What health professionals need to know

Health professionals in Canada have a critical role to play in identifying, reporting and managing potential cases of COVID-19.

Coronaviruses are a large family of viruses, some of which infect only animals, and others that can infect humans. Seven strains of coronavirus are now known to cause illness in humans.

The strain of coronavirus found in Wuhan is the most recent of 7 known strains. Of the 6 others, 4 cause only minor respiratory symptoms similar to those of a cold, and 2, severe acute respiratory syndrome and Middle East respiratory syndrome, have been associated with more serious and life-threatening diseases.

Those who are infected with COVID-19 may have little to no symptoms. Symptoms, similar to a cold or flu, may take up to 14 days to appear after exposure to COVID-19. Current studies are investigating if the virus can be transmitted to others if someone is not showing symptoms. Symptoms include:

• fever
• cough
• difficulty breathing
• pneumonia in both lungs

In severe cases, infection can lead to death.

The World Health Organization (WHO) is actively monitoring the situation and has issued updated information on the outbreak, including a risk assessment, advice on public health measures and infection prevention and control, and enhanced surveillance.

The Public Health Agency of Canada (PHAC) is also monitoring the COVID-19 situation closely and providing updates as new information becomes available.

Transmission

Current epidemiologic information suggests that human-to-human transmission of COVID-19 can occur when an individual is in close contact with a symptomatic case. Human coronaviruses are most commonly spread from an infected person through: respiratory droplets; close, prolonged personal contact; and touching an infected area, then touching mouth, nose or eyes before washing hands.

Epidemiological information

PHAC is collaborating with provincial and territorial public health partners to collect information on COVID-19 cases in Canada. A detailed epidemiologic summary is available.

Detecting and reporting

Diagnostics

PHAC’s National Microbiology Laboratory (NML) has capacity to identify COVID-19, and is developing and implementing new diagnostic tests, based on the genetic sequence of COVID-19 made available by China on January 10, 2020. Laboratory testing should be initiated in consultation with the respective provincial Public Health Laboratory (PHL). The PHL will then coordinate the submission of specimens to the National Microbiology Laboratory for further testing, as necessary. Refer to Protocol for Microbiological Investigations of Severe Acute Respiratory Infections for details on specimen collection and handling, and regarding consultation with the PHL microbiologist on-call. Refer also to additional laboratory guidance provided by PHLs.

Reporting

Health care professionals can refer to the Interim National Surveillance Guidelines for Coronavirus Disease (COVID-19), and the Interim National COVID-19 Case Report Form, to aid with the detection and reporting of COVID-19 in Canada.

Recommendations to public health care professionals

• Familiarize yourself with the interim national case definition for COVID-19 to consider the possibility of COVID-19 in persons with relevant clinical and exposure history.
• Familiarize yourself with the Interim National COVID-19 Case Report Form, to facilitate case reporting of confirmed and probable COVID-19 cases.
  • Provincial/territorial public health authorities should report confirmed and probable COVID-19 cases to PHAC within 24 hours of their own notification.
  • PHAC must report events that meet the requirements for International Health Regulations Articles 6 and 7 to the WHO within 24 hours of assessment of public health information.
  • The Protocol for Microbiological Investigations of Severe Acute Respiratory Infections (SARI) will help to facilitate the diagnosis of severe respiratory infections due to both unknown and known respiratory pathogens that have the potential for large-scale epidemics.
• Familiarize yourself with the guidance on the public health management of cases and contacts associated with COVID-19.

Infection prevention and control

In the absence of effective drugs or vaccines, infection prevention and control (IPC) strategies to prevent or limit transmission of COVID-19 in healthcare facilities include:

• prompt identification
• appropriate risk assessment
• management and placement of probable and confirmed cases
• investigation and follow up of close contacts

Early recognition and source control

To facilitate early recognition and source control:

• triage for identification and appropriate placement (source control) of patients
• masks, tissues and alcohol-based hand rubs (AHBR) should be available at entrances
• signage should be posted to instruct symptomatic patients to alert healthcare workers, thus prompting completion of a patient screening questionnaire

If a person presents with symptoms of influenza-like illness and within 14 days before the onset of illness, has travelled outside of Canada, and/or been in close contact with a probable or confirmed case of COVID-19 or someone who has travelled outside of Canada:

• place the patient in a designated separate waiting area or space
• encourage the patient with signs and symptoms of an acute respiratory infection to perform respiratory hygiene/cough etiquette, and provide tissues, AHBR and a waste receptacle
• limit visitors to only those who are essential
• do not cohort with other patients (unless necessary, in which case cohort only with patients confirmed to have COVID-19)

Application of routine practices and additional precautions

The application of routine practices and additional precautions (RPAP) is based on a point-of-care risk assessment (PCRA). Health care workers (HCWs) should use a risk assessment approach before and during each patient interaction to evaluate the likelihood of exposure.

In addition to the consistent application of routine practices, follow contact and droplet precautions. This includes the appropriate selection and use of all the following personal protective equipment (PPE):

• gloves
• a long-sleeved gown
• facial protection, such as surgical/procedural mask and eye protection, face shield, or surgical/procedural mask with visor attachment
• an N95 respirator (plus eye protection) should be used when performing aerosol-generating medical procedures (AGMPs) on a person under investigation (PUI) for COVID-19

Hand hygiene should be performed whenever indicated, paying particular attention to during and after removal of PPE, and after leaving the patient care environment.

Treatment

There is currently no vaccine against or specific treatment for COVID-19. Treatment is supportive and should be tailored to the patient's condition.

The WHO has published guidance on the clinical management of severe acute respiratory infection when novel coronavirus infection is suspected.

Drugs and Vaccines

When a vaccine or drug is developed to prevent or treat COVID-19, we will take appropriate action to ensure availability.

Measures include fast-tracking through the:

• scientific review of new drugs or vaccines through a priority review or a notice of compliance with conditions
• use of the Extraordinary Use New Drugs pathway for making a promising new drug or vaccine available in order to secure the health of Canadians during an emergency
• Canadian clinical trials for new vaccines, new or repurposed antivirals, or supportive therapies

Other measures include the:

• Special Access Program for practitioners treating patients with serious or life-threatening conditions when conventional therapies have failed or are unavailable
• the importation of a new drug authorized for sale in the U.S., Switzerland or European Union through the list of drugs for an urgent public health need

Special Access to Remdesivir for COVID-19 in Canada

Gilead Sciences Canada Inc. and Health Canada’s Special Access Programme (SAP) are considering requests for Remdesivir to treat COVID-19 on a patient by patient basis. The drug is not available on a future use basis for stockpiling in anticipation of needs. Requests for Remdesivir need to be to be submitted to both SAP and Gilead.

Diagnostic testing and medical devices

Tests developed by laboratories for their own use don’t require regulatory approval. Canada's National Microbiology Laboratory has implemented testing to diagnose COVID-19 from clinical specimens. The laboratory is working in close collaboration with provincial and territorial public health laboratories, which are now able to test for COVID-19. Laboratory testing should be initiated in consultation with the respective Provincial Health Laboratory.

An Interim Order has been signed to help ensure quicker and more flexible approval of the importation and sale of medical devices that are necessary for Canada’s response to COVID-19, including test kits.

The following diagnostic tests are now available in Canada:

• the Roche Molecular Systems Inc. cobas SARS-CoV-2 diagnostic device; and
• the ThermoFisher Scientific TaqPath™ COVID-19 Combo Kit

An interim order is one of the fastest mechanisms available to the Government of Canada to help make health products available to address larger scale public health emergencies.

If you wish to submit an application for authorization under the Interim Order please contact the Medical Devices Directorate via email hc.devicelicensing-homologationinstruments.sc@canada.ca or call 613-324-7842. Health care professionals can obtain COVID-19 diagnostic test kits or supportive devices not yet approved for sale through the Medical Devices Special Access Program.

For general inquiries about the licensing or authorization of medical devices in Canada; you can contact the Medical Devices Directorate at 613-957-7285 or hc.meddevices-instrumentsmed.sc@canada.ca.

Source: Public Health Agency of Canada