Policy responses for Canada - HSRM


Policy responses for Canada

3.2 Managing cases

The Government of Canada instructs those who become symptomatic to visit a health care professional or connect with their local (e.g., regional or municipal) public health authority (PHAC, 2020l). In either case, individuals are advised to call ahead to receive instruction for next steps (PHAC, 2020l). The triage of Person Under Investigation (PUIs) is determined by local public health authorities (PHAC, 2020h). Clinical management of cases/PUIs is guided by the treating health care provider based on the patient’s condition and the provider’s discretion (PHAC, 2020h). The Government of Canada does not provide recommendations on specific clinical treatment protocols/pathways (PHAC, 2020i) but has published a guidance document for infection prevention and control for COVID-19 in acute health care settings (PHAC, 2020i). PHAC has released interim guidance on the clinical management of patients with moderate to severe COVID-19 illness (last updated April 9, 2020) (PHAC, 2020i). It is not meant to replace clinical judgement or specialist consultation, but instead strengthen the management of patients with evidence-informed guidelines. It also provides best practices for triage and supportive care (PHAC, 2020i).

Neither the Government of Canada nor the PTs advocate for the use of any treatment not licensed by Health Canada (Canada, 2020n). Health Canada has communicated that new health products related to COVID-19 must first be shown to be safe and effective before they are used routinely (ibid). To date, the use of convalescent plasma and proposed drugs, such as hydroxychloroquine and chloroquine, have not been recommended for use in Canada (Health Canada, 2020g). Notably, on April 25, 2020, Health Canada published a recall and safety alert on the use of chloroquine and hydroxychloroquine, citing concern that Canadians may be purchasing it for independent treatment of COVID-19 (Health Canada, 2020d). The safety alert stressed the importance of only using these drugs under the direction of a physician (ibid). On July 28, 2020, it was announced that Health Canada approved the use of Remdesivir, produced by Gilead Sciences Canada, for the treatment of COVID-19 patients with severe symptoms of pneumonia and who require supplemental oxygen (Health Canada, 2020l). On September 15 2020, Health Canada approved the temporary importation of Remdesivir, which can treat adults and adolescents with pneumonia due to COVID-19 (Health Canada, 2020b). This would quicken access to the drug for Canadians, who otherwise would be waiting for the Canadian-labelled, VEKLURY (ibid).

In response to the increased rate of COVID-19 cases and deaths in long-term care facilities across the country, the Government of Canada published a guidance document specific to long-term care homes (last updated April 8, 2020) (PHAC, 2020q). It details important measures to prevent introduction and spread of COVID-19 in long-term care homes, including restricting visitors to those deemed essential and training staff and volunteers on use of personal protective equipment and droplet/contact precautions and case management (PHAC, 2020q). A number of other guidance documents have also been created for health care professionals on infection prevention and control within acute care, long-term care, and home care settings (PHAC, 2020w).

Many PTs have created clinical decision-making tools to facilitate coordination among long-term care and acute care facilities. For instance, the British Columbia Centre for Disease Control (BCCDC) published an algorithm to be used when a long-term resident tests positive for COVID-19 (BCCDC, 2020). It details who should be notified or consulted with and which onsite supportive measures should be provided, such as fluids, respiratory support, and symptomatic relief (BCCDC, 2020).

On April 21, PHAC announced that it had launched a study with the Canadian Pediatric Society to investigate the impact of COVID-19 on children, another vulnerable group for which much about the impact of COVID-19 remains unknown (Ferreira, 2020).

Specific PT measures are reported by the North American Observatory on Health Systems and Policies on their dedicated COVID-19 page (https://ihpme.utoronto.ca/research/research-centres-initiatives/nao/covid19/).

See full reference list under ‘Key links and articles: Full list of references’.