Changes to the Management of COVID-19 Cases, Contacts and Outbreaks in Highest Risk Settings

Advisory Alert

January 15, 2022

*Cette information est seulement disponible en anglais.

To: Long-Term Care Homes, Retirement Homes, First Nation Elder Lodges, Congregate Living Settings, and Hospitals

FOR IMMEDIATE ATTENTION

Changes to the process for managing and reporting COVID-19 cases, contacts and outbreaks in long-term care, retirement homes, First Nation elder lodges, congregate living settings and hospitals.

As you are aware, the guidance on the management of cases and contacts of COVID-19 infections continues to evolve due to the surge of the Omicron variant of concern as outlined within the COVID-19 Integrated Testing & Case, Contact and Outbreak Management Interim Guidance: Omicron Surge (as current). Public Health Sudbury & Districts is updating the local legally enforceable Class Order to align with these changes.

The number of Omicron cases is rising rapidly in Ontario such that individuals with symptoms indicative of COVID-19 can be presumed to be infected with COVID-19 and initiate timely self-isolation to prevent transmission in the community. With the goal of mitigating morbidity and mortality from COVID-19 and to mitigate impacts on hospitals and the broader health system, Public Health is focusing on the management of individuals who work/volunteer/attend or reside in highest risk settings. These settings include hospitals[1] (including complex continuing care facilities and paramedic services), Long-Term Care Homes, retirement homes, congregate living settings (First Nation elder care lodges, group homes, shelters, hospices, correctional institutions).

Eligibility for Molecular Testing (PCR and rapid molecular testing)

Under the updated provincial testing strategy, molecular testing has been prioritized. Eligible individuals include those who are symptomatic and reside in/admitted to or  work/volunteer/attend highest risk settings, asymptomatic contacts of cases in the context of confirmed or suspected outbreaks, as part of admission and transfer to or from hospital and other congregate living settings and other asymptomatic testing in accordance with provincial guidance. For further information on testing eligibility please visit ontario.ca/exposed.

Case management

Immediate response by Long-Term Care Homes, retirement homes, and other congregate livings settings to reports of residents and staff/volunteer/attendee who test positive for COVID-19 (PCR, Rapid Molecular Test [RMT], and Rapid Antigen Test [RAT]) or who have COVID-19 symptoms, is critical in protecting vulnerable residents and essential staff within the setting.

Highest risk settings should immediately isolate, place on droplet and contact precautions, and test any resident who is symptomatic. Staff/volunteers/attendees who develop symptoms during their shift/visit should be isolated until they can safely leave the site. They should further be instructed to isolate and seek testing.

Highest risk settings should immediately take the following key actions in response to a report of a COVID-19 positive resident and not wait for Public Health direction to do so:

• Isolate the resident immediately for at least 10 days (regardless of immunization status).
• Report all positive test results to Public Health Sudbury & Districts (PCR, RMT, and RAT).
• Positive RAT results DO NOT REQUIRE PCR/rapid molecular confirmatory testing.
• Facilities not in outbreak: Positive RAT results should be reported to public health using the Communicable Diseases Notification Form.  In the first section under the lab/point of care test(s) ordered field indicate RAT and date of specimen collection. Provide demographic information of the person tested as well as pertinent clinical information in the appropriate fields on the form. Fax completed forms to 705.677.9618.
• Identify period of contagiousness (48 hours prior to symptom onset if symptomatic, or 48 hours prior to test date if asymptomatic) for purposes of identification of contacts.
• Identify, immediately isolate, and monitor high-risk resident, staff, and other close contacts. Refer to the contact management section below for further information. Contacts (staff/residents/patients) of individual cases do not need to be reported to Public Health unless an outbreak is suspected, see below for further information.
• Manage/provide care using droplet and contact precautions including the use of a fit-tested, seal-checked, N95 respirator.

Highest risk settings should immediately take the following key actions in response to a report of a COVID-19 positive staff/attendee/volunteer (PCR, RMT, and RAT) and not wait for public health direction to do so:

• Advise the individual to isolate immediately and to carefully follow all instructions provided by the Ministry of Health including as this relates to notifying household members to self-isolate and notifying other close contacts
• Advise the individual to stay away from highest risk settings for 10 full days (regardless of vaccination status)
• Report all positive test results to public health (PCR, RMT, RAT).
• Positive RAT results DO NOT REQUIRE PCR/rapid molecular confirmatory testing.
• Facilities not in outbreak: Positive RAT results should be reported using the Communicable Diseases Notification Form and using the process outlined above for residents.
• Identify period of contagiousness (48 hours prior to symptom onset if symptomatic, or 48 hours prior to test date if asymptomatic) for purposes of identification of contacts.
• Identify, immediately isolate, and monitor high-risk resident close contacts. Notify staff and other close contacts exposed within the facility to follow direction provided by the Ministry of Health. Contacts of individual cases do not need to be reported to PHSD unless an outbreak is suspected, see below for further information.

High Risk Close Contact Management

High risk close contacts are defined as a person who:

• Provided care for the patient, including healthcare workers, family member or other caregivers without appropriate use of protective measures (such as PPE), OR
• Had other similar close physical contact, OR
• Lived with or otherwise had close, prolonged contact with a probable or confirmed case while the case was ill.

Refer to current Case and Contact Management Guidelines for specific definitions of close contacts and factors to consider for assessment of exposure risk.

To prevent nosocomial transmission of COVID-19 in highest risk settings, prioritize rapid assessment and notification of patient and HCW/staff exposures to enable prompt self-isolation as required.

High risk close contacts who reside in a highest risk setting must self-isolate (be managed with droplet and contact precautions including the use of a fit-tested, seal-check N95 respirator) for 10 days regardless of vaccination status.

ALL high-risk close contacts who work/attend/volunteer in a highest risk setting should avoid the setting for 10 days and be advised to follow direction provided by Ministry of Health.

Further information on case and contact management of persons who do not reside/work/attend or are not admitted to highest risk settings can be found in an Advisory Alert issued January 5/22.

Outbreak management

Facilities are asked to continually assess if outbreak thresholds have been met as defined in current provincial outbreak surveillance definitions for the setting. Report suspected/confirmed outbreaks to Public Health Sudbury & Districts immediately. The line list outbreak checklist tab can be used to support ongoing active surveillance activities.

• A suspect outbreak in a home is defined as one lab-confirmed COVID-19 case in a resident.
• A confirmed outbreak in a home is defined as two or more lab-confirmed COVID-19 cases in residents and/or staff (or other visitors) in a home with an epidemiological link, within a 14-day period, where at least one case could have reasonably acquired their infection in the home.

Examples of reasonably having acquired infection in a home include:

• No obvious source of infection outside of the setting; OR
• Known exposure in the setting.

Should an outbreak be suspected please complete the basic info and line list tabs and report to PHSD. Include on the line list all case information (those with positive PCR, RMT or RAT results) and indicate the type of test done. Also include information on staff and residents identified as high-risk close contacts.  Ensure to identify links between cases.

All facilities in a confirmed outbreak are to complete the basic info and line list tabs and report to PHSD.  All positive rapid antigen tests (RAT) should be reported on the line list for staff and residents.  Public Health Sudbury & Districts will not be contacting high-risk close contacts or resident cases identified in the context of an outbreak; Public Health will continue to work with facilities to support outbreak management. Please ensure that all applicable ministry guidelines and directives are carefully followed.

Critical Staffing Shortages

Certain Highest Risk Settings experiencing critical staffing shortages may consider early return to work of staff who are otherwise not eligible for early return to work to ensure sufficient staffing levels but only in accordance with the Ministry of Health’s COVID-19 Interim Guidance: Omicron Surge Management of Critical Staffing Shortages in Highest Risk Settings.  This applies to the following highest risk settings and does not require approval of Public Health:

• Hospitals including complex continuing care facilities and paramedic services; and
• Congregate living settings, including long-term care homes, retirement homes, First Nation elder care lodges, group homes, shelters, hospices, and correctional facilities.

For highest risk settings that are eligible, the COVID-19 Risk Assessment Resource found on PHSD website was developed by Public Health Sudbury & Districts to support your facility’s assessment and decision making for early return to work, as aligned with Ministry guidance on critical staffing shortages.

For additional information, or for consultation regarding early return to work, please contact the Control of Infectious Diseases Program at 705.522.9200, ext. 267 or after-hours and holidays at: 705.688.4366. Due to the high volume of calls received, if your call is of an urgent nature and you have been unable to connect with staff, please utilize the on-call number.

Sincerely,

Original Signed By

Dr. Penny Sutcliffe
Medical Officer of Health and Chief Executive Officer

Please note that email addresses of some recipients were provided to Public Health Sudbury & Districts by the College of Physicians and Surgeons of Ontario (CPSO) for the purpose of communications related to COVID-19. If you prefer to no longer receive Advisory Alerts from Public Health, please reply to this email requesting to be removed from our distribution list.

NOTE: All Advisory Alerts are found on our website.

[1] Note that while the provincial COVID-19 Integrated Testing & Case, Contact and Outbreak Management Interim Guidance: Omicron Surge, applies to hospitals including complex continuing care facilities and paramedic services, this Advisory Alert summarizes requirements and direction for LTCH/RH/First Nation elder lodges and congregate care settings in particular. For hospital-specific language and requirements, see the Interim Guidance linked above.

This item was last modified on January 24, 2022