COVID-19: providing care

All health-care settings should continue to actively screen for signs and symptoms of communicable disease, according to Public Health Ontario’s Interim Infection Prevention and Control Measures based on COVID-19 Transmission Risks in Health Care Settings. For community-based settings, patients should be screened virtually and at the point of entry to your clinic. If your clinic is located inside a shared building, consider placing signage both at the entry to the building and at the point of entry to your clinic.

A screening for COVID-19 is clinically relevant (negative or positive) and the College of Physicians and Surgeon’s Medical Records Documentation policy would support documenting this in the patient’s chart.

Assess patients for respiratory illness symptoms and risk factors, either virtually or in person. The CPSO states that in-person care can be provided safely by taking appropriate precautions, including screening and isolating patients with these symptoms and using necessary PPE.

Peer tips for assessing symptomatic patients include:

• Consider scheduling patients with respiratory illness symptoms at the beginning or end of the day when staff and other patients are not in the office. If possible, also consider using a specific exam room, as well as a separate entrance.
• Isolate the patient in a room with a closed door upon arrival. If no exam room is available, ask the patient to wait outside or in a car, and call/text them when room becomes available. After the patient leaves, clean any patient-contact surfaces (i.e. areas within two metres of the patient) as soon as possible.

Starting in Oct. 2024, Ontario adopted a Test-to-Treat policy. This means publicly-funded COVID-19 testing (including rapid antigen tests and PCR testing) is now only recommended for individuals eligible for COVID-19 treatment. This includes symptomatic individuals who are:

• 65+ years of age
• 18+ with an underlying medical condition
• Immunocompromised
• Living with high-risk medical conditions

It also includes hospitalized patients and residents of long-term care homes and other high-risk congregate living settings. In addition, physicians can use their clinical discretion to order PCR testing for individuals outside of these groups.

You can continue to order free rapid antigen tests and supplies for PCR testing through the PPE Supply Portal. To set up an account, email sco.supplies@ontario.ca.

Any tests ordered through the provincial program cannot be sold and individuals tested cannot be charged a fee.

Offering PCR testing in your practice

If you are a community-based physician, you may choose to provide lab-based PCR tests in your practice to eligible patients, but this is not required. If you cannot test in your office and the patient is eligible for testing, refer the patient to a local testing site. Patients with severe symptoms should be referred to the emergency department.

Testing for SARS-CoV-2 variants

There is currently no routine targeted screening for variants of the SARS-CoV-2 virus. However whole genome sequencing is performed for surveillance purposes on a representative sample of positive PCR tests across Ontario and specimens from international travellers. Any patients who have recently travelled outside of Canada (including to the U.S.) should have that marked on the test requisition.

COVID-19 is a designated a “communicable disease” which must be reported to the local public health unit under the Health Protection and Promotion Act. Contact your local public health unit to report any laboratory-confirmed (NOT Rapid Antigen Test only) cases of COVID-19. 

• Symptomatic individuals who are:
  • 65+ years of age
  • Individuals 18+ with an underlying medical condition
  • Immunocompromised
  • Individuals with high-risk medical conditions
• Hospitalized patients
• Residents of long-term care homes and other high-risk congregate living settings
• People in the context of suspected or confirmed outbreaks, as directed by local public health

Yes. Serological testing is available in Ontario in three circumstances:

1. Patients with symptoms compatible with Multisystem Inflammatory Syndrome in Children (MIS-C) who do not have laboratory confirmation of COVID-19 by PCR testing.
2. Patients with severe illness who have tested negative for COVID-19 by PCR testing and where serology would help inform clinical management and/or public health action. (Serology for these patients requires consultation and approval by the testing laboratory).
3. To inform treatment decisions for monoclonal antibody treatment for certain patients who are critically ill (in the ICU due to COVID-19) or moderately ill (in hospital due to COVID-19 and requiring low-flow oxygen).

Serology should NOT be used for screening and diagnosis of acute COVID-19 infection. A positive serology test does not mean a patient is immune to COVID-19. Diagnostic testing for acute COVID-19 infection should be done by validated PCR testing.

No, a time-based approach to clearance can be used for all patients in the general population.

Individuals with any COVID-19 symptoms are recommended to isolate as follows, regardless of COVID-19 test result.

• General population (including health-care workers outside of highest-risk settings): Isolate until fever has resolved and until symptoms have been improving for 24 hours (48 hours for gastrointestinal symptoms)
• Those who are immunocompromised, live in a high-risk setting or were hospitalized for COVID-19: Isolate for 10 days
• Those who required ICU care: Isolate for 20 days, unless otherwise directed by hospital infection control

All groups listed above should wear a mask in public and avoid non-essential visits to high-risk settings such as hospitals and long-term care homes for 10 days from symptom onset.

• Do not need to self-isolate unless symptoms develop
• Should wear a mask in public and avoid non-essential visits to high-risk individuals and settings for 10 days from their positive test date

Household and non-household close contacts should do the following for 10 days from their last exposure:

• Self-monitor for symptoms and isolate if any symptoms develop
• Wear a mask in all public settings
• Avoid non-essential visits to anyone who is immunocompromised or at higher risk of illness (i.e. seniors)
• Avoid non-essential visits to any highest-risk setting, such as hospitals or long-term care homes

Health-care workers who work in a highest-risk setting (e.g. acute care hospital, complex continuing care hospital, congregate living setting or Indigenous community) should speak with their employer and follow their workplace guidance for return to work.

Those who are symptomatic or test positive:

• Should avoid work until their fever has resolved and symptoms have been improving for 24 hours (48 hours for gastrointestinal symptoms)
• After returning to work, for 10 days after symptom onset/positive test, they should:
• Avoid caring for patients/residents at highest risk of severe COVID-19 infection, where possible
• Ensure well-fitting source control masking (e.g., a well-fitting medical mask or fit or non-fit tested N95 respirator or KN95)
• Review PPE and IPAC practices, where possible
• Take unmasked breaks in a separate break room, or with physical distancing, to avoid exposing co-workers
• Work on a single ward or area of the setting as much as possible
• Work in a single facility, as much as possible

Those who are exposed to COVID-19 (including household and similar non-household close contact exposures):

• Should self-monitor for symptoms for 10 days from last exposure and can continue to attend work
• In addition to self-monitoring, individuals may consider the following, where feasible:  
• Actively screening for symptoms ahead of each shift, where possible
• Mask whenever possible in the presence of other staff to reduce exposure to co-workers (e.g. not eating meals/drinking in shared spaces) and maintaining physical distancing if mask removal is required
• Work in only one facility, where possible
• Ensure well-fitting source control masking for the staff to reduce the risk of transmission (e.g. a well-fitted medical mask or fit or non-fit tested respirator or KN95)
• Employers must also follow requirements as per the Occupational Health and Safety Act.

The OMA has compiled a list of resources (member-only content) for finding a lawyer in your area to assist in drafting a will or dealing with other personal legal matters during the pandemic.

For general information on virtual care, visit OntarioMD virtual care. Note that if express verbal consent is collected, it should be documented in the chart.

The CPSO also has a policy related to the provision of virtual care, which should be reviewed carefully before providing care to patients through this modality.

Both the Information and Privacy Commissioner and the CPSO have indicated the importance of obtaining appropriate patient consent and limiting the use of unsecured (unencrypted) communication methods such as unencrypted email and text messages to circumstances where the best interests of the patient require it.