Some Canadian Health Districts Tightening Exposure & Quarantine Rules Over COVID Variants

Simcoe County, Ontario - Credit Wikipedia

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Ten days ago, in UK Variant (B.1.1.7) Confirmed In Ontario Long-Term Care Facility Outbreak, we looked at an outbreak of COVID-19 at a long term care facility in Barrie, Ontario which - at the time - had infected nearly all (124 of 127) of the residents, and roughly half of the staff (n=84).

Tragically, more than 20% of the residents (n=29) in the home had died.

Since then, things have gotten worse, with reports of another long term care facility in the area affected and two cases in the community.  Worse, local media is reporting the number of deaths from the first LTCF has more than doubled to 61. 

That same news story (Globe & Mail COVID-19 variant in Barrie outbreak upends conventional wisdom of spread), reports that the Simcoe Muskoka District Health Unit has changed their definition of what constitutes a `close contact', and has increased the self-isolation time required for contacts of known cases. 

In the United States, The CDC defines a `Close Contact' as:

For COVID-19, a close contact is anyone who was within 6 feet of an infected person for a total of 15 minutes or more. An infected person can spread COVID-19 starting from 48 hours (or 2 days) before the person has any symptoms or tests positive for COVID-19.

Canada, up until now, has used a similar definition (see Updated: Public health management of cases and contacts associated with COVID-19). 

Because of the perceived increased transmissibility of the B.1.1.7 variant the Simcoe Muskoka District Health Unit has changed that to an unprotected exposure (within 2 meters) of any duration. 

This from a HealthFax sent out to physicians and other health-care related entities on the new rules. 

COVID-19: Update #27UK Variant: Revised Mitigation Strategies for Community-Spread 

Attention: Physicians, Emergency Departments, Infection Control Practitioners, Occupational Health Practitioners, Walk-In Clinics/Urgent Care Clinics, Nurse Practitioners, EMS, Designated Officers, Midwives, Family Health Teams, Pharmacies, Central LHIN, NSM LHIN, Beausoleil First Nation, Moose Deer Point First Nation, Rama First Nation, Wahta First Nation, Long-term Care Homes, Retirement Homes, Hospices 

Date: January 26, 2021 

As of January 26, 2021, at 1500 hrs, eight samples of COVID-19 have been identified to be the UK B.1.1.7 variant in SMDHU. An additional 103 individuals who have had a positive first screening test for a variant of concern have also been identified; most being linked to the Roberta Place outbreak. The second confirmatory test involves whole genomic sequencing.

This variant of concern (VOC) is more easily transmitted, resulting in much larger numbers of cases in a very rapid fashion. Public Health Ontario has provided additional direction regarding the management of variants of concern, therefore, the COVID-19 Variant of Concern (VOC) Strategy has been revised. 

Please note that we expect that this document will have numerous changes as more is known about the epidemiology of VOCs locally and in Ontario. Please reference the link above for the most up to date version. 

Relevant Revisions in Strategy 

Comprehensive & timely case and contact management 

• Lower threshold for assessment of high-risk exposures to VOC/VOC-linked cases including: 
• Any cumulative 15 minutes duration of exposure spent less than 2 metres apart (regardless of non-medical mask use by case and/or contact). See healthcare worker (HCW) exception below. 
• Any duration of exposure spent less than 2 metres apart where case or contact is not wearing a mask. See HCW exception below. o Exception: an exposed HCW with appropriate personal protective equipment (PPE), which at a minimum is a medical mask and eye protection, will be deemed a lower-risk contact unless breaches with use noted. 

• All high risk and household contacts (regardless of level of exposure) of confirmed/probable cases linked to potential VOCs to be in quarantine within 24 hours of identification: 
• Release from quarantine should not occur until confirmation of a negative result from a specimen collected on/after day 12. Where contacts are unable to complete end of quarantine testing, quarantine should be extended 14 days after the upper estimate of median incubation period (7 days + 14 days = 21 days) to account for an isolation period of potentially unidentified cases. 
•  If high-risk contacts cannot adequately self-isolate within their primary residence, and rehousing is not feasible, the entire household may be placed in quarantine.

• Infection Prevention and Control/Outbreak Measures 
• Essential visitors no longer allowed onsite to an outbreak facility, when VOC is suspected, unless for palliative reasons and then only one visitor at a time:
• If the facility has only one unit in outbreak, and VOC is suspected, essential visitors can be suspended to that one unit (and not entire facility) as long as cohort staffing measures are in place.  
• Given potential community transmission in Barrie and South Simcoe, all LTCH located in these areas who are in a COVID-19 outbreak, (regardless if VOC is suspected), will no longer allow essential visitors onsite unless for palliative reasons and then only one visitor at a time.  
• For health care, LTCH and retirement home settings, avoid use of staff, students or volunteers that are not adequately trained in IPAC measures.

•  Immunization  
• No revisions at this time.

Meanwhile, yesterday Alberta Canada's Chief Medical Officer Dr. Deena Hinshaw announced the detection of 57 variant cases (50 B1.1.1.7, 7 B.1.351)  in the Province, including 8 community cases, and set out new, stricter self-isolation and quarantine rules for Variant Covid cases and their close contacts. 

In her press conference, Dr. Hinshaw stated:

"If cases choose to stay home during their isolation period, their household contacts will now need to stay at home as well in quarantine, until 14 days have passed from the end of the case's isolation period, for a total of 24 days. Given how easily this variant is spreading in homes, this enhancement is necessary to prevent spread in the community."

You can view the full 25 minute press-conference on YouTube. 

While the roll out of vaccines has provided us with a hint of a light at the end of the pandemic tunnel, the emergence of these more transmissible COVID variants threatens to prolong our journey to daylight. 

Whether these  variants will prove as formidable as some have predicted remains unknown, but it is obvious from these actions that public health officials in Canada are treating these new threats with respect. 

Like it or not, we may find that some of the policies that were deemed adequate against the old `wild type' COVID may need adjusting over time.  

COVID-19 continues to adapt to us - its new found host - and if we hope to end this pandemic any time soon, we may need to make some adjustments as well.