Public Health Ontario (PHO) has released a technical brief outlining updated recommendations for the use of PPE for the care of individuals with suspected or confirmed COVID-19. Key updates are as follows:
- OVID-19 is transmitted through Droplet/Contact routes of transmission. There is no evidence that COVID-19 is transmitted through the airborne route.
- N95 respirators are only recommended for use during aerosol-generating medical procedures (AGMP)performed on suspect or confirmed cases.
- Collection of an NP specimen for detection of COVID 19 does not require an N95 respirator as this procedure is not considered an aerosol generating medical procedure. Clinicians should continue to use gloves, gowns and appropriate eye protection in addition to the procedure mask when appropriate.
- Aerosol generating medical procedures include:
- Endotracheal intubation, including during cardio-pulmonary resuscitation
- Cardio-pulmonary resuscitation
- Open airway suctioning
- Bronchoscopy (Diagnostic or Therapeutic)
- Surgery and autopsy
- Sputum induction (Diagnostic or Therapeutic)
- Non-invasive positive pressure ventilation for acute respiratory failure (CPAP, BiPAP3-5)
- High flow oxygen therapy
Please refer to Updated IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19 for further details.
RESPIRATORY TRACT SPECIMENS AND MEDIUM FOR TRANSPORT:
A single upper respiratory tract specimen will be accepted for COVID-19 testing. Upper respiratory tract specimens include a nasopharyngeal swab (NPS) OR viral throat swab collected in universal transport medium (UTM). NPS is the preferred specimen.
PHO Laboratory has done a limited evaluation on the following specimen collection kits, which can be used for
collection of nasal or nasopharyngeal specimens for COVID-19 testing:
- Chlamydia trachomatis Culture - Female Kit order #: 390083
- Chlamydia trachomatis Culture - Male Kit order #: 390084
- Mycoplasma pneumoniae/Chamydophila pneumoniae PCR Kit order #: 390085
- Roche PCR Media Uniswab Kit order #: 300295 (vendor catalogue 07958021190)
- Bordetella pertussis BP Kit order #: 390052
Note: PHO Laboratory will accept other swab types (except cotton-tipped swabs) and other liquid transport media (except gel or solid media) for COVID-19 testing; however, if the submitted swab and/or media type were not validated at PHO Laboratory for COVID-19 testing, the results will be reported with a disclaimer.
RESOURCES AND OTHER KEY CONSIDERATIONS:
Information is in a dynamic state with evolving recommendations and directives. The Windsor-Essex County Health Unit continues to update our website with a specific section for health care providers. Visit www.wechu.org/coronavirus for credible and reliable COVID-19 updates.
Public health authorities across Canada, and all levels of government, are working together to adapt responses to this rapidly changing situation. The health and safety of our community is our top priority.
We have been receiving a number of calls and concerns from members of the public over the last several days citing the refusal of primary care providers in our community to see patients with any respiratory illness symptoms. The response to COVID-19 is evolving and adapting every day and we need to ensure that our collective support of the health care system remains in place. If you have concerns related to assessing, testing, or treating suspect COVID-19 or patients with other symptoms of respiratory illness please visit our website and review the guidance documents and information available to primary care providers.
In the last CPSO communique to the members, it was stated that
“The CPSO’s expectation during a public health emergency is that physicians act in the best interests of their patients and support the provision of care directly or, where necessary, indirectly by supporting their colleagues and the larger system in responding to the emergency.
More than ever, it is important for the healthcare system to act collaboratively and holistically to meet the
challenges we see today and those ahead. That includes working directly with local public health officials, hospital systems and colleagues to ensure that patients receive the care and support they need. It is important that you protect yourselves and those around you and that physicians who may have been exposed take the necessary precautions to limit any subsequent exposure.”
These are unprecedented times, leadership is needed. The community is looking to health care providers for direction and support. Please continue to work with your patients to ensure appropriate care during this evolving situation.
Dr. Wajid Ahmed, MBBS, MAS, MSc, FRCPC
Medical Officer of Health