Interim national surveillance guidelines for human infection with Coronavirus disease (COVID-19)
Last Updated: February 10, 2020
This document outlines the recommended goals, objectives, and activities for surveillance of human infection with COVID-19 in Canada. These guidelines are based on current available scientific evidence and expert opinion and are subject to change as new information becomes available. It should be read in conjunction with relevant provincial/territorial (P/T) and local legislation, regulations and policies. These guidelines have been developed based on the Canadian situation; therefore, it may differ from surveillance guidance developed by other countries.
On December 31, 2019, Chinese authorities notified the World Health Organization (WHO) of a cluster of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province of China. On January 7, 2020, Chinese authorities identified COVID-19 with a possible zoonotic origin; there is also evidence that the virus can spread between humans.
This is a rapidly evolving situation; cases of COVID-19 have been confirmed by other countries and further travel-related cases may be expected. For information regarding the current global status of COVID-19, visit the World Health Organization's Coronavirus Disease (COVID-19) website.
Surveillance goals and objectives
Given the current evidence of limited human-to-human transmission amongst exported cases to other countries, the primary goal of public health response in Canada is early detection and containment. The secondary objective is to characterize the clinical and epidemiologic features of COVID-19 in order to better inform prevention and control efforts. To accomplish this, the following national surveillance objectives have been developed:
- Early detection of human cases of COVID-19 infection in order limit human-to-human transmission, including secondary infections among close contacts and healthcare workers, in Canada.
- Contribute to evidence on the epidemiological and virological features of the disease (e.g. clinical features and progression, morbidity, mortality, incubation period, mode of transmission, at-risk populations).
- Notify and disseminate information to stakeholders in order to facilitate timely and appropriate public health activities.
- To identify knowledge gaps that would better inform public health response.
As this event evolves, these surveillance objectives may change accordingly.
Case finding and investigation
The Public Health Agency of Canada (PHAC) has developed interim surveillance case definitions for classification and reporting of human cases of COVID-19.
Case Identification and Interview
Classification of an individual as a person under investigation (PUI), a probable, or a confirmed COVID-19 case is an immediate trigger to initiate the public health case management. Detailed recommendations for case management are found in the Interim Guidance: Public Health Management of cases and contacts associated with novel coronavirus (COVID-19).
For the purpose of national surveillance, demographic, clinical and epidemiologic information on all probable and confirmed cases should be collected. The Public Health Agency of Canada has developed a COVID-19 case report form (PDF) to collect these details. Provinces and territories are asked to report information using this form or using a form adapted for use within their jurisdiction.
Required data elements
Required data elements for national reporting are summarized in Box 1.
Box 1. Required data elements for national reporting
- Reporting province/territory
- Surveillance case classification (confirmed vs probable)
- Case details (age, gender, occupation)
- Symptoms (including symptom onset date)
- Pre-existing conditions and risk factors
- Clinical information, including clinical course and outcomes (e.g., hospitalization, ICU admission, death)
- Exposure history (including travel within 14 days prior to symptom onset, contact with an ill person, animal contact)
- Laboratory information (including date and type of specimen collection, test method and result)
Provinces and Territories are asked to report all confirmed and probable cases of COVID-19 within 24 hours of P/T notification to the Public Health Agency of Canada (Figure 1). Early reporting of investigation results of COVID-19 cases in Canada is strongly encouraged, even before analyses are complete. In addition, even preliminary data can be critical in the early assessment of spread within Canada and to inform decision-making.
What to report
How to report
The data can be submitted via the COVID-19 case report form (PDF), or a jurisdictional equivalent. The data can also be submitted via extract from a provincial/territorial information system.Data can be sent electronically to email@example.com or faxed to 1-613-952-4723. For fax, an email notification should be sent to firstname.lastname@example.org (do not attach form).
After regular business hours, please contact PHAC’s Health Portfolio Operations Centre (HPOC) at email@example.com to discuss best method of case reporting.
*Note: In some provinces these will be referred to as "presumptive confirmed cases"
Abbreviations: IHR, International Health Regulations; NFP, national focal point; NML, National Microbiology Laboratory; PAHO/WHO, Pan American Health Organization/World Health Organization; PHAC, Public Health Agency of Canada; P/T, provincial/territorial; Prov. lab; provincial laboratory; PUI, person under investigation; USA, United States of America.
Contact Identification and Management
Close contacts of confirmed and probable cases should be identified and managed as per the Interim Guidance: Public Health Management of cases and contacts associated with novel coronavirus (COVID-19).
As part of contact management, local/provincial/territorial public health authorities are encouraged to maintain a record of clinical (e.g., development of symptoms and dates of onset) and epidemiologic (e.g., relationship and dates of contact with case) characteristics of close contacts. This will aid in understanding the transmissibility, incubation period and infectious period of COVID-19 and support of risk analysis and response.
Laboratory testing should be conducted in accordance with the Canadian Public Health Laboratory Network's Protocol for Microbiological Investigations of Severe Acute Respiratory Infections (SARI). Be aware of approaches in your jurisdiction.
Laboratory testing specific for COVID-19 can be performed in select laboratories (i.e. primarily provincial public health laboratories); however, such cases with a positive laboratory result are considered probable pending NML confirmation (Figure 1). Provincial/territorial public health laboratories should facilitate confirmatory testing at the NML.
Interpretation and dissemination of surveillance data
Key epidemiological and clinical indicators should be analyzed in a timely manner in order to inform the national surveillance objectives outlined in this document. PHAC will routinely conduct and report the results of descriptive analyses of cases, such as distribution by age, gender, geography, exposure history and disease severity indicators. Provinces and territories are encouraged to routinely communicate surveillance information to local/regional public health units, hospitals and clinicians in their jurisdictions, as appropriate.
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