On September 14, 2021, Ontario published an updated version of its COVID-19 Fully Immunized and Previously Positive Individuals: Case, Contact and Outbreak Management Interim Guidance (the “Guidance”). This latest version of the Guidance sets out updated recommendations for case, contact, and outbreak management of Ontarians who are fully immunized and/or have previously tested positive for COVID-19.
Under the Guidance, a “fully immunized individual” is defined as someone who has received:
- One of the following:
- The full series of a COVID-19 vaccine authorized by Health Canada, or any combination of such vaccines,
- One or two doses of a COVID-19 vaccine not authorized by Health Canada, followed by one dose of a COVID-19 mRNA vaccine authorized by Health Canada, or
- Three doses of a COVID-19 vaccine not authorized by Health Canada; and
- They received their final dose of the COVID-19 vaccine at least 14 days ago.
The Guidance also defines a “previously positive individual” as a person who was a confirmed case of COVID-19 where their initial positive result was received less than 90 days ago, and they have been cleared from their initial infection.
We have set out a summary of the recommendations applicable to various groups of fully immunized and previously positive individuals.
Symptomatic Individuals
Fully immunized or previously positive individuals who are symptomatic should self-isolate for ten days and be tested for COVID-19 as soon as possible, in accordance with the Management of Cases and Contacts of COVID-19 in Ontario Guidance (the “Management Guidance”). Upon receiving a negative test and depending on their symptoms, they may be cleared from isolation within 24 to 48 hours. If an individual declines testing, they should isolate for ten days.
Individuals who Test Positive for COVID-19
Fully Immunized Individuals
Fully immunized individuals who test positive and are asymptomatic should self-isolate, be re=tested as soon as possible and case managed as a “low pre-test probability” positive, in accordance with section 4.6 of the Management Guidance. These individuals must continue to isolate pending results from the repeat test.
Fully immunized individuals who test positive and are symptomatic should self-isolate and be case managed in accordance with the Management Guidance.
Previously Positive Individuals
Previously positive individuals who test positive for COVID-19 after receiving clearance from self-isolation should isolate again, be re-tested as soon possible, and managed in accordance with section 4.10 of the Management Guidance to determine whether the positive result represents an ongoing positive from initial infection or a re-infection. These individuals must continue to isolate pending results from the repeat test.
Individuals with High-Risk Exposures to Cases of COVID-19
Residents of High-Risk Congregate Living Settings or Inpatients
Fully immunized or previously positive individuals who have had a high-risk exposure and are residents of long-term care/retirement homes, inpatients, or have increased risk of secondary transmission are encouraged to self-isolate and get tested as soon as possible, even if they remain asymptomatic.
Health Care Workers
Fully immunized or previously positive individuals who have had a high-risk exposure and are health care workers are not required to self-isolate, but should get tested as soon as possible, maintain masking and physical distancing outside of the home, and self-monitor for symptoms for ten days from their last exposure. If they develop symptoms of COVID-19, they must self-isolate and get tested immediately.
They are also encouraged to report their exposure to their employer or workplace occupational health department and follow any restrictions and requirements provided.
All Other Symptomatic Individuals
All other fully immunized or previously positive individuals who have had a high-risk exposure and are symptomatic should get tested as soon as possible and must self-isolate pending test results. Upon receiving a negative result and depending on their symptoms, they may be cleared from isolation within 24 to 48 hours. If an individual declines testing, they should isolate for ten days.
All Other Asymptomatic Individuals
All other fully immunized or previously positive individuals who have had a high-risk exposure and are asymptomatic are generally not required to self-isolate, but should get tested as soon as possible, maintain masking and physical distancing outside of the home, and self-monitor for symptoms for ten days from their last exposure. They are generally not required to self-isolate while awaiting test results. If they develop symptoms of COVID-19, they must self-isolate and get tested immediately.
However, the local public health unit may exercise its discretion to direct an asymptomatic individual to self-isolate. For example, self-isolation may be required of an individual in the event that the local public health unit finds that they were exposed to a known or suspected COVID-19 variant.
Individuals Who Are Part of an Outbreak of COVID-19
In an outbreak setting, testing may exclude fully immunized and previously positive individuals. However, these individuals should be included in testing in certain circumstances, such as if a high-risk exposure is determined or cannot be ruled out, ongoing/uncontrolled transmission is occurring, if the outbreak is occurring in a particularly vulnerable population.
In settings with “cohort-based dismissals” of potentially exposed individuals, such as schools, childcare settings, camps, and some workplaces, cohorts should continue to be dismissed. Return of partial cohorts is permitted at the discretion of the public health unit. Fully immunized and previously positive individuals may be allowed to return to the setting while the outbreak is ongoing if all infection prevention and control measures as required for outbreak management are maintained. Unless otherwise advised by the public health unit, household members of dismissed cohorts (for example, parents, siblings, roommates, and other individuals who live with the symptomatic individual) are not expected to stay at home during the period of the dismissal.
Takeaways for Employers
The Guidance provides employers with an understanding of how to manage fully vaccinated or previously positive employees in the workplace who may have been exposed to COVID-19 or tested positive for COVID-19.
Notably, different self-isolation and testing requirements apply to unvaccinated individuals in comparison to fully vaccinated or previously positive individuals. For example, the COVID-19 Quick Reference Public Health Guidance on Testing and Clearance provides that if an individual is a high risk contact and they are not fully immunized or previously positive, they must isolate for ten days from their last exposure to a positive case regardless of whether or not they obtain a negative test result, and must remain asymptomatic after ten days to be cleared from isolation. Employers should be aware of these different requirements to ensure proper management of potential risks of exposure to COVID-19 in the workplace.
This blog is provided as an information service and summary of workplace legal issues.
This information is not intended as legal advice.