Updated guidance for suspect cases of novel coronavirus (2019-nCoV)

The first case of novel coronavirus was confirmed in B.C. this week. The patient had travelled to Wuhan City and had symptom onset after returning to Canada. The patient was promptly isolated and the current risk to British Columbians continues to be low.

The BCCDC has updated guidance for health care workers in order to facilitate detection of novel coronavirus given that there has been extensive spread through China outside of Hubei Province.

Consider testing for:

• Patients with compatible symptoms (e.g. fever, cough, or difficulty breathing) AND

• History of travel to affected areas of China within two weeks prior to illness onset OR other index of suspicion (e.g. contact with an ill person with such travel history) AND

• No clear alternative diagnosis

For patients meeting these criteria:

• Offer the patient a surgical mask and place the patient in a separate room

• Use contact and droplet precautions (gloves, gowns, surgical mask and eye protection) particularly during sample collection

• Obtain a NP swab and throat swab (red top or blue top COPAN) and send both swabs to the BCCDC Provincial Laboratory and ensure that the requisition indicates testing for “novel coronavirus” (for consultation regarding testing, please call the BCCDC PHL Medical Microbiologist on-call at 604-661-7033)
  

Notify the Medical Health Officer on-call for cases where there is a high index of suspicion. These include patients with severe respiratory presentations (particularly lower respiratory symptoms) AND

• Travel to Hubei province in the 14 days before onset of illness OR
• Close contact with a confirmed or probable case of 2019-nCoV within 14 days before their illness onset OR
• Close contact with a person with acute respiratory illness who has been to an affected area within 14 days prior to their illness onset

Discharge planning:

• If the patient is well enough to return home, discharge the patient with a surgical mask and advise the patient to isolate at home
• Provide the “Instructions for patients being tested for novel coronavirus” document (attached to this alert) to the patient
• Confirm the patient’s contact information. Clinicians should make arrangements to notify patients of novel coronavirus results so that patients can stop self-isolation if swab results are negative. Should the swab results be positive, Public Health will provide follow-up.

We ask that patients be tested promptly at the location where they present in order to limit spread of the virus and to minimize burden on the Emergency Department. Please ensure that you have proper signage, the required swabs, and personal protective equipment (PPE) at your location so that you can appropriately assess and manage patients.

Instructions for patients being tested for novel coronavirus

Your doctor has determined that you can safely be cared for at home. To prevent the spread of contagious respiratory illnesses including novel coronavirus, we advise that you self-isolate at home for 72 hours until your test results are complete.

If your test is positive, you will receive a call from Public Health within 72 hours. If you have not received a call from your doctor or Public Health after 72 hours, you can stop self-isolation.

Instructions for self-isolation:

1. Stay home except to get urgent medical care – Do not go to work, school, or public areas (e.g. places of worship, stores, shopping malls, and restaurants). Cancel non-urgent appointments. Do not use public transportation or taxis. Your doctor may provide you with a note excusing you from work or school.
2. Separate yourself from other people in your home – Stay and sleep in a well-ventilated room separate from other people. Use a separate bathroom if available. Use a face mask in shared spaces. Household members should stay in another home or place of residence if possible, especially if they have compromised immune systems or chronic health conditions. Restrict visitors.
3. Avoid sharing household items - Do not share dishes, cups, eating utensils, towels, bedding, or other items with people in your home. After using these items, wash them thoroughly with soap and water.
4. Wear a facemask – Wear a face mask when you are in the same room with other people and when you visit a health care facility. If your mask gets wet or dirty, change it.
5. Cover your coughs and sneezes – Cover your mouth and nose with a tissue when you cough/sneeze, or cough/sneeze into your sleeve instead of your hand. Throw used tissues into a lined trash can in your room before disposal with other household waste. Immediately wash your hands.
6. Wash your hands – Wash your hands often and thoroughly with soap and water for at least 20 seconds. Use disposable paper towels when possible. For more information on handwashing visit HealthLinkBC. If soap and water are not available, use alcohol based sanitizer. Avoid touching your eyes, nose, and mouth with unwashed hands.
7. Clean and disinfect frequently touched surfaces – Clean and disinfect frequently touched surfaces (e.g. counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables) once per day with regular household disinfectant containing 1 part bleach to 99 parts water.
8. Notify health care facilities before you visit – Call ahead before visiting a health care facility, and advise them that you have or are being tested for novel coronavirus. Remind health care providers when you arrive. This will help health care facilities to take steps to keep other people from becoming infected.
9. Monitor your symptoms – Seek medical attention if you have trouble breathing, are unable to tolerate fluids, or if your illness is worsening. Notify health care facilities and health care providers (e.g. emergency departments, ambulance paramedics, doctor’s offices) before you visit.