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Coronavirus Disease 2019: Tips for Family Doctors

Screen. Apply Precautions. Report and Refer.

Updated: February 13, 2020

Family doctors must report to their local public health unit all patients suspected of having Coronavirus 2019 (COVID-10). Please refer to the Ministry of Health's Guidance for Primary Care Providers in a Community Setting for the up-to-date case definition, and information on screening, assessment and reporting.

Of note, the risks posed by this coronavirus to Ontarians appear to be low at this time. For any questions related to the ministry guidance on COVID-19, call the Ministry of Health's 24/7 Healthcare Provider Hotline: 1-866-212-2272 or email the Ministry's Emergency Operations Centre (during regular business hours): [email protected].

Below is a brief guide, developed by the OCFP and informed by partners, to assist you in your screening and infection prevention/control activities. Check our webpage regularly and follow us on Twitter (@OntarioCollege) for up-to-date information and resources.

Note: Only primary care clinicians who can safely use and have access to N95 respirators should conduct detailed clinical examinations on an at-risk patient. Providers must also have appropriate cleaning procedures (see: Guidance for Primary Care Providers in a Community Setting). 

SCREEN

Clinic Preparedness

** Specific screening questions for Coronavirus Disease 2019 are noted below. The ARI (Acute Respiratory Infection) algorithm should be applied during influenza season and for any patients requesting an appointment for fever and cough.

A. Determine whether your medical office/clinic has onsite capacity to safely conduct clinical assessments and testing:

  • Many medical offices/clinics in Ontario do not have the capacity to conduct clinical assessments, examinations and testing for COVID-19. As further detailed below and in the Ministry of Health's Guidance, you should only conduct a clinical examination and collect specimens for at-risk patients if
    • You can safely* use and access N95 respirators; AND
    • You have a separate isolation area available; AND
    • Patients in your isolation area have access to surgical/procedure masks; AND
    • You have appropriate disinfection procedures.

* Using it in a way that does not contaminate the wearer or others when doffing; and, the person wearing it does not have any underlying conditions that could affect their breathing significantly with use.

B. Screen your patients before they come to your clinic:

  • Screen patients before scheduling appointments by training medical office assistants/reception staff on the screening questions.

*Local public health unit OR local public health authority in your province/territory
**Guidance for travellers who have recently been to mainland China

±As further detailed in the Ministry of Health's Guidance, options may include: testing facilitated by the local public health unit; testing in the primary care office (see "A" above) & ensuring coordination of sample delivery to the Public Health Ontario Laboratory (416-235-6556 / 1-877-604-4567); or referral to the nearest emergency department - all referrals to hospital should be made to a triage nurse.

  • Consider posting signage/messages on your website, having a message on your voicemail and/or sending an email blast to encourage patients to self-identify. A sample message to patients may be as follows:
    • "If you have a cough and/or fever, and if you or someone close to you has recently travelled to China, PLEASE call Telehealth (1-866-797-0000) or your local public health unit for further direction and testing. To avoid the spread of infection, do not go to clinic or hospital before calling.
  • Allocate a separate isolation room, if possible, where symptomatic patients can be separated from the rest of the waiting room.
  • As with the guidelines for general infection control in the physician office, patients with fever and cough or difficulty breathing should be scheduled at the end of the day (provided they are not in distress) to reduce the number of people exposed and for better room cleaning afterwards.

C. Screen your patients at the point of entry to your clinic:

  • Post signage that your patients can see as soon as they enter your clinic.
  • Have masks and alcohol-based hand sanitizer and tissues available on entry to your clinic for patients entering with fever and cough
  • Ensure reception staff are at least two (2) meters away from patients.
    • Ideally, ensure reception staff conducting screening are behind a barrier to protect from droplet/contact spread (e.g., a plexiglass barrier can protect reception staff from sneezing/coughing patients).
  • Ensure clinic staff are ready to apply precautions, when applicable.

*Person Under Investigation (PUI) for COVID-19 -- is the patient presenting with the following:

   1. Fever and/or onset of cough or difficulty breathing

  AND any of the following:

   2. Travel to mainland China in the 14 days before the onset of illness

  OR

  Close contact with a confirmed or probable case of COVID-19

  OR

  Close contact with a person with acute respiratory illness who has been to mainland China within 14 days prior to their symptom onset

*Some people, such as the elderly and people who are immunocompromised, may not develop a fever. The presence of new/worse cough or shortness of breath may be enough to trigger further precautions.

APPLY PRECAUTIONS*, REPORT AND REFER, AS REQUIRED

Ask Patient to:

  • Wash their hands;
  • Wait in separate isolation area if possible or keep two-metre distance from other patients and clinic staff (symptomatic patients should be separated from the rest of the waiting room);
  • Wear a surgical/procedure mask (this should be available on entry to clinic for self-identification).

Initiate Droplet and Contact Precautions for Suspected Coronavirus Cases:

  • Apply vigilant hand hygiene;
  • Use gloves, gowns, fit-tested, seal-checked N95 respirators and eye protection when entering the same room as the patient or when transporting or caring for the patient;
  • Postpone elective procedures that generate droplets (e.g. dental care).

 If an at-risk patient shows up to clinic, and the clinic does not have the capacity (see A above) to safely conduct a clinical examination and collect specimens:

 ▢ The family doctor should use a procedure mask and isolate the patient, including providing a procedure mask for the patient to wear; AND

 ▢ Contact your local public health unit to report the PUI, and to discuss the most appropriate way for the patient to be clinically assessed and be tested.

You may conduct a clinical history and visual assessment while under contact/droplet precautions and maintaining a 2-meter distance from the patient.


*For more information on Routine Practices and Additional Precautions, health care workers should refer to (PIDAC's) Routine Practices and Additional Precautions in All Health Care Settings and Annex B: Prevention of Transmission of Acute Respiratory Infection in all Health Care Settings)

Report

  • Call your local public health unit to report the suspected case, and to discuss the most appropriate way for the patient to be clinically assessed and tested.
  • In addition, for clinics with the onsite capacity to safely conduct clinical assessments and testing (see "A" above), follow Public Health Ontario's testing procedures to safely collect and send appropriate specimens for COVID-19 to PHO.

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