Clinical Guidelines - Expansion of Testing Criteria and Discontinuing Self-Isolation
DATE: 3/25/2020 @ 12:00 p.m.
TO: SHA, EOC, ACOS, Practitioner Staff; all Saskatchewan MHOs
FROM: Dr. Julie Kryzanowski, SHA Senior Medical Health Officer
RE: Updated COVID-19 Clinical Guidelines – Expansion of Testing Criteria and Discontinuing Self-Isolation
The following updated guidance is provided to inform clinical decisions about testing, and management of positive test results and persons required to self-isolate due to the presence of COVID-19 symptoms.
The information currently posted at the link Clinical Guidelines for Testing, Management and Reporting (March 21, 2020) will be UPDATED (March 25, 2020) as follows:
What is new?
- Expanded testing criteria to include new populations recommended and prioritized for testing.
What has changed?
- Persons who have been required to self-isolate due to the presence of COVID-19 symptoms may discontinue self-isolation 14 days after symptom onset (or date of diagnosis if an asymptomatic case) OR 24 hours after symptoms significantly resolve (whichever is later).
- MHO consultation not required to discontinue self-isolation.
- Those who work in health care settings may need to meet additional requirements before returning to their workplace. Continue self-isolation until discontinued – consult with OHS and/or IPAC.
What is the same?
- Cases admitted to hospital or health care facility or residents of long term care or personal care homes continue to require 2 negative tests, a minimum of 24 hours apart, before lifting infection prevention and control (IPAC) precautions.
Rationale
- Updated guidance is provided:
- To promote strategic use of laboratory resources and supplies
- To support identification of triggers for key public health actions
- To provide a justifiable strategy that can be used to manage expectations regarding who is to be tested
- Populations for testing are prioritized based on consideration of:
- the likelihood of individuals within those groups to be at risk for serious disease,
- the potential to transmit the virus within a health care facility, prison or vulnerable community setting,
- the potential to have a serious impact on health care delivery and other critical infrastructure, or
- the risk that an exposure has occurred and thus higher likelihood of testing positive.
- Requirements for repeat testing before discontinuing self-isolation based on consideration of:
- PCR testing will pick up non-viable virus or virus particles – producing a positive result when live virus may not be present
- Serial virus isolation was conducted on a small number of patients in Germany – after day 8 of illness/symptoms no live virus was recovered from these patients but several remained positive by PCR. (Pre-print copy: https://www.medrxiv.org/content/10.1101/2020.03.05.20030502v1 )
- In the absence of conclusive data the use of 14 days (versus 8 errs) on the side of caution and is a consistent message to communicate to health care providers and the public.
These recommendations are developed and reviewed by the Senior Medical Health Officer with Provincial Clinical Departments of Public Health and Preventive Medicine, Family Medicine and Laboratory Medicine and provided with the support of the provincial Chief Medical Health Officer.
Please note that provincial and national* guidance will continue to be updated as situation evolves within Saskatchewan and across Canada, and based on evidence and best practice.
*Federal-provincial-territorial Special Advisory Committee on the Novel Coronavirus (SAC) comprises members of the Pan-Canadian Public Health Network Council and the Council of Chief Medical Officers of Health of Canada.
This information is for the recipient(s) listed and is considered confidential by law.
If you are not the intended recipient, any use, disclosure, copying or communication of the contents is strictly prohibited.