What type of exposure to COVID-19 requires self-isolation in Ontario?

Summary

The following is a short summary of the available evidence on what type of exposure to COVID-19 requires self-isolation in Ontario. Four national guidance, two provincial guidance, and one municipal guidance were found to answer this question and were used in this REAL Summary. For additional information about each of the sources, see the Table below.

The Government of Canada states that an individual must quarantine for 14 days if they: 1) are returning from travel outside of Canada, even if they don’t have symptoms; 2) have had close contact with someone who has or is suspected of having COVID-19; or 3) have been told by public health that they may have been exposed and need to quarantine [1,2]. If an individual starts to feel symptoms of COVID-19, the Government of Ontario states in its COVID-19: Stop the spread (January 2021) guidance to: 1) go to an assessment centre; 2) avoid leaving home for other reasons; 3) inform all close contacts (defined as persons being less than two metres away or living in the same household) within the 48 hours prior to the start of symptoms; and 4) monitor symptoms and self-isolate [6]. While waiting for laboratory results, the Eastern Ontario Health Unit advises in their Self-Monitoring, Self-Isolation and Isolation Instructions for COVID-19 guidance that one should remain in self-isolation [7]. An Emergency Order under the Government of Canada Quarantine Act requires any travellers entering Canada to either quarantine for 14 days from the day they enter Canada, even if they do not have symptoms, or isolate if they have symptoms [1,3].

In its Coronavirus disease (COVID-19): Travel restrictions, exemptions and advice (January 2021), the Government of Canada notes that a suitable place to quarantine has the following characteristics : 1) without any people who are 65 years or older, underlying medical conditions or compromised immune systems; 2) is not a group living environment; and 3) has access to necessities such as water, food, medication and heat in the colder months [2]. Public Health Ontario states in its How to Self-Isolate (October 2020) guidance that one should self-isolate for 14 days from the start of symptoms, which means: 1) avoiding going to work, school, public places or public transportation; 2) avoiding visitors unless essential care providers; 3) making sure any shared rooms have good airflow such as open windows and practicing adequate hand hygiene; and 4) wearing a mask over their nose and mouth when leaving the house to see a health care provider or to get tested [5].

In the report by the Government of Canada, COVID Alert: Canada’s COVID-19 exposure notification app (July 2020), exposure is defined as being less than 2 metres apart from someone who is COVID-19 positive for more than 15 minutes over the past 14 days [4]. If an app user meets these criteria for exposure, the app user will be notified and should contact their local public health authority for further instructions [4].

Evidence

What‘s Trending on Social Media and Media

The Government of Canada has released a short video (September 2020) explaining how the COVID Alert app works.

NBC News released an article (August 2020) to create awareness about the risk of being exposed during various activities. Dr Ezekiel Emanuel, a bioethicist, said coronavirus infection risk is related to four factors: whether the activity is indoors or outdoors, crowd size, exposure time, and whether heavy breathing (e.g., shouting, singing, etc.) is involved.

Organizational Scan

Both the Government of Canada and the province of Ontario (February 2021) have created COVID-19 self-assessment tools for anyone who is concerned they were exposed to COVID-19 or have symptoms. Based on the results of the assessment tools, recommendations are provided on what to do next [15,16].

Public Health Ontario released a guide for caregivers, household members and close contacts for someone with COVID-19 (July 2020). Members of the public can contact their local public health unit for any specific instructions about how to monitor an individual’s health and what to do if someone starts to feel sick, this guide suggests washing hands frequently, wear and dispose of PPE properly, limit the number of home visitors, and tips of cleaning home, laundry and household items [17].

Public Health Ontario created a resource about self-isolation for those with COVID-19 symptoms or who may have been exposed to COVID-19 (October 2020). Guidelines include staying home and avoiding contact with others, keeping a distance of at least two metres, and wearing a face covering, washing hands, and covering coughs and sneezes [18].

The Government of Ontario (January 2021) announced that voluntary COVID-19 isolation centres will open in Oshawa and Brampton. In addition, isolation centres serving the City of Toronto will expand. All new and expanded centres are expected to be open by the end of January 2021 [19].

Review of Evidence

Resource	Type/Source of Evidence	Last Updated
How to quarantine at home when you may have been exposed to COVID-19 and have no symptoms — Government of Canada	National Guidance	A person needs to quarantine for 14 days if they: 1) are returning from travel outside of Canada; 2) have had close contact with someone who has or is suspected to have COVID-19; 3) have been told by public health that they may have been exposed and need to quarantine. The Government of Canada has implemented an Emergency Order under the Quarantine Act that requires any person entering Canada to quarantine for 14 days if they do not have symptoms or to isolate for 14 days if they do have symptoms in order to limit the introduction and spread of COVID-19. The 14-day period begins on the day the person enters Canada. Last Updated: October 22, 2020
Coronavirus disease (COVID-19): Travel restrictions, exemptions and advice — Government of Canada	National Guidance	Starting February 3, 2021, air travellers five years of age or older are required to provide proof of a negative COVID-19 molecular test result to the airline prior to boarding international flights bound for Canada, take a COVID-19 test on arrival and must reserve a room in a Government of Canada-approved hotel for three nights awaiting test results. Even if a person does not have COVID-19 symptoms they must still isolate for 14 days when entering Canada. A suitable place to quarantine is one that: 1) does not have any people who are 65 years or older, have underlying medical conditions or compromised immune systems; 2) isn’t a group living environment; and 3) has access to necessities such as water, food, medication and heat in the colder months. Last Updated: January 28, 2021
Quarantine Act — Government of Canada	National Guidance	The purpose of the Quarantine Act is to protect the health of a population by taking comprehensive measures to prevent the introduction and spread of communicable diseases within a population. Last Updated: January 9, 2021
COVID Alert: Canada’s COVID-19 exposure notification app — Government of Canada	National Guidance	This guidance describes the new COVID Alert app, which informs Canadians if they have been exposed to COVID-19. If someone tests positive for COVID-19, any person who has spent more than 15 minutes with them, with less than 2 metres apart and over the last 14 days will be notified that they may have been exposed through the app. If the app sends a notification about a potential exposure, the individual should get in touch with the local public health authority for further instruction. Last Updated: July 30, 2020
How to Self-Isolate — Public Health Ontario	Provincial Guidance	To self-isolate one should: 1) avoid going to work, school, public places or public transportation; 2) avoid visitors unless essential care providers; 3) make sure any shared rooms have good airflow such as open windows; practice adequate hand hygiene; and 4) wear a mask over your nose and mouth when leaving the house to see a health care provider or to get tested. If an individual develops symptoms, it is advised to contact Telehealth (1-866-797-0000) or a health care provider. Anyone with whom an individual had close physical contact with before or after symptoms started should also self-isolate. Last Updated: October 27, 2020
COVID-19: Stop the spread — Government of Ontario	Provincial Guidance	An individual who should start to feel symptoms of COVID-19 should go to an assessment centre to get tested, stay at home unless they are going to the assessment centre, and tell people in close contact with the individual in the 48 hours before symptoms began to monitor symptoms and self-isolate. Close contact in the context of COVID-19 is defined as being less than two metres away from or living in the same household as someone with COVID-19. It is advised to call 911 if someone experiences severe difficulty breathing, severe chest pain, feels confused or unsure of where they are, or loses consciousness. Last Updated: January 28, 2021
Self-Monitoring, Self-Isolation and Isolation Instructions for COVID-19 — EOHU: Eastern Ontario Health Unit	Municipal Guidance	If an individual is waiting for laboratory test results, they should remain in self-isolation. If there are others in the home, the self-isolating individual should: 1) stay in a separate room and use a separate bathroom, if possible; 2) keep as much distance among members of the household; 3) keep interactions brief and wear a mask; 4) clean and disinfect surfaces at least once daily (e.g., toilets, doorknobs, television remotes, phones; and 5) avoid contact with pets if they live with other people that may also be touching them. Last Updated: October 5, 2020
COVID-19 Self-Assessment Tool — Government of Canada	Organizational Scan	Last Updated: October 5, 2020
COVID-19 Self-Assessment — Government of Ontario	Organizational Scan	Last Updated: January 31, 2021
Self-isolation: Guide for caregivers, household members and close contacts — Public Health Ontario	Organizational Scan	Last Updated: July 30, 2020
How to Self-Isolate — Public Health Ontario	Organizational Scan	Last Updated: October 27, 2020
Ontario Opens COVID-19 Isolation Centres in Hardest Hit Communities — Government of Ontario	Organizational Scan	Last Updated: January 20, 2021
Disclaimer: The summaries provided are distillations of reviews that have synthesized many individual studies. As such, summarized information may not always be applicable to every context. Each piece of evidence is hyperlinked to the original source.

1 Related Question

What precautions should people take for indoor visits in Toronto?

On January 14, 2021, the Ontario government implemented a province-wide shutdown [20]. The Stay-At-Home order (January 2021) permitted people to go out only for necessities and required that people wear a mask in indoor public spaces and when physical distancing is a challenge [20]. In Toronto, the following events and gatherings are permitted (as of March 18th, 2021) while in the Grey zone: outdoor gatherings with 10 people or less with physical distancing; and, in the case of religious ceremonies, rites and services can have up to 15% capacity of the room indoors or up to 50 people outdoors [21]. The following events and gatherings are not permitted in the grey lockdown zone: indoor organized events and indoor social gatherings with members outside of the same household; indoor & outdoor dining at food establishments and meetings; and, event spaces must be closed. The City of Toronto (January 2021) also notes that one should be mindful that the more people an individual interacts with at a gathering and the longer the interactions last, the higher the risk of COVID-19 infection and spread [21].

If it is necessary to interact with those outside of one’s household, risk mitigating strategies recommended by the Government of Canada and the US Centers for Disease Control and Prevention (January 2021) include: 1) ensuring the indoor space is well ventilated (i.e., windows can help with ventilation); 2) minimizing gestures requiring close contact (i.e., hugging, hand-shaking, etc.); 3) having a hand sanitizing station; 4) wearing a mask; 5) making sure guests and members of the household have not had COVID-19 symptoms in the past 14 days; 6) designating one person to serve food and handle shareable items (i.e., condiments, pitchers, etc.); 7) considering use of single-use utensils; 8) using touchless garbage cans; 8) disinfecting commonly touched surfaces after the visit; 9) arranging tables and chairs to allow for social distancing; and 10) hand washing for at least 20 seconds when entering and exiting social gatherings. It is also recommended to keep a list of guests for potential future contact tracing if someone becomes sick later [22].