Changes to COVID-19 testing 'welcomed' by OSMH officials

Although the number of people visiting the COVID-19 assessment centre at Orillia Soldiers’ Memorial Hospital (OSMH) has been declining, the percentage of those being tested for the virus is on the rise.

That trend could continue now that updated guidelines for testing have been released by the province.

The assessment centre at OSMH opened March 19, when 176 people attended and 12 per cent were tested. The next day, March 20, saw the greatest number of visitors to date, with 288. Nine per cent were tested that day.

The lowest number of visitors to date was nine on April 10. Thirty-three per cent of them were tested.

The latest update from the province adds the following to the list of priority groups for testing: residents of other congregate living settings and institutions, persons working in congregate living settings and institutions, persons living in same household of health-care workers/care providers/first responders, specific priority populations, essential workers, and cross-border workers.

“We welcome the changes that increase the testing,” said OSMH president and CEO Carmine Stumpo.

When OSMH’s assessment centre opened, it was operating seven days a week, eight hours a day. Its hours were later reduced by three on weekend days, going from a total of 56 to 50 hours per week.

If the updated guidelines lead to a spike in visits, “we will adjust our hours based on what the community needs,” Stumpo said.

The hospital still encourages people to take advantage of other resources before deciding to attend the clinic. There is an online self-assessment tool, and people can also call Telehealth Ontario at 1-866-797-0000 to speak with a nurse.

Although more people are being considered priority for testing, doing the tests on those who are not showing symptoms is still “generally not supported,” Stumpo said.

“With that said, there’s a recognition that symptoms may appear differently than they did before.”

Stumpo was referring to the new guidelines that state “atypical presentations of COVID-19 should be considered, particularly in children, older persons, and people living with a developmental disability.”

Atypical symptoms of COVID-19 include unexplained fatigue/malaise, delirium (acutely altered mental status and inattention), falls, acute functional decline, exacerbation of chronic conditions, chills, headaches, and croup. Among the atypical signs are unexplained tachycardia, including age-specific tachycardia for children, decrease in blood pressure, unexplained hypoxia (even if it’s mild), and lethargy, difficulty feeding in infants (if no other diagnosis).

With that new information, as well as the addition of essential workers to the priority list, “we anticipate that will change the number of people who qualify for testing,” Stumpo said.

OrilliaMatters recently ran an article about a woman who, before being diagnosed with COVID-19, was turned away from the local assessment centre because it was not accepting referrals from Telehealth Ontario.

The new guidelines state assessment centres are now “being asked to immediately accept all referrals that are being received from health-care sources such as Telehealth and primary care providers.”

The document detailing the Ministry of Health's updated guidelines can be found in its entirety at the bottom of this article.

Personal protective equipment

OSMH workers have been going through about 2,000 masks per day, though that number fluctuates. It sounds like a lot, but Stumpo said there are “no immediate concerns” about the hospital’s stock of masks and other personal protective equipment.

The response to the hospital’s call for donations of personal protective equipment “has been going very well,” he said.

“Our supply right now seems to be stabilizing,” he said, but added the demand could change at any time and the hospital is still accepting donations.

As for ventilators, there are still extra ones on standby, Stumpo said.

The hospital has lots of capacity right now thanks to strategic decisions made in preparation for a potential surge of COVID-19 cases.

OSMH is at about one-third capacity “for several reasons,” he said, noting the two main contributors are the cancellation of non-urgent elective surgeries and the transfer of alternate-level-of-care patients to other facilities. Those patients were transferred to long-term care homes and retirement residences before the province put a hold on such moves.

Stumpo urges everyone to continue taking the proper precautions to prevent the spread of the disease.

“It’s certainly not the time to stop the excellent work around physical distancing,” he said. “It can undo very quickly if we drop our guard.”

Following is the Ministry of Health's updated guidelines for testing

COVID-19 Provincial Testing Guidance Update

April 15, 2020

As the COVID-19 outbreak continues to evolve and laboratory testing capacity has increased, Ontario’s provincial testing guidance is also being updated.

This document is an update to the COVID-19 Provincial Testing Guidance Update issued April 8, 2020. This document also adds to the Quick Reference Public Health Guidance on Testing and Clearance. This information is current as of April 15, 2020 and may be updated as the situation on COVID-19 continues to evolve. The following updated testing guidance should be used as appropriate.

It is expected that this guidance will be consistently applied across all regions in Ontario to help guide decision making regarding COVID-19 testing of further priority population groups.

There several updates to this document including the addition of:

1. Residents of Other Congregate Living Settings and Institutions

2. Persons Working in Congregate Living Settings and Institutions

3. Persons Living in Same Household of Healthcare Workers/Care Providers/First Responders

4. Specific Priority Populations

5. Essential Workers

6. Cross-border workers

1. Hospital Inpatients

Definition: Patients requiring/likely requiring inpatient admission. This does not include outpatients.

Testing Guidance:

Following active surveillance, any patient/resident with the following, should be tested:

Symptomatic patients/residents in line with the provincial case definition, who are experiencing one of the following symptoms revised from previous guidance:

• Fever (Temperature of 37.8°C or greater); OR

• Any new/worsening symptom (e.g. cough, shortness of breath (dyspnea), sore throat, runny nose or sneezing, nasal congestion, hoarse voice, difficulty swallowing, new olfactory or taste disorder(s), nausea/vomiting, diarrhea, abdominal pain); OR

• Clinical or radiological evidence of pneumonia.

Atypical presentations of COVID-19 should be considered, particularly in children, older persons, and people living with a developmental disability. For a list of potential atypical symptoms, please see Appendix.

2. Residents Living in Long-Term Care and Retirement Homes

Definition: Residents living in either long-term care/nursing homes or retirement homes.

• Long-term care/nursing homes: Health care homes designed for adults who need access to on-site 24-hour nursing care and frequent assistance with activities of daily living

• Retirement homes: Privately-owned, self-funded residences that provide rental accommodation with care and services for seniors who can live independently with minimal to moderate support

Any persons with the following, should be tested as soon as possible:

Symptomatic patients/residents in line with the provincial case definition, who are experiencing one of the following symptoms revised from previous guidance:

• Fever (Temperature of 37.8°C or greater); OR

• Clinical or radiological evidence of pneumonia.

Asymptomatic patients: Please note that the ministry has asked hospitals to temporarily stop transferring patients to long-term care and retirement homes. However, in the unlikely event that a transfer is still required, asymptomatic patients transferred from a hospital to a longterm care home or retirement home must be tested, and results received, prior to transfer. A negative result does not rule out the potential for incubating illness and all patients should remain under droplet/contact precautions in a 14-day self-isolation period following transfer.

In the event of a symptomatic resident in an institutional setting, asymptomatic residents living in the same room should be tested immediately along with the symptomatic resident.

In the event of an outbreak of COVID-19 in a long-term care home or retirement home asymptomatic contacts of a confirmed case, determined in consultation with the local public health unit, should be tested including:

All residents living in adjacent rooms
All staff working on the unit/care hub
All essential visitors that attended at the unit/care hub
Any other contacts deemed appropriate for testing based on a risk assessment by local public health

Local public health may also, based on a risk assessment, determine whether any of the abovementioned individuals do not require testing (e.g. a resident that has been in self-isolation during the period of communicability).

3. Residents of Other Congregate Living Settings and Institutions

Definition: Persons living in all other congregate living settings and institutions (e.g. homeless shelters, prisons, correctional facilities, day care for essential workers, group homes, community supported living, disability-specific communities/congregate settings, short-term rehab, hospices, other shelters).

Testing Guidance:

Following active surveillance, any persons with the following, should be tested as soon as possible:

Persons in line with the provincial case definition, who are experiencing one of the following symptoms or signs revised from previous guidance:

Fever (Temperature of 37.8°C or greater); OR
Any new/worsening symptom (e.g. cough, shortness of breath (dyspnea), sore throat, runny nose or sneezing, nasal congestion, hoarse voice, difficulty swallowing, new olfactory or taste disorder(s), nausea/vomiting, diarrhea, abdominal pain); OR
Clinical or radiological evidence of pneumonia.

Asymptomatic patients transferred from a hospital to a hospice setting must be tested and results received prior to transfer.

Testing of asymptomatic persons is generally not recommended, unless as directed by the local public health unit as part of outbreak management in the congregate setting.

4. Persons Working in Congregate Living Settings and Institutions

Definition: Persons working/providing care in all other congregate living settings and institutions not covered by the previous congregate living settings guidance (e.g. homeless shelters, prisons, correctional facilities, day care for essential workers, group homes, community supported living, disability-specific communities/congregate settings, hospices).

Testing Guidance:

Following active surveillance, any persons with the following, should be tested as soon as possible:

Persons in line with the provincial case definition, who are experiencing one of the following symptoms or signs revised from previous guidance:

Fever (Temperature of 37.8°C or greater); OR
Any new/worsening symptom (e.g. cough, shortness of breath (dyspnea), sore throat, runny nose or sneezing, nasal congestion, hoarse voice, difficulty swallowing, new olfactory or taste disorder(s), nausea/vomiting, diarrhea, abdominal pain); OR
Clinical or radiological evidence of pneumonia.
Atypical presentations of COVID-19 should be considered, particularly in children, older persons, and people living with a developmental disability. For a list of potential atypical symptoms, please see Appendix.

Testing of asymptomatic persons is generally not recommended, unless as directed by the local public health unit as part of outbreak management in the congregate setting.

5. Healthcare Workers/Caregivers/Care Providers/First Responders

This section applies to healthcare workers, caregivers (i.e. volunteers, family members of residents in a hospital/long-term care, retirement home, other congregate setting or institutional setting) and care providers (e.g., employees, privately-hired support workers) and first responders.

Testing Guidance:

Persons in line with the provincial case definition, who are experiencing one of the following symptoms or signs revised from previous guidance:

Fever (Temperature of 37.8°C or greater); OR
Any new/worsening symptom (e.g. cough, shortness of breath (dyspnea), sore throat, runny nose or sneezing, nasal congestion, hoarse voice, difficulty swallowing, new olfactory or taste disorder(s), nausea/vomiting, diarrhea, abdominal pain); OR
Clinical or radiological evidence of pneumonia.

6. Persons Living in Same Household of Healthcare Workers/Care Providers/First Responders

Definition: Symptomatic persons living in the same household (or similar close regular contact) as a healthcare worker, care providers (e.g., employees, privately-hired support workers) and first responders.

Testing Guidance:

Any persons with the following, should be tested as soon as possible:

Persons in line with the provincial case definition, who are experiencing one of the following symptoms or signs revised from previous guidance:

Fever (Temperature of 37.8°C or greater); OR
Any new/worsening symptom (e.g. cough, shortness of breath (dyspnea), sore throat, runny nose or sneezing, nasal congestion, hoarse voice, difficulty swallowing, new olfactory or taste disorder(s), nausea/vomiting, diarrhea, abdominal pain); OR
Clinical or radiological evidence of pneumonia.

Testing of asymptomatic persons is generally not recommended.

7. Remote/Isolated/Rural/Indigenous Communities

Testing Guidance:

Testing should be offered to individuals who are experiencing one of the following symptoms:

Fever (Temperature of 37.8°C or greater); OR
Any new/worsening symptom (e.g. cough, shortness of breath (dyspnea), sore throat, runny nose or sneezing, nasal congestion, hoarse voice, difficulty swallowing, new olfactory or taste disorder(s), nausea/vomiting, diarrhea, abdominal pain); OR
Clinical or radiological evidence of pneumonia.

In the event of a confirmed case of COVID-19 in a remote, isolated, rural or Indigenous community testing of contacts should be considered in consultation with the local public health unit.

8. Specific Priority Populations

Definition: Patients requiring frequent contact with the healthcare system due to the nature of their current course of treatment for an underlying condition (e.g. patients undergoing chemotherapy/cancer treatment, dialysis, pre-/post-transplant, pregnant persons, neonates).

Testing Guidance:

Any persons with the following, should be tested as soon as possible:

Any persons in line with the provincial case definition, who are experiencing one of the following symptoms or signs revised from previous guidance:

Fever (Temperature of 37.8°C or greater); OR
Any new/worsening symptom (e.g. cough, shortness of breath (dyspnea), sore throat, runny nose or sneezing, nasal congestion, hoarse voice, difficulty swallowing, new olfactory or taste disorder(s), nausea/vomiting, diarrhea, abdominal pain); OR
Clinical or radiological evidence of pneumonia.

Atypical presentations of COVID-19 should be considered, particularly in older persons, children and people living with a developmental disability. For a list of potential atypical symptoms, please see Appendix.

Testing of asymptomatic persons is generally not recommended
Newborns born to mothers with suspected or known COVID-19 at the time of birth should be tested for COVID-19 within 24 hours of delivery, regardless of symptoms.

9. Essential Workers

Definition: Essential workers not covered under previous guidance, in line with the current provincial list of workers who are critical to preserving life, health and basic societal functioning.

NOTE: This list is subject to change based on provincial guidance issued here: https://www.ontario.ca/page/list-essential-workplaces

Testing Guidance:

Any persons with the following, should be tested as soon as possible:

Persons in line with the provincial case definition, who are experiencing one of the following symptoms or signs revised from previous guidance:

Fever (Temperature of 37.8°C or greater); OR
Any new/worsening symptom (e.g. cough, shortness of breath (dyspnea), sore throat, runny nose or sneezing, nasal congestion, hoarse voice, difficulty swallowing, new olfactory or taste disorder(s), nausea/vomiting, diarrhea, abdominal pain); OR
Clinical or radiological evidence of pneumonia.

Testing of asymptomatic persons is generally not recommended.

10. Cross-Border Workers

Definition: Workers not covered in previous guidance, who reside in Ontario, but who cross the Canadian border for work.

Testing Guidance:

Any persons with the following, should be tested as soon as possible:

Persons in line with the provincial case definition, who are experiencing one of the following symptoms or signs revised in previous guidance:

Fever (Temperature of 37.8°C or greater); OR
Any new/worsening symptom (e.g. cough, shortness of breath (dyspnea), sore throat, runny nose or sneezing, nasal congestion, hoarse voice, difficulty swallowing, new olfactory or taste disorder(s), nausea/vomiting, diarrhea, abdominal pain); OR
Clinical or radiological evidence of pneumonia.

Testing of asymptomatic persons is generally not recommended.

Priorities in Situations of Resource Limitations

All facilities conducting testing should ensure an appropriate amount of swabs are available and exercise prudence when ordering swabs to ensure an equitable distribution across the province. Where there are shortages of testing supplies, the following groups should be prioritized for testing within 24 hours to inform public health and clinical management for these individuals:

Symptomatic health care workers (regardless of care delivery setting) and staff who work in health care facilities
Symptomatic residents and staff in Long Term Care facilities and retirement homes and other institutional settings e.g. homeless shelters, prisons, correctional facilities, day care for essential workers, group homes, community supported living, disability-specific communities/congregate settings (as per outbreak guidance)
Hospitalized patients admitted with symptoms compatible with COVID-19 respiratory symptoms (new or exacerbated)
Symptomatic members of remote, isolated, rural and/or Indigenous communities
Symptomatic travelers identified at a point of entry to Canada
Symptomatic first responders (i.e. firefighters, police)
Individuals referred for testing by local public health

Reminders:

Testing of asymptomatic patients, residents or staff is generally not recommended.
Clinicians should continue to use their discretion to make decisions on which individuals to test.

Appendix:

Atypical Symptoms/Signs of COVID-19

Symptoms