Coronavirus Outbreak – Information for staff, physicians, learners and volunteers – FAQ

Please note: This information is not for distribution outside of Unity Health; we are using a private section of our external website to allow staff easy access to these materials offsite and after hours.

Novel Wuhan coronavirus (2019-nCoV) frequently asked questions

Updated as of Feb. 12

There will be significant activities occurring to ensure that we are fully prepared for any case that may arrive at Unity Health. With new information being shared daily, we ask all our people to keep up to date on the latest information. View more coronavirus outbreak information for staff, physicians, learners and volunteers.

2019-nCoV

The 2019-nCoV is a newly recognized coronavirus that was recognized as causing human disease in late 2019 in Wuhan, China. Coronaviruses are a large family of viruses ranging from well known viruses that can cause the common cold, to viruses like SARS that are extremely severe. We do not yet know the full spectrum of disease of 2019-nCoV although it appears capable of causing both mild and severe illness.

No, seasonal coronavirus and 2019-nCoV are different types of coronavirus. Seasonal coronavirus is common in Canada and is one of the causes of the common cold and usually results in a mild illness. 2019-nCoV is a new coronavirus and much remains unknown about it. While it also causes a cold- or flu-like illness, it can also result in severe disease although we do not yet know how often this occurs. Note that when patients with a fever and respiratory illness are tested for 2019-nCoV, they are also tested for more common viruses like influenza and regular coronavirus – so you may see test results positive for coronavirus but these are NOT the 2019-nCoV coronavirus.

Although the WHO and Public Health Agency of Canada recommend Droplet-Contact Precautions for 2019-nCoV, Unity Health and the Ministry of Health are recommending Airborne, Droplet and Contact precautions out of an abundance of caution and until further information is available about how this virus transmits.

The single most important thing that you can do is to use routine practices for all clinical interactions. Routine practices include conducting a risk assessment, performing hand hygiene, disinfecting all shared equipment, and wearing all required personal protective equipment relevant to the patient’s condition and the planned clinical task.

You should also understand the Unity Health patient screening protocol for 2019 novel coronavirus and the person protective equipment required if you are assessing or caring for a suspected or confirmed case.

Even if you have not traveled, staying home from work if you have a febrile respiratory illness is critically important to protect your patients and colleagues. If you are unwell, please notify Occupational/Corporate Health and Safety Services and stay home!

Finally, all staff should ensure that they:

  • are fit tested and know your N95 respirator fit, and that it is available in your area
  • are trained and confident in the correct donning and doffing of personal protective equipment (PPE) required for Airborne, Droplet and Contact precautions
    • A video is available here
    • Contact the Infection Prevention and Control representative for your area to schedule in-person training
There is a guidance document that has been provided by the Ministry that outlines appropriate practice – please familiarize yourself with this. You should screen patients if you can before you go into their home and, if they meet criteria for suspected cases, contact public health to determine the next steps. In some cases it may be necessary to send them to the Emergency Department or public health may be able to assess them at home.
  • Use safe practices for every clinical interaction. By using appropriate routine practices for all clinical encounters, including performing hand hygiene, disinfecting shared equipment and wearing personal protective equipment as required, we can significantly reduce the risk of 2019-nCoV transmission even from an unrecognized case. See our ‘Routine Practices and Additional Precautions’ policy for further information.
AND
  • Perform admission and routine screening for acute respiratory infections (ARI). All patients presenting should be screened on presentation/admission and daily for Acute Respiratory Infection (ARI), defined here as:
    • Fever and new or worsening SOB or cough/shortness of breath and/or
    • Pneumonia on CXR/CT
AND 2019-nCoV assessment criteria
Criteria Description
1. Fever and new or worsening SOB/cough
AND at least one of the following:
2. a Returned from China within 14 days of onset of illness
2. b Is a close contact of a person with new or worsening SOB or cough who was in China within 14 days prior to the onset of their illness
2. c Is a close contact of a case of 2019-nCoV
If there is no travel/exposure history and tuberculosis is not a consideration, patients with ARI should be placed in droplet/contact precautions, and gown, gloves, surgical mask and eye protection should be used in addition to routine practices. These precautions will also substantially reduce the risk of 2019-nCoV transmission. If relevant travel and/or exposure history is identified, follow the procedures described below for a suspected case of 2019-nCoV.
  • Ask the patient to clean their hands and provide them with a surgical mask
  • If you havea n airborne isolation room in your area, move the patient there; if an airborne isolation room is not available, move the patient to a private room or designated area away from other patients and staff
  • Put up a sign indicating that the patient is in Airborne, Droplet and Contact precautions
  • Staff must use Airborne, Droplet and Contact precautions for all interactions with suspected cases (i.e. fit-tested, seal-checked N95 respirator, eye protection, gown and gloves in addition to routine practices)
  • Contact Infection Prevention and Control immediately through locating/Switchboard
  • Suspect case = someone who meets the screening criteria (right now that they have travelled to China within 14 days of illness onset and they have a fever or cough)
  • Probable case = someone who meets the screening criteria and laboratory diagnosis of 2019-nCoV is not available, inconclusive or negative (if specimen quality or timing is suspect)
  • Presumptive case = someone tests positive at the Ontario Public Health lab
  • Confirmed case = someone tests positive at the national lab
Testing should only proceed after the patient is reviewed by Infection Prevention and Control and microbiology. Specimens must be:
  • approved by Infection Prevention and Control prior to ordering/collecting
  • clearly labeled as suspect 2019-nCoV
  • hand delivered to microbiology. DO NOT place any specimens (including bloodwork) into the pneumatic tube system.
The following specimens may be tested for 2019-nCoV in suspect patients:
Specimen Kit/Container
Nasopharyngeal swab (NPS) AND Viral Throat Swab NP Swab Kit in multi-organism Universal Transport Medium for both NP and Throat swab
Other Contact microbiology laboratory prior to obtaining any other type of specimen.
If you have any questions about specimen collection, please contact microbiology or Infection Prevention and Control. Testing for other respiratory viruses and community-acquired pneumonia: Patients with suspect 2019-nCoV will also be tested for other respiratory viruses using the same NP swab collected for coronavirus testing. If presenting with signs of pneumonia, they should be tested for bacterial causes as applicable. Suggested tests may include (after approval by microbiology):
  • PCR for Influenza and other respiratory viruses
  • Blood Cultures
  • Mycoplasma pneumoniae/Chlamydophila pneumoniae PCR – this can be ordered on the same NP or throat swab submitted for n-CoV testing
  • Legionella PCR can be ordered on the same lower respiratory tract specimens submitted for n-CoV testing (e.g. BAL, pleural fluid, lung tissues)
  • Legionella urinary antigen testing: submit a urine specimen.
There is no 2019-nCoV at Unity Health. If you find a patient that has gotten lost and ended up in a non-clinical area, you can safely offer help and assistance as you would in any other circumstances.

There is no concern about underreporting. 2019-nCoV is now a reportable disease in Ontario and suspected and confirmed cases must be reported to Public Health by law.

We do not have access to that level of detail for all cases in Toronto. No case at Unity Health has met that criteria.

Screening

Unity Health has initiated patient screening in the ED and all ambulatory areas. All patients coming to triage or registration are asked about symptoms of 2019-nCoV and travel to China within the last 14 days. Those with symptoms and travel are promptly isolated and managed in precautions and in consultation with infection prevention and control.
We are not routinely screening visitors at this time. As per our usual policy, we are asking ill visitors to refrain from visiting if possible. The only exception is for family members accompanying a suspected case of 2019-nCoV as they may have been exposed.

Our Coronavirus Management Team is meeting daily and is in close contact with our partners including Toronto Public Health and the Ministry for the latest information so that we can quickly change our procedures if needed.

There are barriers between patients and staff in both of our Emergency Departments. At St. Michael’s, the first barrier is a staff member in full personal protective equipment (PPE) and then triage and registration are behind Plexiglas. At St. Joseph’s, patients and visitors are directed to the welcome desk which is fully screened in behind a glass partition. If a patient requires additional screening, staff will go into full PPE to escort the patient into an appropriate location.

If the person is symptomatic and has been to China, let Infection Prevention and Control know – they will assess on a case by case basis.

We are actively working on developing a ‘protected’ code blue policy that would apply to suspected or confirmed cases of 2019-nCoV. Staff will be updated about this soon and certainly this would be rolled out immediately if a suspected patient were admitted.

Masks and other personal protective equipment (PPE)

Putting on and taking off PPE properly is as important as selecting the correct PPE. Infection Prevention and Control will be offering in-person refreshers on how to safely don and doff the personal protective equipment required to assess and care for patients with suspected 2019-nCoV infection – watch for announcements about the timing of these sessions at all sites. Here’s a video outlining the process as well.

We are not giving out masks for personal use. Our personal protective equipment is intended to protect all staff while at work and we need to ensure that we have sufficient supplies at all times in order to assure staff and patient safety.

Masks should be used as part of routine practices by staff and physicians in clinical areas.

All ambulatory areas are being treated in the same way – they are receiving instructions and training on personal protective equipment. At this time, there is no recommendation for all staff to wear masks or for access to be limited to any of our sites.

We have a pandemic supply of personal protective equipment that we are distributing across our sites and we are working with suppliers to ensure we have an ample supply to replenish our stocks as needed.

Everyone who works in clinical areas and who may need to wear an N95 mask as part of their work should have up-to-date mask fit testing. Check this page for the latest information on fit testing times at your site.

Please check your fit testing card for the make and model and the date in which you were tested. Fit testing is valid for a period of two years. If you need to get retested, please visit the Occupational Health and Safety office at your site.

Providence
Location: OHSW, D207
Monday and Tuesday, 8 a.m. to 4 p.m.
Wednesday, 6:30 a.m. to 4 p.m.


St. Joseph’s
Location: OHS, Sunnyside room 204
Monday to Friday, 7:30 a.m. to 3 p.m.

St. Michael’s
Location: CHSS, 2-037 Shuter

Monday to Friday, 7 a.m. to 3 p.m.

Our supplies are for use by our clinical teams. If someone is asking for a mask for their personal use outside of the hospital, they should be encouraged to visit their local hardware store or pharmacy for purchase. 

No – our Gift Shops will not be selling masks (N95 or patient/surgical masks).

Cleaning

Environmental Services staff will be notified anytime a suspected case is assessed and the area will be cleaned and disinfected immediately afterwards. Our routinely used cleaning and disinfection procedures will remove and inactivate coronavirus. Environmental services staff will be using the same personal protective equipment as all other staff that enter the room of a patient with suspected coronavirus.

Contact your site’s Environmental Services team to let them know where the hand sanitizer is that needs refilling.

Emergency Department

We are asking everyone to limit movement through the Emergency Department if possible to allow more space for patients. We have asked all areas transferring to the Emergency Department from an ambulatory clinic, code blue or other medical emergency to call ahead to the team leader so they can be prepared for screening.

Waterproof gowns are available for specific procedures as part of routine practices in Emergency Departments and other areas where they may be needed if exposure to large amounts of fluid are possible. They are not something we are routinely recommending for patients suspected for 2019-nCoV but can be used in specific circumstances.

Occupational Health

If you have travelled to China and are about to return to work, please get in touch with your site’s Occupational Health and Safety team before coming in:
  • Providence: 416-285-3755
  • St. Michael’s: 416-864-5400
  • St. Joseph’s: 416-530-6800

Unity Health Toronto operates in one of the most diverse cities in the world. Our patient and our employee populations reflect this diversity and includes large numbers of people of Chinese descent. Our approach to screening and instituting precautions to protect our staff and patients is based on infection prevention and control best practices and conforms to the standards set by the Ministry of Health and Toronto Public Health. We are taking great care to ensure that these precautions continue to adhere to these high standards and reflect respect for all of our patients and visitors. At the same time we recognize that in some pockets of our society, Chinese individuals may be being subject to bias and racism borne out of fear or ignorance about the origins and nature of the coronavirus (2019-nCoV). Our values of human dignity and inclusivity not only mean that this sort of treatment is not acceptable at Unity Health, but also that we all have a role to play to actively support our patients and staff who may feel excluded or disadvantaged as a result of differential treatment of members of the Chinese community. To support this expectation, we will ensure that this forms a part of our internal communication about 2019-nCoV going forward.

More questions

There are a few glitches we are looking at fixing based on our experience on Jan. 31 but this method of communication is available for the next time we need it and we will consider it in providing updates moving forward. In the meantime, you can find the latest information related to 2019-nCoV on our resource page.
We recognize the developments related to 2019-nCoV may cause some anxiety for our people. Please remember that the risk remains low, and be assured we are taking all steps to ensure staff safety. Staff, including physicians, experiencing significant anxiety should free to contact our Employee and Family Assistance Program (EFAP) line: guidanceresources.com or 1-866-606-6367.
For questions related to: Contact:
Infection Prevention and Control (IPAC) Your site’s IPAC department directly:
Corporate Health and Safety Services (CHSS) Your site’s CHSS team:
  • St. Joseph’s: 416-530-6800
  • St. Michael’s: 416-864-5400
  • Providence: 416-285-3755
Support The Employee and Family Assistance Program:
Anything else Communications at questions@unityhealth.to
For more information, visit www.ontario.ca/coronaviruso or the Public Health Agency of Canada’s website.