Ontario reveals new rules on managing COVID-19 cases, outbreaks — including in schools

With Ontario facing a delta variant-driven fourth wave of COVID-19, the provincial government has released guidelines for both vaccinated and unvaccinated people around testing and self-isolation for those who might be exposed to the virus.

Guidelines lay out more restrictive rules for people who have not been vaccinated

Nurse Jane Harrison helps administer COVID-19 tests out of a mobile clinic operated by Anishnawbe Health Toronto in late 2020. The provincial government has released new guidelines for those who come into contact with people who have the virus. (Evan Mitsui/CBC)

With Ontario facing a delta variant-driven fourth wave of COVID-19, the provincial government has released guidelines around testing and self-isolation for those who might be exposed to the virus — with the rules dependent on vaccination status.

Though the new rules are complex, they contain one basic theme: vaccinated Ontarians will be subject to fewer restrictions and more lenient isolation requirements compared to people who are unvaccinated.

Documents shared by the province Wednesday also outline how possible COVID-19 exposures will be managed in schools this year. Provincial spokesperson Alexandra Hilkene said in a statement that the government is taking a "balanced and cautious approach" to ensure schools stay open for in-person learning for the entire school year.

"The Chief Medical Officer of Health and health experts will continue to review data and provide advice to the government on the appropriate and effective measures that are needed to protect the health and safety of Ontarians and keep our kids in the classroom," she said.

All of the province's new guidance can be found at the bottom of this story.

The province has laid out guidelines for what people should do if they are exposed to someone who has tested positive for COVID-19 in this flowchart, which breaks things down for those vaccinated and unvaccinated:

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Rules for vaccinated people

Ontarians who are vaccinated, asymptomatic and exposed to a confirmed case are "likely" (depending on their specific public health unit) not required to self-isolate, but should get tested, the province says. Those people should also self-monitor for any symptoms for 10 days, as well as follow public health measures like wearing masks outside their home. 

People in this category are also instructed to self-isolate and get tested if they develop symptoms. Members of their household don't need to self-isolate.

If a vaccinated person is exposed to a confirmed case and does develop symptoms, they are instructed to self-isolate and get tested right away. If that test comes back positive, they must self-isolate for 10 days, the province says. If the test is negative, they can stop self-isolating once those symptoms have improved for at least a day, or two days for gastrointestinal symptoms.

In this category, members of the same household don't need to self-isolate if they've been vaccinated. If they don't have their shots, they would need to self-isolate until the exposed person gets a negative test result.

Dr. Kieran Moore, Ontario's chief medical officer of health, said this week that daily COVID-19 case counts will be less of a focus for the province through the fall, and as students return to in-person learning. (Lars Hagberg/The Canadian Press)

Rules for unvaccinated people

For people who aren't vaccinated and come into contact with a confirmed case, the rules are different.

In this situation, an unvaccinated person has to self-isolate for 10 days and immediately get tested. If the test is negative, a second test is recommended on or after day seven of that self-isolation period. The province says a person in this category has to self-isolate for this period following their last exposure, even if they test negative.

If the person who has been exposed has no symptoms, fully-immunized household members don't need to self isolate. But if they aren't vaccinated, they should stay home except for "essential reasons" like work or school during the exposed person's isolation period.

Health-care providers with Unity Health Toronto administer the Pfizer-BioNTech COVID-19 vaccine at a one-day pop-up clinic in the Eaton Centre in July. (Evan Mitsui/CBC)

If the person who was exposed and isn't vaccinated does have symptoms, they must be improving for at least a day (or 48 hours for gastrointestinal symptoms) before isolation can end.

Again, fully vaccinated household members in this situation don't have to self-isolate, but people who don't have their shots should self-isolate while the exposed person is awaiting test results, then stay home except for essential reasons during the exposed person's isolation period.

What about schools?

The province also released specific guidelines for how local public health units should approach confirmed cases and outbreaks in schools.

For this purpose, it has defined an outbreak in a school or child-care setting as two or more lab-confirmed COVID-19 cases in students, staff or other visitors, where at least one case can be linked to the school or facility, including related transportation like a bus.

Measures to deal with cases or outbreaks will largely be handled by the local public health unit, and can be scaled up or down depending on the specific situation and risks, the province says.

Examples of the kinds of steps health units can take in the case of school outbreaks include specific signage, further restricting visitors, minimizing the movement of staff between cohorts and limiting the activities of students to their own cohort.

A full list of measures available can be found in the document at the bottom of this story.

Ontario Premier Doug Ford, left, and Education Minister Stephen Lecce walk the halls at Father Leo J. Austin Catholic Secondary School in Whitby in July 2020. (Nathan Denette/The Canadian Press)

The province said it expects whole dismissals of schools due to COVID-19 cases to be rare.

It is anticipated that the likelihood of whole school dismissal will be exceptionally low in schools with high immunization coverage among students," the documents say, without referencing the fact that children under 12 are currently ineligible to be vaccinated in Canada.

However, public health units can shut down schools if the circumstances of an outbreak necessitate such a move.

As for how schools should handle symptomatic individuals and their contacts, it depends on how that individual may have been exposed and the vaccination status of their possible contacts.

Students and staff who have symptoms of COVID-19 should get tested and isolate while they await results, the province said. 

Unless that person is deemed a probable case or tests positive, "dismissal and isolation of asymptomatic contacts in the school is not generally recommended."

If a symptomatic person tests negative, or their illness is diagnosed as something other than COVID-19, they can return to school after symptoms have improved for at least 24 hours. If their symptoms are gastrointestinal, however, they should wait at least 48 hours before returning.

See the province's guidance for yourself here:

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