Dear Doctor,

What’s new?

• COVID-19 new screening protocol now includes anyone who has travelled outside of Canada
• Today the Nova Scotia Health Authority (NSHA) established assessment centres where people can be screened and tested separately from emergency departments:
  • Eastern Zone: Cape Breton Regional (opened at noon)
  • Western Zone: Valley Regional, South Shore Regional and Yarmouth Regional Hospitals opened at 9:00 a.m.
  • Northern Zone: Colchester East Hants Centre 3:30 to 6:30 p.m., East Side Collaborative Practice (New Glasgow) 1:00 to 4:00 p.m., Cumberland Regional Health Care Centre  3:00 to 7:00 p.m.
  • Central Zone: Cobequid Community Health Centre opened at 9:00 a.m.
• The NSHA has created an online information hub; bookmark it for easy access
• The Public Health Agency of Canada (PHAC) is recommending that Canadians avoid all cruise ship travel due to the ongoing COVID-19 outbreak

Update – Dr. Rob Strang, Chief Medical Officer (March 9, 2020)

• With rapid global spread of SARS-CoV-2, we are shifting the surveillance focus to include anyone who has travelled outside of Canada. They will be instructed at border entry and through public messaging to:

1. Monitor their health for 14 days from the day they entered Canada and minimize their contact with those at high risk of severe COVID-19 illness (e.g. not visiting a long-term care facility)
2. Self-isolate if they begin to feel unwell in the 14-day period
3. Call 811 if they develop fever (>38°c) OR new onset (or exacerbation of chronic) cough in the 14-day period to arrange testing for the SARS-CoV-2 virus

• When a patient presents for health care, use the screening tool to ensure suspect cases are managed appropriately (LINK ROB’s UPDATE)
• At this time, there is no known community transmission of SARS-CoV-2 within Canada, but clinicians with concerns about COVID-19 in a patient who has travelled within Canada can contact their local Medical Officer of Health (MOH) to discuss testing. During business hours, the local MOH can be contacted through the appropriate regional hospital switchboard (in Central Zone this is QEII locating); after hours, phone 902-473-2222 and ask for the MOH on-call

Read Dr. Strang’s full update

Office-based infection prevention and control

Follow standard precautions in your office/community clinic as you would for other respiratory illnesses:

• Screen patients on intake. For those with respiratory symptoms, provide a surgical/procedure mask and separate them from other patients by at least two meters
• Ask patients to practise respiratory/cough etiquette
  • Cover coughs and sneezes with a tissue. Dispose used tissues in the garbage and wash hands, or use an alcohol-based hand rub immediately after OR
  • Cough/sneeze into elbow, not hand
• Practise good hand hygiene by using alcohol-based hand rub or water/soap if hands are visibly soiled
• Clean and disinfect items. First wash using soapy water, then disinfect using regular cleaning products or a solution of one-part bleach to nine-parts water
• Disinfect phones, remote controls, computers and other handheld devices with 70% alcohol or wipes
• Wash or launder clothing, sheets and towels on a regular basis
• Dispose of garbage on a regular basis. Wash hands afterward

Practice/office considerations

• Have a business continuity or emergency plan in place
• Remove from reception areas non-essential items like magazines, stuffed toys and other items that cannot be easily cleaned
• Think about what you will do if several employees become sick
• Support employees who may become ill. Talk to your staff about flexible hours or alternative work options should they need to stay at home for an extended period
• Support proper infection prevention and control measures in your business. Post handwashing signs and provide alcohol-based hand rub to encourage frequent hand hygiene and ensure space/surface cleaning is completed

Quick facts and cases in Canada

• There are no reported cases of COVID-19 in Nova Scotia
• There are currently 77 confirmed cases in Canada: 34 in Ontario, 32 in British Columbia, four in Quebec and seven in Alberta. There has been one death in Canada. The virus continues to expand globally
• There is no need for healthy individuals to wear a mask within Canada, unless they are experiencing symptoms or caring for someone with COVID-19
  • COVID-19 is most often being spread through close contact with a person who is showing symptoms (symptomatic cases). While experts believe that spread from a person who is asymptomatic is possible, this is rare

• The Government of Canada continues to recommend avoiding all non-essential travel to China, Iran and Northern Italy (level 3 travel advisory). Japan and South Korea have level 2 (special precautions) and France, Germany, Hong Kong, Singapore and Spain have level 1 (no special precautions) travel advisories
• The Government of Canada has set up a novel coronavirus information line at 1-833-784-4397

Give your feedback on coronavirus

Chief Public Health Officer Dr. Theresa Tam is Canada’s response lead for the coronavirus outbreak. She is seeking feedback from physicians to inform the Public Health Agency of Canada and the Special Advisory Committee on Coronavirus. This committee is reviewing measures to prevent the spread of COVID-19. Dr. Tam would like your input on gaps, issues and communication preferences. Email your comments to Barb Johnson.

Additional resources

• Nova Scotia Health Authority
• Government of Canada
• Public Health Agency of Canada
  • Information for health professionals
  • Symptoms and treatment
  • Travel advice
  • Guidance for infection control in acute care
• Department of Health and Wellness
• Canadian Medical Association