Screening, Testing & Treating Patients

Please note that as things change rapidly, Q&As and guidelines will be updated. Review this website often to ensure you have the most up to date information or consult your leader if you have concerns or identify discrepancies.

Should patients come to the hospital for testing?  

Patients who have mild respiratory symptoms and are concerned about COVID-19, should call 8-1-1, see their family physician, or go to their nearest walk-in-clinic or Urgent and Primary Care Centre. They should NOT go to the Emergency Department for COVID-19 testing.

If there are designated screening centres established in the future, we will distribute this information.

Only patients who are ill enough to warrant a possible admission, should be referred to the ED.

Who should be tested for COVID-19? 

The following groups should be tested if they develop new respiratory or gastrointestinal symptoms, however mild, including fever, cough, shortness of breath, rhinorrhea, dysphagia, vomiting or diarrhea:

Residents or staff of long term care facilities who have developed new-onset respiratory or gastrointestinal illness.

OR

Patients who are part of an investigation of a cluster or outbreak who have developed new-onset respiratory or gastrointestinal illness (testing only as approved by the Medical Health Officer)

The following groups should only be tested if they present with fever ≥ 38 degrees Celsius and one of the following symptoms:

  • Cough
  • Shortness of breath
  • Diarrhea

Health Care Workers who have provided direct patient care while symptomatic without appropriate personal protective equipment to patients who are either elderly or immunocompromised

OR

Hospitalized, or likely to be hospitalized patients, including pregnant women in their 3rd trimester, patients on hemodialysis, or cancer patients receiving radiation or chemotherapy

To prioritize testing, please label the requisition as coming from:

  • Hospital (label as HOSP)
  • Long-term care facility (label as LTCF)
  • Health Care Worker (label as HCW)

For all patients tested:

  • Offer them a surgical mask and place them in a separate room.
  • Please collect a nasopharyngeal swab.Use either the routine Copan NP swabs or the skin/mucosal swabs for HSV/VZV viral testing (the containers have a pink liquid and a red or blue cap –see photos below).
  • When obtaining a swab, ensure that you wear, at a minimum, a surgical mask and eye protection.
  • If results are positive, VCH Public Health will be notified immediately and will follow up directly with the patient and any contacts, as appropriate.
Who should not be tested for COVID-19?
  • Patients without symptoms
  • Patients with mild respiratory symptoms, who can be managed at home. This includes returning travellers with an onset of illness within 14 days of return to Canada.

Please advise patients, with or without a history of travel, who have respiratory symptoms that can be managed at home, to self-isolate at home for at least seven days.  After seven days, if their temperature is normal, they can return to their routine activities. Coughing may persist for several weeks, so a cough alone does not mean they need to continue to self-isolate for more than 7 days.  

How do we order a test for COVID-19?  

For those individuals where testing for COVID-19 is clinically indicated and it is safe for them to go home, please ask them to stay at home and avoid contact with others (self-isolate) until they get their results. Please distribute this information to them before they leave.

How do I order COVID-19 testing?
Order COVID-19 NP swab on Cerner. If other testing is indicated (e.g. - Influenza), order separately. More updated information can be found here.

What is the expected turn-around-time?
Expected turn-around-time is within 24 hours.  Large batches of specimens are run and reported almost continuously, seven a week.

Where can I view the results for my patient?
COVID-19 results are reported in Cerner and CareConnect:

How do I know if the COVID-19 results are still pending?
In Cerner, pending tests are not displayed in the ‘Results Review’ tab.  The ‘Orders’ tab must be viewed to determine which laboratory tests are still “In Process”:

In CareConnect, the ‘Test Status’ is displayed under the ‘Labs’ tab.

What samples to collect?
In the outpatient setting collect a Nasopharyngeal NP swab.

https://www.youtube.com/watch?v=DVJNWefmHjE (NEJM NP collection video)

For patients with severe respiratory illness or hospitalized patients, collect a NP and/or sputum, endotracheal aspirate, bronchoalveolar lavage, etc.

Given the global swab and collection media shortage, use either the Copan NP UTM swabs (used for Influenza or other respiratory virus testing), or the skin/mucosal swabs for HSV/VZV viral testing (the containers have a pink liquid in them and a red or blue cap); alternatively, use Becton Dickison UVT swabs.

How will we know if a swab comes back positive for COVID-19?  ↓
If the patient is positive for COVID-19, the medical microbiologist on-call will inform the MRP directly and the result will be released on Cerner/Care Connect.  Infection Prevention and Control will be alerted if the patient is an inpatient.  There may be a delay before the positive result is communicated publicly by the Provincial Health Officer, but the treating team will be alerted immediately. 
What should we do if a patient is swabbed but then can go home?  
This patient handout sheet can be given to the patient, instructing them of where to call for results and instructions on self-isolating until the results are back.  If the swab is positive for COVID-19, VCH Public Health will also be in touch with them.  You do not have to follow up with them for results.
What if a patient is tested and they also need to be admitted before the results are available?  
1.) Ensure the patient is on droplet and contact precautions.  IPAC will be involved will all cases. 2.) Discuss with the patient care coordinator that they must be in a single room. If needed use Metered-Dose Inhalers (MDIs) with spacers to minimize the use of nebulized meds. 3.) If the patient is going to undergo Aerosol Generating Procedures (AGPs) including nebulizers, the patient will have to be on airborne and contact precautions and placed in a negative pressure room.  Please discuss with the respiratory therapy team if you have questions or concerns about AGPs. 4.) If patients are at risk of needing airway management you can discuss this with RT and ICU/CCOT.
Should trainees be involved if a patient is suspected or positive for COVID-19
There is no absolute restriction on trainees being involved. However, physician teams should be limited in size to only the attending physician plus one resident.  You may also want to recommend that pregnant providers not be involved with COVID-19 patients.
What is the treatment for a patient with COVID-19
At this time the treatment is supportive.  There is no role for steroids or IVIG.  There will likely be trials on using novel agents starting in the weeks ahead that may become accessible at PHC.  
Do I have to call Infectious diseases or respirology for suspected or confirmed cases of COVID-19? 
No, but they are happy to assist in cases of severe illness, questions regarding diagnosis, etc.  If in doubt, feel free to call the staff on call.
This page last updated Apr 5, 2020 12:56pm PDT