Information to help support you as a physician in the community in our region.
A new coronavirus is causing respiratory infections in a number of affected areas worldwide. BC has confirmed cases of the novel coronavirus; however, the risk to British Columbians continus to be low. All necessary precautions are being taken to prevent the spread of infection. We have multiple systems in place to prepare for, detect and respond to prevent the spread of serious infectious diseases in the province.
Below are some frequently asked questions and responses to help support you as a healthcare provider in our region.
Is it safe to continue seeing my newborn patients and babies in the clinic?
Yes, it is safe to do so, but make sure to follow the recommended advice for hand hygiene and cleaning of physician offices. To keep other patients safe, patients with respiratory symptoms should be calling your office ahead of time, so that you are able to decide whether they need to come in to be tested for COVID-19 and what precautions you can take when they do so. For example, you can place these patients in a separate room or at least 2 metres away from other patients upon their arrival.
In general, you can also minimize the spread of infection in your waiting room by spacing out appointments and maintaining a 2 metre distance between patients (please see Q&A below).
Public Health does not provide postpartum care to newborns or parents.
I am a physician and a patient has presented to my worksite with flu-like symptoms and need to be tested for COVID-19. What personal protective equipment (PPE) should I be wearing?
Use contact and droplet precautions. Required personal protective equipment (PPE) includes: gloves, gowns, surgical mask and eye protection/face shield) particularly during sample collection.
Should I test all patients with influenza-like illness symptoms for coronavirus?
No. Clinicians should test individuals with new-onset respiratory symptoms who are:
- Hospitalized or likely to be hospitalized (this includes people who are likely to be hospitalized for any condition such as women in the third trimester in pregnancy, people receiving chemotherapy or radiation and those on hemodialysis)
- Health care workers
- Residents of long term care facilities
- Individuals part of an investigation of a cluster or outbreak, particularly in congregate settings*
Symptomatic immunocompromised individuals may be swabbed at the discretion of their health care provider based on individualized assessment.
*Examples of congregate settings include shelters, work camps, and correctional facilities (based on direction from Public Health)
DO NOT TEST asymptomatic patients or patients with mild symptoms, including returning travelers with mild symptoms.
What do I do if a patient has indications for testing, based on the criteria in the previous question?
For these patients, clinicians should:
Give the patient a surgical mask to wear and place the patient in a separate room (if a separate room is unavailable, seat the patient at least 2 metres away from others)
Use contact and droplet precautions (this includes: gloves, gowns, surgical mask and eye protection/face shield) particularly during sample collection
Test for novel coronavirus (see instructions below)
If the patient is well enough to return home, discharge the patient with a surgical mask and advise the patient to self-isolate at home. Self-Isolation instructions are available in English, Chinese (Simplified), Chinese (Traditional) and Punjabi.
Confirm the patient’s contact information.
Inform the patient to call the BCCDC Coronavirus Hotline (1-833-707-2792) to receive their results and guidance regarding self-isolation if swab results are negative. Should the swab results be positive, Public Health provides follow-up.
Where do I send patients to get tested?
We recommended that patients be tested promptly at the location where they present. Forwarding patients to local emergency departments is not appropriate.
Please ensure that you have proper signage, the required swabs, and personal protective equipment (PPE) at your location so that you can appropriately assess and manage patients.
How do I test for novel coronavirus?
Obtain a single swab under droplet and contact precautions. A nasopharyngeal (NP) swab is preferred over a throat swab.
Send the swab to the BCCDC Provincial Laboratory (for consultation regarding testing, please call the BCCDC PHL Medical Microbiologist on-call at 604-661-7033)
To collect a NP swab OR throat swab
(**new**) Use either:
The routine Copan NP swabs used for Influenza or other respiratory virus testing, or the skin/mucosal swabs for HSV/VZV viral testing (the containers have a pink liquid in it and a red or blue cap).
The Hologic Aptima Unisex Swab Specimen Collection Kit used for endocervical and male urethra swab specimen collection. Use the blue swab to obtain an NP. (Please note: It is harder and less flexible. Insert the swab gently into the deep nares and rotate the swab for 10 to 30 seconds to obtain an adequate sample. Break the swab at the scoreline and place into the transport vial.)
Prioritize testing by labelling the requisition as coming from:
Hospital (label as HOSP)
Long-term care facility (label as LTCF)
Health Care Worker (label as HCW1 for those in roles critical to direct patient care delivery, or HCW2 for those in roles critical to supporting patient care delivery)
Do patients with confirmed COVID-19 need a test of recovery?
Any severe case of COVID-19 that requires hospitalization needs 2 negative COVID-19 tests collected at least 24 hours apart to be considered recovered. The test of recovery should be done after symptoms resolve. Hospitalized COVID-19 patients can be discharged prior to the end of the 10 day infectious period, if they are deemed well enough to recover at home by their most responsible physician. The two negative COVID-19 tests do not need to be collected prior to discharge and can be done as an outpatient.
All other cases of COVID-19 (mild symptoms and not requiring hospitalization), including Fraser Health staff and medical staff who have tested positive, do not require a test of recovery. In these cases, the patient is considered recovered 10 days after the onset of symptoms, or when the symptoms resolve, whichever is later. Coughing may persist for several weeks, so a cough alone does not mean they are not recovered.
A patient coughed/sneezed in my face and I had no PPE, what should I do?
Based on BCCDC guidelines, perform appropriate hand hygiene then immediately wash all skin surfaces that have been contaminated thoroughly with soap and warm water.
Perform self-monitoring for symptoms and self-isolate if you develop symptoms. If the patient tests positive for COVID-19, please refer to the question “My patient tested positive and I examined this patient, what do I do?”
My patient tested positive and I examined this patient, what do I do?
If you are asymptomatic, there is no need to take additional action. Please continue to work and follow the recommended precautions for all Fraser Health staff and medical staff:
Practice physical distancing, except when providing direct clinical care
Self-monitor daily for signs and symptoms of illness
Wear a surgical/procedure mask and eye protection in all patient care areas during your shift.*
Follow IPC protocols for hand hygiene and the use of personal protective equipment when delivering patient care
Public Health will contact you during the course of the case investigation if it is deemed necessary.
*The mask can be donned at the beginning of the shift and can be worn throughout the entire shift as long as it is not visibly soiled, damp, damaged or hard to breathe/see-through; it does not need to be changed between patients.
If you are symptomatic, you should self-isolate at home and do not go to work. Contact an assessment centre to get tested as soon as possible. Please see the Q & A’s on “When do staff and medical staff get tested, self-isolate, and return to work?” and “How do I self-isolate” for more details.
Do I need to contact the Medical Health Officer for any of my patients who test positive?
Public Health is notified of all positive cases by the Provincial lab and will investigate all cases.
Physicians can test for COVID-19 without consulting a Medical Health Officer.
Please refer to the MHO updates for the latest guidance on suspect cases of novel coronavirus.
How is novel coronavirus treated?
Currently, there is no specific treatment for novel coronavirus.
When do health care workers get tested, self-isolate, and return to work?
Health care workers who have respiratory symptoms are to stop working, get tested for COVID-19, and self-isolate while awaiting test results. If you test negative, return to work when asymptomatic. Coughing may persist for several weeks, so just a lingering dry cough should not preclude you from returning to work.
If you test positive, you are to self-isolate for 10 days from the onset of symptoms, and return to work after the 10th day if you are afebrile and asymptomatic. For health care workers who test positive, you do not need a negative test of clearance before returning to work unless you were ill enough to be hospitalized, in which case 2 negative tests taken at least 24 hours apart are required before return to work. Coughing may persist for several weeks, so a cough alone does not mean you need to continue to self-isolate for more than 10 days.
Health care workers who have treated patients with confirmed or suspected COVID-19 and those who are returning travelers can continue working and do not need to self-isolate or get tested so long as they are asymptomatic. The exception is travelers returning from Italy, Iran, or Hubei, China. If you are returning from these three places, you must self-isolate for 14 days.
Health care workers who are a household contact of a known positive COVID-19 case are to self-isolate based on instructions provided by the Public Health Nurse who will be in touch.
How do I self-isolate?
The following steps can be taken to self-isolate:
- Stay home and avoid situations where you may come in contact with others. Do not go to work, school, or public areas, and do not use public transport or taxis.
- Avoid having visitors to your home.
- Avoid those who have chronic conditions, compromised immune systems, and older adults.
- Avoid face to face contact with others and keep a distance of at least 2 metres if you are in the same space.
- Practice frequent hand hygiene and cover your mouth and nose with your arm when coughing or sneezing.
- During the period of self-isolation, self-monitor for fever, cough or difficulty breathing. If you have these symptoms call the local public health authority or 8-1-1.
Additionally, if you need to self-isolate and live with other people:
- It is better that the other people you live with stay somewhere else, especially if they have a weak immune system or chronic health conditions.
- If you need to share a home, stay and sleep in a separate room with good airflow that is away from others and use a separate bathroom if you can.
- Avoid face to face contact with others. Friends or family can drop off food outside your door.
- Wear a face mask if you are in the same room as someone else or when you leave the house to see a healthcare provider. Maintain a distance of at least 2 metres from other people when possible.
Plan ahead and prepare for what you will do if you or a family member becomes sick and needs care. You can ask friends or relatives if you require help with buying groceries, other shopping or picking up medication. Alternatively, you can order groceries and medication by phone or online.
Source – BC Centre for Disease Control
Has there been any guidance given on how to clean private physician offices after novel coronavirus testing?
Cleaning products and disinfectants that are regularly used in hospitals and health care settings are strong enough to deactivate coronaviruses and prevent their spread. Cleaning of visibly soiled surfaces followed by disinfection is recommended for the prevention of COVID-19 and other viral respiratory illnesses.
As per Provincial Infection Control Network of BC guidance, clean any organic matter from patient areas, then disinfect patient areas with a 1-part bleach and 9-part water solution (5,000 ppm bleach solution) or 0.5% accelerated hydrogen peroxide. Consider cleaning and disinfecting shared equipment and other horizontal surfaces.
Please refer to the BCCDC Environmental Cleaning and Disinfectants for Physicians’ Offices document for more details.
How do I mitigate the spread of infection in my waiting room?
Consider exploring virtual care options or conducting home visits for patient. If patients present to your offices consider spacing out appointments, asking patients to wear a mask if they have symptoms and maintain a 2 metre distance between patients.
New testing guidelines should prevent people with mild symptoms from attending your clinic. Consider referring patients to the BCCDC website and self-assessment tool.