nwt office of the chief public health officer interim
TRANSCRIPT
NWT Office of the Chief Public Health Officer Interim Public Health
Management of Covid-19 Exposures/Symptoms Healthcare professionals
(HCPs) should review NWT’s communicable disease manual chapter (the
chapter) Coronavirus Disease (COVID-19) Interim Public Health
Disease Management for the Northwest Territories
Updated: December 22, 2021
YES
This is a controlled document; paper copies are not controlled and should be checked against the electronic file version prior to use.
NO Follow appropriate guidance (Public Health/Protect NWT)
based on exposure
Fever ≥ 38 0 C OR Cough (new onset or worsening
chronic cough) OR Dyspnea
Is client experiencing any of the above signs or symptoms (not definitively attributable to another cause)?
Sore throat Rhinorrhea/Sneezing Headache
Test for COVID-19 & Isolate
Exposure Criteria In the last 14 days a person is/has:
A contact of a probable* or confirmed* case; OR Returned to the NWT from outside the territory; OR Exposure to travellers (household, work, etc.); OR
Not a Suspect Case**: Negative test AND Clinical Resolution*
Fatigue Malaise Myalgia
(see reverse)
**Suspect Case A person with symptoms of COVID; AND Meets exposure criteria
1 of 2
Diarrhea/Vomiting Anosmia/Dysgeusia Anorexia
Other concerns for COVID-19OR
Refer to Diagnosis Section and Table 1 in Chapter for testing guidance and Algorithm for Retesting and Management of Resolved Cases for guidance on repeat testing for previously positive cases
Assess and test for other respiratory illnesses (e.g. pertussis, TB, influenza) as appropriate Advise client to isolate until direction from Health Care Provider
Determine disposition of client to isolate in hospital or safely self-isolate as outpatient (see Table 3 Chapter) Determine monitoring of client with consideration of public health risk assessment and available resource
Refer to NTHSSA guidance for current management of suspect, probable and confirmed cases as new variants emerge
Assess severity and clinically manage client as
per NTHSSA guidance.
Was involved in a COVID-19 cluster or outbreak; OR A laboratory exposure to biological material known to contain COVID -19
*see reverse for confirmed, probable or suspect case definition, and management of contacts
For Case & Contact Management See Reverse
Refused Test: Follow routine public
heath measures and stay home if sick
Positive Result Confirmed case
Case
caseSuspect Case**
Regardless of Vaccination Status: Initial PCR and 48 hr test Negative AND Afebrile AND Clinical Resolution*
*D/C isolation after 2nd negative test unless high concern for COVID-19.
Negative Result Consider retesting
or worsen
48 hrs
days
Consult Clinical Lead
with chronic cough, reactive airways
For all suspect, probable and confirmed cases household members must isolate. Local public health determines duration of isolation.
Requirements for Discontinuation of Isolation
2 of 2
Healthcare professionals (HCPs) should review NWT’s communicable disease manual chapter (The Chapter) on Coronavirus Disease (COVID-19) Interim Public Health Disease Management for the Northwest Territories.
*This algorithm does not replace specific public health guidance based on risk assessment by local public health/OCPHO
CASES
Reporting Requirements
HCPs: Report the following immediately by phone to OCPHO (867) 920-8646
Confirmed, probable cases
Outbreak or suspect outbreak
Send Send
Confirmed Case A person with laboratory confirmation of infection with a validated NAAT
Probable Case 1. A person who has symptoms compatible with COVID-19 and: Had a high-risk exposure with a
confirmed COVID-19 case (i.e. close contact) OR was exposed to a known cluster or outbreak of COVID-19 AND
Has not been tested for SARS- CoV-2 (lab-based NAAT assay) or the result is inconclusive
OR
2. Had a POC NAAT or POC antigen test for SARS-CoV-2 result that is preliminary (presumptive) positive
Suspect Case A person with clinical illness and exposure criteria (see reverse) who isn’t a confirmed or probable case
Case Isolation Requirements
Cases MUST isolate 10 days minimum, depending on severity of COVID-19
illness further isolation may be required.
Discontinuing Isolation of a Case
Follow NTHSSA guidance, policies and
procedures
Identify Contacts Determine communicable period of case:
Symptomatic: Two days before until a minimum of 10 days after symptom onset in a confirmed or probable case in those with mild illness. Severe and critical cases are communicable for longer, a minimum of 20 days after symptom onset, depending on severity. Asymptomatic: Two days before until a minimum of 10 days after the date the lab sample was collected from a confirmed case. If a person develops mild illness, health care providers should anchor the communicable period to test date, but observe discontinuation criteria for mild cases (i.e.
they cannot discontinue isolation if they have a progressive illness). * In high-risk settings, OCPHO may extend communicable period to 72 hours before symptom onset or date of test. Use contact line list COVID-19 to gather appropriate information on contact exposure details
Who is a contact of a case: A contact is a person exposed to a confirmed, probable or suspect case during their communicable period who:
Provided direct care or exposed to bodily fluids without recommended PPE;
Had direct physical contact with a case for any amount of time without recommended PPE;
Lived/stayed with, or shared a closed space with case for ≥ 10min without recommended PPE;
Was in a close range conversation or in a room where a case was singing, shouting or breathing heavily for any period of time without recommended PPE;
Was on any aircraft in affected rows;
o On a small aircraft all passengers may be considered contacts
Was notified by another jurisdiction or national COVID-19 exposure app
Who is not a contact of a case (non-contact)
Those who do not meet the criteria of a contact including those who have transient interactions (brief public exposures, e.g. restaurants, stores)
Management of non-contacts
Advise to self-monitor for symptoms, isolate if symptoms develop and test
Provide reassurance and education resources
Follow employer guidance if
indicated
Contact Isolation Requirements All contacts of a case must isolate for a minimum of 8 days regardless of vaccination status. See below for discontinuation criteria.
Households of Contacts (Contacts of Contacts) Isolation Recommendations (regardless of vaccination status) OCPHO recommends the following for the household in the first 72 hours after exposure: Limit physical interactions between your household
and others; Wear well fitted and constructed masks in social
settings, especially in indoor settings; Avoid high risk activities (gym, faith based
gatherings, restaurants, etc.) Do not attend large gatherings
Household of symptomatic contact (probable case): Probable case and household members are
required to isolate Notify local public health to arrange further
assessment, including testing for household
Contact Testing Requirements All contacts to be tested with PCR to identify new cases Testing schedule: At identification as a contact (initial test) Day 4 At any point symptoms develop
o If first symptomatic test negative, requires repeat test in 48 hours Exit test (day 8)
If an individual refuses testing see management below
Testing Terminology
Contact Management – Finding new cases → Determine if contact is symptomatic
* Any contact who is or becomes symptomatic is a probable case – see management of probable cases
Initial Test: when identified as a contact Exit test: prior to discontinuation of isolation
Discontinuation of Isolation for Contacts OCPHO requires the following: If asymptomatic and a negative day 8 test, isolation may be D/C Any symptomatic contacts, treat as probable case – isolate immediately, notify local public health and
arrange for testing as recommended If an individual refuses testing, they must isolate for 10 days from last exposure and local public health must
complete a risk assessment before ending isolation *For household clusters, outbreaks or high risk settings, OCPHO may advise specific isolation and testing requirements after local public health completes risk assessment
Case & Contact Investigation
See also COVID-19 Chapter
Complete reporting forms
Identify exposures /contacts
Review Additional Measures Consult OCPHO for direction on management of contacts or non-contacts in high risk settings including: School, LTFC, or remote or closed worksite outbreaks Any outbreak involving sporting events, communal living arrangements, etc. Exposures in densely populated public settings
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Updated: December 22, 2021
YES
This is a controlled document; paper copies are not controlled and should be checked against the electronic file version prior to use.
NO Follow appropriate guidance (Public Health/Protect NWT)
based on exposure
Fever ≥ 38 0 C OR Cough (new onset or worsening
chronic cough) OR Dyspnea
Is client experiencing any of the above signs or symptoms (not definitively attributable to another cause)?
Sore throat Rhinorrhea/Sneezing Headache
Test for COVID-19 & Isolate
Exposure Criteria In the last 14 days a person is/has:
A contact of a probable* or confirmed* case; OR Returned to the NWT from outside the territory; OR Exposure to travellers (household, work, etc.); OR
Not a Suspect Case**: Negative test AND Clinical Resolution*
Fatigue Malaise Myalgia
(see reverse)
**Suspect Case A person with symptoms of COVID; AND Meets exposure criteria
1 of 2
Diarrhea/Vomiting Anosmia/Dysgeusia Anorexia
Other concerns for COVID-19OR
Refer to Diagnosis Section and Table 1 in Chapter for testing guidance and Algorithm for Retesting and Management of Resolved Cases for guidance on repeat testing for previously positive cases
Assess and test for other respiratory illnesses (e.g. pertussis, TB, influenza) as appropriate Advise client to isolate until direction from Health Care Provider
Determine disposition of client to isolate in hospital or safely self-isolate as outpatient (see Table 3 Chapter) Determine monitoring of client with consideration of public health risk assessment and available resource
Refer to NTHSSA guidance for current management of suspect, probable and confirmed cases as new variants emerge
Assess severity and clinically manage client as
per NTHSSA guidance.
Was involved in a COVID-19 cluster or outbreak; OR A laboratory exposure to biological material known to contain COVID -19
*see reverse for confirmed, probable or suspect case definition, and management of contacts
For Case & Contact Management See Reverse
Refused Test: Follow routine public
heath measures and stay home if sick
Positive Result Confirmed case
Case
caseSuspect Case**
Regardless of Vaccination Status: Initial PCR and 48 hr test Negative AND Afebrile AND Clinical Resolution*
*D/C isolation after 2nd negative test unless high concern for COVID-19.
Negative Result Consider retesting
or worsen
48 hrs
days
Consult Clinical Lead
with chronic cough, reactive airways
For all suspect, probable and confirmed cases household members must isolate. Local public health determines duration of isolation.
Requirements for Discontinuation of Isolation
2 of 2
Healthcare professionals (HCPs) should review NWT’s communicable disease manual chapter (The Chapter) on Coronavirus Disease (COVID-19) Interim Public Health Disease Management for the Northwest Territories.
*This algorithm does not replace specific public health guidance based on risk assessment by local public health/OCPHO
CASES
Reporting Requirements
HCPs: Report the following immediately by phone to OCPHO (867) 920-8646
Confirmed, probable cases
Outbreak or suspect outbreak
Send Send
Confirmed Case A person with laboratory confirmation of infection with a validated NAAT
Probable Case 1. A person who has symptoms compatible with COVID-19 and: Had a high-risk exposure with a
confirmed COVID-19 case (i.e. close contact) OR was exposed to a known cluster or outbreak of COVID-19 AND
Has not been tested for SARS- CoV-2 (lab-based NAAT assay) or the result is inconclusive
OR
2. Had a POC NAAT or POC antigen test for SARS-CoV-2 result that is preliminary (presumptive) positive
Suspect Case A person with clinical illness and exposure criteria (see reverse) who isn’t a confirmed or probable case
Case Isolation Requirements
Cases MUST isolate 10 days minimum, depending on severity of COVID-19
illness further isolation may be required.
Discontinuing Isolation of a Case
Follow NTHSSA guidance, policies and
procedures
Identify Contacts Determine communicable period of case:
Symptomatic: Two days before until a minimum of 10 days after symptom onset in a confirmed or probable case in those with mild illness. Severe and critical cases are communicable for longer, a minimum of 20 days after symptom onset, depending on severity. Asymptomatic: Two days before until a minimum of 10 days after the date the lab sample was collected from a confirmed case. If a person develops mild illness, health care providers should anchor the communicable period to test date, but observe discontinuation criteria for mild cases (i.e.
they cannot discontinue isolation if they have a progressive illness). * In high-risk settings, OCPHO may extend communicable period to 72 hours before symptom onset or date of test. Use contact line list COVID-19 to gather appropriate information on contact exposure details
Who is a contact of a case: A contact is a person exposed to a confirmed, probable or suspect case during their communicable period who:
Provided direct care or exposed to bodily fluids without recommended PPE;
Had direct physical contact with a case for any amount of time without recommended PPE;
Lived/stayed with, or shared a closed space with case for ≥ 10min without recommended PPE;
Was in a close range conversation or in a room where a case was singing, shouting or breathing heavily for any period of time without recommended PPE;
Was on any aircraft in affected rows;
o On a small aircraft all passengers may be considered contacts
Was notified by another jurisdiction or national COVID-19 exposure app
Who is not a contact of a case (non-contact)
Those who do not meet the criteria of a contact including those who have transient interactions (brief public exposures, e.g. restaurants, stores)
Management of non-contacts
Advise to self-monitor for symptoms, isolate if symptoms develop and test
Provide reassurance and education resources
Follow employer guidance if
indicated
Contact Isolation Requirements All contacts of a case must isolate for a minimum of 8 days regardless of vaccination status. See below for discontinuation criteria.
Households of Contacts (Contacts of Contacts) Isolation Recommendations (regardless of vaccination status) OCPHO recommends the following for the household in the first 72 hours after exposure: Limit physical interactions between your household
and others; Wear well fitted and constructed masks in social
settings, especially in indoor settings; Avoid high risk activities (gym, faith based
gatherings, restaurants, etc.) Do not attend large gatherings
Household of symptomatic contact (probable case): Probable case and household members are
required to isolate Notify local public health to arrange further
assessment, including testing for household
Contact Testing Requirements All contacts to be tested with PCR to identify new cases Testing schedule: At identification as a contact (initial test) Day 4 At any point symptoms develop
o If first symptomatic test negative, requires repeat test in 48 hours Exit test (day 8)
If an individual refuses testing see management below
Testing Terminology
Contact Management – Finding new cases → Determine if contact is symptomatic
* Any contact who is or becomes symptomatic is a probable case – see management of probable cases
Initial Test: when identified as a contact Exit test: prior to discontinuation of isolation
Discontinuation of Isolation for Contacts OCPHO requires the following: If asymptomatic and a negative day 8 test, isolation may be D/C Any symptomatic contacts, treat as probable case – isolate immediately, notify local public health and
arrange for testing as recommended If an individual refuses testing, they must isolate for 10 days from last exposure and local public health must
complete a risk assessment before ending isolation *For household clusters, outbreaks or high risk settings, OCPHO may advise specific isolation and testing requirements after local public health completes risk assessment
Case & Contact Investigation
See also COVID-19 Chapter
Complete reporting forms
Identify exposures /contacts
Review Additional Measures Consult OCPHO for direction on management of contacts or non-contacts in high risk settings including: School, LTFC, or remote or closed worksite outbreaks Any outbreak involving sporting events, communal living arrangements, etc. Exposures in densely populated public settings
Page-1
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