Definitions

Updated October 2, 2025

A resident is suspected to have a viral respiratory illness (VRI) when they have acute onset of signs and symptoms based on clinical judgement* and test results may be pending.

VRI signs and symptoms include a new or worsening cough and/or fever** and any one or more of the following (not listed in any particular order of significance):

• Shortness of breath.
• Runny or stuffy nose (i.e., congestion) or sneezing.
• Sore throat or hoarseness or difficulty swallowing.
• Other non-specific symptoms may include tiredness, malaise, muscle aches (i.e., myalgia), headache, and nausea, vomiting, diarrhea (maybe present in some residents) or loss of sense of taste or smell (more common for COVID-19 infection).

Note:
* Clinical judgement is required to assess probable VRI cases. Other etiologies including non-infectious causes must be considered and ruled out (e.g., side effect of medication or chronic health conditions).
**Fever may or may not be present, particularly in the elderly, the immunocompromised, or those taking medications such as steroids, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), or Acetylsalicylic Acid (ASA). A temperature <35.6 or > 37.4ºC in the elderly may be an indication of infection.

See Tool 31 for helpful information about common respiratory viruses. 

Respiratory illness characterized by serious illness

• Illness is more than “a bad cold” in many or most of those affected
• Illness may be remarkable in its suddenness and accompanying extreme fatigue (prostration)
• Affected individuals are not up and about while ill
• Eating and drinking are likely to be affected
• There are complications such as pneumonia (viral or secondary bacterial), heart failure or septicaemia in residents or staff for whom pre-existing frailty or underlying chronic illness is not a satisfactory explanation for such complications
• Illness may be prolonged, with cases taking longer than expected to recover

Respiratory illness characterized by predominately mild illness

• Illness is mild and “common cold-like” in most of those affected
• From onset (or within a day or two), activity levels, including eating and drinking, are not markedly different than usual

Note: There may be individual exceptions due to an underlying, pre-existing illness that makes certain individuals very susceptible to complications from any respiratory infection.

Viral respiratory illness follow up definitions

Please note: If two or more organisms are identified (e.g. COVID-19 and influenza), consult Public Health (PH) to determine the appropriate follow up.

(*): In general, management of cases and infection control measures will be at the unit level. There may be units in the care community that are on different measures. As well, depending on the care community layout and movement of staff/residents between units, two or more units may be put on the same measures.

Staff cases - COVID-19 and influenza:

• Are no longer required to be reported daily to public health.
• Facilities are encouraged to use Tool 28 as a line list to track cases and use the staff checklist available (COVID-19), as needed, for situational assessment and preventative/control measures.
• Facilities should be able to provide information (e.g., how many staff are sick with respiratory illness and how many are positive for influenza or COVID-19) if asked by Public Health.