COVID-19 testing & case and contact management
January 5, 2021
In response to the rapidly spreading and highly transmissible Omicron variant, the Ontario government, in consultation with the Chief Medical Officer of Health, announced on December 30, 2021 updated interim COVID-19 testing and isolation guidance.
COVID-19 Case and Contact Management in the Context of the Omicron Variant
Please be advised that the Ministry of Health guidance on COVID case and contact management is rapidly changing in the face of the Omicron surge. We are shifting to a new “paradigm” of how COVID-19 is managed with the goal of protecting vulnerable people at highest risk of severe outcomes, protecting public health and health system capacity, and ensuring maintenance of critical infrastructure.
In follow up to an Advisory Alert issued on December 24, 2021, this Advisory Alert provides a summary of updated eligibility for PCR testing, and isolation guidance for cases, contacts, and people experiencing COVID-19 symptoms. For the complete document, refer to the Ministry of Health Interim Guidance.
PCR Testing based on eligibility
With increasing numbers of people seeking testing, molecular testing (PCR or rapid molecular) is prioritized based on clinical and public health needs. For a complete list of individuals who are eligible for a molecular test effective December 31, 2021, visit ontario.ca/exposed.
Isolate when ill and if household member is ill
Anyone experiencing the following must isolate for at least 5 days if fully vaccinated or under 12 years of age, or 10 days if 12 or older and not fully vaccinated or immune compromised, regardless of age. Household members must also self-isolate:
- At least one of fever/chills, cough, shortness of breath, decrease/loss of smell and taste
- Two ore more of sore throat, headache, extreme fatigue, runny nose/nasal congestion, muscle aches/joint pain, gastrointestinal symptoms
The individual with symptoms should get tested if they are eligible.
This flow chart (p.10, Government of Ontario) provides an overview to help your patients with symptoms determine if they must self-isolate.
Rapid antigen testing (RAT)
As access to PCR testing is increasingly limited, anyone who tests positive with a rapid antigen test should be considered to have COVID-19. A confirmatory PCR test is not required while access to PCR testing remains limited.
Please do not report RAT positive test results or patients you suspect to have COVID-19 based on symptoms or exposure history to Public Health unless they live, work, volunteer, or are admitted in a highest risk setting:
- hospitals and health care settings, including complex continuing care facilities and acute care facilities,
- congregate living settings and institutions including Long-Term Care Homes, retirement homes, First Nation elder care lodges, group homes, shelters, hospices, temporary foreign worker settings, and correctional institutions
- health care workers providing care to immunocompromised people,
Public Health will follow-up with highest risk settings for case and contact management within the setting, as well as to assess if criteria has been met to declare an outbreak.
All other patients should follow Public Health instructions if they are symptomatic or have had confirmed COVID-19.
Self-isolation guidance for cases and contacts
Individuals who receive a positive PCR test, rapid molecular, or RAT must notify their household and other close contacts that they have been exposed to a COVID-19 case and direct them to Government of Ontario’s website; ontario.ca/exposed.
A person is considered a close contact if they were:
- less than two metres away from an individual who tested positive for COVID-19 for at least 15 minutes, or multiple shorter lengths of time;
- during their exposure to the person with COVID-19 wasn’t wearing personal protective equipment;
- and they were with the person that has COVID-19 in the 48 hours before the positive cases’ symptoms began or before the case received their positive test result, whichever came first.
The following flowcharts provide an overview for when individuals need to self-isolate.
- You’ve been exposed to someone who has tested positive for COVID-19 (p. 13, Government of Ontario, PDF)
- You’ve been exposed to someone who has tested positive for COVID-19 and you work in a high-risk setting (p. 15, Government of Ontario, PDF)
Management of critical staffing shortages in highest risk settings
To support the management of critical staffing shortages in highest risk settings, test-to-work strategy may be implemented, in which staff are able to return to work when they would otherwise be required to self-isolate or otherwise not attend work for 10 days from last exposure. Highest risk settings considering this approach are to consult with Public Health Sudbury & Districts.
For more information on the Updated Eligibility for PCR Testing and Case and Contact Management Guidance in Ontario read the Government of Ontario’s backgrounder.