Ontario public health officials now recommend testing some asymptomatic patients at long-term care homes
Published Thursday, April 9, 2020 11:21AM EDT
Last Updated Thursday, April 9, 2020 4:15PM EDT
The province is now recommending that those who have been newly admitted or re-admitted to long-term care or retirement homes should be tested for COVID-19 even if they are not showing symptoms of the virus.
On Thursday, the province released its updated testing guidelines for priority groups, including health care workers, long-term care and retirement homes, patients admitted to hospitals, and people in remote and Indigenous communities.
For those who have recently been admitted to a long-term care or retirement home or patients who are re-admitted to a facility after being hospitalized, the new guidelines suggest that testing should be performed on those people even if they are asymptomatic.
“Patients transferred from hospital to a long-term care home should be tested prior to the transfer,” the new guidelines stipulate.
The guidelines also state that those who test negative for the virus should remain under a 14-day self-isolation after they have been admitted to the facility.
Until now, public health officials have not recommended testing for people who are not showing symptoms of COVID-19 unless they were a close contact of a known case.
Other countries – including Singapore, South Korea, Germany and Iceland – have suggested that asymptomatic transmission is a major factor in the spread of the disease and must be detected if the outbreak is to be contained.
The province is reporting 69 COVID-19 outbreaks at long-term care homes in Ontario and there have been 88 deaths linked to those outbreaks, nearly half of all virus-related deaths in the province.
In Toronto, an outbreak at the Seven Oaks long-term care home has resulted in at least 16 deaths and at a nursing home in Bobcaygeon, Ont., 29 patients infected with COVID-19 have now died.
The updated guidelines state that in the event of an outbreak at a long-term care or retirement home, asymptomatic contacts of a confirmed case, including residents living in adjacent rooms, staff working on the unit, essential visitors that have attended the unit, and “any other contacts deemed appropriate” should be tested.
Public health officials say testing should be conducted on any long-term care or retirement home resident or worker that has any single symptom linked the virus, including fever, a new or worsening acute respiratory illness symptom, or evidence of pneumonia.
Atypical symptoms, including unexplained fatigue and digestive symptoms, such as nausea, vomiting, diarrhea, and abdominal pain, should also be considered when deciding whether to test for the virus, the guidelines state.
The same recommendations apply to hospital inpatients and residents of remote and Indigenous communities.
All health care workers, first-responders, and caregivers, including volunteers and family members, should be tested “as soon as feasible” if they develop any symptom linked to COVID-19, according to the province’s new guidelines.
The province has also directed all facilities conducting testing to “exercise prudence” when ordering swabs to ensure there are enough to go around across the province.
Public health officials add that when shortages occur, testing should be prioritized for certain groups, including symptomatic health care workers, symptomatic residents and staff at long-term care and retirement homes, hospitalized patients admitted with respiratory symptoms, symptomatic members of remote, isolated, rural, and Indigenous communities, and symptomatic first responders.
The updated guidelines were released one day after Premier Doug Ford called on public health officials to start testing “everyone possible” for COVID-19.
Despite having the capacity to conduct more than 13,000 tests per day, just 3,200 COVID-19 tests were processed in the province between Tuesday and Wednesday.
Ontario's Chief Medical Officer of Health, Dr. David Williams, said the new guidelines were formulated after consulting "various expert panels."
"We put out a lot of aspects related to enhanced testing in the long-term care setting and retirement homes. That is the group that has one of the highest vulnerabilities in COVID-19 and it is one of the ones we are seeing a lot of outbreaks in and a lot of cases and it has been a challenge across Canada on how to deal with this," Williams said.
The province confirmed that more than 5,000 tests were conducted in the past 24 hours.
When asked about whether testing will be expanded to include more members of the general public, Williams said the purpose of testing is to inform public health officials about "how to protect our vulnerable populations."
"There is no sector that does population-wide testing of everybody and I haven't seen a country globally that has done that," Williams said. "Some have done quite a bit, such as South Korea, but no one has attempted to screen everybody in the country."