Updated: Public health management of cases and contacts associated with coronavirus disease 2019 (COVID-19)
Updated April 10, 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
- Contact management (of probable and confirmed cases)
- Appendix 1: Instructions for isolating in the home or co-living setting
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) to support the management of cases and contacts of coronavirus disease 2019 (COVID-19) within their jurisdictions.
The strategy outlined in this guidance is intended to focus on case and contact management, in order to mitigate the health impacts of COVID-19 on Canadians. This guidance is based on the Canadian context and public health assumptions that reflect the currently available scientific evidence and expert opinion. The timing and intensity of virus activity has varied across Canada and within provinces and territories, i.e., some regions have had many cases and are experiencing local community transmission, while others continue to have isolated cases with limited person to person transmission. Consequently, the focus and intensity of public health actions may vary among jurisdictions as they each manage the situation they are experiencing at a given time. 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
Reporting and Notification
The interim national case definitionReference 1 for COVID-19 has been updated, specifically for confirmed, probable and suspect cases, 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, probable or suspect), and individuals who have symptoms compatible with COVID-19, but do not meet the currently identified exposure criteria for infection, 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 and to establish communication links with all involved health care providers for the full duration of illness.
Facilitate appropriate laboratory testing by the health care provider at a community, hospital or reference laboratory (i.e., the National Microbiology Laboratory or a provincial public health laboratory (PHL) running a validated assay). This consists of detection of at least one specific gene target by a NAAT assay (e.g. real-time PCR or nucleic acid sequencing). Specimens being sent for testing should include information on exposure/travel history. Refer to national Protocol for Microbiological Investigations of Severe Acute Respiratory Infections (SARI)Reference 2 for details on specimen collection and handling, and for information on how to consult with the PHL microbiologist on-call. Refer also to additional laboratory guidance provided by PHLs.
The treating health care provider will provide clinical management of the case (whether in the home or in an acute care setting) based on their condition and at the discretion of the health care provider. At this time, there is no specific pharmaceutical treatment (e.g. antivirals) for cases of COVID-19. Canadian guidance on the clinical management of patients with moderate to severe COVID-19 is available.Reference 3
Health care workers providing care for a case 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 (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. It is important that people who do not require hospital-level care convalesce in a suitable environment where effective isolation and appropriate monitoring (i.e. for worsening of illness) can be provided.
Cases should be isolated in the home setting while symptomatic (i.e. not go out unless directed to do so to seek medical care, do not take public transportation to seek medical care and avoid contact with others). If transferring a case from the community to an acute care facility, notify the receiving facility prior to arrival to ensure appropriate IPC measures are in place.
Home isolation should continue for a minimum of 10 days from the onset of symptoms or as directed by the PHA. The criteria for discontinuing home isolation includes: at least 10 days have passed since onset of first symptom or laboratory confirmation of an asymptomatic case, 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.
The location where a person will be isolated will be determined by their healthcare provider and the PHA. 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 Public Health Agency of Canada's Chief Public Health Officer will designate a facility for travellers who do not have an appropriate place to isolate.
When determining the suitability of an isolation location, there are several factors for PHAs to consider:
- Ability to self-manage: The case should be able to monitor their own symptoms and maintain respiratory etiquette and hand hygiene (See Appendix 1).
- Access to care. Some circumstances may require care from a household member (e.g., 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 does not require hospitalization, with consideration given to their baseline health status and the presence of risk factors (i.e., 65 years of age and older, chronic underlying or immunocompromising conditions that may increase risk of complications from COVID-19.
- Suitable home care environment. In the home, the case should stay in a room of their own so that they can be isolated from other household members. If residing in a dormitory, such as at a post-secondary institution or where there is overcrowded housing, efforts should be made to provide the case with a single room (e.g. relocate any other roommates to another location) with a private bathroom. If a separate room is not feasible, ensure that shared spaces are well ventilated (e.g. 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 it is difficult to separate the case physically in their own room, hanging a sheet from the ceiling to separate the ill person from others may be considered. If the ill person is sleeping in the same room as other persons, it is important to maintain at least 2 metres distance from others (e.g. separate beds and have people sleep head-to-toe, if possible). If a separate bathroom is not available, the bathroom should be cleaned and disinfected frequently.
- Cohorting cases in co-living settings (e.g. those living in 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 cases together. For example, if there are two cases who reside in a co-living setting and single rooms are not available, they could share a double room.
- 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.
- Risk to others in the home. Household members with conditions that put them at higher risk of complications of COVID-19 (e.g. underlying chronic or immunocompromising conditions, or the elderly) 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 benefits of breastfeeding and the insignificant role of breast milk in transmission of other respiratory viruses, breastfeeding can continue; however, the case should wear a medical mask, or if not available, a non-medical mask or face covering (i.e., constructed to completely cover the nose and mouth without gaping, and secured to the head by ties or ear loops) or cover the baby with a blanket or towel. The mother should adhere to respiratory etiquette and perform hand hygiene before and after close contact with the baby.Reference 6
PHAs should encourage individuals, families and communities to create a supportive environment for people who are isolating to 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 generate public trust. 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 includes having daily contact with the case for symptom monitoring, to assess for symptom resolution, or to assess for progression of illness. It is recommended that cases be monitored until they have met the criteria set by the PHA for discontinuing isolation;
- Public health instructions should be provided 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. See Appendix 1: Instructions for isolating a case in the home or co-living setting for specific advice.
Contact management (of probable and confirmed cases)
In an effort to help prevent or reduce the spread of COVID-19 in Canada, the entire population has been asked to:
- stay at home as much as possible,
- when outside of the home, practice physical distancing from others,
- avoid crowded places,
- self-monitor for symptoms of COVID-19, and
- isolate themselves within the home-setting should symptoms develop and follow instructions provided by their PHA.
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 for individuals who are not being tested and information on how symptomatic suspect cases should inform their contacts.
Contact tracing effortsFootnote b should consider all individuals with whom a case had contact with 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 of 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.
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, 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 the virus that causes COVID-19, the individual is no longer managed as a case, but should continue to quarantine (self-isolate) until 14 days from last exposure since they are still a contact of a case. The contact may be considered for re-testing if they have worsening /progression of symptoms.
- If laboratory testing is not conducted, the contact, who is now being managed as a suspect or probable case, after completing at least 10 days of home isolation may need to resume quarantine (self-isolation) until 14 days from last exposure since they are still a contact of a case and not a lab confirmed case themselves.
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 c:
|Risk Level||Description of Risk LevelFootnote d||Isolation Level/ Contact actions||Public health authority (PHA) actions|
|High||Close contact(s) of a case:
||Self-monitor for symptoms for 14 days following their last contact.
Avoid close contact with individuals at higher risk for severe illness
|Low/No known risk||Only transient interactions (e.g., 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 (self-isolation) enforceable through an emergency order under the Quarantine Act: Minimizing the Risk of Exposure to COVID-19 in Canada - Order (Mandatory Isolation). Therefore, all incoming travellers are required to quarantine (self-isolate) at home (or another designated location) for 14 days following their arrival to Canada and:
- 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 follow directions provided by the PHA, which will include:
- where to go for care (if required),
- appropriate mode of transportation to use, and
- IPC precautions to be followed.
Exemptions from quarantine (self-isolation) 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. These workers should:
- follow good respiratory etiquette and hand hygiene practices
- practice physical distancing from others,
- self-monitor for symptoms of COVID-19, and
- isolate within the home-setting should symptoms develop
Any traveller who develops symptoms compatible with COVID-19 within the 14-day mandatory quarantine (self-isolation) period should be considered and managed as a suspect case.
- If laboratory testing is conducted and is determined to be negative for COVID-19, the individual is no longer considered a suspect case but must continue their mandatory quarantine (self-isolation) 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 continue to isolate for a minimum of 10 days from the onset of symptoms. If this period of isolation exceeds the original 14 day mandatory quarantine (self-isolation) period, the local PHA should advise when to discontinue home isolation, provided that the case is afebrile and has improved clinically improved. If the 10-day period of isolation occurs entirely within 14 mandatory quarantine (self-isolation) period, the traveller must continue their mandatory quarantine (self-isolation) for the remainder of the 14-day monitoring period as per the emergency order. If on day 14 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 (self-isolation) period starting the day they enter Canada
- timing of notification and likelihood of getting sufficient passenger contact information (i.e., 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 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:
- 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, e.g. 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.
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 (e.g. caregivers, roommates) to prevent transmission to others in the home
- Supplies for the home when isolating
Isolating in the home setting
Stay at home
The case (confirmed, probable or suspect) should isolate themselves in the home setting for a minimum of 10 days from the onset of symptoms or as directed by the PHA. The criteria for discontinuing home isolation includes: at least 10 days have passed since onset of first symptom or laboratory confirmation of an asymptomatic case, the case did not require hospitalization, the case is afebrile and has improved clinically.
Staying at home means:
- Not going out unless directed to do so (i.e. to seek medical care)
- Not going to school, work, or other public areas
- Not using public transportation (e.g. buses, subways, taxis)
Personal Protective Measures for infection prevention and control
The case should follow good respiratory etiquette and hand hygiene practices.
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 (i.e., constructed to completely cover the nose and mouth without gaping, and secured to the head by ties or ear loops) 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 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 using 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 (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 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 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 face covering (i.e., 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.
When interactions within 2 metres are unavoidable, these should be as brief as possible, and the case should wear a medical mask, or if not available, a non-medical mask or face covering (i.e., 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 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, non-medical mask or face covering (i.e., 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. These 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 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. After putting on a new mask, 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.
- 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 both 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 your skin or any surfaces before you discard it in a waste container or place it in a hamper for laundering Wash hands with soap and water or ABHS.
Limit contact with pets and other animals
Due to the theoretical possibility that animals in the home could be infected by COVID-19 or transfer the virus from one person to another on their fur, as a precautionary measure, it is recommended that the case also refrain with contact with pets. If this is not possible, practice good hand hygiene before and after touching animals, and their food/supplies, as well as good respiratory etiquette.
Avoid Sharing Personal Household Items
The case 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
Disinfectants can kill the virus making it no longer possible to infect people. High-touch areas such as toilets, bedside tables and door handles should be disinfected daily 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. When approved hard surface disinfectants are not available, for household disinfection, 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. 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
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
At this time, there is no specific pharmaceutical treatment for COVID-19. 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 (e.g., 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 (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.
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
It is important to for others in the home 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.
- Prevent exposure to contaminated items and surfaces. Do not use personal items that belong to the case such as toothbrushes, towels, washcloths, bed linen, cigarettes, unwashed eating utensils, drinks, phones, computers, or other electronic devices. The lid of the toilet should be put down before flushing to prevent contamination of the environment.
- Frequent cleaning and disinfecting. High-touch areas such as toilets, bedside tables and door handles should be disinfected daily 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. When approved hard surface disinfectants are not available, for household disinfection, 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.
- 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 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 and after removing gloves. If the laundry container comes in contact with contaminated laundry, it can be disinfected 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. When approved hard surface disinfectants are not available, for household disinfection, 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.
- Use of personal protective equipment. If household members have direct contact with the case, they should wear a medical mask, or if not available, a non-medical mask or face covering (i.e., 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 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 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 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. When approved hard surface disinfectants are not available, for household disinfection, 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, being mindful not to contaminate the environment with the eye protection.
- 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 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 then disinfected after each use with 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. When approved hard surface disinfectants are not available, for household disinfection, 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.
Supplies for the home when isolating
- Medical mask, or if not available, a non-medical mask or face covering (i.e., 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 an approved hard surface disinfectant is not available, bleach containing 5 % sodium hypochlorite, and a container for dilution
- Alcohol (70%) prep wipes or cleaners suitable for cleaning high- touch electronics (e.g., phones)
- Regular laundry soap
- Dish soap
- Disposable paper towels
- Reference 1
PHAC. Interim National Case Definition: Novel Coronavirus (2019-nCoV). [Online] 2 April 2020. [Accessed on 10 April 2020] https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/national-case-definition.html
- Reference 2
Canadian Public Health Laboratory Network. Protocol For Microbiological Investigations Of Severe Acute Respiratory Infections (SARI). [Online] 2013. [Accessed: 30 March 2020] https://www.canada.ca/en/public-health/services/emerging-respiratory-pathogens/protocol-microbiological-investigations-severe-acute-respiratory-infections-sari.html
- Reference 3
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 4 April 2020] https://www.ammi.ca/Content/Clinical%20Care%20COVID-19%20Guidance%20FINAL%20April2%20ENGLISH%281%29.pdf
- Reference 4
Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings [Online] September 2017[Accessed on 30 March 2020] https://www.canada.ca/en/public-health/services/publications/diseases-conditions/routine-practices-precautions-healthcare-associated-infections.html
- Reference 5
PHAC. Infection prevention and control for novel coronavirus (2019-nCoV): Interim guidance for acute healthcare settings. [Online] February 24, 2020. [Accessed April 5, 2020] https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/interim-guidance-acute-healthcare-settings.html
- Reference 6
WHO. Home care for patients with suspected novel coronavirus (nCoV) infection presenting with mild symptoms and management of contacts. [Online] 17 March 2020. [Accessed on 4 April 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
- Reference 7
WHO. Global surveillance for COVID-19 caused by human infection with COVID-19 virus Interim guidance. [Online] 20 March 2020. Accessed on April 7, 2020. https://www.who.int/publications-detail/global-surveillance-for-human-infection-with-novel-coronavirus-(2019-ncov)
- Reference 8
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
- 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 February 12, 2020 (version 4.0).
- 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 face coverings in preventing infection has not been proven.
- Footnote f
Prolonged exposure is defined as lasting for more than 15 minutes
- Footnote g
In general, self-isolation means that a contact stays in their home and does not go out, and avoids contact with others and practises 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. 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.
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