COVID Update 19/05/2020

COVID Testing Criteria for Primary Care

Dear Primary Care colleagues,

We are at a phase in our pandemic response where community wide testing is paramount.

Physical distancing, widespread economic and social closures as well as emphasis on hand hygiene, respiratory etiquette and masking have been hugely successful in reducing community spread of COVID-19. The resources for testing (PPE, lab capacity) have gradually increased.  Over the past 8 weeks, we have used the ingredients of social isolation and testing in a variety of “recipes” – testing criteria have been targeted to specific populations and to an ever increasing list of symptoms. You have played an essential role in helping inform, support and direct your patients to appropriate testing resources. 

Our goal in this next phase of pandemic response to is detect as many people with symptoms as quickly as we can, test them and perform appropriate case isolation and contact tracing for those who test positive.  Rapid testing, appropriate social isolation and contact tracing is the response needed for successful “re-opening” of our economy and social spaces.

In other words, any person with symptoms that could be related to COVID should be encouraged to go for testing, regardless of any other risk factor.

So – your job in primary care is now twofold. Actively encourage anyone with symptoms, however mild, that could be related to COVID to be tested.  Only test asymptomatic individuals where indicated by Public Health, especially close contacts of confirmed cases.  The list of potential COVID symptoms follows.

(Your clinical judgement is still called for – a pattern of seasonal allergy that is the same this year as all previous years does not require a referral for COVID testing. But a new set of symptoms involving conjunctivitis, runny nose and a change in smell warrants a test.)

Common symptoms of COVID-19 include:

  • Fever (temperature of 37.8°C or greater)
  • New or worsening cough
  • Shortness of breath (dyspnea)

Other symptoms of COVID-19 can include:

  • Sore throat
  • Difficulty swallowing
  • New olfactory or taste disorder(s)
  • Nausea/vomiting, diarrhea, abdominal pain
  • Runny nose, or nasal congestion – in absence of underlying reason for these symptoms such as seasonal allergies, post nasal drip, etc.

Atypical symptoms can include:

  • Unexplained fatigue/malaise
  • Delirium (acutely altered mental status and inattention)
  • Unexplained or increased number of falls
  • Acute functional decline
  • Exacerbation of chronic conditions
  • Chills
  • Headaches
  • Croup
  • Conjunctivitis
  • Multisystem inflammatory vasculitis in children

An updated screening guide for patients can be found here.

A summary of the overall provincial testing guidelines can be found here.

Here is a refresher from the BMJ on testing in general and how the properties of a specific test must be interpreted within a clinical context.  No test is perfect.

A Reminder on how to access testing – (please note: backline phone numbers for the assessment centre cannot be included in the publicly-available HFAM website. It may be useful to print this email or note them somewhere for your reference)

  1. If your patient qualifies for COVID 19 Testing and is a community-based health care worker, first responder, a child under the age of 4, or is unable to access the mountain drive through testing site, please call the St Joe’s Assessment centre at (see hfam email May 19 for number)* to book an appointment. (Health care workers within either hospital system will continue to access testing through their occupational health services).
  2. Any patient who screens positive and is not part of the groups mentioned in  #1 may be booked at either the drive through testing site or the St Joe’s Assessment Centre
  3. Drive through testing site appointments may be booked by calling (see hfam email May 19 for number)* .The site is located within the Dave Andreychuk Mountain Arena, 25 Hester Street.  (just off Upper James and south of Mohawk).
  4. Testing appointments for St. Joe’s Assessment Centre may be booked by calling (see hfam email May 19 for number)*.

Finally, patients may also be referred to public health for screening.  The Public Health Covid-19 Hotline 905-974-9848 will do the screening and book appointments for people with a positive screen.