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Frequently Asked Questions on Novel Coronavirus (COVID-19)

Niagara Region Public Health and Emergency Services is closely monitoring the COVID-19 pandemic. This is an evolving situation and we'll continue to update information as it becomes available.

If you have questions, call our COVID-19 Primary Care Info-Line Monday to Friday, 9:15 a.m. - 4:30 p.m. Call 905-688-8248, press 7, then press 1 for physicians.

Updated Jan. 15

General Information for Niagara

Return to School

Public Health is committed to identifying and working collaboratively with Niagara's school boards and the community on reopening concerns as well as advising on communication and outbreak guidance for schools. We're sharing best evidence with school boards around:

  • Risk mitigation
  • Active and passive screening
  • Support for physical distancing
  • Personal protective equipment
  • Infection prevention control measures

Resources are being shared with the schools directly. If you or your practice are advising teachers or parents, or providing resources, let us know what's being shared so that we can ensure consistent communication. Email the primary care and stakeholder engagement advisor.

  • What information is Public Health providing school boards, parents and students?

    Public Health has summarized the Ontario guidelines which outline the measures required to keep staff, visitors and students safe and healthy when reopening schools. Information and our resources can be found at reopening schools during COVID-19.

  • Where can I find data relating to school associated COVID-19 cases?

    All four school boards in Niagara provide information on confirmed cases and school closure status. For specific school-related data in Niagara, visit schools during COVID-19.

  • I have a patient who must cross the border to attend school in the United States. What are their isolation requirements?

    For information, visit the Government of Canada’s website on how to quarantine at home.

  • Has Public Health developed a protocol if a student tests positive for COVID-19?

    The province released their Operational Guidance: COVID-19 Management in Schools. The guidance includes details around case and contact management, cohorts and outbreak management, and school closures.

    If a student or adult tests positive and is part of a school setting, Public Health investigates to determine any potential risk to others. If an outbreak is declared in a school setting, Public Health closely supports schools to help minimize the transmission of infection and provide case-specific recommendations.

  • What are the recommendations for symptomatic children who fail the COVID-19 school / child care screening AND for those who are sent home due to symptoms?

    Public Health recommends that any child with symptoms of COVID-19 who fails screening remain at home or return home as soon as possible if symptoms develop at school or child care.

    Learn about symptoms and next steps.

  • What are the steps after an assessment of a symptomatic child for COVID-19?

    After assessing someone with COVID-19 symptoms:

    • If a COVID-19 test is indicated, you can do the swab if desired, or complete a referral to the assessment centre. For a copy of the documentation referral form, email the primary care and stakeholder engagement advisor.
    • If swab / referral cannot be completed by your office, the parent / guardian can self-refer to the Niagara Health assessment centre at 905-378-4647 ext. 42819
    • If they have any remaining questions, they can call the Public Health COVID-19 Info-Line for referral at 905-688-8248, press 7, then press 2

    Once it's determined that a COVID-19 test is indicated, the symptomatic child AND all household members must self-isolate while awaiting test results.

    • If the child receives a positive result, the child and household members should remain in isolation. Public Health will contact the family to provide further direction and support.
    • If the test is negative, household members may leave self-isolation, but the child cannot until they have not had any symptoms for 24 hours or it's been 10 days since their symptoms started (whichever is shorter). They also must not have a fever, be using fever reducing medications, and have symptom improvement.

    If the symptom or symptoms are related to a chronic or pre-existing condition, such as allergies, post-nasal drip, migraines, asthma, and a test is NOT recommended, they can return to the school / child care once they feel well enough, without waiting for symptoms to resolve.

    If you provide advice that COVID-19 is unlikely and a test is NOT recommended, but the symptoms are not attributed to a non-infectious condition, the child should stay out of school / child care until they have not had any symptoms for 24 hours or it's been 10 days since their symptoms started (whichever is shorter). They also must not have a fever, be using fever reducing medications, and have symptom improvement.

    If a recommended COVID-19 test is declined or families have refused to call a health care provider, the child and all household members must complete a 10 day self-isolation period from the onset of symptoms.

  • Are there other indications for exclusion from school / child care beyond a failed screen?

    Yes, exclusion from school / child care also applies to individuals who:

    • Tested positive for COVID-19
    • Reside with anyone who is exhibiting symptoms of COVID-19 and a decision has been made to arrange for a COVID-19 test
    • Reside with anyone who is awaiting results from a COVID-19 test
    • Have been exposed to a confirmed case of COVID-19
    • Have travelled outside of Canada in the past 14 days
  • My patient (child) has seasonal allergies (or other underlying condition). Will they pass the COVID-19 screening checklist at school / child care?

    When the screening tool asks if a child has "a runny or congested nose (not due to allergies)" a parent may answer "No" if the child has a runny / congested nose AND is known to have allergies (or other chronic condition) such that a runny / congested nose is usual for the child, and the current symptoms are not at all different.

    Public Health doesn't recommend that a school / child care facility ask for a doctor's note for previously diagnosed conditions, including allergies. Parent attestation is adequate.

  • I am recommending a test for COVID-19. When can the child return to school / child care?

    If the child has received a negative test result, the child should stay out of school / child care until 24 hours after their symptoms have resolved OR, 10 days after the onset of their symptoms, whichever is shorter, as long as the child does not have a fever (without use of fever-reducing medications) and symptoms are improving.

    If the child receives a positive result, the child and household members should remain in isolation. Public Health will contact the family to provide further direction and support.

    If a recommended COVID-19 test is declined or families have refused to see a health care provider, the child and all household members must complete a 10 day self-isolation period from the onset of symptoms.

Workplace Inquiries

Employers and employees have a role to play to reduce the community spread of COVID-19. Find recommendations and information that apply to all workplaces and businesses, except health care settings, to help prevent the spread of COVID-19.

  • My patient is concerned about potential increased risk with return to work due to underlying health conditions. What is the recommendation?

    This would need to be addressed on an individual basis.

    For any workplace, if you're concerned about an employee's risk due to their medical status, all employees should connect with their occupational health, and have their occupational health connect with you.

  • I am a health care worker and was tested for COVID-19. When can I return to work?

    Anyone with a positive test result will be contacted by Public Health to determine the period of self-isolation. In general, there is a minimum 10 day self-isolation period after symptom onset.

    If you received a negative test result:

    It's important to remember that a COVID-19 test is only a snapshot of your health on the specific date and time the swab was taken. No testing is perfect and a negative result doesn't mean you haven't been exposed to COVID-19. You can still develop symptoms days after your test was taken.

    If you tested negative, but have had a high risk exposure, such as returning from travel outside of Canada or contact with a confirmed case:

    • If it has not been 14 days since your last exposure you need to stay in self-isolation for 14 days from the date of your last exposure

    If you have tested negative and have not had a high risk exposure:

    • You can return to work once you no longer have symptoms
    • If after 10 days, you still have symptoms, as long as your symptoms are mostly resolved and you have no fever, you can return to work

    If you begin to develop COVID-19 symptoms after a negative test, even if they're mild, you need to be retested.

    Refer to the Ontario Ministry of Health guidance document (page 9) under Health and Human Resources for more information for health care workers who are critical to operations.

    Workers in the health care field include regulated health professionals, workers from retirement homes, hospitals, clinics, long-term care, independent health facilities, mental health and addictions counselling.

  • My patient is declining a COVID-19 test because they're concerned about repercussions in the workplace. How can I help them?

    Niagara Region Public Health recommends testing for individuals who are symptomatic or have been recommended by a health care provider or public health to get tested. If testing is declined, they should isolate alongside their household until 10 days after symptom onset.

    You can reassure your patient that consent is obtained from the employee before Niagara Region Public Health discloses personal health information to the employer.

Testing and Self-Isolation

Niagara Region Public Health offices don't provide COVID-19 testing. Anyone who requires testing is referred for an appointment at one of the testing locations in Niagara.

COVID-19 is a new infectious disease and is classified as a disease of public health significance. When testing in your office, positive cases must be reported to Public Health by calling 905-688-8248 and following the prompts.

If testing your own patients in the office, reporting to Public Health on the number of swabs used / tests conducted in offices is no longer a requirement.

  • What is the process for sending symptomatic patients for testing?

    Niagara Health has three assessment centres located in St. Catharines, Niagara Falls and Welland. All centres allow for patient self-referrals and require appointments for COVID-19 testing.

    A temporary drive-thru testing centre (separate from Niagara Health assessment centres) is located in Fort Erie. This testing centre is by physician referral and appointment only. For questions on the referral process, email the primary care and stakeholder engagement advisor.

  • What do I need to know about asymptomatic testing?

    Asymptomatic testing is not recommended by Public Health, unless under the direction of Public Health on a case-by-case basis. Anyone with respiratory symptoms, other mild symptoms, or fever that you suspect may have COVID-19 or anyone concerned that they may have been exposed to COVID-19 should be referred to the assessment centre for testing, if you're not testing in your office.

  • Are pharmacies in Niagara offering testing to asymptomatic patients?

    Yes, see the list of all COVID-19 testing locations.

  • What is the turnaround time on receiving results after testing?

    It can take up to approximately seven days to receive lab test results for COVID-19. With the large number of swabs that labs are processing, results are taking longer than usual to be posted. It's important that your patient remains in self-isolation while they wait for their lab test result.

    Public Health doesn't have earlier access to your patients COVID-19 test results and is unable to respond to callers on our COVID-19 Info-Line that are asking for laboratory results. If patients are having difficulty accessing results or need a paper copy, have them call 905-378-4647 and ask for the Release of Information Office.

    If your patient receives an indeterminate result from their online search for results, this may mean that results are not completed by the lab. Tell the patient to continue to check back in a day or two for their results if they haven't been contacted by the testing site / provider.

    If the result is a true indeterminate result for COVID-19 from the laboratory, the testing site / provider will contact the patient regarding repeating the test.

  • How are test results accessed?

    Public Health will follow-up with anyone who tests positive.

    Review our August 17 memo on how to access test results. For more information, visit testing and lab results for COVID-19.

    Some patients who are tested may not have access to their test results through the online portal, specifically those without OHIP, with a red-white OHIP card, without internet access or language barriers. If you're testing your patient, confirm before, or at the time of testing, that they're able to access the online portal. Any individual without access to the online portal must be informed by telephone of their result as soon as reasonably possible.

  • Who is responsible for notifying patients of their result?

    Public Health will notify all patients with positive COVID-19 tests. Patients may access their own results online, or contact their primary health care provider for results.

  • Who can be tested for COVID-19?

    Anyone concerned that they may have been exposed to COVID-19 or anyone with respiratory symptoms, other mild symptoms, or fever that you suspect may have COVID-19 can be referred for testing. For more information on who should be tested, visit the COVID-19 Provincial Testing Guidance Update.

    Dr. Brian Kerley from the Niagara North Family Health Team has created a video to inform Niagara residents about the rational use of testing for COVID-19 using the nasopharyngeal swab and how to interpret the results.

    Get more information on Public Health Ontario's ongoing viral detection and repeat positives review.

  • Are family members and close contacts of cases to be sent for testing?

    Public health nurses are working directly with the close contacts of all laboratory confirmed COVID-19 cases in Niagara. They're providing close contacts with medical direction and instruction for testing and self-isolation.

  • Do all patients tested for COVID-19 need to self-isolate for 10 days?

    Learn more about self-isolation. Health care providers can also provide Public Health’s self-isolation fact sheet to patients.

    If your patient has no symptoms, has not had known close contact with a positive case of COVID-19 and no travel history but decided to get a COVID-19 test, they need to self-monitor for symptoms but are not required to self-isolate.

    A COVID-19 test is only a snapshot of your patient's health on the specific date and time the swab was taken. No testing is perfect and a negative result doesn't mean that they haven't been exposed to COVID-19. Individuals can still develop symptoms days after a test was taken.

    • If your patient's test comes back negative, but they begin to develop COVID-19 symptoms, even if they're mild, they need to be retested and self-isolate while they await their test result. This is important so we can all protect the health and safety of our loved ones and our community from whatever infection they may have.

    If patient is positive for COVID-19:

    • They must self-isolate for a minimum of 10 days and will be contacted by Public Health for further instructions
    • If your patient is a health care worker, see specific instructions for health care workers below

    If patient is negative for COVID-19:

    • If symptoms have resolved and they're not a contact of a confirmed case, nor recently travelled outside of the country, then they can resume normal activities
    • If the patient is a close contact of a confirmed case, they should continue to self-isolate for 14 days from the date of last exposure to this case. If they have recently travelled outside of the country, they must complete quarantine for 14 days from their date of return from travel.
    • We continue to encourage physical distancing, frequent hand-hygiene, avoidance of public places and self-monitoring for symptoms
  • What do I need to test patients in my office?

    Important: If you're testing for COVID-19, refer to the Public Health Ontario Updated IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19.

    Make sure the patient is sent home with instructions to self-isolate and manage prescription(s) or other needs in a way that assumes the patient has COVID-19.

    You will also need:

    • A room to isolate patient (doesn't need to be a negative pressure room)
    • Personal protective equipment - gloves, gowns, surgical mask and eye protection (face shield or goggles are acceptable as eye protection)
    • NP swabs
    • COVID-19 Virus Test Requisition
    • Coronavirus Labstract
    • Hand hygiene facilities available
    • Cleaning supplies
  • How can I access swabs to test for COVID-19?

    A single upper respiratory tract specimen will be accepted for COVID-19 testing.

    Testing for COVID-19 is done by real-time PCR using protocols validated by PHO Laboratory and the NML. Public Health Ontario has provided information on testing for COVID-19 and to support the interpretation of lab results. View their information on test methods.

    One serological test for antibodies to the virus has been approved by Health Canada but is not yet available for widespread use. Review the Ministry’s COVID-19 Provincial Testing Guidance Update for more information on serology testing (page 2).

  • Does Public Health have any direction on COVID-19 specimen transport?

    Niagara Region Public Health cannot provide specimen pick-up and transport at this time. Work with your local lab to coordinate specimen pick-up based on the transportation of dangerous goods criteria.

    • Ensure process for specimen transport is in place before specimen collection
    • Before preparing for transport of the specimen, ensure that at least two unique identifiers are located on the specimen containers and the lab test requisition is placed in the exterior pocket of the plastic biohazard bag
    • The specimen must be placed in a sealed biohazard bag
    • The closed container is then placed inside the specimen transport bag with an absorbent pad in the bottom of the bag
    • Specimens are to be stored at two to eight degrees Celsius following collection
    • Specimen must reach the laboratory within 72 hours of collection

Scenarios

  • I have a patient who is asymptomatic, no travel history, but they had contact with someone who is having acute respiratory symptoms and is awaiting test results.

    In general, asymptomatic individuals without exposure to a confirmed case should not be referred for testing.

    People with a household member who has been referred for testing or is awaiting test results should self-isolate until the result is received. If the result is negative, they can discontinue isolation. If the test is positive, they should remain in self-isolation and will be advised further by Public Health.

    If an asymptomatic individual has had close contact with someone with symptoms of COVID-19 who is awaiting test results, but is not in their household, they should self-monitor.

  • My patient received a negative COVID-19 result after having a history of travel, but is still symptomatic.

    Anyone who travels outside of Canada should self-isolate for at least 14 days after their return, regardless of symptoms and test results.

    • Continue self-isolating if they have respiratory symptoms until those symptoms resolve, or up to a full 10 days since the beginning of symptoms, whichever is longer. After 10 days, if symptoms have improved and only residual cough remains, they may return to daily activities
    • If symptoms haven't changed or have worsened, then patients must continue to self-isolate and follow up with you, their health care provider, to be reassessed

Infection Prevention and Control

To prevent the spread of COVID-19, follow environmental cleaning and disinfecting recommendations for COVID-19 for health care settings and follow Public Health Ontario's guidance on cleaning and disinfection for public settings.

Public Health Ontario’s Infection Prevention and Control Assessment for Primary Care, Specialty and Walk-in Clinics during COVID-19 checklist provides guidance, supports and resources for:

  • Planning and preparing before restarting or continuing services
  • Screening staff, patients and visitors and how to provide care for patients who screen positive for COVID-19
  • Reprocessing of reusable medical equipment / devices
  • Ensuring physical distancing requirements and more

Providing Care during COVID-19

Follow the Ministry of Health's COVID-19 Guidance: Primary Care Providers in a Community Setting for in-person care and essential visits.

The Chief Medical Officer of Health's Directive #2, limiting the provision of non-essential in-person care, has been amended to support the gradual resumption of non-essential health care. The direction isn't to have you return to normal practice, but rather move towards a 'new normal'. To support this, the Ontario Ministry of Health has made available COVID-19 Operational Requirements for Health Sector Restart.

As the gradual restart of services continues, you're in the best position to determine which services can continue to be offered virtually, such as phone consultations, virtual assessments, and which services can safely resume in-person. As a reminder, Ontario approved new physician billing codes for telephone assessments, enabling doctors to conduct more assessments over the phone rather than in their clinic.

You will also need to be cautious and resume practice in a controlled and gradual manner while taking steps to protect yourself, your staff, the patient and the public. This document outlines measures that must be in place in order to meet public health guidelines and promote a safe environment for the provision of in-person health services by health care providers.

  • Should I delay post-exposure prophylaxis for probable or confirmed cases of COVID-19 or their close contacts?

    No. The National Advisory Committee on Immunization states that if post-exposure prophylaxis (PEP) is required (for example measles, hepatitis A, hepatitis B, rabies, meningococcus and varicella), it should be given without delay to all patients who need it.

  • What do my patients need to know about all these new office practices?

    It's important that your patients are informed in advance about your new office practices, the safety precautions you're taking, and how you're keeping each other safe.

    Active and passive screening of patients is extremely important during this time. Patients and essential visitors should be screened over the phone for symptoms of COVID-19 before their appointments and can be told what to expect when they come into the office for their appointment.

    If they screen positive over the phone, the appointment should be deferred if possible and the individual referred for testing.

    As an additional precautionary measure, on the day of the appointments, patients and essential visitors should be screened again on site, with staff taking proper precautionary measures to protect against the possible spread of COVID-19.

    Your office may consider posting signage to inform patients of the specific measures being taken to ensure the safety of patients and clinical staff during this time, such as screening of patients and essential visitors, cleaning and disinfecting frequency of examination rooms and high-touch surfaces, and use of personal protective equipment.

    You can order the Novel Coronavirus (COVID-19) Screening Poster for Primary Care Providers and other Infection Prevention and Control print material on Public Health's resources order page.

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