Sioux Lookout area First Nations COVID-19 Testing Strategy, updated June 2 2020

Sioux Lookout area First Nations COVID-19 Testing Strategy

Note: The following strategy is consistent with the current provincial guidance (as of May 28, 2020) related to testing for COVID-19. Guidance may change based on changes to testing supplies, lab capacity, etc.

PART 1: TESTING FOR COVID-19 IN A NORTHERN COMMUNITY
The following section applies to offering COVID-19 tests in a northern community. The testing can be done at the nursing station or at other sites in the community.

1. TESTING FOR ANYONE WITH POSSIBLE SIGNS OR SYMPTOMS
a. One or more of the following signs or symptoms:

 Fever (temperature of 37.8oC or greater); OR
 Any new/worsening symptom (e.g. cough, shortness of breath (dyspnea), sore throat, difficulty swallowing, new olfactory or taste disorder(s), nausea/vomiting, diarrhea, abdominal pain, runny nose or nasal congestion*); OR
 Clinical or radiological evidence of pneumonia.
* Note: in absence of underlying reason for these symptoms such as seasonal allergies, postnasal drip, etc.
 

b. Test elderly and children with atypical presentations of COVID-19:
Atypical symptoms include:
▪ unexplained fatigue/malaise/myalgias
▪ delirium (acutely altered mental status an inattention)
▪ unexplained or increased number of falls
▪ acute functional decline
▪ exacerbation of chronic conditions
▪ chills
▪ headaches
▪ croup
▪ conjunctivitis
▪ multisystem inflammatory vasculitis in children (e.g. persistent fever, abdominal pain, conjunctivitis, gastrointestinal symptoms and rash)

Atypical signs include:
▪ unexplained tachycardia, including age specific tachycardia for children
▪ decrease in blood pressure
▪ unexplained hypoxia (even if mild, i.e. O2 sat <90%)
▪ lethargy, difficulty feeding in infants (if no other diagnosis)

2. TESTING FOR MANAGEMENT OF CASES AND CONTACTS

a. Offer a test to all close contacts of confirmed cases:
 Symptomatic – test at the time of identification
 Asymptomatic – test at the time of identification, repeat the test if the contact develops symptoms during the 14-day quarantine period

Note that contact tracing will be coordinated by the Preventing Infectious Diseases team at SLFNHA.

All close contacts should be quarantined for 14 days from the last time they were exposed to the confirmed case of COVID-19. Note that 14-day quarantine should continue despite a negative test.
 

b. Offer a COVID-19 test to close contacts of probable cases:
Testing of close contacts of probable cases should be done only after consultation with the Preventing Infectious Diseases team at SLFNHA.

A probable case is defined as someone (who has not had a laboratory test) with symptoms compatible with COVID-19 plus close contact with a confirmed case of COVID-19 or travel within the last 14 days to an area impacted by COVID-19 or lived in or worked in a facility known to be experiencing an outbreak of COVID-19.
 

DEFINTION OF CLOSE CONTACT

Household contact: Any person living in the same household while the case was not self-isolating (includes members of an extended family, roommates, boarders, “couch surfers”, etc.)

Non-household close contact:

▪ Any person who provided care for the patient (e.g. healthcare workers or other caregivers)

▪ Any person who otherwise had close, prolonged contact (spent greater than 15 minutes in face to face contact (e.g. talking while not keeping 2 metres apart).

Note: Transient interactions (e.g. walking by the case or being briefly in the same room) are not considered close contact. They do not require follow-up or testing but can be instructed to self-monitor.

3. RISK BASED TESTING FOR PEOPLE WITHOUT SYMPTOMS
a. Offer a test to community members returning to the community after travel who:
 are returning from a region that has had a confirmed COVID-19 case within the last 14 days
 have visited institutions or congregate care settings experiencing a COVID-19 outbreak.
It is recommended that returning community members that meet the above criteria complete 14 days of quarantine (self-isolation) regardless of the test result.

b. Offer a test to community members returning to the community after travel who:
 are concerned they might have been exposed to COVID-19.
It is recommended that community members returning from an area with NO COVID-19 cases in the past 14 days be asked to self-monitor for 14 days.
 

c. Offer a test to all community visitors who:
 are travelling from a region that has had a confirmed COVID-19 case in the past 14 days.
It is recommended that visitors plan their community visit well in advance and where possible make every attempt to self-isolate for 14 days prior to their visit. Visitors should inform the community’s leadership of their travel plans as soon as they are aware of their prospective travel.
 

d. Offer a test to visiting essential service providers who:
 did not have a test prior to travelling to the community AND
 are travelling from a region that has had a confirmed COVID-19 case in the past 14 days.
It is recommended that essential service providers complete 14 days of quarantine (self-isolation) prior to travelling to the community and then travel by charter.

PART 2: TESTING FOR COVID-19 PRIOR TO TRAVELLING TO A NORTHERN COMMUNITY
 

The following section applies to people that DO NOT have signs or symptoms of COVID and for whom it is possible to have a COVID-19 test done before travel to a northern community.

A negative test result does not guarantee that someone does not have COVID-19.
 

1. Community members returning after medical travel regardless of the location of the health services:
 Test before discharge from hospital
 Test following medical appointment prior to travel home

Community members and escorts are encouraged to practice rigorous physical distancing and hand washing, as much as possible, while out of community. They may wish to consider the use of face mask while out of community.
 

2. Visiting healthcare providers:
 Test if coming from a region that has had a confirmed COVID-19 case within the past 14 days
 Test if worked at a COVID-19 assessment centre in the past 14 days
 Test if visited institutions or congregate care settings experiencing a COVID-19 outbreak
 Test if live in a household with other members who work in the health care field or congregate care setting and are coming from a region that has had a confirmed COVID-19 case within the past 14 days.

Where possible, healthcare providers must complete 14 days of quarantine (self-isolation) prior to entering a community. These individuals can complete quarantine in the region they are traveling from if they travel via chartered flights. Where possible, health care providers should be tested prior to entering communities
 

3. Visiting contract workers:
 Test if coming from a region that has had a confirmed COVID-19 case within the past 14 days
 Test if worked at a construction site where physical distancing was not practiced in the past 14 days

Where possible, contract workers must complete 14 days of quarantine (self-isolation) prior to entering a community. If necessary, they can complete quarantine seven (7) days prior to travel and seven (7) days after arrival in community as long as they fly by charter. Where possible, visiting workers should be tested prior to entering communities

4. Visiting other essential service providers:
 Test if coming from a region that has had a confirmed COVID-19 case within the past 14 days

Currently, there is no indication to test an entire northern community for COVID-19. For any person without symptoms without a history of recent travel, known exposure or any other risk – a negative test is only good for that point in time, and ongoing monitoring for symptoms, with retesting and isolation if symptoms occur are key.