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COVID-19
Health Care Provider
      Briefing
Middlesex and London Region
      January 4, 2022

Welcome
        Presenter:
   Dr. Alex Summers
Acting Medical Officer of Health
 Middlesex-London Health Unit

       @alexsummers4

Surveillance Report
As of January 3rd :
• Over 281.8 million COVID-19 cases and over 5.4 million deaths
  have been reported worldwide
• Over 8.6 billion vaccine doses administered worldwide
• 756,361 cases of this illness confirmed in Ontario, including
  10,194 deaths
• Locally:

Data source: Ontario Ministry of Health (Ministry) Public Health Case and Contact Management Solution (CCM), extracted
2022-01-04. Data current as of the end of day 2022-01-03.

Cases by Reported Date

Data source: Ontario Ministry of Health (Ministry) Public Health Case and Contact Management Solution (CCM), extracted
2022-01-04. Data current as of the end of day 2022-01-03.

COVID-19 Vaccine Update

Data source: Ontario Ministry of Health (Ministry) Public Health Case and Contact Management Solution
(CCM), extracted 2022-01-04. Data current as of the end of day 2022-01-03.

COVID-19 Vaccine Coverage

Data source: Ontario Ministry of Health (Ministry) Public Health Case and Contact Management Solution (CCM), extracted 2022-01-04.
Data current as of the end of day 2022-01-03.

Key Updates
•   Prioritization of case and contact management
•   Changes to COVID-19 testing eligibility
•   Changes to self-isolation requirements
•   Expanded public health measures

Prioritization of case and contact
           management

Prioritization of case and contact management
• Containment is no longer an option.
   • With previous variants and at lower incidence levels, case investigation and
     contact tracing could prevent transmission. That’s no longer the case in most
     instances.
• Omicron is moving more quickly than we can identify it.
   • Testing for it, and the subsequent case investigation and contact tracing efforts
     that it used to trigger, is no longer preventing substantial transmission.
• Case and contact management will now be focused on cases who live,
  work, attend, or are admitted in highest risk settings.
   • These include hospitals, long-term care and retirement homes, congregate
     living settings where immunocompromised people live, and First Nations
     communities.
   • Cases in other settings will not be notified, nor will they be investigated by
     MLHU.

COVID-19 Cases in Highest Risk Settings
Highest risk settings include:
• Hospitals
• Long-term care and retirement homes
• Congregate living settings where immunocompromised
  people live
• Correctional institutions
• Paramedics
• First Nations, Inuit, Métis communities

Not considered a highest-risk settings
• Schools
• Childcare settings
• Primary care settings, including
  vaccination clinics

Changes to COVID-19 testing eligibility

Changes to COVID-19 testing eligibility
• Most people with COVID-19 symptoms will no longer need to be
  tested.
• The reasons that people in the general community have been
  tested up until now were:
   (a) to help with the surveillance of COVID-19 in the community and
   (b) to trigger case investigation and contact tracing efforts.
• Given that we now know that Omicron is widespread and that
  case investigation in the community is no longer indicated,
  testing most people for COVID-19 is no longer required.
• Testing is still indicated for symptomatic individuals who live or
  work in the highest-risk settings, as well as those who are
  admitted to hospital.
• Close contacts also no longer need to be tested.

Eligibility for molecular testing (PCR or rapid
                 molecular testing)
• Symptomatic people who fall into one of the following groups:
    •   Hospitalized patients
    •   Patients seeking emergency medical care, at the discretion of the treating clinician
    •   Patient-facing healthcare workers
    •   Staff, volunteers, residents/inpatients, essential care providers, and visitors in
        hospitals and congregate living settings, including Long-Term Care, retirement
        homes, First Nation elder care lodges, group homes, shelters, hospices, temporary
        foreign worker settings, and correctional institutions.
• Symptomatic outpatients for whom COVID-19 treatment is being considered
    • includes those 70 and older who have a risk factor including obesity (BMI ≥30),
      dialysis or stage 5 kidney disease (eGFR

Eligibility for molecular testing (PCR or rapid
                    molecular testing)
•     Symptomatic people who are underhoused or homeless
•     Symptomatic elementary and secondary students and
      education staff who have received a PCR self-collection kit
      through their school
•     Symptomatic/asymptomatic people who are from First Nation,
      Inuit, and Métis communities and individuals travelling into
      these communities for work
•     Symptomatic /asymptomatic people on admission/transfer to
      or from hospital or congregate living setting

Eligibility for molecular testing (PCR or rapid
                    molecular testing)
•    High risk contacts and asymptomatic/symptomatic people in the
     context of confirmed or suspected outbreaks in highest risk
     settings, including hospitals, long-term care, retirement homes,
     other congregate living settings and institutions, and other
     settings as directed by the local public health unit
•    Asymptomatic testing in hospital, long-term care, retirement
     homes and other congregate living settings and institutions as
     per provincial guidance and/or Directives, or as directed by
     public health units.

Alignment of testing guidance and CCM
• Note that the testing eligibility largely aligns with
  those with whom case investigation will occur.
• Other purpose for testing is to assist with clinical
  decisions.

Changes to self-isolation requirements
     for both cases and contacts

If you develop symptoms of COVID-19 or
            test positive for COVID-19
• Self-isolate immediately:
   • Individuals who are vaccinated, as well as children under 12 who have
     symptoms of COVID-19 will be required to isolate for five days following the
     onset of symptoms. These individuals may end their period of isolation after
     five days, if their symptoms are improving for at least 24 hours.
   • Individuals who are unvaccinated, partially vaccinated or
     immunocompromised must isolate for 10 days.
   • Individuals that live in a high-risk setting (i.e., hospitals, long-term care,
     retirement homes, congregate living settings where immunocompromised
     people live) must self-isolate for 10 days, regardless of their vaccination
     status.

If you develop symptoms of COVID-19 or
            test positive for COVID-19
• If you are someone who works in a high-risk healthcare setting (i.e.
  paramedics, hospitals, long-term care, retirement homes,
  congregate living settings where immunocompromised people live):
   • Notify your employer as soon as possible.
   • You should not visit the high-risk setting for 10 days since symptom onset, or
     from your date of diagnosis.
   • Workers in these settings may return to work early on day seven of their
     isolation with a negative PCR test, or two negative rapid antigen tests on day
     six and seven.

If you are exposed to someone who has
tested positive or has symptoms of COVID-19
•   If you are fully vaccinated, or under the age of 12, and you have no
    symptoms, and do not live with the positive case or person with
    symptoms, you are advised to:
    •   Self-monitor for symptoms for 10 days since you last interacted with the
        positive case
    •   Maintain masking, physical distancing and adherence to all other public
        health measures if leaving home
    •   Do not visit any high-risk settings or individuals who may be at higher risk
        of illness (e.g., seniors) for 10 days from your last exposure.
•   If you are not fully vaccinated, or are immunocompromised, you must
    isolate immediately for 10 days following your last contact.
•   If you live with the positive case or person with symptoms, you must
    isolate for the length of their isolation period.

If you are exposed to someone who has
tested positive or has symptoms of COVID-19
•   If you live, work, attend, volunteer, or have been admitted in a
    high-risk health care setting:
    •   Notify your employer
    •   Do not visit the high-risk setting for 10 days since your last exposure.
    •   In certain situations, rapid antigen tests (RATs) may be used as a part of a
        “test-to-work” protocol, in which asymptomatic staff in high-risk settings
        can return to work when they would otherwise need to isolate at home.

Test-to-work
•   Strategy to support work-self isolation to meet critical
    workforce needs in which staff are able to return to work
    when they would otherwise be on self-isolation at home.
    •   While the safest approach is to continue self-isolating, all layers of
        protection in the hierarchy of controls should be optimized to
        reduce the risk of having an exposed individual in the workplace.

•   The test-to-work strategy is predominantly for close contacts,
    as opposed to cases. Staff who are cases (i.e. have tested
    positive or symptomatic) should be considered only in the
    dire critical staffing shortage situation.

Staff eligible for work-self-isolation
• Staff who are critical to operations in these settings who are
  household contacts of cases, or have been otherwise advised to
  self-isolate, may return to work on work self-isolation if:
   •   They remain asymptomatic; AND
   •   are actively screened ahead of each shift; AND
   •   are fully vaccinated; AND
   •   continuously test negative on required testing

Testing requirements for work-self-isolation

Expanded public health
      measures

Expanded public health measures
•   Province will return to the modified version of Step
    Two of the Roadmap to Reopen effective Wednesday,
    January 5, 2022 at 12:01 a.m. for at least 21 days (until
    January 26, 2022), subject to trends in public health
    and health system indicators.
•   Starting January 5, students will pivot to remote
    learning with free emergency child-care planned for
    school-aged children of health care and other eligible
    frontline workers.

Expanded public health measures
• Reducing social gathering limits to five people indoors and 10 people outdoors.
• Limiting capacity at organized public events to five people indoors.
• Requiring businesses and organizations to ensure employees work remotely unless the
  nature of their work requires them to be on-site.
• Limiting capacity at indoor weddings, funerals, and religious services, rites and ceremonies
  to 50% capacity of the particular room.
    •   Outdoor services are limited to the number of people that can maintain 2 metres of physical
        distance. Social gatherings associated with these services must adhere to the social gathering
        limits.
• Retail settings, including shopping malls, permitted at 50% capacity.
    •   For shopping malls physical distancing will be required in line-ups, loitering will not be permitted
        and food courts will be required to close.
• Personal care services permitted at 50% capacity and other restrictions.
    •   Saunas, steam rooms, and oxygen bars closed.
• Closing indoor meeting and event spaces with limited exceptions but permitting outdoor
  spaces to remain open with restrictions.
• Public libraries limited to 50% capacity.

Expanded public health measures
•   Closing indoor dining at restaurants, bars and other food or drink establishments.
      •   Outdoor dining with restrictions, takeout, drive through and delivery is permitted.
•   Closing indoor concert venues, theatres, cinemas, rehearsals and recorded performances permitted
    with restrictions.
•   Closing museums, galleries, zoos, science centres, landmarks, historic sites, botanical gardens and
    similar attractions, amusement parks and waterparks, tour and guide services and fairs, rural
    exhibitions, and festivals.
      •   Outdoor establishments permitted to open with restrictions and with spectator occupancy, where applicable,
          limited to 50% capacity.
•   Closing indoor horse racing tracks, car racing tracks and other similar venues.
      •   Outdoor establishments permitted to open with restrictions and with spectator occupancy limited to 50%
          capacity.
•   Closing indoor sport and recreational fitness facilities including gyms, except for athletes training for
    the Olympics and Paralympics and select professional and elite amateur sport leagues.
      •   Outdoor facilities are permitted to operate but with the number of spectators not to exceed 50% occupancy
          and other requirements.
•   School buildings would be permitted to open for child care operations, including emergency child
    care, to provide in-person instruction for students with special education needs who cannot be
    accommodated remotely and for staff who are unable to deliver quality instruction from home.

Flu in Middlesex-London

Questions?
• Ask using chat function now, or after the
  webinar at:
  healthcareproviders@mlhu.on.ca
• For urgent matters please call the Health
  Unit’s main line at 519-663-5317.
• For more information
  www.healthunit.com/healthcare-
  providers