Wednesday, March 11, 2020

Coronavirus: Facts about Exposure Criteria, Testing and Case Surveillance for COVID-19 in Canada



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The nurses’unions warned the national guidelines to protect nurses, doctors and other hospital staff from exposure to the highly contagious virus are less stringent than those in other jurisdictions.”

Dr. BonnieHenry, British Columbia’s provincial health officer, said after announcing the death this week that an infected care aide from the same facility is believed to have worked at two other facilities.

“It’s a challenge with our system, with care homes,” she said. “We know that whether it’s care workers or nurses, even physicians, we work in many different health authorities, many different facilities sometimes. That is part of the ongoing investigation at the Lynn Valley care home, to find out exactly where everybody worked and make sure that the other facilities are investigated.” (Bains, 2020).


Fact #1: The two highest risk groups for being exposed, getting infected, and for transmitting and spreading a virus to others are family members, and health care workers. 

A great deal of epidemiological research is done to examine who is most at-risk when new infectious outbreaks and epidemics occur in Canada, and abroad. Thousands of health care workers in China have been infected by COVID-19 on the job. Many have lost their lives. 

Many of those workers unintentionally transmitted the virus to others, including other patients they were caring for, their families, and within their local communities. This is now happening across Canada according to the latest media reports that are now reporting on health care workers who are testing positive for COVID-19.

The Canadian Federation of Nurses Unions is warning that the federal public health agency's guidelines to protect front-line health-care workers from outbreaks of diseases like the novel coronavirus don't go far enough, and might be putting them and patients at risk.

Fact #2: The Public Health Agency of Canada, the agency taking the lead on managing the coronavirus/COVID-19 in Canada has:

Restricted the exposure criteria in a way that does not allow for testing of those who do not fit Canada’s narrow exposure and testing criteria. This has not changed as the epidemiological research has come out, as the virus has spread and scaled up internationally, and more health care workers are being confirmed to have COVID-19 in Canada.

- Continues to exclude ALL Canadian health care workers (doctors, nurses, residential care aides, and all others) from the exposure and testing criteria.

- Continues to exclude ALL individuals who may have been exposed to COVID-19 through health care exposures (their doctors, nurses, care aides etc.).

- Continues to exclude ALL family members, work colleagues, or others who may who may have been exposed to COVID-19 from health care exposures, or ANY other community exposures. 

- Continues to exclude ALL first responders, including police officers, paramedics, and fire fighters. 

- Continues to exclude ALL front-line workers working with medium to high-risk patients exposed to/having undiagnosed COVID-19.

Not responded adequately to changes in the reported epidemiological risk factors, dynamics, and research coming out about health care, and community exposures.

Outcome: There are potentially thousands of individuals across Canada who have been exposed to COVID-19, are carriers/transmitters, and who are contributing to community transmission and spread in Canada. 

Public health authorities in Canada continue to state that risks of contracting COVID-19 remain low as of this week. That is not accurate, evidence-based, credible, or reliable information for Canadians/others. 

Risk Level: Canada should be seen as medium to high risk for COVID-19. People who are at higher risk of complications that could lead to more severe, or critical cases and/or those at higher risk of mortality from COVID-19 should do all they can to prevent becoming infected, such as social distancing and improved personal hygiene. 


As of March 10 2020 the Public Health Agency of Canada Exposure Criteria is:

In the 14 days before onset of illness, a person who:

Traveled to an “affected area”: China (mainland); Hong Kong; Iran; Italy; Japan; Singapore; South Korea; OR

Had close contact with a confirmed or probable case of COVID-19;

Definition: A close contact is defined as a person who provided care for the patient, including health care workers, family members or other caregivers, or who had other similar close physical contact or who lived with or otherwise had close prolonged contact with a probable or confirmed case while the case was ill. OR

Had close contact with a person with acute respiratory illness who has been to an affected area within 14 days prior to their illness onset. OR

Had laboratory exposure to biological material (e.g. primary clinical specimens, virus culture isolates) known to contain COVID-19.

Factors that raise the index of suspicion should also be considered:

Other exposure scenarios not specifically mentioned here may arise and may be considered at jurisdictional discretion (e.g. history of being a patient in the same ward of facility during a nosocomial outbreak of COVID-19).

Note: PHAC/the Federal government have not added the United States to the list of “affected countries.” 

As of March 10th, 2020, Washington State reported 267 total cases reported statewide, with 24 deaths.


What Can You Do About This Situation

Email, or contact your MP (Member of Parliament): Tell them you want them to advocate for the exposure criteria to be changed and updated in BC and that more testing for COVID-19 can occur in Canada.

Report local test refusals to MP’s and senators: Advise them if you, anyone in your family, or in your community has been refused testing for COVID-19. BC’s elected officials have been completely silent while community transmission is spreading, including in their own ridings. 

Find out your MP’s contact information here: https://www.ourcommons.ca/Members/en

Find Canadian Senators contact information here: sencanada.ca/en/contact-information

References

Bains, C. (2020). Better protections needed for health-care workers during COVID-19: advocates. Canadian Press/Medicine Hat News. Retrieved from: https://medicinehatnews.com/news/national-news/2020/03/11/better-protections-needed-for-healthcare-workers-during-covid19-advocates/.

Canadian Press. (2020). Nurses' unions warn national standards for coronavirus protection too low. Retrieved from: https://ca.news.yahoo.com/nurses-unions-warn-federal-standards-120004579.html.

Government of Canada/Public Health Agency of Canada. B. Case Surveillance and C. Exposure criteria. Retrieved from: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/national-case-definition.html#exposure

King 5 News. (2020). Here are the deaths and cases of coronavirus in Washington state. Retrieved from: https://www.king5.com/article/news/health/coronavirus/coronavirus-covid-19-deaths-cases-washington-state/281-68179a8d-9ea9-461a-9077-1f32675b802b.

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