Frequently Asked Questions about COVID-19 – February 12, 2020

What is a coronavirus?
Coronaviruses are a type of virus than cause respiratory illness in humans and animals. Coronavirus infections are common and usually mild, and can cause the common cold. Some types can cause more severe illness, such as pneumonia.

Why is this coronavirus “new” or “novel”?
After several people in China became sick, all the tests for known viruses, such as influenza, were negative. This new virus had not been identified before and therefore is ‘new’ or ‘novel’. The respiratory illness caused by this virus is called COVID-19.

Is this virus the same as the SARS virus?
No, this new coronavirus is a different virus. It is in the same group (family) as the virus that causes SARS.

What is the risk level in our communities, in Ontario, and in Canada now?
The risk in all parts of Canada is low.

What are the symptoms of COVID-19?
Symptoms include:
• fever
• cough
• difficulty breathing/shortness of breath

Who is at risk?
At this time it appears that people who have been in China, especially Hubei Province, are most at risk of being infected. Many people have a mild form of the illness and do not need to be in the hospital, and have recovered at home. Some people, such as the elderly or those with chronic medical conditions, have had severe disease.

How is the virus spread?
Our knowledge is based on what is known about similar coronaviruses and we are learning more.
Most often, spread from person-to-person happens among people who spend a lot of time together (close contacts).
It is thought to spread by “respiratory droplets”. When an infected person doesn’t cover their sneeze or cough, the droplets can land in the mouth or nose of people who are nearby. It can also spread when an infected person sneezes or coughs into their hands, doesn’t wash their hands, and transfers the virus to surfaces like door handles. When other people touch these surfaces and then touch their mouth, nose or eyes, they can become infected with the virus.

How can people prevent getting sick with this virus?
Like other respiratory infections, such as influenza, there are things that people can do to protect themselves and others.
• wash your hands often with soap under warm running water for at least 20 seconds
• use alcohol-based hand sanitizer if soap and water are not available
• avoid touching your eyes, nose and mouth
• avoid close contact with people who are sick
• cough or sneeze into your sleeve or a tissue; if you use a tissue to cover your mouth and nose when you cough or sneeze, put the used tissue in the garbage right away, and then wash your hands
• if you are sick, stay at home and monitor your condition; if you have worsening symptoms contact your health provider
• clean and disinfect frequently touched objects and surfaces

Should I wear a mask to protect myself?
No, for day-to-day activities, there is no need to wear a mask if you are not sick. If you have a cough, or other symptoms, you might be asked to wear a mask if you go to a nursing station or other health centre to prevent others from getting sick.

How is the virus diagnosed?
If a person has specific risk factors for COVID-19, such as recent travel from China, there is a test that can be ordered by a health care provider. A health care provider will take samples from the nose and throat and then send it to a lab for testing.

Is there a treatment?
There is no specific treatment for this infection. Most people who have had it get better on their own. Very ill people who need to be in hospital receive “supportive care”, which means treating the patient’s symptoms, such as giving fluids and oxygen, until the patient’s immune system can get rid of the virus.

Is there a vaccine?
There is no vaccine at this time, but researchers are working to create a vaccine.

Does the flu vaccine offer protection?
No the flu vaccine is not effective for coronaviruses, but it is effective for influenza. Since we are still in flu season, and the flu can cause serious illness, we recommend all eligible people get the flu vaccine (unless they cannot for a medical reason).

What is Indigenous Services Canada – Ontario Region doing?
Although the risk is low in Ontario, we are preparing in case we see more infections. By doing this we will be ready to diagnose and treat people quickly and prevent the spread of infection.

We have provided guidance and training to nurses on how to prepare for a possible patient with COVID-19, and what to do if a possible patient comes to a nursing station or health centre. This guidance is the same as for any clinic in Ontario. We are making sure that we have the right equipment available to assess and manage a possible patient.

We are sending information to health directors and First Nations partners so that they are aware of the latest information. Through daily briefings we are keeping up to date with information on COVID-19 as it becomes available from the Public Health Agency, the Ministry of Health and Long-term Care, and Public Health Ontario.

Where can I get accurate and up to date information about COVID-19?
We have learned of incorrect information posted on social media and the internet.
We encourage everyone to get information from reliable sources.
Two reliable websites that are updated regularly are:
Ministry of Health and Long-Term Care
https://www.ontario.ca/page/wuhan-novel-coronavirus-2019-ncov
Government of Canada
https://www.canada.ca/en/public-health/services/diseases/coronavirus.html

~~

12 FEB 2020,
Dear Health Director:
We are writing to provide you with an update about the outbreak of respiratory illness in China caused by a newly discovered type of coronavirus, this respiratory illness is now called COVID-19. We continue to receive daily updates from the Ministry of Health and Long-Term Care of Ontario, and the Public Health Agency of Canada. In this letter we would like to provide you with updated information.

What is the risk level in Ontario and Canada now?
The risk in Ontario and Canada remains low.

How many people in Ontario and Canada have been diagnosed with this infection?
In Ontario, there have been three people diagnosed with COVID-19 who had travelled from China, and all are doing well. In British Columbia there have been a total of four people diagnosed with this illness. All are recovering or have already recovered.

How is the health of people who were evacuated from Wuhan, China, and are now quarantined at Canadian Forces Base Trenton?
None of these people have shown signs or symptoms of COVID-19. They will be monitored daily until the end of the quarantine period, which is 14 days after arrival in Canada.

Where can I get accurate information about COVID-19?
We have learned that incorrect information continues to be posted on social media and the internet. We encourage everyone to get information from reliable sources. Two good websites that are updated regularly are:
Ministry of Health and Long-Term Care
https://www.ontario.ca/page/wuhan-novel-coronavirus-2019-ncov
Government of Canada
https://www.canada.ca/en/public-health/services/diseases/coronavirus.html

What is the First Nations and Inuit Health Branch in Ontario doing?
Although the risk is low, we are preparing in case there are more infections in Ontario. By doing this we will be ready to treat people quickly and prevent the spread of infection.

We continue to communicate daily with the Ministry of Health and Long-Term Care of Ontario, the Public Health Agency of Canada, and health units in Ontario so that we have a coordinated approach. We have provided guidance to nurses on how to prepare for a possible patient with COVID-19, and what to do if a possible patient comes to a nursing station or health centres. This guidance is the same as that for any clinic in Ontario.

We have provided webinars to nursing staff and other health workers, and are updating this webinar with new information as it becomes available.

How can people prevent getting sick with respiratory viruses?
There are things that people can do to protect themselves and others. Washing your hands frequently is very important to prevent infections. When coughing or sneezing, do not sneeze or cough into your hands but into your sleeve. If you are sick, stay home until you are well.

We are attaching a “frequently-asked questions” sheet that you may find helpful in answering questions about COVID-19.
Regards,
Maurica Maher, MD, MSc, FRCPC
Regional Public Health Physician, ON Region

~~

31 JAN 2020,
Dear Health Director:
We are writing to provide an update about the outbreak of respiratory illness in China caused by a newly discovered type of coronavirus. We continue to receive daily updates from the Ministry of Health and Long-Term Care of Ontario, and the Public Health Agency of Canada. On January 30, the World Health Organization declared the coronavirus outbreak in China a “public health emergency of international importance”. This has caused concern for some communities.

In this letter we answer some new questions that we have received recently.

What is the risk level in Ontario and Canada now?
The risk in Ontario and Canada remains low.

How many people in Ontario and Canada have been diagnosed with this infection?
In Ontario, there have been two people who travelled from China have been diagnosed with coronavirus. In British Columbia, one person who travelled from China has been diagnosed with this virus. All three are recovering from their illness.

Why did the World Health Organization declare the coronavirus outbreak in China a “public health emergency of international importance”?
Unlike Canada, some countries do not have strong public health and health care systems. The World Health Organization (WHO) is concerned about spread of this virus to those countries. By declaring a public health emergency, the WHO has alerted all countries to be prepared for the virus and work together to take action to prevent spread. Canada and Ontario have already been doing this and will continue to do so.

There is no public health emergency in Canada or Ontario.

Where can I get accurate information about the coronavirus?
We have learned of incorrect information posted on social media and the internet. We encourage everyone to get information from reliable sources. Two good websites that are updated regularly are:

Ministry of Health and Long-Term Care
https://www.ontario.ca/page/wuhan-novel-coronavirus-2019-ncov
Government of Canada https://www.canada.ca/en/public-health/services/diseases/coronavirus.html

What is the First Nations and Inuit Health Branch in Ontario doing?
Although the risk is low, we are preparing in case we see more infections in Ontario. By doing this we will be ready to treat people quickly and prevent the spread of infection.
We are communicating regularly with First Nations partners, the Ministry of Health and Long-Term Care of Ontario, the Public Health Agency of Canada, and health units in Ontario so that we have a coordinated approach. We have provided guidance to nurses on how to prepare for a possible patient with coronavirus, and what to do if a patient comes to a nursing station or health centre. This guidance is the same as for any clinic in Ontario.

How can people prevent getting sick with any respiratory virus?
There are things people can do to protect themselves and others:
• wash your hands frequently
• cough or sneeze into your sleeve or a tissue
• if you are sick, stay home until you are well

Maurica Maher, MD, MSc, FRCPC
Regional Public Health Physician
Shari Glenn, NP (PHC)
Director of Primary Care

~~

27 JAN 2020,

Dear Health Director:

We are writing to provide you with current information about the outbreak of respiratory illness in Wuhan, China that is caused by a new coronavirus. As you are probably aware, there are two probable cases in Toronto, in a couple who recently travelled from Wuhan, China. These people are isolated and being monitored. We want to assure you that we are aware of this situation and are following it closely. We are in ongoing contact with the Public Health Agency of Canada and receiving regular updates from them. We have provided up to date information to our nursing stations and health centres, and will continue to do so.

The risk to people in Canada who have not travelled to China is low.

We would like to answer some questions that we have received from First Nations community members.

What is a coronavirus?

Coronaviruses are a large family of viruses that come from animals but can cause respiratory illness in humans. Coronavirus infections are common and usually mild, for example they can cause the common cold. Symptoms are usually mild to moderate and can include fever, headache, cough, sore throat, and feeling unwell. More uncommonly, coronaviruses can also cause serious illness such as pneumonia, respiratory failure, kidney failure, or even death.

Why is this coronavirus “new”?

After several people in China became sick, all the tests for known viruses, such as influenza, were negative. This new virus had not been identified previously and therefore is ‘new’.

Who is at risk?

At this time it appears that people who have been in China, especially the city of Wuhan, are most at risk of being infected. People who are older (65 years) or who have heart or lung problems appear to be at risk of more severe disease. People in Canada who have not been travelling to China are not considered to be at risk.

How is the virus spread?
This virus, like other respiratory viruses, is probably spread when people sneeze or cough into their hands and transfer virus to surfaces like water taps, door handles, and table tops. When other people touch these surfaces and then their nose or eyes, they become infected with the virus. It is not known if it can be spread through the air or through other ways.

Is there a vaccine?
There is no vaccine for this virus at this time.

How is the virus diagnosed?
If a person has been to China and then become sick, they can be tested for this virus. A health care provider can take a sample from the nose or throat, and then send it to a laboratory for testing.

Is there a treatment?
There is no specific treatment for any coronavirus infection. Very ill people who need to be in hospital receive “supportive care”, which means treating the patient’s symptoms, such as giving fluids and oxygen until the patient’s immune system can remove the virus.

How can people prevent getting sick with this virus?
Like all respiratory infections, there are things that people can do to protect themselves and others. Washing your hands frequently is most important. When coughing or sneezing, do not sneeze or cough into your hands but into your sleeve. If you use a tissue, put it in the garbage after use and wash your hands afterward. If you are sick, stay at home and monitor your condition. There is no evidence that face masks prevent illness and they are not recommended at this time. Anyone with worsening symptoms of a respiratory infection of any kind should contact their health provider.

What is Indigenous Services Canada – Ontario Region doing?
Our communicable disease team has been closely monitoring the situation since learning of the discovery of the new virus and the illnesses in China.
We have provided information to nursing stations and health centres about the virus, and what to do if the providers suspect that someone could have this infection, even though it is not likely at this time. This includes reaching out to our communicable disease team for guidance on assessing patients and possible testing if the person has been to China.
We are receiving updates regularly from the Public Health Agency of Canada, Public Health Ontario, and our provincial public health units.

What is the Public Health Agency of Canada doing?
The Public Health Agency of Canada is in regular contact with the World Health Organization, and is actively assessing any possible risk to Canadians. They provide regular updates to the provinces and to Indigenous Services Canada.

They have also put in place additional measures at large airports in Toronto, Montreal and Vancouver to remind travellers to inform Border Services Officers if they have respiratory symptoms, and have added an extra health screening question when travellers arrive.

Updated information is available at https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html

Our healthcare professionals will continue to monitor this situation and provide updated information as it becomes available. In the meantime we encourage you to share this information with your community and review community preparedness plans as a proactive measure.

Sincerely,
Maurica Maher, MD, MSc, FRCPC Shari Glenn, NP (PHC)
Regional Public Health Physician Director of Primary Care

~~~

To:All Ontario Region Nursing Stations, Health Centres, and Health Centres with Treatment
From: Maurica Maher, MD MSc, FRCPC Shari Glenn, NP (PHC)
Regional Public Health Physician Director of Primary Health Care
First Nations and Inuit Health Branch: Ontario Region, ISC

23 JAN 2020
Regarding Novel Coronavirus Infection
Purpose: To provide currently available information about a newly-identified coronavirus in China.

On December 31, 2019, the Wuhan Municipal Health Commission in Hubei province, Central China, issued a public statement that they had identified an outbreak of pneumonia of unknown cause. China has made a determination that a novel coronavirus (referred to as 2019-nCoV) is responsible for cases of pneumonia in the Wuhan outbreak. The Public Health Agency of Canada is actively monitoring the situation regarding a novel coronavirus (2019-nCoV) identified in patients with pneumonia in Wuhan, China, as well as imported cases in other countries. The Public Health Agency of Canada (PHAC) is in close contact with the World Health Organization to assess the situation and any potential risk to Canadians. At this time there is no clear evidence that this virus is spread easily from person-to-person, although person-to-person transmission has occurred.

The Public Health Agency of Canada is putting in place measures to enhance identification of possibly infected people over the coming week. These include messaging on arrival screens at Toronto, Montreal and Vancouver international airports reminding travellers to inform a Border Services Officer if they are experiencing flu-like symptoms, and an additional health screening question will be added to electronic kiosks.

The overall risk of disease spread to Canada and First Nations communities is considered low at this time, and there have been no cases in Canada.
This is an evolving situation and updates will be provided as more information is learned about the illness. Public Health Ontario and PHAC are updating information regularly.

What are the symptoms of a coronavirus infection?
Coronaviruses are a large family of viruses that originate in animals but are known to cause respiratory illness in humans, particularly during the fall and winter months. Other novel coronaviruses have included Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS-CoV).
Coronavirus infections are common and typically lead to the common cold. Gastrointestinal disease is possible for young infants. Coronavirus symptoms are usually mild to moderate and can include:
• Headache
• Cough
• Sore throat
• Fever
• Feeling generally unwell
Although rare, coronavirus can also cause serious illness such as pneumonia, respiratory failure, kidney failure, or even death.

Role of the CHN:
• Clients presenting with (a) fever and acute respiratory illness or pneumonia AND (b) travel to Wuhan, China, within 14 days prior to onset of symptoms should be clinically assessed and reported to the CD nurse immediately.
• After hours, the CHN should contact the EPHO on call (1-855-407-2676) to access the medical officer on call.
• Symptomatic clients who had contact with individuals meeting the above criteria should also be assessed.
• Clinicians should continue routine infection prevention and control practices, and apply additional respiratory precautions, based on risk assessment when caring for clients.
• Clinicians should encourage all clients to practice good hand hygiene and other practices such as staying home when ill to prevent the spread of respiratory infections. Influenza is still circulating in Ontario and Canada.

Resources:
Novel Coronavirus (2019-nCoV). Public Health Ontario. https://www.publichealthontario.ca/en/diseases-and-conditions/infectious-diseases/respiratory-diseases/novel-coronavirus
Novel Coronavirus (2019-nCoV) Testing. Public Health Ontario.
https://www.publichealthontario.ca/en/laboratory-services/test-information-index/wuhan-novel-coronavirus
Public Health Agency of Canada Novel Coronavirus Update: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html
Public Health Agency of Canada Novel Coronavirus Symptoms
https://www.canada.ca/en/public-health/services/diseases/coronavirus.html