Ontario has updated testing guidelines to prioritize those who are at the greatest risk, while shifting away from untargeted asymptomatic testing, and reducing the number of symptoms on the screen guidance algorithm that triggers testing for children in school or daycare. There is also clear guidance for enabling early return to school/daycare without testing for children who do not match the screening algorithm.
Patients should be referred to assessment centres for testing if they are:
- Showing COVID-19 symptoms (note symptom algorithms for adults and childen below);
- Have been exposed to a confirmed case of the virus, as informed by your public health unit or exposure notification through the COVID Alert app;
- A resident or work in a setting that has a COVID-19 outbreak, as identified and informed by our local public health unit
- Eligible for testing as part of a targeted testing initiative directed by the Ministry of Health or the Ministry of Long-Term Care.
Other people who are not showing symptoms and not eligible for testing as part of groups 2-4 can get tested for COVID-19 at select pharmacies. To find the closest pharmacy, visit Ontario.ca/covidtest.
Current Symptom Reference lists
The Ontario Ministry of Health Reference Document for Symptoms
Summary screening algorithm
COVID-19 Patient Screen Guidance (adults)
Changes were made to the provincial COVID-19 school and child care screening criteria on Feb 16 2021as a response to emerging “Variants of Concern”:
Single-symptom screening
Staff, students and children with any new or worsening symptom of COVID-19, even those with only one symptom, must stay home until:
- They receive a negative COVID-19 test result;
- They receive an alternative diagnosis by a health care professional; or
- It has been 10 days since their symptom onset and they are feeling better.
New isolation requirement for household contacts of symptomatic individuals in response to emerging “variants of concern”
All asymptomatic household contacts of symptomatic individuals are required to quarantine until the symptomatic individual receives a negative COVID-19 test result or an alternative diagnosis by a health care professional. If the symptomatic individual does not seek COVID-19 testing, all household contacts must quarantine for 14 days from their last contact with that symptomatic individual.
The criteria for testing in the Screen Guidance below has been superseded by this advice, and an undated version of the COVID-19 Patient Screen Guidance will be provided by the Ministry shortly and will be updated here when it becomes available)
COVID-19 Patient Screen Guidance (children in school or daycare)
Significant symptoms outlined in the symptom algorithm in the “Patient Screen Guidance” above include new or worsening cough, fever (>37.8), shortness of breath (even when not active), change in taste or smell, loss of smell or taste, chills, new onset muscle aches and fatigue. People may also report unexplained or significant headache, sore throat, difficulty swallowing, pink eye, runny nose or nasal congestion without other known cause, abdominal pain, nausea/vomiting, diarrhea.
Be on the lookout for atypical symptoms in children, seniors >70years, and people living with a developmental disability. These may include delirium, unexplained or increase in falls, acute functional decline, exacerbation of chronic conditions. Symptoms and signs in young children may include lethargy and/or decreased feeding (if no other diagnosis), croup and unexplained tachycardia (using age specific tachycardia reference ranges for children). Children have also been reported as presenting with lesions on extremities resembling chilblains / pernio, and rarely with atypical Kawasaki disease (Multisystem inflammatory vasculitis).
Read the full provincial testing criteria.
Read more about pre-symptomatic and asymptomatic transmission from the CEP here.
A patient who screens positive for symptoms of COVID-19 over the phone should be offered a telephone consultation (see Ministry of Health Guidance to Primary Care 09/11/2020) with a primary care provider ideally on the same day, and advised to start self isolating immediately. This discussion should include a thorough history-taking and assessment of symptoms and managing them (see Step by Step guidance in Assessment and Management of COVID).
New isolation requirement for household contacts of symptomatic individuals in response to emerging “variants of concern”
All asymptomatic household contacts of symptomatic individuals are required to quarantine until the symptomatic individual receives a negative COVID-19 test result or an alternative diagnosis by a health care professional. If the symptomatic individual does not seek COVID-19 testing, all household contacts must quarantine for 14 days from their last contact with that symptomatic individual.