contact with individuals at higher risk for severe illness
  • Conduct a risk assessment for non-close contacts, if feasible
  • No active monitoring
  • Any contact who develops symptoms within the monitoring period should be considered a PUI and from an IPC perspective should be managed as a case. If test is negative, individual is no longer a PUI, but should continue to self-isolate until 14 days from last exposure
  • If transferring a PUI from the community to an acute care facility, it will be important to notify the receiving facility prior to arrival to ensure appropriate IPC measures are in place
Low/No risk

Only transient interactions (e.g., walking by the case or being briefly in the same room)

  • No monitoring required
  • No action required

Persons possibly exposed through travel

Decisions regarding the management of travellers who may have been unknowingly exposed to the virus that causes COVID-19 while travelling should take into consideration:

All of these considerations together with analysis of the potential positive and negative impacts of a recommendation should inform the measures implemented for returning travellers.

Table 2 describes recommendations for travellers who have travelled outside of Canada in the previous 14 days. All measures should start upon arrival in Canada and continue for a period of 14 days.

Table : Recommendations for travellers returning from outside Canada
Travel location Traveller type Traveller actions PHA actions
Any country/area for which a Level 3 Travel Health Notice is in effect All travellers
  • Self-isolate (ideally at home) for 14 days following arrival in Canada
  • Follow good respiratory etiquette and hand hygiene practices.
  • Self-monitor for the appearance of symptoms, particularly fever and respiratory symptoms such as coughing or shortness of breath.
  • Take and record temperature daily and avoid the use of fever reducing medications (e.g., acetaminophen, ibuprofen) as much as possible. These medications could mask an early symptom of COVID-19.
  • Isolate within the home setting as quickly as possible should symptoms develop, and contact the local PHA for further direction, which will include:
    • where to go for care,
    • appropriate mode of transportation to use, and
    • IPC precautions to be followed.
  • Provide self-isolation instructions for travellers
Any country/area outside of Canada (i.e., excluding those for which a level 3 THN is in effect) Health care providers and those working in health care settings
  • Follow advice of PHA authority or employer (whichever is more stringent)
  • Do a risk assessment considering local epidemiology, response goal, health care delivery resources and potential positive and negative impacts of recommendations.
  • Provide recommendations to all stakeholders
Critical infrastructure workers
  • Follow advice of PHA authority or employer (whichever is more stringent)
  • Do a risk assessment considering local epidemiology, response goal, critical infrastructure resources and potential positive and negative impacts of recommendations.
  • Provide recommendations to all stakeholders
Primary and secondary school students and staff
  • Follow advice of PHA or school board /employer (whichever is more stringent)
  • Do a risk assessment considering local epidemiology, response goal, ability to modify school setting to reduce transmission, and potential positive and negative impacts of recommendations.
  • Provide recommendations to all stakeholders
All other travellers
  • Self-monitor for symptoms for 14 days following arrival in Canada.
  • Self-isolation is not required.
  • Self-isolate as quickly as possible should symptoms develop, and contact the local PHA for further direction, which will include where to go for care, the appropriate mode of transportation to use, and IPC precautions to be followed
  • Avoid crowded public spaces and places where rapid self-isolation upon onset of symptoms may not be feasible. Examples of crowded public spaces and places include mass gatherings, such as concerts and sporting events.
  • Avoid close contact with individuals at higher risk for severe illness.
  • No active monitoring

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:

There is no direct evidence at present that contacting individual air travellers has facilitated early case finding. Nor is there in evidence regarding transmission risk in relation to flight duration.

Should the PHA determine that contact tracing individual air travellers is warranted, the Public Health Agency of Canada's Office of Border and Travel Health can assist 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. PHA may 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.

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:

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.

Appendix 1: Instructions for isolating in the home or co-living setting

Isolating in the home setting

Stay at home

The case/PUI should isolate themselves in the home setting until advised by the Public Health Authority (PHA) that isolation can be discontinued. Staying at home means:

Personal Protective Measures for infection prevention and control

The case/PUI should follow good respiratory etiquette and hand hygiene practices.

Respiratory etiquette
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 or procedural mask or 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 your arm, not your hand

Hand hygiene
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 15-20 seconds:

  • Before and after preparing food;
  • Before and after eating;
  • After using the toilet;
  • Before and after using a medical or procedural 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 (e.g. 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 their eyes, nose, and mouth with unwashed hands.

Monitor your symptoms

The case/PUI should monitor their 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, instructions will be provided regarding transportation (e.g. by ambulance or private vehicle). If calling an ambulance, the dispatcher should be notified that the case/PUI may 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 or procedural mask 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/PUI 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.

When interactions within 2 metres are unavoidable, these should be as brief as possible, and the case/PUI should wear a medical or procedural mask. 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/PUI must leave the home setting, a medical or procedural mask should be worn.

Medical or procedural Masks
Face masks (medical or procedural) provide a physical barrier that may help 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 guaranteed to stop infections and should be combined with other prevention measures including respiratory etiquette and hand hygiene.

Applying a consistent approach to putting on and taking off a mask are key in providing overall protective benefits. The following steps will help to ensure masks are used effectively:

  • Before putting on a mask, wash hands with soap and water or ABHS. The mask should be worn with the coloured side facing out.
  • Cover mouth and nose with mask and make sure there are no gaps between your face and the mask, press the mask tight to your face using your fingers to secure along the perimeter of the mask, pressing firmly over the bridge of your nose. Wash hands again with soap and water or ABHS.
  • Avoid touching the mask while using it; if you do, clean your hands with soap and water or alcohol-based hand sanitizer.
  • Replace the mask with a new one as soon as it is damp or dirty with secretions. Do not re-use single-use masks.
  • To remove the mask, remove both straps from behind the ears. Do not touch the front of mask, and ensure that the front of the mask does not touch your skin or any surfaces before you discard it immediately in a closed waste container. Wash hands with alcohol-based hand rub or soap and water.

Limit contact with pets

Due to the theoretical possibility that animals in the home could be infected by COVID-19, it is recommended that cases also refrain with contact with pets, if possible.

Avoid Sharing Personal Household Items

The Case/PUI should not share personal items with others, such as toothbrushes, towels, washcloths, bed linen, cigarettes, unwashed eating utensils, drinks, phones, computers, or other electronic devices.

Clean all high-touch surfaces

High-touch areas such as toilets, bedside tables and door handles should be disinfected daily using a store bought disinfectant, or if not available, a diluted bleach solution (one part bleach to 9 parts water to make a 0.5% sodium hypochlorite solution). If they can withstand the use of liquids for disinfection, high-touch electronics such as phones, computers and other devices may be disinfected with 70% alcohol (e.g. alcohol prep wipes).Reference 7

Disinfectants can kill the virus making it no longer possible to infect people. 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.

All used disposable contaminated items should be placed in a lined container before disposing of them with other household waste.

Self-care while convalescing

Treatment

At this time, there is no specific treatment for COVID-19. The case/PUI 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/PUI should monitor their temperature daily, or more frequently if they have a fever (e.g., sweating, chills), or if their symptoms are changing. Temperatures should be recorded and reported to the PHA as per its instructions. If the case/PUI is taking acetaminophen (e.g. Tylenol) or ibuprofen (e.g. 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. Airflow can be improved by opening windows and doors, as weather permits.

Stay connected

Staying at home and not being able to do normal everyday activities outside of the home can be socially isolating. PHA can encourage people who are isolating themselves at home to connect with family and friends by phone or computer.

Precautions for household members (e.g. caregivers, roommates) to prevent transmission to others in the home

For caregivers of a case/PUI, it is important to take appropriate steps to protect yourself and others in the home environment from contracting COVID-19.

Eye Protection
Eye protection is recommended to protect the mucous membranes of the eyes during case/PUI care or activities likely to generate splashes or sprays of body 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 above).
  • 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 a store bought disinfectant , or if not available, a diluted bleach solution (0.5% sodium hypochlorite), being mindful not to contaminate the environment with the eye protection.
  • Perform hand hygiene.

Gloves
Disposable single use gloves should be worn when in direct contact with the ill person, cleaning contaminated surfaces, and handling items soiled with body 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 and decontaminated after each use with a store bought disinfectant, or if not available, a diluted bleach solution (0.5% sodium hypochlorite).

Supplies for the home when isolating

References

Reference 1

PHAC. Interim National Case Definition: Novel Coronavirus (2019-nCoV). [Online] 6 February 2020. [Accessed on 7 February 2020] https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/national-case-definition.html

Return to reference 1 referrer

Reference 2

Canadian Public Health Laboratory Network. Protocol For Microbiological Investigations Of Severe Acute Respiratory Infections (SARI). [Online] 2013. [Accessed: 16 January 2020] https://www.canada.ca/en/public-health/services/emerging-respiratory-pathogens/protocol-microbiological-investigations-severe-acute-respiratory-infections-sari.html

Return to reference 2 referrer

Reference 3

WHO. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected. [Online] 11 January 2020. [Accessed on 17 January 2020] https://www.who.int/internal-publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected

Return to reference 3 referrer

Reference 4

Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings [online] September 2017[Accessed on Feb 22, 2020] https://www.canada.ca/en/public-health/services/publications/diseases-conditions/routine-practices-precautions-healthcare-associated-infections.html

Return to reference 4 referrer

Reference 5

PHAC. Infection prevention and control for novel coronavirus (2019-nCoV): Interim guidance for acute healthcare settings. [online] February 4, 2020. [Accessed February 7, 2020] https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/interim-guidance-acute-healthcare-settings.html

Return to reference 5 referrer

Reference 6

WHO. Home care for patients with suspected novel coronavirus (nCoV) infection presenting with mild symptoms and management of contacts. [Online] 4 February 2020. [Accessed on 7 February 2020] https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts

Return to reference 6 referrer

Reference 7

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

Return to reference 7 referrer

Footnotes

Footnote a

Decisions on discontinuing isolation should be made by the PHA in conjunction with the case's health care providers, considering both the clinical and laboratory findings. The Canadian Public Health Laboratory Network recommends two consecutive negative tests for the virus that causes COVID-19, at least 24 hours apart be considered as laboratory evidence that the case is no longer communicable; at a minimum collect NP swabs, with consideration for both NP and throat swabs at all sampling times to maximize sensitivity for detecting the virus.

Return to footnote a referrer

Footnote b

Where applicable and where the PHA is aware of persons being tested

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Footnote c

The recommendations for contact management may also be applied to contacts of PUI if warranted, based on an individual risk assessment.

Return to footnote c referrer

Footnote d

Adapted from Public Health Ontario. At-a-Glance Risk Levels and Precautions for COVID-19. February 2020.

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Footnote e

Adapted from Public Health Ontario. Public health management of cases and contacts of novel coronavirus (COVID-19) in Ontario February 12, 2020 (version 4.0).

Return to footnote e referrer

Footnote f

As part of the individual risk assessment, consider the duration of the contact's exposure (e.g., a longer exposure time likely increases the risk), the case's symptoms (coughing or severe illness likely increases exposure risk) and whether exposure occurred in a health care setting.

Return to footnote f referrer

Footnote g

In general, self-isolation means that a contact stays in their home and does not go out, and avoids being within the same room with others within the home setting. If this cannot be avoided, a distance of at least 2 metres should be maintained from others.

Return to footnote g referrer

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. 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.

Return to footnote h referrer

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