Frequently Asked Questions on Novel Coronavirus (COVID-19)

Niagara Region Public Health and Emergency Services is closely monitoring the COVID-19 pandemic. This is an evolving situation and we'll continue to update information as it becomes available. Check often for updates.

Priority Testing

Health care professionals don't need to prioritize in referring patients to Public Health’s COVID-19 Info-Line.

Anyone with respiratory symptoms, other mild symptoms, or fever that you suspect may have COVID-19 can be referred for testing.

The province provided guidance on asymptomatic, risk-based testing. You can now refer the following people for testing:

  • People who are concerned that they've been exposed to COVID-19, including people who are contacts of or may have been exposed to a confirmed or suspected case
  • People who are at risk of exposure to COVID-19 through their employment, including essential workers, such as health care workers, grocery store employees and food processing plants

Priority Appointments

The following groups with symptoms are considered higher risk. This list is being used by the assessment centres to prioritize the scheduling of appointments:

  • People with close contact with a confirmed case
  • Health care provider providing direct patient care, including paramedics and dental, and their household members
  • Allied health care professional working in an institution, including hospital pharmacy, X-ray, etc.
  • Essential workers, including fire, police, health care institution, critical infrastructure, transportation, airline, grocery store, etc.
  • Vulnerable populations:
    • Older adults (60 or older)
    • Those with underlying medical conditions
    • Residents of long-term care homes, retirement homes and supportive housing
    • Those who reside in an institution, such as dormitory shelter, correctional facility, migrant worker housing, homeless shelter, etc.
    • Neonates, pregnant women
    • Those who live in remote / rural / isolated and / or Indigenous communities

General Information

  • Are COVID-19 statistics in Niagara available?

    Yes, view the most up-to-date COVID-19 statistics in Niagara.

  • Do health care professionals have a direct extension into the Public Health COVID-19 Info-Line?

    Public health nurses are available to work with you and your patients seven days a week from 9:15 a.m. to 7:30 p.m. Monday through Friday and 9:15 a.m. to 4:15 p.m. Saturday and Sunday.

    • Health care professionals: 905-688-8248 - press 7, then press 1
    • Patients: 905-688-8248 or toll-free at 1-888-505-6074 - press 7, then press 2 for member of the public
  • What is the case definition for COVID-19?

    For the most up-to-date COVID-19 case definitions, refer to the Ministry of Health COVID-19 Guidance. The case definition is for use by Public Health and for public health purposes.

  • What are the symptoms for COVID-19?

    Across the globe, we're seeing 80 per cent of cases having mild to moderate illness and more than that on the first day that they are symptomatic. Elderly people and those with underlying medical conditions are often experiencing more severe illness. Learn about the signs and symptoms of COVID-19.

    Allergy season is upon us and minor symptoms are COVID-19 can mirror common allergy symptoms. We ask that you use your clinical judgement to determine whether your patient is presenting with their typical seasonal allergies or may have COVID-19.

    Anyone with respiratory symptoms, other mild symptoms, or fever that you suspect may have COVID-19 can be referred for testing.

  • Did you know there is a new billing code for telephone COVID-19 assessments?

    Ontario approved new physician billing codes for telephone assessments, enabling doctors to conduct more assessments over the phone rather than in their clinic.

  • Who should self-isolate?

    Requirements for self-isolation include:

    • An individual that develops symptoms (regardless of exposure)
    • Those who are required to do so under the Quarantine Act due to travel outside of Canada
    • A close contact of a positive case with COVID-19
    • A laboratory confirmed case with COVID-19

    If patients who are required to self-isolate must go out for a medical appointment or urgent care, they must contact the COVID-19 Info-line at 905-688-8248 press 7, then press 2 and a nurse will give them detailed instructions to follow to protect themselves, their family and members of the public.

  • What is a close contact?

    A close contact may be a:

    • Household member or person who provided care for your patient
    • Person who had close, prolonged contact with your patient

    Public Health is working to identify all potential close contacts of a positive case of COVID-19. They will follow up with anyone identified as having come into contact with the case and instruct them on self-isolation requirements based on their level of risk.

  • Are you interested and available to help provincial efforts to prevent and control the spread of COVID-19?

    Ontario is looking for people with experience in providing health care to help provincial efforts to prevent and control the spread of COVID-19. If you are a health care provider working part-time, a former health care provider who is retired or on inactive status or a health care provider in training and you would like to be matched to positions and opportunities where services are needed most, sign up on the Workforce Matching Portal.

Testing

  • Do I need to notify Niagara Region Public Health and Emergency Services when I test someone for COVID-19?

    Yes. In addition to COVID-19 being a new infectious disease it is also classified as a disease of public health significance and must be reported to Public Health. If you are testing patients for COVID-19, notify Public Health immediately by calling 905-688-8248 and follow the prompts.

    Ensure that the patient is sent home with instructions to self-isolate and manage prescription(s) or other needs in a way that assumes the patient has COVID-19.

  • Is Niagara Region Public Health testing for COVID-19?

    No. Niagara Region Public Health offices don't provide COVID-19 testing. Anyone who requires testing is referred for an appointment at one of the testing locations in Niagara.

  • What is the process for sending patients for testing?

    As of May 25, Niagara Health opened up access to their two assessment centres in Niagara Falls and St. Catharines to allow for patient self-referrals and walk-in appointments for COVID-19 testing.

    A temporary drive-thru testing centre (separate from the Niagara Health assessment centres) serves south Niagara and is located in Fort Erie. This testing centre is by appointment only.

    Primary care providers can screen their own patients over the phone and directly refer those who are symptomatic to a COVID-19 testing location.

    We recognize that patients talking to their trusted health care provider is the optimal approach. You have relationships with your patients, know their medical history and can best assess their symptoms. A toolkit is available to support your office in setting up your clinic and notifying your patients, should you choose to offer this to your patient roster. Contact the primary care and stakeholder engagement advisor for a copy of the toolkit and referral form.

    Public Health’s COVID-19 Info-Line is still available for physicians, health care providers and patients. Call 905-688-8248, and follow the prompts.

  • Are family members and close contacts of cases to be sent for testing?

    Public health nurses are working directly with the close contacts of all laboratory confirmed COVID-19 cases in Niagara. They're providing close contacts with medical direction and instruction for testing and self-isolation.

    Watch a video on the contact tracing process Public Health performs with every positive COVID-19 case from Dr. Hirji and Sandra, a nurse from the infectious disease program.

    The province provided guidance on asymptomatic, risk-based testing. You can now refer the following people for testing:

    • People who are concerned that they've been exposed to COVID-19, including people who are contacts of or may have been exposed to a confirmed or suspected case
    • People who are at risk of exposure to COVID-19 through their employment, including essential workers, such as health care workers, grocery store employees and food processing plants
  • Does NP swab collection constitute an aerosolizing procedure?

    No. An NP is not aerosol generating.

  • Do all patients tested for COVID-19 need to be self-isolated for 14 days?

    Patients who are tested for COVID-19 should self-isolate until they receive their test results.

    If patient is positive for COVID-19:

    • They must self-isolate for a minimum of 14 days or until they are asymptomatic, whichever is longer
    • See specific instructions for health care workers under scenarios below

    If patient is negative for COVID-19:

    • If the patient no longer has any respiratory symptoms and is not a contact of a confirmed case, nor recently travelled outside of the country, then they can resume normal activities
    • If the patient is a close contact of a confirmed case, they should continue to self-isolate for 14 days from the date of last exposure to this case. If they have recently travelled outside of the country, they must complete quarantine for 14 days from their date of return from travel.
    • We continue to encourage physical distancing, frequent hand-hygiene, avoidance public places and self-monitoring for symptoms
  • What is the test for COVID-19?

    A single upper respiratory tract specimen will be accepted for COVID-19 testing. Upper respiratory tract specimens include a nasopharyngeal swab (NP) OR viral throat swab collected in universal transport medium (UTM). NP is the preferred specimen.

    Testing for COVID-19 is done by real-time PCR using protocols validated by PHO Laboratory and the NML. Serological testing for antibodies to the virus are not approved for use in Canada. Public Health Ontario has provided information on testing for COVID-19 and to support the interpretation of lab results. View their information on test methods.

  • What is the process for ordering swabs from Public Health Ontario labs?

    To order swabs from Public Health Ontario, use the requisition for specimen containers and supplies.

  • What is the turnaround time on receiving results after testing?

    It can take up to approximately seven days to receive lab test results for COVID-19. With the large number of swabs that labs are processing, results are taking longer than usual to be posted. Public Health doesn't have earlier access to the results than health care providers do. It's important that your patient remains in self-isolation while they wait for their lab test result.

    If your patient receives an indeterminate result from their online search for results, this may mean that results are not completed by the lab. Advise the patient to continue to check back in a day or two for their results if they have not been contacted by the testing site / provider.

    If the result is a true indeterminate result for COVID-19 from the laboratory, the testing site / provider will contact the patient regarding repeating the test.

  • How are test results accessed?

    Public Health will follow-up with anyone who tests positive.

    Physicians can access patient test results on Clinical Connect. Public Health doesn't have earlier access to patient test results.

    Patients in Niagara are encouraged to check their results by signing up for My Chart. Ontario has also launched a new online portal for the public to access their COVID-19 test results online. However, this portal only contains lab test information submitted to the Ministry by participating laboratories across Ontario.

  • Do I need to collect a separate swab for COVID-19 and influenza?

    Influenza testing is reserved for sentinel physicians, hospitals and long-term care homes.

  • Does Public Health have any direction on COVID-19 specimen transport?

    Niagara Region Public Health cannot provide specimen pick up and transport at this time. Work with your local lab to co-ordinate specimen pick up based on the transportation of dangerous goods criteria.

    • Ensure process for specimen transport is in place before specimen collection
    • Before preparing for transport of the specimen, ensure that at least two unique identifiers are located on the specimen containers and the lab test requisition is placed in the exterior pocket of the plastic biohazard bag
    • The specimen must be placed in a sealed biohazard bag
    • The closed container is then placed inside the specimen transport bag with an absorbent pad in the bottom of the bag
    • Specimens are to be stored at 2-8 degrees Celsius following collection

Scenarios

  • I am a health care worker and tested positive for COVID-19. When can I go back to work?

    Based on the latest science and guidance of provincial experts, most individuals who work in the health care field can return to work unless otherwise directed by their employer / occupational health and safety if they have:

    • Recovered from mild to moderate illness
    • Were never hospitalized for their illness
    • Completed 14 days in self-isolation (starting on the day they were tested)
    • Don't have shortness of breath

    Workers in the health care field include regulated health professionals, workers from retirement homes, hospitals, clinics, long-term care, independent health facilities, mental health and addictions counselling.

    Health care workers who tested positive and experienced severe illness and required hospitalization need to receive two negative results, 24 hours apart to discontinue self-isolation and return to work. The public health infectious disease nurse assigned to the case will arrange for follow up testing.

  • I have a patient who is asymptomatic, no travel history, but they had contact with someone who is having acute respiratory symptoms and is awaiting test results.

    The province provided guidance on asymptomatic, risk-based testing. People who are concerned that they've been exposed to COVID-19 can be referred for testing. This includes people who are contacts of, or may have been exposed, to a confirmed or suspected case.

    Advise them to:

    • Self-isolate for 14 days from the last exposure to the symptomatic person, everyone in the household should self-isolate for 14 days. If they live in the same household as the symptomatic person, everyone in the household should self-isolate for 14 days.
    • Call Niagara Region Public Health COVID-19 Info-Line at 905-688-8248, press 7 then press 2, or call your office
    • If symptoms develop, they will need to remain in self-isolation for 14 days from symptom onset
    • If they remain asymptomatic for 14 days they can discontinue self-isolation after that period, and practice physical distancing, avoiding public places and self-monitoring for symptoms
  • My patient received a negative COVID-19 result after having history of travel but is still symptomatic.

    Advise your patient to:

    • Continue self-isolating if they have respiratory symptoms until those symptoms resolve, or up to a full 14 days since the beginning of symptoms, whichever is longer. After 14 days, if symptoms have improved, and only residual cough remains, they may return to daily activities while being mindful of physical distancing, avoiding public places and self-monitoring for symptoms.
    • If symptoms haven't changed or have worsened, then patients must continue to self-isolate and follow up with you, their health care provider, to be reassessed
  • I have a patient who is asymptomatic, no travel history, but they had contact with someone who travelled but doesn't have symptoms.

    See priority testing for more information.

    Tell them to:

    • Avoid crowded public spaces and places where they can't easily separate themselves from others if they become ill
    • Call Niagara Region Public Health COVID-19 Info-Line at 905-688-8248 ext. 7019 or call your office if they experience symptoms of COVID-19, such as fever, new cough or difficulty breathing
    • Call ahead before visiting any health care provider and let them know about their exposure to someone with travel history and symptoms so the provider can ensure that they use proper infection control measures
    • Monitor for symptoms for 14 days after exposure
    • Common signs of infection include fever, new cough, shortness of breath and difficulty breathing

Infection Prevention and Control

Providing Care during COVID-19

Follow the Ministry of Health's COVID-19 Guidance: Primary Care Providers in a Community Setting for in-person care and essential visits. Also, the Ontario College of Family Physicians provided clarity around what personal protective equipment is necessary in which clinical scenarios.

  • What is the guidance around well child visits?

    Read our interim guidance on which well child visits should be conducted in-person during the pandemic, and recommendations for providing routine immunizations.

  • What internal logistics should my office consider for immunization appointments?

    Family physicians have raised concerns about in-person visits during the COVID-19 pandemic. There are ways to minimize risk, as noted on page 2 of Considerations for family physicians: In-person visits when phone / video isn't enough.

    PPE: The Ontario College of Family Physicians states that "at the present time, full personal protective equipment is not routine practice for non-infectious illnesses but a surgical mask and gloves / hand hygiene is likely best practice, especially in regions with suspected community spread."

    Here are some recommendations while providing essential immunization appointments:

    • Protect yourself and your staff when seeing patients:
    • Display appropriate signage
    • Talk to your patients about vaccinations and pain management
      • Let them know that vaccination appointments are available and why its important that publicly funded vaccines are still administered
      • Ask them to plan ahead for pain management
    • Support patients in maintaining physical distancing. Suggestions include:
      • Space chairs in your waiting room two metres apart
      • Use bright tape to indicate physical distancing marks on the ground where needed (like the wait line for front reception)
      • Allow only one caregiver to accompany the individual being immunized when necessary
      • Space out immunization appointments so patients don't cross paths. Consider making immunization appointments for the first hour of the day after disinfecting the office overnight for patients that are more vulnerable.
      • If space or layout permits, consider having patients coming in for immunizations use a separate entrance and go to a room strictly maintained for immunizations
  • When should I consider delivering immunizations to my patients?

    For children up to two years of age
    We strongly encourage you to complete all publicly funded immunizations on time for children up to two years of age as per the Publicly Funded Immunization Schedules for Ontario.

    For children between two and seven years of age
    The schedule allows for some flexibility in terms of when the 4-6 year old vaccinations are administered. You may consider postponing these vaccinations until your patients are close to being overdue.

    Health care providers and those working in health care settings
    Provide immunization according to the Canadian Immunization Guide’s recommended immunization for health care workers.

    Child care educators
    Provide vaccines as directed by the Medical Officer of Health.

    Post-exposure prophylaxis
    Including hepatitis B vaccination to newborns of carrier mothers, and outbreak control as a prevention and management strategy should not be delayed or deferred.

    If you're already seeing the following patients for urgent health issues or other necessary visits, use this opportunity to provide immunizations.

    Adolescents / Adults
    Provide immunization according to the Publicly Funded Immunization Schedules for Ontario.

    Seniors
    Pneumococcal vaccine if eligible (routine boosters of Pneumovax 23 are only recommended in certain situations).

    Pregnant women, family members or caregivers of infants and young children
    Tdap booster following recommendations for use and eligibility.

  • Is there guidance for delayed and catch-up immunization?

    Most routine vaccines, if delayed, can be given at the earliest opportunity.

    For vaccines that are given as part of a series, subsequent doses can be adjusted accordingly. One exception is the vaccine that provides protection against rotavirus, as the schedule includes a minimum and maximum age.

    The Canadian Immunization Guide states that in general, "regardless of the time between doses, interruption of a vaccine series does not require restarting the series as delays between doses do not result in a reduction in final antibody concentrations for most multi-dose products," with the exception of cholera and rabies vaccine.

    Maximum protection is generally not attained until the complete vaccine series has been administered.

    Administration of multiple vaccines at the same visit is one strategy for ensuring catch-up immunization.

Vaccine Storage and Handling

  • What do I do with vaccine wastage?

    During this time, maintain vaccine wastage, including expired vaccine, at your premises. Keep it separate from usable vaccine by removing from the fridge. Clearly indicate that these vaccines are wasted.

    Don't return vaccine wastage to Public Health until further notice.

  • How do I monitor the vaccine fridge temperature?
    • Continue to record minimum, maximum and current temperatures twice daily of the refrigerator used for vaccine storage during all days the office is open
    • If your office is closed, arrange for a staff member to record fridge temperatures at least weekly, but preferably every 72 hours
    • Consider purchasing a data logger as a back up to your digital thermometer in the event of a thermometer malfunction or power outage. The digital min/max thermometer is your main temperature monitoring device even with a data logger in place. Continue to document the temperature readings from the digital min/max thermometer in the temperature logbook.
    • Set the data logger to record temperatures every 5 to 10 minutes, but no longer than every 30 minutes provided it doesn't overwrite readings prior to download. This recording frequency is most beneficial when determining vaccine stability after a temperature excursion.
    • Go to the office weekly to download the data logger. Record the temperature readings from the digital min/max thermometer at this time in the temperature logbook.
    • Indicate any closure dates in the temperature logbook
    • Promptly report any out of range temperatures to Public Health so that vaccine stability can be determined
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