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. to 7:30 p.m. Call 905-688-8248, press 7, then press 1 for physicians.

General Information

Return to School

Public Health is committed to identifying and working collaboratively with Niagara's school boards 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're advising teachers or parents in your practice, let us know what's being shared so that we can ensure consistent communication. Email the primary care and stakeholder engagement advisor.

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 and must be reported to Public Health. If you're testing patients for COVID-19, notify Public Health immediately by calling 905-688-8248 and follow the prompts. 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.

  • 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?

    The Ontario government is partnering with pharmacies to expand access to asymptomatic COVID-19 testing. As of Friday, Sept. 25, a select number of pharmacies in Ontario will begin offering testing by appointment only to those without COVID-19 symptoms. Those with symptoms should go to an assessment centre for a test.

    Those looking to be tested at a pharmacy need to be asymptomatic and meet specific criteria. They will also need to call a participating pharmacy to make an appointment.

    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 are not testing in your office.

  • 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 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 14 days?

    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 re-tested 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 14 days or until they are asymptomatic, whichever is longer
    • See specific instructions for health care workers under scenarios 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 public places and self-monitoring for symptoms
  • How can I access swabs to test for COVID-19?

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

    To order swabs from Public Health Ontario, use the requisition for specimen containers and supplies.

    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).

    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.

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

    While awaiting test results, you must normally self-isolate. However, if you have no symptoms, even mild symptoms, no known close contact with a positive case of COVID-19, and no travel history, but you decided to get a COVID-19 test, you can return to work but self-monitor.

    If you received a positive test result:
    Based on the latest science and new guidance from the Ministry of Health on July 29, 2020, most individuals who work in the health care field can return to work unless otherwise directed by their employer / occupational health and safety if they have:

    • Recovered from mild to moderate illness
    • Don't have shortness of breath or a fever (seek medical attention if you still have shortness of breath or a fever)
    • Were never hospitalized for their illness
    • Completed 14 days in self-isolation (starting on the day they were tested)

    Health care workers who tested positive and experienced severe illness and required hospitalization need to receive two negative results, 24 hours apart to discontinue self-isolation and return to work. For more information and details on exceptional circumstances, please review recommendations for health care workers return to work.

    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 your test comes back negative, but you begin to develop COVID-19 symptoms, even if they're mild, you need to be re-tested.

    • Once you have received a negative result, you can return to work once you're asymptomatic (no longer have symptoms) as long as you have not had a known exposure (such as returning to Canada or contact with a confirmed case) to someone with COVID-19. If after 14 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 have received a negative test result, but it has not been 14 days since your last exposure (such as returning to Canada or contact with a confirmed case), you need to stay in self-isolation for 14 days from the date of your last exposure

    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.

  • 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.

    The province provided guidance on asymptomatic, risk-based testing. People who are concerned that they've been exposed to COVID-19 can be referred for testing. This includes people who are contacts of, or may have been exposed, to a confirmed or suspected case.

    Advise them to:

    • Self-isolate for 14 days from the last exposure to the symptomatic person. If they live in the same household as the symptomatic person, everyone in the household should self-isolate for 14 days.
    • Call Niagara Region Public Health COVID-19 Info-Line at 905-688-8248, press 7 then press 2, or call your office
    • If symptoms develop, they will need to remain in self-isolation for 14 days from symptom onset
    • If they remain asymptomatic for 14 days they can discontinue self-isolation after that period, and practice physical distancing, avoiding public places and self-monitoring for symptoms
  • My patient received a negative COVID-19 result after having history of travel but is still symptomatic.

    Advise your patient to:

    • Continue self-isolating if they have respiratory symptoms until those symptoms resolve, or up to a full 14 days since the beginning of symptoms, whichever is longer. After 14 days, if symptoms have improved, and only residual cough remains, they may return to daily activities while being mindful of physical distancing, avoiding public places and self-monitoring for symptoms.
    • 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
  • I have a patient who is asymptomatic, no travel history, but they had contact with an asymptomatic person who travelled.

    Tell them to:

    • Avoid crowded public spaces and places where they can't easily separate themselves from others if they become ill
    • Call Niagara Region Public Health COVID-19 Info-Line at 905-688-8248 ext. 7019 or call your office if they experience symptoms of COVID-19, such as fever, new cough or difficulty breathing
    • Call ahead before visiting any health care provider and let them know about their exposure to someone with travel history and symptoms so the provider can ensure that they use proper infection control measures
    • Monitor for symptoms for 14 days after exposure
    • Common signs of infection include fever, new cough, shortness of breath and difficulty breathing

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.

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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