1. Content
  2. When to test for COVID-19?
  3. How testing is done?
  4. COVID-19 Assessment Centre
  5. COVID-19 Care Clinics
  6. Investigations
  7. Vaccinations 
  8. Complications

When to test for COVID-19?

Testing for COVID-19 should be strongly considered for individuals with recent onset of fever, cough, or shortness of breath. While these symptoms are associated with other viral illnesses as well, there is increased likelihood of a COVID-19 infection if the person has traveled in the past 14 days, or had close contact with a suspected or confirmed case of COVID-19. Please see the Government of Canada COVID-19 symptom self assessment tool, and a list of COVID-19 screening sites in Canada on our assessment centers tab. For additional information and support, please contact any of the available helplines listed in the resources tab.

The most common symptoms in patients with COVID-19 include:

  • Fever
  • Dry cough
  • Shortness of breath
  • Loss of smell/taste
  • Fatigue
  • Muscle aches
  • Weight loss
  • Sputum production
  • Sore throat

Additional less common symptoms have been described and listed here

How testing is done?

The purpose of the COVID-19 testing is to detect the viral RNA. Viral RNA is basically a blueprint or a recipe that is unique for the virus. This allows healthcare professionals to determine whether a person has this specific virus or not. Testing for COVID-19 is done by collecting a swab from the inner lining of the nose (where the virus may be located) to look for presence of the infection-causing SARS-CoV-2 virus. Once a swab is collected, it is sent for testing to a laboratory where any virus RNA is extracted from the swab, and detected with a technique known as reverse transcription polymerase chain reaction (RT-PCR).

Steps for COVID-19 Testing: 

  1. Collect a swab from the area at the back of the nose, known as nasopharynx
  2. Send the swab to a laboratory to extract viral RNA 
  3. Viral RNA is detected using a technique known as reverse transcription polymerase chain reaction (RT-PCR)

The following video by the New England Journal of Medicine provides a brief overview of how the nasopharyngeal swab is done:

Test Results: 

Testing at Public Health Ontario testing centres is performed 7 days a week and results may take up to four days. Turnaround time may improve as more hospital-based laboratories are recruited for performing tests. The results of this test will be made available to the requesting healthcare provider, as indicated on the requisition. Due to the public health issues associated with this condition, all the positive test results will be provided to the local public health unit. Currently, all the negative test results will also be provided to the local public health unit.

COVID-19 Assessment Centre

COVID-19 assessment centre is an out-of-hospital clinic where COVID-19 testing occurs and people are assessed by healthcare professionals. Please check your local public health unit website. This website specifically explains who can be tested at the assessment centre, as not everyone can be tested at these centres. 

What happens at a COVID-19 Assessment Centre? 

  • Once you arrive, you will be asked to sanitize your hands and wear a mask at the entrance
  • Your travel and contact history will be taken along with your symptoms
  • A healthcare professional will assess you and COVID-19 testing will be done if required 
  • Testing will include obtaining a swab from the area at the back of the nose 
  • Your healthcare provider and Public Health will follow up with you if you tested positive and further guidance will be provided  

Special Note: People can now access their test results via the online portal launched by the government on April 3, 2020. The portal is located here: https://covid-19.ontario.ca/

COVID-19 Care Clinics

COVID-19 care clinics are out of hospital clinics where patients with worsening symptoms (e.g. fever, cough, cold-like symptoms) can be seen by healthcare professionals and provided with care.

What happens at the COVID-19 Care Clinics? 

  • Wait in line while ensuring physical distancing (at least 2 meters or 6 feet) 
  • Once inside at the entrance, everyone will be asked to sanitize their hands and wear a mask 
  • You will initially be assessed by a nurse and then asked to wait in the waiting area 
  • When it is your turn, a nurse or a doctor will assess your condition and provide appropriate care, which may include treatment or recommendations for treatment at home 
  • Some patients may have to take an x-ray or other diagnostic tests depending on their situation 
  • Complex conditions will require a hospital visit 

Special Notes

  • You are not allowed to bring any visitors with you at the testing centre unless for compassionate reasons in order to minimize the risk of COVID-19 spread 
  • Please bring your health card, list of current medications, and any other items needed while waiting for the assessment
  • Anyone with worsening symptoms such as fever, cough or cold-like symptoms can come to the assessment centre including children 2 years of age or older

Investigations

While the approach to the management of COVID-19 varies across Canada, some possible tests and monitors which may be ordered by a healthcare practitioner for suspected infections include:

  • Blood tests
  • Blood oxygenation monitors
  • Blood and sputum cultures
  • X-ray or CT imaging of the lungs

A lung CT scan image demonstrating “ground-glass” and consolidation findings associated with the COVID-19 infection:


Case courtesy of Dr. Bahman Rasuli, Radiopaedia.org, rID: 74576

Treatment

While there are still no specific treatments available for COVID-19, care of infected patients is focused on supportive care. To prevent the spread of COVID-19, all suspected or confirmed cases will be instructed on infection prevention, and placed into at-home or in-hospital isolation. Medical treatment of patients depends strongly on the severity of illness and presence of risk factors (older age, heart disease, diabetes, high blood pressure, chronic lung disease, chronic kidney disease, and cancer). While the exact treatment varies across healthcare facilities, it includes:

  • Hospital admission
  • Close monitoring
  • Supportive care
    • Medications to reduce fever and coughing
    • Antimicrobials to prevent additional infections
    • Oxygen or lung ventilation machines
  • Ongoing trials demonstrate some benefit from the use of anti-viral agents (protease inhibitors, ritonavir, and lopinavir)

Vaccinations 

England: Testing of Potential Vaccine by University of Oxford and Jenner Institute 

The University of Oxford in England and Jenner Institute have developed a potential candidate for COVID-19 called ChAdOx1 nCoV-19. Human trials have already begun and will involve administering the potential vaccine to 510 healthy volunteers between the ages of 18 and 55 years. Rapid production of this vaccine has already begun in case the clinical trials are successful in order to conduct larger trials and for possible deployment in the future.   

This vaccine consists of a chimpanzee adenovirus vaccine vector which was developed at Oxford’s Jenner Institute. It is not a replicating virus which ensures that it cannot cause ongoing infection. The chimpanzee adenovirus vector was also chosen due to its safety profile as it has been well studied for different diseases. This adenovirus vector produces spike proteins which are found on the surface of COVID-19. These spike proteins will cause the body to produce antibodies against it. This will ensure protection from COVID-19 because if infected, the antibodies will attach the spike proteins on COVID-19. 

U.S: Moderna Inc. began Human Trials in March 

The testing of a potential vaccine called mRNA – 1273 is being conducted at the Kaiser Permanente Washington Health Research Institute in Seattle. This trial involves giving two shots of the potential vaccine, 28 days apart, to 45 healthy volunteers between the ages of 18 and 55. 

mRNA – 1273 is basically a messenger molecule that will cause the body’s cells to express proteins which will stimulate the body to produce antibodies against it. Having these antibodies will allow people to have immunity against COVID-19. 

BioNTech and Pfizer to begin clinical trial of a potential vaccine later this month 

A German biotech company BioNTech and U.S. pharmaceutical giant Pfizer have developed a few mRNA based potential vaccine candidates for COVID-19 under the BNT162 Vaccine Program. The clinical trial is planned to begin later this month and will involve testing on 200 German volunteers between the ages of 18 and 55 years. The second stage of this trial will involve testing on people with high risk for COVID-19. 

China: 2 Clinical Trials for COVID-19 Vaccine 

China gave approval for the first human trial for a potential vaccine candidate developed by the military-backed Academy of Military Medical Sciences and CanSino Biologics. Another trial is being conducted by Beijing-based Sinovac Biotech and the Wuhan Institute of Biological Products.

Complications

Analysis of 44,500 COVID-19 patients conducted by the Chinese Centre for Disease Control and Prevention revealed that 81% of infected patients had absent or mild pneumonia. Severe disease (shortness of breath, decreased blood oxygen, or involvement of >50% of the lung) was observed in 14% of patients, while critical disease (respiratory failure, shock, or multi-organ dysfunction) was observed in the remaining 5% of patients. Reported complications include:

  • Acute respiratory distress syndrome (widespread inflammation of the lungs leading to respiratory difficulties and possible long-term changes to the lungs affecting their function)
  • Acute cardiac injury
  • Secondary infections
  • Sepsis (medical emergency resulting from over-activation of the immune system in response to an infection)
  • Acute kidney injury
  • Multi-organ failure

 The information on this page has been compiled with sources from: