Interim Guidance: Case and Contact Management of COVID- 19 Immunized Individuals - DEPARTMENT OF HEALTH AND COMMUNITY SERVICES PUBLIC HEALTH ...
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Interim Guidance: Case and Contact Management of COVID- 19 Immunized Individuals DEPARTMENT OF HEALTH AND COMMUNITY SERVICES PUBLIC HEALTH BRANCH, GOVERNMENT OF NEWFOUNDLAND AND LABRADOR JULY 16, 2021
Definitions
Fully Immunized
An individual is considered fully immunized ≥14 days after receiving their second dose of a two-dose
COVID-19 vaccine series or 14 days after immunization with a one-dose COVID-19 vaccine of a Health
Canada approved COVID-19 vaccine product. Confirmation of vaccination history is generally
recommended for informing public health case and contact management guidance. Proof of vaccination
is the official vaccination record received from a health care provider. The vaccine must be a Health
Canada approved COVID-19 vaccine product. The documentation must include the individuals name,
date of birth, date of vaccination, and the province, territory or country the vaccine was administered.
Pictures and scanned copies of paper vaccination records will be accepted.
Partially Immunized
An individual is considered partially immunized 14 days after the first dose of a two dose COVID-19
vaccine series or less than 14 days after their immunization with a one-dose COVID-19 vaccine.
Individuals who are partially immunized will be managed as unimmunized. Confirmation of vaccination
history is generally recommended for informing public health case and contact management guidance.
COVID-19 Breakthrough Case Definition (Interim)
As defined in the national case definition for Coronavirus disease (COVID-19), a NEW case of COVID-19
that occurs a minimum of 7 days after receipt of the second dose of a COVID-19 vaccine product that
requires two doses, or 14 days after receipt of a COVID-19 vaccine product that requires only a single
dose.
Case and Contact Management of COVID-19 Immunized Individuals
For the purposes of this document, individuals with past history of COVID-19 infection will be
managed based on immunization status.
Fully Immunized Individuals who are Symptomatic for COVID-19 with No Known Exposure
All fully immunized individuals who have symptoms of COVID-19 should be managed in accordance with
the Public Health Management of Cases and Contacts of COVID-19 in Newfoundland and Labrador.
These individuals must self-isolate and obtain a test for COVID-19 immediately.
Upon receiving a negative PCR test result, symptomatic individuals who are fully immunized can
be cleared from isolation once symptoms have resolved for at least 24 hours.
1Fully Immunized Individuals Who Test Positive for COVID-19
All fully immunized individuals who test positive for COVID-19 should be managed in accordance with
the Public Health Management of Cases and Contacts of COVID-19 in Newfoundland and Labrador.
Contact Tracing
Contact tracing efforts will include all individuals who were in contact with the case minimum 72 hours
prior to symptom onset or if asymptomatic, minimum 72 hours prior to a positive specimen test date
and up until the case was no longer considered infectious. An individual risk assessment conducted by
Public Health will identify the contact’s exposure risk and vaccination status to determine the testing
regime, isolation parameters and monitoring period. Table 1 classifies contacts based on immunization
status and exposure, and provides public health advice for each category. Recommendations in this
document will be updated as evidence regarding vaccine effectiveness and coverage becomes
available.
Table 1: Contact Management Guidance by Vaccination Status for COVID-19 Exposures
HIGH RISK CLOSE CONTACTS
(partially immunized or unimmunized)
Exposure Level Public Health Actions
Anyone who lives with a case, has direct physical contact with a Isolate at home for 14 days post-exposure.
case, or is exposed to their infectious body fluids (e.g. the cases
caregiver, intimate partner or child receiving care from a case, Testing should be arranged for contacts exposed 72 hours prior
etc.) to symptom onset or 72 hours prior to positive specimen
collection date and up until the case was no longer considered
Anyone who has shared an indoor space (e.g. same room) for a infectious.
prolonged* period of time including closed spaces, crowded
spaces or settings where close interaction may occur (e.g. social If test is positive, manage as a case in accordance with Public
gatherings and workplaces, etc.) without adhering to Health Management of Cases and Contacts of COVID-19 in
appropriate individual and setting-specific mitigation measures Newfoundland and Labrador.
(e.g. physical distancing and masking).
If test is negative, continue to isolate and monitor for COVID-
Anyone who has had a close range conversation with a case or 19 symptoms for 14 days post-exposure to case.
has been in a setting where a case has been singing, shouting,
or heavy breathing (e.g. exercise) without adhering to If the first test was negative, re-test on day 11-13.
appropriate individual and setting-specific mitigation measures
(e.g. physical distancing and masking). If at anytime the individual develops symptoms or symptoms
progress/worsen, retest as soon as possible using the online
Anyone who has shared an indoor space (e.g. same room) with COVID-19 Self-Assessment Tool or call 811.
a case for a prolonged* period of time including closed spaces,
crowded spaces or settings where close interaction may occur Household contacts (who are unable to strictly adhere to
(e.g. social gathering and workplaces, etc.) with partial physical distancing within the home) must extend the isolation
adherence to appropriate individual and setting-specific for 14 days from the day of recovery for the case.
mitigation measures (e.g. physical distancing and masking).
See additional self-isolation guidance for household contacts in
Measures for COVID-19 Variants of Concern Case, Contact, and
Outbreak Management: Interim Guidance for Newfoundland
Immunocompromised individuals should be managed as unimmunized
and Labrador
regardless of immunization status.
2Individuals should be reminded to follow good hand hygiene and
respiratory etiquette and to avoid taking fever-reducing medications as
these can mask the early signs of COVID-19.
HIGH RISK CLOSE CONTACTS
(fully immunized)
Exposure Level Public Health Actions
See above Asymptomatic Individuals
Asymptomatic contacts who are fully immunized are not
required to self-isolate at home or in the community.
Asymptomatic contacts who are fully immunized should be
tested 72 hours after exposure and advised to monitor for
symptoms for 14 days post-exposure. These individuals do not
need to isolate while awaiting test results.
Repeat testing day on 11-13 is recommended.
If the individual becomes symptomatic they must isolate right away and
complete the online COVID-19 Self-Assessment Tool or call 811.
This excludes healthcare workers, residents of long-term care, personal
care homes, retirement homes and patients admitted to health care
settings. See below for section related to Long Term Care and Health Care
Workers.
Symptomatic Individuals
Self-isolate and get tested as soon as possible.
If test is negative, continue to isolate and repeat
testing on day 7 post-exposure.
Symptomatic individuals who are fully immunized
can be cleared from isolation 10 days post-exposure
and/or when symptoms have resolved (whichever
is longer).
Retesting on 11-13 is recommended.
If contact is not tested, they will be managed as a
Suspect Case and must isolate for a minimum of 10
days after symptom onset or until recovered by
Public Health.
If test is positive, follow as COVID-19 case as per the Public Health
Management of Cases and Contacts of COVID-19 in Newfoundland and
Labrador.
This excludes healthcare workers, residents of long-term care, personal
care homes, retirement homes and patients admitted to health care
settings. See below for section related to Long Term Care and Health Care
Workers.
LOW RISK CONTACTS
(partially or unimmunized)
Exposure Level Public Health Actions
Anyone who has shared an indoor space (e.g. same room) with Asymptomatic Individuals
a case for a prolonged period of time including closed spaces, Individuals must obtain test 72 hours post-exposure.
3crowded spaces or settings where close interaction may occur Must isolate until test results are available.
(e.g. social gathering and workplaces, restaurants, flight If negative, self-monitor for 14 days after last exposure to the
advisories, etc.) with FULL adherence to appropriate individual case.
and setting-specific mitigation measures (e.g. physical Retest on day 11-13.
distancing and masking).
Symptomatic Individuals
Anyone who has had a close range conversation with a case or Self-isolate for 14 days and get tested as soon as possible.
has been in a setting where a case has been singing, shouting, If test is negative, then re-test on day 11-13.
or heavy breathing (e.g. exercise) with FULL adherence to
appropriate individual and setting-specific mitigation measures
(e.g. physical distancing and masking).
Immunocompromised individuals should be managed as unimmunized
regardless of immunization status.
LOW RISK CONTACTS
(fully immunized)
Exposure Level Public Health Actions
As above Asymptomatic Individuals
• Asymptomatic contacts who are fully immunized should be
tested 72 hours after exposure and advised to monitor for
symptoms for 14 days post-exposure. These individuals do not
need to isolate while awaiting test results.
• If the individual becomes symptomatic they must isolate right
away and complete the online COVID-19 Self-Assessment Tool
or call 811.
Symptomatic Individual.
Self-isolate and get tested as soon as possible. If test is
negative, continue to isolate and repeat testing on day 7 post-
exposure.
Repeat testing on day 11-13.
Symptomatic individuals who are fully immunized can be
cleared from isolation 10 days post-exposure and once
symptoms resolved (whichever is longer).
*A period of 15 cumulative minutes over 24 hours has been selected to distinguish between brief and prolonged contact as a starting point,
considering other aspects of the interaction.
Residents of Long-term Care/Retirement Homes and Inpatients
Fully immunized residents in long-term care, personal care homes, retirement homes and individuals
who are admitted to acute care settings, who are contacts to a case are required to isolate for 14 days
post-exposure and obtain testing, even if they remain asymptomatic.
NOTE: This is due to the higher risk of severe disease and death in this population, coupled with risk
of transmission in long-term care and retirement homes and healthcare settings.
4References Alberta Health Services (2021, May 31). Return to Work Decision Chart for Healthcare Workers. https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-return-to-work-decision-chart- healthcare-worker.pdf Nova Scotia (2021, May 10). Interim Guidance: Public Health Measures of Cases and Contacts Associated with Novel Coronavirus (COVID-19). https://novascotia.ca/dhw/cdpc/documents/Coronavirus-Interim- Public-Health-Meausures.pdf Ontario Ministry of Health (2021, May 6). COVID-19 Fully Vaccinated Individuals: Case, Contact, and Outbreak Management Interim Guidance. https://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/contact_mngmt/COVID -19_fully_vaccinated_interim_guidance.pdf
Appendix A: Risk Classification for Asymptomatic Health Care Workers with Potential Exposure to COVID-
19 Patients/Residents/Clients in Healthcare Settings
Purpose: To provide guidance on the HCW exposure risk for contact with a patient who is a suspect, probable or confirmed COVID-19 case
(including Variants of Concern (VoCs). Healthcare workers who develops signs and symptoms of COVID-19 must immediately self-isolate and
contact Occupational Health (OH)
Page 2: Table 1-HCW risks when patient/resident/client NOT wearing a mask-positive for COVID-19
Page 3: Table 2-HCW risks when patient/resident/client IS wearing a mask, additional considerations to elevate risk level-positive for COVID-19
Page 4: Table 3-HCW risk when patient/resident or client develops symptoms and clinician swabs for COVID-19 and HAS COVID Risk Factors.
Page 5: Table 4-HCW risk when patient/resident or clients develops symptoms and No COVID-19 Risk Factors
Page 6: Definitions, Risk Levels, Scenarios
Page 7: Recommendations for Monitoring
If the screening of the patient reveals that the patient has influenza-like symptoms and/or suspect or confirmed COVID-19, the HCWs should follow Droplet-
Contact Precautions:
A Level II gown or approve equivalent standard
Medical Mask or approved equivalent standard
A face shield must be worn when providing patient care
Nitrile Gloves – 12 inch with extended cuffs
N95 Respirator or approved equivalent standards, with face shield, must be worn for AGMPs
Neck protection for AGMPs as determined by PCRA
Eye protection (e.g., full face shields), in addition to medical masks (continuous eye protection), may be recommended for all HCWs when they have contact
with patients, based on local epidemiology and PCRA. This is determined by the Regional MOH and/or CMOH.
When determining risk of exposure, it is important to consider the following:
If other infection control practices were not met (i.e. Hand hygiene – 4 moments)
If assessment by OH determines that there was a risk of exposure
If there was exposure to an environment where an AGMP was performed before settle time complete
Breach in PPE (i.e. N95 becomes unsealed, eye protection becomes dislodged)
Inconsistent use of mask/face covering by case
Consideration of Variants of Concern (VoCs)Table 1. Covid-19 positive patient/resident/client that is not wearing a mask or face covering consistently during interactions with
HCW (beginning 72 hours prior to symptom onset or if asymptomatic, 72 hours prior to positive test result)
Risk Factors (Potential Scenarios) – patient/client/resident NOT WEARING Risk level Contact Work Restrictions for Asymptomatic HCWs and
MASK (without Type Recommended Monitoring
consideration
of vaccine
status)
HCW PPE: None High Close
Contact If HCW is fully vaccinated, no need to isolate and no work
restrictions. Monitor for symptoms as a precaution and
isolate if symptoms develop.
HCW PPE: Performing an Aerosol Generating Medical Procedure (AGMP) & No N95 High Close
respirator/No eye protection Contact
If HCW is partially vaccinated, Exclude from work, self-isolate
for 14 days after last exposure, self-monitoring
recommended. If symptoms develop, call OH.
HCW PPE: Not wearing a medical mask or not wearing it properly (no eye High Close
protection) Contact
If HCW is Unvaccinated, Exclude from work, self-isolate for 14
HCW: Wearing a medical mask and no eye protection High Close days after last exposure, self-monitoring recommended. If
Contact
symptoms develop call OH.
Refer to the Table 1, High Risk Close Contacts for testing
requirements (pages 2 and 3).
HCW PPE: Wearing all recommended PPE Low Non-close No work restrictions continue to wear appropriate PPE for
Contact contact/droplet precautions. Continual self-monitoring with for
14 days after last exposure. If symptoms develop call OH.
HCW PPE: Wearing all recommended PPE except gown and gloves Low Non-close No work restrictions continue to wear appropriate PPE for
Contact contact/droplet precautions. Continual self-monitoring with for
14 days after last exposure. If symptoms develop call OH.
HCW PPE: No PPE; interaction greater than 2 meters apart and less than 15- None Not a No work restrictions, continual self-monitoring, and contact OH if
minutes in a 24-hour period Contact symptoms developTable 2: Covid-19 positive patient/resident/client that is wearing a mask or face covering appropriately (source control covering mouth and nose)
Risk Level Contact Type Work Restrictions for Asymptomatic HCW and Recommended
Risk Factors (Potential Scenarios) – patient/client/resident (without Monitoring
WEARING MASK consideration of
vaccine status)
HCW PPE: None High Non-close
Contact If HCW is fully vaccinated, no need to isolate and no work
HCW PPE: Not wearing a medical mask or not wearing it High Non-close restrictions. Monitor for symptoms as a precaution and isolate if
appropriately Contact symptoms develop
HCW PPE: Wearing a medical mask but NOT wearing eye High Non-close If HCW is partially vaccinated, Exclude from work, self-isolate
protection Contact for 14 days after last exposure, self-monitoring recommended. If
symptoms develop, call OH.
If HCW is Unvaccinated, Exclude from work, self-isolate for 14
days after last exposure, self-monitoring recommended. If
symptoms develop call OH.
HCW PPE: Wearing all recommended PPE except gown and gloves Low Non-close No work restrictions, continual self-monitoring, for 14 days after last
Contact exposure and complete self-assessment tool as required.
HCW PPE: Wearing all recommended PPE Low Non-close No work restrictions, continual self-monitoring, for 14 days after last
Contact exposure and complete self-assessment tool as required.
HCW PPE: No PPE; interaction greater than 2 meters apart and less None Not a contact No work restrictions, continual self-monitoring, for 14 days after last
than 15-minutes in a 24-hour period exposure and complete self-assessment tool as required.Table 3: Symptomatic patient/resident/client that is not wearing a mask or face covering appropriately (source control covering mouth and nose) with COVID Risk
Factors, with swab result pending
Note: If swab positive, contact OH & refer to Table 1
Risk Factors (Potential Scenarios) – In the past 14 days: Risk Level Contact Type Work Restrictions for Asymptomatic HCW and
Contact with a COVID positive person (without Recommended Monitoring
Contact with a symptomatic traveler consideration of
vaccine status)
Traveled outside the Atlantic Bubble
Received an alert on the COVID-19 Alert App
HCW PPE: None High Close Contact
If HCW is fully vaccinated, no need to isolate and no work
restrictions. Monitor for symptoms as a precaution and
isolate if symptoms develop
HCW PPE: Not wearing a medical mask or not wearing it appropriately High Close Contact If HCW is partially vaccinated, Exclude from work, self-
isolate for 14 days after last exposure, self-monitoring
recommended. If symptoms develop, call OH.
If HCW is Unvaccinated, Exclude from work, self-isolate for 14
days after last exposure, self-monitoring recommended. If
HCW PPE: Wearing a medical mask but NOT wearing eye protection High Non-close Contact symptoms develop call OH.
HCW PPE: Wearing all recommended PPE except gown and gloves Low Non-close Contact HCW should practice droplet/contact precautions as indicated
and ensure mask wearing with all interactions. No work
restrictions and NO SELF-ISOLATION AT HOME REQUIRED.
HCW PPE: Wearing all recommended PPE None Non-close Contact No restrictions
HCW PPE: No PPE; interaction greater than 2 meters apart and less than 15- None Not a contact No restrictions.
minutes in a 24-hour periodTable 4: Symptomatic patient/resident/client that is not wearing a mask or face covering appropriately (source control covering mouth and nose) with NO COVID
Risk Factors
Note: If swab positive, contact OH & refer to Table 1
Risk Factors (Potential Scenarios) – Patient/resident/client develops symptoms Risk Level Contact Type Work Restrictions for Asymptomatic HCW and
after admission, (with negative swab on admission) or a resident in LTC, and (without Recommended Monitoring
clinician swabs for Covid 19-based on these symptoms. consideration of
vaccine status)
HCW PPE: None Low Close Contact HCW should practice droplet/contact precautions as indicated
and ensure mask wearing with all interactions. No work
restrictions and NO SELF-ISOLATION AT HOME REQUIRED.
HCW PPE: Not wearing a medical mask or not wearing it appropriately Low Close Contact HCW should practice droplet/contact precautions as
indicated and ensure mask wearing with all interactions. No
work restrictions and NO SELF-ISOLATION AT HOME
REQUIRED.
HCW PPE: Wearing a medical mask but NOT wearing eye protection Low Non-close Contact HCW should practice droplet/contact precautions as indicated
and ensure mask wearing with all interactions. No work
restrictions and NO SELF-ISOLATION AT HOME REQUIRED.
HCW PPE: Wearing all recommended PPE except gown and gloves None Non-close Contact HCW should practice droplet/contact precautions as indicated
and ensure mask wearing with all interactions. No work
restrictions and NO SELF-ISOLATION AT HOME REQUIRED.
HCW PPE: Wearing all recommended PPE None Non-close Contact No restrictions
HCW PPE: No PPE; interaction greater than 2 meters apart and less than 15- None Not a contact No restrictions.
minutes in a 24-hour periodDefinitions
Close contact is defined as a person who:
Provided direct care for the case without consistent and appropriate use of recommended Personal Protective Equipment (PPE); OR
Close prolonged (≥15 minutes) contact within two meters of a confirmed COVID-19 case in a 24-hour period; OR
Had direct contact with infectious body fluids of a case (e.g., was coughed or sneezed on) without the appropriate use of recommended PPE
Non-close contact is defined as a person who:
Provided care for the case with consistent and appropriate use of PPE; OR
Not a Contact is defined as a person who:
Only transient interactions (e.g. walking by the case or being briefly in the same room) or as a result of local community transmission
Had prolonged (≥15 minutes) contact but not was not within two meters of a confirmed COVID-19 case
Health Care Worker (HCW) is defined as:
Individuals who provide health care or support services. For this purpose, includes HCWs working in the intensive care unit,
emergency room, environmental services (selected employees), laboratory services (selected employees),
paramedicine/emergency medical service (public and private), community health nurses and home care workers who visit homes.
Risk Levels
High-risk exposures refers to HCWs who have had prolonged close contact with patients with COVID-19 (beginning 48 hours before
onset of symptoms or 48 hours prior to date of positive swab test if asymptomatic) who were not wearing a cloth face
covering/facemask while HCW eye, nose and/or mouth were exposed to material potentially infectious with the virus causing COVID-
19 (e.g., being present in the room for AGMP procedures that generate aerosols or when respiratory secretions are likely to be poorly
controlled).
Medium-risk exposures refers to HCWs who had prolonged close contact with patients with COVID-19 (beginning 48 hours before
onset of symptoms or 48 hours prior to date of positive swab test if asymptomatic) who were not wearing a cloth face covering/
facemask while HCW nose/mouth were covered but eyes were exposed to material potentially infectious with the virus causing
COVID-19.
Some low-risk exposures may be considered medium-risk depending on the type of care activity performed. For example, HCW whowas wearing a gown, gloves, eye protection and a facemask (instead of a respirator) during an aerosol generating procedure would be considered to have a medium-risk exposure. If an AGMP had not been performed, they would have been considered low risk. Low-risk exposures refers to brief interactions with patients with COVID-19 (beginning 48 hours before onset of symptom or 48 hours prior to date of positive swab test if asymptomatic) or prolonged close contact with patients (beginning 48 hours before onset of symptoms or date of diagnosis if asymptomatic) who were wearing a cloth face covering or facemask for source control. HCW PPE use of eye protection in addition to a facemask or respirator would further lower the risk of exposure. Low-risk exposures can be elevated dependent on point of care assessments and environmental factors. No-risk exposures refers to interactions greater than 2 meters apart and less than 15-minutes in a 24 hour period Recommendations for Monitoring Based on COVID-19 Exposure Risk HCWs in any of the risk exposure categories who develop signs or symptoms compatible with COVID-19 must contact OH for referral for testing and forevaluation prior to returning to work. High or Medium-risk Exposure Level HCWs in the high or medium-risk category should undergo self-monitoring, self-isolation and restriction from work in any healthcare setting until 14 days after their last exposure, dependent upon their vaccination status as noted in the previous tables. If they develop any fever* OR symptoms consistent with COVID-19 (see appendix A) they should promptly call the OH for referral to testing. OH will contact the HCW after testing for evaluation prior to returning to work. Low-risk Exposure Level HCW in the low-risk category should perform self-monitoring and tracking (for potential contact tracing purposes) until 14 days after the last potential exposure. Asymptomatic HCWs in this category are not restricted from work. HCW’s should remain alert for symptoms consistent with COVID-19. They should complete the staff-screening tool to ensure asymptomatic before leaving home and reporting for work. If they develop fever* OR symptoms consistent with COVID-19 they should immediately self-isolate (separate themselves from others) and call the OH for referral to testing. OH will contact the HCW after testing for evaluation prior to returning to work.
No-risk Exposure Level
Proper adherence to currently recommended infection control practices, including all recommended PPE, should protect HCW having
prolonged direct contact with patients infected with COVID-19. However, to account for any inconsistencies in use, or adherence that
could result in unrecognizedexposures, HCW still perform self-monitoring with self-screening as described under the low-risk exposure
category.
*Fever is either measured temperature > 38.0oC or subjective fever. Note that fever may be intermittent, or may not be
present in those who are elderly,immunosuppressed, or taking certain medications (e.g., NSAIDs). Clinical judgement
should be used to guide testing of HCWs in such situations.
Additional Scenarios:
Additional scenarios that would elevate the risk level for exposed HCW. For example:
• HCWs who were wearing a gown, gloves, eye protection, and a facemask (instead of a respirator) during an
AGMP would be considered to have a medium-risk exposure.
• HCWs not using all recommended PPE who have only brief/transient interactions with a patient, regardless
of whether patient was wearing a cloth face covering or facemask are considered low risk. Examples of brief
interactions include brief conversation at a triage desk; briefly entering a patient room but not having direct
contact with the patient or the patient’s secretions/excretions; entering the patient room immediately after
the patient was discharged, as long as no AGMP was performed within 1 hour prior to discharge.
• HCWs who walk by a patient or who have no direct contact with the patient or their secretions/excretions
and no entry into the patient room areconsidered to have no identifiable risk.You can also read
