May 20, 2020 COVID-19 eForm Update

In accordance with the May 14, 2020 provincial guidelines, "As of May 14, 2020, any Ontarian presenting with at least one symptom or sign from the list below should be considered for testing for COVID-19":

http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/2019_guidance.aspx#case)

The COVID screening algorithm has been updated accordingly:

  • Any major or minor symptom on its own is now considered sufficient for a positive screen and a testing consideration (previously 2 "minor" symptoms were required)
  • Hoarseness and sneezing have been removed as symptoms
  • Changed the testing recommendation text from, "You are probably eligible for COVID-19 testing" to the more informative, "Based on Canadian guidelines, COVID-19 testing should be considered."

May 17, 2020 COVID-19 eForm Update

  • The ER symptoms are now asked up-front, prior to the general symptom screen, which is in alignment with the majority of other screening and assessment tools.
  • Most of the separate yes/no questions have been converted to a checkbox/"none of the above" approach to make it much less tedious for patients to complete each time.
  • With the expansion of testing to all exposed and symptomatic individuals, the algorithm is somewhat simpler. The vulnerable-population and occupational questions are no longer needed for the recommendations, so they have been removed. The outcome for the screening protocol has been simplified to 3 outcomes: ER redirection, positive screen with testing suggested, and a negative screen. The messaging has been updated in accordance with the clinical guidelines for each scenario.
  • The symptom checklist has been updated to incorporate the best wording and elements from the Ontario May 2 guidelines, in addition to the Ontario provincial tool, the covid19Toronto tool, and others.
  • The French translations have been updated for the email screening questionnaire, the triaging tool, and the self-assessment tool. (If any further edits are required for the French translations of these tools, please reach out to info@cognisantmd.com)

May 10, 2020 COVID-19 eForm Update

  • Updated the symptom screening algorithm to reflect the Ontario Ministry of Health COVID-19 Screening Guidance Document (current May 2, 2020) 
    • In particular, the symptom list is now:
      • fever
      • new or worsening cough
      • shortness of breath at rest, or an inability to lie down because of difficulty breathing
      • sore throat
      • hoarse voice
      • difficulty swallowing
      • lost sense of taste or smell
      • chills
      • headaches
      • unexplained fatigue / illness-feeling
      • diarrhea
      • abdominal/stomach pain
      • nausea / vomiting
      • pink eye (conjunctivitis)
      • runny nose/sneezing without other known cause
      • nasal congestion without other known cause
    • The following new questions will also show for patients over age 65:
      - delirium (sudden confusion or unpredictable emotional distress)
      - unexplained or increased number of falls
      - sudden unexplained decline in ability to function with routine daily activities
      - unexplained worsening of chronic illness

Apr 17, 2020 COVID-19 eForm Update

  • Updated the home and occupational risk factors to a new "Workplace and Home Setting" section to account for the latest Ontario testing criteria:
  • Added specific mentions for: caregivers, personal support workers, group homes, nursing homes, rural, remote, isolated or Indigenous community, and other essential service providers
  • Changed the "Workplace and Home Setting" section to use a checkbox and "none of the above" to reduce the number of "no" clicks for typical submissions
  • Changed "immunosuppression" to "a condition or treatment that affects your immune system (e.g. HIV, lupus, other autoimmune disorder)
  • Changed "cardiovascular disease (including heart attack)" to "heart condition / cardiovascular disease"
  • For the self assessment tool and the triaging form, changed the wording for patients when testing is likely indicated. Previously it did not specifically mention that COVID-19 testing may be indicated due to the policy of test rationing. Now with clear guidelines, in accordnace with the Ontario tool, it says: "Please call your healthcare provider or your local telehealth provider. You may be eligible for a COVID-19 test. You should self-isolate in the meantime. Do not leave your home until you are instructed to do so."
  • Improved some of the French translations

Mar 27, 2020 COVID-19 eForm Update

All Tools:

  • Updated the initial symptom screening list to limit the number of "false positive" new symptoms (changed questions are marked with a *). Added sudden complete loss of smell or taste (anosmia / dysgeusia) as an important new presenting symptom.
    • fever
      chills or shakes
      sore throat
      cough
      headache
      new unexplained muscle aches *
      new or worsening fatigue *
      runny nose
      new widespread joint aches *
      nausea
      diarrhea
      abdominal/stomach pain
      shortness of breath at rest, or an inability to lie down because of difficulty breathing
      sudden complete loss of smell or taste *
  • Updated French translations
  • Changed all positive symptom answers to flag in red
  • Changed all positive occupational / risk answers to flag in yellow or red
  • Added a new red stop sign image for emergency department redirects
  • Added pregnancy as a risk factor question

Kiosk Screen

  • Updated and expanded the kiosk and online booking screening questions for consistency with the other tools

Self Assessment Tool

  • Moved the Age question into a separate preliminary page

Mar 24, 2020 COVID-19 eForm Update: Symptom Checker and Triage Form

  • In accordance with other symptom checkers, we have updated the emergency questions to limit the number of patients unnecessarily sent to the ER:
    • Dropped the dizziness question since it is no longer listed in other tools
    • Changed "chest pain" to "severe chest pain"
    • Changed to "severe difficulty breathing (for example, struggling for each breath, speaking in single words)"
  • Updated the French version of the tool with similar translations

Mar 23, 2020 COVID-19 eForm Update: Symptom Checker and Triage Form

  • Updated the tool to reflect the latest guidelines in Toronto as well as the general recommendations in the Alberta, BC and Ontario tools. Please note that there is not a universal consensus in terms of how the questions should be asked or even what the recommendation should be in terms of testing.  However, we have updated the tool to reflect the key recommendations shared across all the tools, while also collecting and documenting a useful history for clinicians.
  • Updated the previous indication for COVID-19 testing (symptoms + (occupational exposure or age/comorbidity) to advise the patient to instead call for advice. The guidelines for this decision aren't yet universally accepted in the country. The current recommendation among the Toronto hospitals is to keep these patients isolated at home rather than sending them in for testing, due to the risk of contracting or spreading the virus.
  • Updated the symptom-but-no-risk message to be clearer regarding the advice against testing: "Since you have symptoms, it is possible that you have the COVID-19 virus. However, testing is currently not recommended due to the risk of exposing yourself or others the virus."
    The guidelines suggest it is better for these patients to self-isolate at home.
  • Changed the lethargy question to: "having a very hard time waking up or feeling confused with decreased consciousness", since many patients do not know what "lethargy" means. (Consistent with the Toronto symptom checker.)
  • Changed the weakness question to say "severe", i.e. "severe weakness that impairs your ability to carry out activities of daily living (such as showering, preparing meals, and dressing)" - to limit false positives sending patients to the ER.

 References: