Updated Respiratory Virus Guidance

18 October 2023

MEMO -Monika Warren, COO, Provincial Coordinated Health Services and CNO, Shared Health

With the arrival of fall, and the movement of many social and educational activities indoors, respiratory virus circulation is once again increasing in our communities and amongst health-care teams and the populations we care for.

Manitoba’s guidance related to respiratory viruses continues to be informed by evidence and leading practice. Clinical leaders have completed a jurisdictional scan and made a number of recommendations intended to reduce the spread and impact of respiratory illness on our most vulnerable patients, residents and clients.

For many of us, dealing with a seasonal respiratory illness is an inconvenience. It may cause us to miss work, school, and/or social activities. But for populations at higher risk of severe illness, such as young children, older adults, and people with chronic health conditions, the effects of any respiratory virus can be severe, causing serious illness, hospitalization and even death.

Manitoba, like other jurisdictions across the country, has begun to plan for a return of some enhanced protections, including the use of medical masks by health-care workers during interactions with patients, residents and clients. This additional masking precaution will allow for a simpler return to work process in that health-care workers may return to work when they are feeling well, without consideration of the number of days they have been off.

These precautions treat all respiratory viruses similarly, in recognition of the severe effects that influenza, COVID-19 and other seasonal respiratory illness can have on vulnerable populations. Thank you for your understanding as we implement these changes in advance of the fall respiratory illness season.

Please take some time to review updated practice guidance.

All changes will take effect October 18, 2023.

For Health-Care Workers

A return of universal masking during direct care
Effective October 18, 2023, health-care workers will be required to wear a medical grade mask while interacting with patients, long-term care residents and clients. This applies to all health-care workers in all settings (acute, long-term care and community).

Masks are not required in common areas such as elevators, cafeterias, hallways, or nursing stations as well as any area where direct care is not provided.
Where routine practices and additional precautions require additional personal protective equipment, staff are to follow existing guidance including point of care risk assessment. Medical masks and N95 respirators remain available to you and point of care risk assessments continue to be a valuable tool in assessing the presence of risk.

Return to work
With the return of universal masking, an additional preventative measure will soon be in place to minimize the risk of transmission from staff to patient/resident/client. This allows for a change in Return-to-Work Guidance while minimizing the risk to vulnerable populations.

Effective October 18, 2023, health-care workers who have been away from work due to a respiratory illness will be able to return as soon as they are feeling well (fit for work) and afebrile (without fever without the aid of fever-reducing medication).
There is no requirement for staff to test for COVID-19 unless indicated by public health guidance (for immunocompromised individuals where a positive test may alter their course of treatment).

Isolation
Isolation protocols have also been updated.
For confirmed COVID-19 positive:
• For patients and residents who are not immunocompromised, the isolation period (droplet/contact precautions) has been reduced to a period of seven days, which must end with a minimum 24-hour period of being asymptomatic.
• For patients and residents who are immunocompromised, the isolation period remains 10 days, and must end with a minimum 24-hour period of being asymptomatic.

For close contacts of a confirmed COVID-19 positive individual:
• For long term care residents, asymptomatic contacts still do not require isolation but must be monitored for symptoms. Symptomatic contacts will continue to be isolated.
• Within acute care settings, patients who are close contacts will continue to be isolated and time period has changed from 10 days to seven days from last contact to a COVID-19 case.

Aerosol-Generating Medical Procedures
Aerosol-Generating Medical Procedures (AGMPs) carry an increased risk of transmission/spread of COVID-19. AGMP accommodation and cohorting recommendations are unchanged. Refer to: https://sharedhealthmb.ca/files/aerosol-generating-medical-procedures-AGMPs.pdf.

For Patients/Residents/Clients, Visitors, and Designated Caregivers
Masks Recommended, Not Required in Most Settings
For general visitors, designated care providers and individuals seeking care, masks will be readily available and strongly encouraged, but will not be required except in areas where an immunocompromised population is receiving care. Signage will indicate where masks are required.

Symptomatic patients/residents/clients will continue to be asked to wear a mask for the safety of everyone around them (as tolerated).
In areas where Additional Precautions are in place, designated caregivers and general visitors will be able to visit with appropriate PPE.
In areas of outbreak, designated caregivers can continue to visit with appropriate PPE.

Visitor Guidelines
Visitor guidelines are unchanged. Visit: https://sharedhealthmb.ca/files/expanded-visitation-acute-and-pch.pdf
And review this important reminder specific to PCH settings: outbreak-management-pch.pdf (sharedhealthmb.ca).

Quick Links
• Aerosol-Generating Medical Procedures – https://sharedhealthmb.ca/files/aerosol-generating-medical-procedures-AGMPs.pdf
• Point of Care Risk Assessment – https://sharedhealthmb.ca/files/covid-19-point-of-care-risk-assessment-tool.pdf
• Routine Practices and Additional Precautions – Refer to: https://sharedhealthmb.ca/files/routine-practices-protocol.pdf
• ED/UC Screening – https://sharedhealthmb.ca/files/COVID-19-update.pdf
• Infection Prevention & Control Learning Booklet https://sharedhealthmb.ca/files/infection-prevention-and-control-learning-booklet.pdf
• Visitation guidelines for Acute & Long Term Care – https://sharedhealthmb.ca/files/expanded-visitation-acute-and-pch.pdf
• COVID-19 Acute Care Highlights – Provincial – https://sharedhealthmb.ca/files/COVID-19-highlights-provincial.pdf
• COVID-19 Acute Care Highlights – Winnipeg – https://sharedhealthmb.ca/files/COVID-19-highlights-winnipeg.pdf
• COVID-19 Long Term Care Highlights – Provincial – https://sharedhealthmb.ca/files/COVID-19-highlights-provincial-ltc.pdf
• COVID-19 Long Term Care Highlights – Winnipeg – https://sharedhealthmb.ca/files/COVID-19-highlights-winnipeg-ltc.pdf
• COVID-19 Masking Recommended Poster – https://sharedhealthmb.ca/files/covid-19-mask-friendly-poster-bi.pdf
• Visitor Reminders Poster – English – https://sharedhealthmb.ca/files/covid-19-screening-poster-all-eng.pdf
• Visitor Reminders Poster – French – https://sharedhealthmb.ca/files/covid-19-screening-poster-all-fr.pdf