Interim national surveillance guidelines for human infection with Coronavirus disease (COVID-19)

Last Updated: February 10, 2020

Purpose

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.

Background

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:

  1. 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.
  2. 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).
  3. Notify and disseminate information to stakeholders in order to facilitate timely and appropriate public health activities.
  4. 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

Case Definitions

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 an interim COVID-19 case report form 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)

National reporting

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

Provinces and Territories are asked to provide all the required data elements (as found on COVID-19 case report form and summarized in Box 1).

How to report

The data can be submitted via the COVID-19 case report form, or a jurisdictional equivalent. The data can also be submitted via extract from a provincial/territorial information system.

Data can be sent electronically to phac.hsfluepi.aspc@canada.ca or faxed to 1-613-952-4723. For fax, an email notification should be sent to phac.hsfluepi.aspc@canada.ca (do not attach form).

After regular business hours, please contact PHAC’s Health Portfolio Operations Centre (HPOC) at phac-aspc.hpoc-cops@canada.ca to discuss best method of case reporting.

Figure 1. Reporting process for national notification of human infection with COVID-19
Figure 1 - Text description

Figure 1 is a flow chart describing the national reporting process for cases with human infection of COVID-19. When a patient is assessed at a health care facility as a person under investigation (PUI), a specimen is sent to the provincial laboratory for testing, while the local public health authority collects case details and conducts investigations (until evidence exists to exclude the patient as a potential case), and forwards the case information to the provincial/territorial (P/T) public health authority. If the provincial testing result is negative, the provincial laboratory relays the result to the P/T public health authority, and the case is excluded. If the provincial testing result is not available, inconclusive or negative (if specimen quality or timing is suspect), the provincial laboratory forwards the specimen to the National Microbiology Laboratory (NML) for further testing and confirmation. If the provincial testing result is positive, the provincial laboratory forwards the specimen to NML for confirmation, and notifies the P/T public health authority of the probable case. NML will relay confirmatory results to the provincial laboratory and the P/T public health authority. If the confirmatory test is negative, the P/T public health authority excludes the case or informs the Public Health Agency of Canada (PHAC) of a change in status (exclusion) of an existing probable case. If the confirmatory test is positive, the P/T public health authority informs PHAC of the new confirmed case or informs PHAC of the change in status from a probable to a confirmed case. Within 24 hours of P/T notification of the probable or confirmed case, the P/T public health authority sends a completed case report form to PHAC. PHAC then notifies the Pan American Health Organization/World Health Organization (PAHO/WHO) of the probable or confirmed case via the International Health Regulations National Focal Point (IHR NFP) within 24 hours of national notification under Article 6, with copy to the United States of America and Mexico.

*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

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.

Useful links

Government of Canada: Coronavirus infection: Symptoms and treatment

World Health Organization: Coronavirus disease (COVID-19)

European Centre for Disease Control: COVID-19

Centre for Disease Control: Coronavirus Disease 2019

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