# COVID-19
March 24, 2020 3
Case Definition (1)

# Person Under Investigation (PUI)
- A person with fever and/or cough who meets the exposure criteria and for whom a laboratory test for COVID-19 1 has been or is expected to be requested.
Note: There is limited evidence on the likelihood of COVID-19 presenting as a co-infection with other pathogens. At this time, the identification of one causative agent should not exclude  where the index of suspicion 2 may be high.

# Confirmed Case
A person with laboratory confirmation of infection with the virus that causes COVID-19 is performed at a reference laboratory (NML or a provincial public health laboratory), and consists of positive nucleic acid amplification tests 3 (NAAT) on at least two specific genome targets or a single positive target with nucleic acid sequencing.
Positive laboratory tests at a non-reference laboratory require additional testing at a reference laboratory for confirmation.

# Probable Case
A person:
- with fever (over 38.0 degrees Celsius) and/or new onset of (or exacerbation of chronic) cough AND - who meets the COVID-19 exposure criteria AND - in whom laboratory diagnosis of COVID-19 is o inconclusive 4 , o negative (if specimen quality or timing is suspect), or o positive but not confirmed by the National Microbiology Laboratory (NML) or provincial public health laboratory by nucleic acid amplification tests (NAAT)

# Prince Edward Island Exposure Criteria
In the 14 days 5 before onset of illness, a person who:
- Traveled outside Prince Edward Island (PEI) OR  Had close contact 6 with a confirmed or probable case of COVID-19 within 14 days before their illness onset OR  Had close contact with a person with acute respiratory illness who has travelled outside of PEI within 14 days prior to their illness onset OR  Laboratory exposure to biological material (e.g. primary clinical specimens, virus culture isolates) known to contain COVID-19.
Factors that raise the index of suspicion 7 should also be considered.  (1-800-545-7661) or through the single window email: phacaspc.hpoc-cops@canada.ca.

# Etiology (4)
Coronaviruses are a large family of viruses that are common in many different species of animals, including camels, cattle, cats, and bats. Rarely, animal coronaviruses can infect people and then spread between people such as with Middle East Respiratory Syndrome (MERS), Severe Acute Respiratory Syndrome (SARS), and now with COVID-19.
Cases were initially linked to exposure to live animals at a seafood market in Wuhan City but the substantial increase in cases thereafter is due to human-to-human transmission of the virus.
The COVID-19 is an emerging respiratory pathogen with uncertain key epidemiological, clinical and virological characteristics.

# Clinical Presentation
The clinical spectrum of 2019 novel coronavirus (COVID-19) infection is still being defined. Illnesses associated with the COVID-19, are similar to several respiratory illnesses and include fever, dry cough, sore throat and headache. Most cases are considered mild to moderate with a subset experiencing more severe illness with shortness of breath and difficulty breathing. Deaths have been reported among approximately two to four per cent of detected cases in China although it is likely that the actual risk of such severe outcomes is lower given milder cases are less likely to be detected.
The complete clinical picture with regard to COVID-19 is not fully understood. Reported illnesses have ranged from infected people with little to no symptoms to severe illness and death.

# Diagnosis
Diagnosis is made by isolation of the COVID-19 in a nasopharyngeal swab and throat swab for PCR and sent a provincial lab for presumptive result and confirmed by the National Microbiology Laboratory (refer to Appendix A).

# Epidemiology

# Reservoir
Early on, many of the patients in the outbreak of respiratory illness caused by COVID-19 in Wuhan, China had some link to a large seafood and live animal market, suggesting animal-toperson spread. Later, a growing number of patients reportedly did not have exposure to animal markets, indicating person-to-person spread.

# Transmission
Transmission occurs person to person in symptomatic individuals via droplet.

# Incubation Period
Current estimates of the incubation period range from 1 to 12.5 days with median estimates of 5-6 days.

# Period of Communicability
Unknown.

# Host Susceptibility
Host susceptibility remains somewhat unknown. Information indicates that risk factors for disease include host factors (chronic disease, age) and exposure factors. 

# Canada
Updated numbers of COVID-19 in Canada are available on the Public Health Agency of Canada website.

# Prince Edward Island
There have been three cases of COVID-19 reported in PEI.

# Control (Appendix B) Person Under Investigation (PUI)
A person under investigation is defined as a person with a fever or acute respiratory illness, or pneumonia, who meets the exposure criteria and for whom a laboratory test for COVID-19 has been or is expected to be requested.

# Management of a Case/PUI
- Follow up is only done if the case/contact meets the case definition and is being investigated. - Droplet/contact precautions are to be put in place in health care facilities until the test is confirmed and/or the case is no longer symptomatic. - Any aerosol-generating medical procedures should be avoided in the home environment.
- Complete the Interim National COVID-19 Case Report Form (Appendix C).
- Precautions can be discontinued for a case 14 days after symptoms began, as long as the case feels well. If the case is a health care worker 2 negative swabs 24 hours apart will be required before resuming work.

# Treatment of a Case
There is no specific treatment for disease caused by a COVID-19. However, many of the symptoms can be treated and therefore treatment is based on the individual's clinical condition.

# Management of Contacts
Contact tracing and counselling are to be completed 8 for all reported cases. A close contact is defined as;
- Those who provided care for the case, including healthcare workers, family members or other caregivers, or who had other similar close physical contact without consistent and appropriate use of personal protective equipment, OR  those who lived with or otherwise had close prolonged contact (within 2 metres) with a probable or confirmed case while the case was ill, OR  those who have had direct contact with infectious body fluids of a probable or confirmed case (e.g., was coughed or sneezed on) while not wearing recommended personal protective equipment.
Those who are identified as a contact of a case will be instructed to self-isolate and monitor for symptoms for 14 days. Public Health Nursing (PHN) will be following up with the close contacts daily. If symptoms occur, testing will be arranged.

# Self-Isolating in the Home Setting
All people that have travelled outside Prince Edward Island are asked to self-isolate for 14 days upon their return regardless of symptoms. If symptomatic, a case or person under investigation (PUI) should call 811 to be screened for testing and isolate themselves in the home setting until advised by the Chief Public Health Office (CPHO) that isolation can be discontinued. Staying at home means:
- Not going out unless directed to do so (i.e. to seek medical care)  Not going to school, work, or other public areas  Not using public transportation (e.g. buses, taxis, etc)  Taking short walk outside, close to home, and only if a 6 ft distance from others can be maintained.
NOTE: Exceptions will be made for individuals who are considered essential workers (e.g. health care workers, truck drivers, airline crews, essential frontline workers in the public or private sector, workers in critical sectors). Upon their return from domestic travel, essential workers will be:  screened upon entry to the province  asked to self-monitor daily for symptoms of COVID-19 if feeling well  asked to self-isolate if experiencing symptoms of COVID-19.

# Preventative Measures
- Public education and communication about COVID-19.  All travelers who have returned from outside Prince Edward Island are being asked to selfisolate for 14 days and monitor themselves and their children closely, and to call 811 if they develop any symptoms (fever, cough, or difficulty breathing).

# Testing
Testing will be arranged through 811.
The following criteria are being used to screen for testing from March 23-March 30: 

# Infection Prevention and Control in the Community
Follow these routine prevention measures to stay healthy:
- Wash your hands frequently with soap and water or use alcohol-based hand rub when hands are not visibly soiled.
- Cough and sneeze into your elbow or a tissue. If using a tissue, immediately place it in a waste disposal and wash your hands.
- If possible, stay home when ill with acute respiratory symptoms; if this is not possible, limit close contact with others.
- Limit touching your eyes, nose, and mouth.
- Don't share items that may have saliva on them such as drinking glasses and water bottles.
- Frequently clean surfaces like taps, doorknobs, and countertops.
- Use of masks by the general public for respiratory illnesses such as influenza and novel coronavirus have not been shown to be effective in preventing virus spread and are not recommended for prevention.

# Infection Prevention and Control in the Healthcare Facility
In the absence of effective drugs or vaccines, infection prevention and control (IPC) strategies to prevent or limit transmission of COVID-19 in healthcare facilities include:  masks, tissues and alcohol-based hand rubs (ABHR) should be available at entrances  signage should be posted to instruct symptomatic patients to alert healthcare workers, thus prompting completion of a patient screening questionnaire IF a person presents with symptoms of influenza-like illness:
- and within 14 days before the onset of illness, has travelled to an area outside of PEI  and/or been in close contact with a probable or confirmed case of COVID-19 THEN the following actions should be taken:
- Place the patient in a designated separate waiting area or space.
- Encourage the patient with signs and symptoms of an acute respiratory infection to perform respiratory hygiene/cough etiquette, and provide tissues, ABHR and a waste receptacle. 3. Limit visitors. 4. Do not cohort with other patients (unless necessary, in which case cohort only with patients confirmed to have COVID-19 infection).

# Application of Routine Practices and Additional Precautions
The application of routine practices and additional precautions (RPAP) is based on a point-of-care risk assessment (PCRA). Health care workers (HCWs) should use a risk assessment approach before and during each patient interaction to evaluate the likelihood of exposure.
In addition to the consistent application of routine practices, follow contact and droplet precautions. This includes the appropriate selection and use of all the following personal protective equipment (PPE):
- gloves  a long-sleeved gown  facial protection, such as surgical/procedural mask and eye protection, face shield, or surgical/procedural mask with visor attachment  an N95 respirator (plus eye protection) should be used when performing aerosol-generating medical procedures 9 (AGMPs) on a person under investigation (PUI) for COVID-19 infection.
- Hand hygiene should be performed whenever indicated, paying particular attention to during and after removal of PPE, and after leaving the patient care environment. 

# Infection Prevention and Control Guidelines

# COVID-19
March 24, 2020

# Appendix A: Novel Coronavirus (COVID-19) Testing
All people with travel and symptoms for testing will be screened through 811. Screening will take place at clinics set up in Charlottetown and Summerside. All patients admitted to the hospital for respiratory illness will be tested for COVID-19.