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).
Please do not delay routine infant and childhood immunizations. It is important to complete immunization schedules and delaying or postponing these can lead to missed immunizations.
I am a physician working in the community. What personal protective equipment (PPE) should I be wearing?
All physicians who have face to face contact with patients are to wear a surgical mask and eye protection (ie., face shield, goggles, or safety glasses) during their shift.
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.
Gloves should be worn when providing direct care to patients. In line with droplet and contact precautions, a gown should be worn when providing care to any patient with symptoms of COVID-19 and when collecting samples for testing. Gloves and gowns must be changed between patients.
Currently, there is no good evidence demonstrating routine aerosolization of COVID-19 in a community setting and an N95 respirator is not generally needed. However, an N95 respirator should be used for aerosol-generating procedures, and some of these may occur in the community setting. The use of CPAP machines or nebulizers for respiratory disease are considered aerosol-generating procedures, and an N95 respirator should be worn along with eye protection, gloves, and a gown when using or demonstrating these in clinic. Please refer to the list of COVID-19 Aerosol Generating Medical Procedures.
Who should I test for coronavirus?
What do I do if a patient has symptoms suspicious for COVID-19?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 or send patient to assessment centre to get tested (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), sign up for text results, or myehealth 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.
- Refer to our self-isolation page for patients for guidance on how long and how to self-isolate.
- Inform the patient to self-monitor daily for fever, cough and worsening symptoms and check their temperature each day (if possible)
- If they have worsening symptoms at any time OR they are not feeling better 5 to 6 days after they initially started feeling unwell, tell them to call 8-1-1 or their family doctor. If at any time they are feeling very unwell and are worried it might be an emergency (e.g. severe difficulty breathing or chest pain), tell them to call 911.
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.
If you are unable to test at your location, you may direct patients to call 8-1-1 to find the nearest centre or follow the links below
- Collection centre finder (Mobile and desktop)
- Collection centre finder for Internet Explorer users
How do I test for novel coronavirus?
Who can self-swab for COVID-19? How is it done?
RNs, LNs, registered psychiatric nurse practitioners, and physicians who are competent in NP swabbing are allowed to self-swab.
- use the appropriate viral swab collection kit (see “How do I test for novel coronarvirus”),
- you must have the ability to insert the swab to the posterior nasopharynx as well as be able to maintain sterility of the swab.
- the clinician completing the self-swabbing needs to wear gloves, but no gown or face shield is required.
- correctly label and place the swab in the biohazard bag with the requisition, then follow regular protocol for the storage and transporting of the sample.
The requisition needs to include the name of the ordering physician or nurse practitioner, be labelled to indicate that it is from a health care worker as described above, and include both the full name and PHN so that the testing will be prioritized.
Do patients with confirmed COVID-19 need a test of recovery?
For all mild to moderate cases of COVID-19 not requiring hospitalization, including patients who are health care workers, tests of recovery are not required nor recommended. In this case, COVID-19 cases are considered not infectious once they are finished their self-isolation period.
For severe cases of COVID-19 who required hospitalization a test of recovery is required for patients while admitted in hospital and for patients transferred into long-term care facilities after at least 10 days have passed since onset of symptoms AND symptoms related to COVID-19 have resolved (apart from a lingering dry cough) AND two consecutive negative NP swabs are obtained at least 24 hours apart.
A patient coughed/sneezed in my face and I had no PPE, what should I do?
If the patient is suspected or confirmed to have COVID-19, please follow direction of public health. BCCDC detailed guidance on COVID-19 exposure risk assessment is available for more
If the patient is not suspected to have COVID-19, notify your supervisor. Consider a test for the patient if they have developed symptoms. You may continue to work, but continue to practice infection prevention and control measures, continue to self-monitor for symptoms, and continue to wear appropriate PPE. If the patient later tests positive for COVID-19, please refer to the question “My patient tested positive and I examined this patient before they had symptoms, what do I do?
If at anytime you develop symptoms, stop working, self-isolate, and get tested.
My patient tested positive and I examined this patient before they had symptoms, what do I do?
Public Health will contact you during the course of the case and contact investigation and provide further instruction.
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.
How do I self-isolate?
Stay home the whole time you self-isolate. Try to arrange for food and essential items to be delivered and dropped off at your door when you need them.
Avoid face to face contact with others, including those who live in your home.
Do not go to work, school, or public areas
If you must leave the home, such as for an urgent medical assessment, do not use public transport, taxis, or ride shares. Call the medical centre in advance of going.
Do not have non-essential visitors to your home.
If possible, have other people who live in your home stay somewhere else, especially if they have a chronic health condition or are older.
If you need to share a home, stay and sleep in a separate room with good airflow that is away from others. Use a separate bathroom if possible, and keep at least 2 metres distance away from others.
Wear a face mask if you are in the same room as someone else or when you must leave the house to see a healthcare provider.
Practice frequent hand hygiene and cough or sneeze into your elbow or tissue
During the period of self-isolation, self-monitor daily for fever, cough or worsening symptoms. Check your temperature daily (if possible). The BC self-assessment tool will help you assess your symptoms.
If you are having worsening symptoms, call 8-1-1 or your family doctor
If your symptoms are not improving at 5 or more days after you initially started feeling unwell, call 811 or your family doctor
If at any time you are feeling very unwell and are worried this might be an emergency (e.g., severe difficulty breathing or chest pain), call 911.
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.
When do health care workers get tested, self-isolate, and return to work?
For healthcare workers who have symptoms of COVID-19:
Stop working, get tested for COVID-19, and self-isolate while awaiting test results.
If you test positive, regardless of your travel and COVID-19 exposure history, 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 without fever-reducing medications and asymptomatic. Coughing may persist for several weeks, so just a lingering dry cough alone does not mean you need to continue to self-isolate for more than 10 days.
If you test negative and have not been exposed to anyone with COVID-19 and are not an international returning traveller, return to work when asymptomatic. Coughing may persist for several weeks, so just a lingering dry cough should not stop you from returning to work.
If you test negative and are a returning international traveller, self isolate for a minimum of 14 days from when you landed in Canada and/or when symptoms resolve, whichever is longer. Public health may contact you if you should return to work earlier.
If you test negative and were exposed to someone with COVID-19 while at work and were not wearing appropriate PPE, self isolate until cleared by public health to return to work.
If you test negative and are a close household contact where someone you live with has COVID-19, self-isolate for a minimum of 10 days from when you started feeling sick and/or 14 days from the day you were exposed, whichever is longer.
You can find information on how long and how to self isolate after a negative test from the following healthcare and essential worker handout.
Health care workers who feel well:
Health care workers with appropriate PPE who have treated patients with confirmed or suspected COVID-19 can continue working and do not need to get tested so long as they are asymptomatic. If PPE was not worn or there was a high risk exposure, refer to BCCDC detailed guidance on exposure risk assessment. Public health will contact you and provide further direction if needed.
Returning travelers who are health care workers can continue working but should otherwise self-isolate outside of work for 14 days. For example, they should avoid non-essential trips to public places, monitor for symptoms, and make sure not to work if they are feeling unwell. They do not need to get tested so long as they are asymptomatic.
For health care workers who are a household contact of a known positive COVID-19 case, please follow instructions provided by public health who will contact you.
What supports are available to support my well-being?
Fraser Health is offering supports for medical staff varying from in-person to telephone conversations and group sessions. These include emotional support, mental health and well being, stress and anxiety management and self-care tools. Follow this link for more information.
Starting Tuesday, April 7, the BC Physician Health Program (PHP) will be offering free drop-in Physician Peer Support Sessions every Tuesday and Thursday from 4 pm to 5pm PST via Zoom. For more information, please visit COVID-19 Physician Peer Support Sessions.
What child care resources are available for physicians?
Child care is necessary to ensure essential service workers are able to support community efforts to battle the pandemic. The government is putting measures in place to ensure that appropriate, safe care is available for children who need it.
- Essential workers can fill out a form to identify their need for urgent child care for children aged 0-5 years. You can access the forms online or by calling 1-888-338-6622 and selecting option 4.
- For child care support for children ages 5-12, please contact your local school, school board or Child Care Resource and Referral Society. Child Care Resource and Referral Society support parents and caregivers by providing referrals to child care centres with available spaces in your geographic area. We understand that there are currently spaces available in child care centres across the region. For more information, please visit Child Care Resource and Referral Society.
For more information, please visit Government of BC - Child Care Response to COVID-19.
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.