DHW SURVEILLANCE GUIDELINES FOR NOVEL CORONAVIRUS DISEASE .
DHW SURVEILLANCE GUIDELINES FOR NOVEL CORONAVIRUS DISEASE (COVID-19)Table of Contents:Page 1.Page 2.Instructions to complete the NS Novel Coronavirus (COVID-19) Provincial Case Report FormInstructions to enter COVID-19 investigations in PanoramaSection 1. Instructions to create Panorama investigation based on disease classificationA)Case-Person Under InvestigationB)Case-SuspectC)Case-Probable (PROVINCIAL)D)Case-Probable (NATIONAL)E)Case-Confirmed (NATIONAL)F)Contact-Person Under InvestigationSection 2. Guidance on data entry from NS Novel Coronavirus (COVID-19) Provincial Case Report FormPage 9.Page 10.Page 10.Page 10.Page 10.Page 11.Instructions for expanded COVID-19 testing through Nova Scotia Medical Examiner Service (NSMES)Appendix A. Link to National COVID-19 Case DefinitionsAppendix B. Provincial-Probable COVID-19 Case DefinitionAppendix C. Link to National Resolved COVID-19 Case DefinitionAppendix D. Link to National Deceased COVID-19 Case DefinitionAppendix E. Surveillance guidance for Out of Province COVID-19 CasesGeneral Instructions: Using the NS Novel Coronavirus (COVID-19) Provincial Case Report Form,obtain all information from the individual. Create an investigation in Panorama and enter all information from theform into Panorama.Case Report Form: NS Coronavirus Disease (COVID-19) Case Report FormUse the NS Coronavirus Disease (COVID-19) Case Report Form to obtain information from theindividual. This form aligns to fields in Nova Scotia’s public health information system, Panorama. Allfields in the case report form should be completed electronically in Panorama. As new informationbecomes available, ensure Panorama is updated.1March 15, 2021
Data Entry of COVID-19 investigations in Panorama:Overview of case definition* flow for COVID-19 investigations in Panorama:*Please see surveillance case definitions in Appendix A.Case- NationalConfirmedCase- NationalProbableContact - PersonUnder InvestigationCase-Person UnderInvestigationCase- ProvincialProbableCaseNationalSuspectInstructions for entry into Panorama: Create a Panorama investigation as shown below insection 1: A-F. Once investigation has been created, proceed to section 2 to enter therequired fields from the NS Coronavirus Disease (COVID-19) Case Report Form in Panorama.DHW will only be reporting on NATIONAL CONFIRMED and NATIONALPROBABLE COVID-19 cases. Ensure that case definitions are met.2March 15, 2021
SECTION 1:A) Persons under investigation for COVID-19For individuals under investigation for COVID-19 by Public Health, create a new investigation for the client inPanorama as follows:Search Client and select “Subject Summary” on left hand navigation. Under Communicable Disease EncounterInvestigation Group, click “Create investigation”, and enter as follows:Field in mInformation SourcePriorityDispositionResponsible Organization/ InvestigatorReporting NotificationData Entry InstructionSelect “Unusual and Emerging Disease” from the dropdown listSelect “National” from the dropdown listSelect “Case- Person Under Investigation” from the dropdown listSelect “COVID-19” from the dropdown listLeave blankLeave blankSelect “Investigation in Progress”Follow routine business practice for entryFollow routine business practice for entryB) Suspect Case for COVID-19 (meeting a National Suspect case definition for COVID-19)For individuals who have met a national suspect case definition for COVID-19 (see Appendix A), create a newinvestigation for the client in Panorama as follows:Search Client and select “Subject Summary” on left hand navigation. Under Communicable Disease EncounterInvestigation Group, click “Create investigation”, and enter as follows:Field in mInformation SourcePriorityDispositionResponsible Organization/InvestigatorReporting NotificationData Entry InstructionSelect “Unusual and Emerging Disease” from the dropdown listSelect “National” from the dropdown listSelect “Case- Suspect” from the dropdown listSelect “COVID-19” from the dropdown listLeave blankLeave blankSelect “Investigation in Progress”Follow routine business practice for entryFollow routine business practice for entry3March 15, 2021
C) Provincial Probable Case for COVID-19 (Meeting NS Provincial Probable case definition forCOVID-19)For individuals who have met a provincial probable case definition for COVID-19 (see Appendix B), update theinformation previously recorded in A) to reflect the updated classification as a “Provincial-Case-Probable” inPanorama as described below. If the case was never entered previously as a “Case-PUI”, then enter theinvestigation as described in A), above) with an authority of “Provincial” and classification as “Case-Probable”.Search client in Panorama and select “Subject Summary” on left hand navigation. If they already have an“Unusual/Emerging Disease” investigation, select the investigation ID to put the investigation in context.With investigation in context, on left hand navigation, select “Investigation Details” “Disease Summary”. OnDisease Summary page, click “Update” on bottom right corner.Update the following fields:Field in PanoramaData Entry InstructionClick radio button on investigation classification table and click updateAuthoritySelect “Provincial” from the dropdown listClassificationSelect “Case-Probable” from the dropdown listClassification DateDate of ClassificationClick “Apply Update” and the “Save” at bottom or top of the pageWhen/if further lab results are received for a Provincial-Probable case of COVID-19 and the lab result ispositive, update case classification as required. If lab result is negative, discuss further public health actionswith MOH. Requirement to continue public health follow-up after inconclusive or negative re-tests will be atthe discretion of the MOH. If no further public health action is required, change the disposition to “CompletedNo Further Action Required” and change the status to “Closed”.D) National Probable Case for COVID-19 (Meeting a National Probable case definition for COVID-19)For individuals who have met a national probable case definition for COVID-19 (see Appendix A), update theinformation previously recorded in A) to reflect the updated classification as a “National-Case- Probable” inPanorama as described below. If a case was never entered previously as a “Case-PUI”, then enter a newinvestigation (as described in A), above) with an authority of “National” and classification as “Case-Probable”.Search client in Panorama and select “Subject Summary” on left hand navigation. If they already have an“Unusual/Emerging Disease” investigation, select the investigation ID to put the investigation in context.With investigation in context, on left hand nav, select “Investigation Details” - “Disease Summary”. OnDisease summary page, click “Update” on bottom right corner.Update the following fields:4March 15, 2021
Field in PanoramaData Entry InstructionClick radio button on investigation classification table and click updateAuthoritySelect “National” from the dropdown listClassificationSelect “Case- Probable” from the dropdown listClassification DateDate of classificationClick “Apply Update” and the “Save” at bottom or top of pageWhen/if further lab results are received for a National-Probable case of COVID-19, update case classification asrequired. If lab result is negative, change the disposition to “Completed- No Further Action Required” andchange the status to “Closed”. Requirement to continue public health follow-up after inconclusive or negativeretests will be at the discretion of the MOH.E) Confirmed Case for COVID-19 (Meeting a PHAC confirmed case definition for COVID-19)For individuals who have met a confirmed case definition for COVID-19 (see Appendix A), update theinvestigation in A) to reflect the updated status as a “Case- Confirmed” in Panorama.Search client in Panorama and select “Subject Summary” on left hand navigation. If they already have an“Unusual/Emerging Disease” investigation, select the investigation ID to put the investigation in context.With investigation in context, on left hand nav, select “Investigation Details” - “Disease Summary”. OnDisease summary page, click “Update” on bottom right corner.Update the following fields:Field in PanoramaData Entry InstructionClick radio button on investigation classification table and click updateAuthoritySelect “National” from the dropdown listClassificationSelect “Case- Confirmed” from the dropdown listClassification DateDate of classificationClick “Apply Update” and the “Save” at bottom or top of page5March 15, 2021
Lab Report Entry (If Entering Manually)With investigation in context, on left hand nav, select “Lab”, select “Lab Quick Entry”. Enter manual lab reportusing standard business procedure.Update the following fields:Field in PanoramaTest NameResult NameResult StatusInterpreted ResultDiseaseMicroorganismData Entry InstructionType “NAAT” and select itSelect “Presence or identity” from the dropdownSelect status from the dropdownSelect result from the dropdownSelect “Unusual and Emerging Disease” from the dropdown listSelect “COVID-19” from the dropdown listClick “Save” at bottom of pageF) Contact- Person under investigation for COVID-19For individuals that are reported as contacts, create a new investigation for the contact in Panorama asfollows:Search client and select “Subject Summary” on left hand navigation. Under Communicable Disease EncounterInvestigation Group, click “Create investigation”. Alternatively, investigations for contacts can be created fromthe exposures screen. Create investigation as follows:NB. For contacts, ensure exposure (eg. Acquisition event) is recordedField in mCommentPriorityDispositionResponsible Organization/InvestigatorReporting NotificationData Entry InstructionSelect “Unusual and Emerging Disease” from the dropdown listSelect “National” from the dropdown listSelect “Contact-Person Under Investigation” from the dropdownlistSelect “COVID-19” from the dropdown listLeave BlankLeave blankSelect “Investigation in Progress”Follow routine business practice for entryFollow routine business practice for entry6March 15, 2021
SECTION 2:Once the investigation for COVID-19 has been created, enter the all fields from the NS Novel Coronavirus Disease(COVID-19) Case Report Form into Panorama as outlined below:Page onNS COVID19 Form111-2Section onCOVID-19 FormPanorama Data Entry LocationCommentsCase informationLeft hand nav investigation details Investigation InformationEnsure the address “address at time ofinvestigation” includes a postal code.Surveillance CaseClassificationLeft hand nav investigation details DiseaseSummarySelect appropriate "classification" from dropdownand update as investigation progresses.Case DetailsLeft hand nav Subject Client Details Immigration Information Client Demographics Ethnicity Indigenous InformationLeft hand nav Signs & Symptoms EnterResponseLeft hand nav Subject Summary SelectInvestigation InvestigationDetails Investigation Information SensitiveEnvironment/Occupation Select fromdropdownLeft hand nav Risk Factor Enter ingconditions andrisk factors6Outbreak/cluster linkLeft hand nav Exposure summary6Clinical courseand outcomesLeft hand nav Outcomes Select from dropdown Add SaveEnsure to “Set Onset” for earliest symptom. Addsymptoms beyond the presets as needed.If this specific risk factor is already pertinent toanother investigation(s), please "add" the risk factoragain and make pertinent to the COVID-19investigation. Do not update the existing risk factor,as this will update the risk factor for the otherinvestigation(s).Add risk factors beyond the presets as needed.Link to an outbreak or cluster as needed.Add new outcomes as investigation progresses.Ensure dates reflect the date client's outcomechanged. A case should have multiple outcomesadded as the investigation progresses; please enterALL outcomes that apply as they occur.7March 15, 2021
Page onNS COVID19 Form7-8Section onCOVID-19 FormExposures andTransmissionsPanorama Data Entry LocationLeft hand nav Exposure Summary CreateAcquisition Event CommentsCreate as many Acquisition Events as required.Create as many Transmission Events as required.Left hand nav Exposure Summary CreateTransmission Event 8March 15, 2021
Instructions for expanded COVID-19 testing through NSMESAs part of the Office of the Chief Medical Officer of Health (OCMOH) response to the COVID-19 outbreak,expanded testing for the COVID-19 virus is occurring in partnership with the Nova Scotia Medical ExaminerService (NSMES). Autopsies conducted by NSMES for fatality investigations will be tested for COVID-19,whether COVID-19 is suspected in determining cause and manner of death or not. During the NSMES deathinvestigation, next of kin will be notified by NSMES that this expanded testing is occurring, at the direction ofOCMOH. Lab results generated through this expanded testing will be communicated to NSHA Public Healthfrom the provincial lab through existing mechanisms. Lab results for COVID-19 generated from testing byNSMES contain ME Case Numbers rather than identifiers. Public Health will be required to contact NSMES (oncall investigator: 902-424-2722) to decode any positive results. Negative results generated through expanded testing by NSMES will not be actioned by Public Health.Positive results generated through expanded testing by NSMES will be actioned within the regularmandate and scope of public health notifiable disease follow up (requires decoding of the result withNSMES). For a positive test that directly relates to cause and manner of death, NSMES would revisethe Medical Certificate of Death, if already completed. NSMES would not contact the family with thisresult as this will be part of the NSHA Public Health COVID-19 investigation.Indeterminant results generated through expanded testing by NSMES will not be actioned by PublicHealth. However, indeterminant results related to death investigations where there is a high suspicionof COVID-19 as part of determining cause and manner of death would be actioned through existingprocesses (communication between NSMES, Public Health, and the provincial lab).9March 15, 2021
Appendix A. Link to National COVID-19 Case #natAppendix B. Provincial Probable COVID-19 Case DefinitionProvincial – Case Probable: A person with an indeterminate or negative lab result, who does not meet therequirements of the National Probable Case Definition, but as directed by the MOH, requires PH follow-up.Appendix C. Link to National Resolved Case resNotes on how to assess recoveries when NSH PH is not following the case: If Public Health follow-up has been completed in another Province/Territory, NSH Public Health shouldcontact the case 10 days after symptom onset, or specimen collection for asymptomatic cases, todetermine if they meet the above definition of “Resolved”.If a case is lost to follow-up by Public Health, the outcome in Panorama should be changed to“Recovered” if at least 10 days have passed since either case’s onset of first symptom or, forasymptomatic cases, date swab was taken.Appendix D. Link to National Deceased Case #dec10March 15, 2021
Appendix E. Surveillance Guidance for Out of Province COVID-19 CasesTable 1. Surveillance Guidance for out of province COVID-19 cases**Note: These examples may not cover every unique situation. When in doubt, please emailsurveillanceDHW@novascotia.ca for clarification. For standard notifiable disease case counting rules, urveillanceguidelines/Case Counting for Surveillance.pdfWhere is the individualScenarioPanorama Entrycurrently located? Wherewere they tested?Case is a NS residentwho is a RotationalWorker workingoutside of NSCase is a NS residentwho is a RotationalWorker workingoutside of NSCase is a NS residentwho is a RotationalWorker workingoutside of NSCase is a resident ofXX province (not NS)and is visiting NS orworking in NSCase is a resident ofXX province (not NS),but still has an NSHCN-Located in NovaScotia.-Tested in Nova Scotia. Classification: National- Case Confirmed Full PH follow-up completed in NS.-Located in XX Province(not NS).-Tested in XX Province(not NS)- NS receivesthe referral/lab resultfrom XX province-Located in NovaScotia.-Tested in XX Province(not NS)- NS receivesthe referral/lab resultfrom XX province-Located in NovaScotia.-Tested in Nova Scotia. -Located in XX Province(not NS).-Tested in XX Province(not NS)- NS receivesthe referral/lab resultfrom XX provinceClassification: National- Case ConfirmedStatus Open/closed. NS to call after 10 days to confirm recovery.Disposition: follow-up completed outside of PH.Risk factors are answered with “unknown” Classification: National- Case Confirmed Full PH follow-up completed in NS. Classification: National- Case ConfirmedStatus: OpenDisposition: Out of Province Referral (Set disposition to OOPreferral at the start of the investigation and do NOT change thisdisposition even when investigation is complete; this willensure individual is not counted as an NS case)Full PH follow-up completed in NS.Send information on OOP case to DHW surveillance for referral tothe individual’s province of residence. Classification: National- Case Confirmed Status: Closed Disposition: Out of Province Referral (Set disposition to OOPreferral at the start of the investigation and do NOT change thisdisposition even when investigation is complete; this willensure individual is not counted as an NS case)No further PH follow-up completed in NS.Send information on OOP case to DHW surveillance for referral backto the individual’s current province of residence.11March 15, 2021
Case is a universitystudent who is livingin NS to attendschool (could havean OOP health card)-Located in NovaScotia.-Tested in Nova Scotia. Classification: National- Case ConfirmedFull PH follow-up completed in NS.12March 15, 2021
Case Report Form: NS Coronavirus Disease (COVID-19) Case Report Form Use the NS Coronavirus Disease (COVID-19) Case Report Form to obtain information from the individual. This form aligns to fields in Nova Scotia’s public health information system, Panorama. All fields in the case report form should be completed electronically in Panorama.
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