March 18, 2020

Dear Stakeholder:
We are writing to provide information on the novel coronavirus (COVID-19), and the evolving outbreak in BC.
As the areas affected by the outbreak changes and we learn more about the virus, we will provide updated public health recommendations. We are now aware that this virus can cause a range of mild to severe symptoms, and it is possible that people will not recognize symptoms that are mild. Given this new information, there are steps that people at risk of COVID-19 can take to reduce the chance of spread to others.

We recognize that as social sector organizations you provide very important services to vulnerable segments of our population who may be at greater risk of COVID-19 such as people who are homeless, street-entrenched, reliant on group care, and/or persons living with other illness or disability. Suspending the important services you provide can cause unintended consequences for clients and other frontline providers.
We recommend that your organization work to adapt the way in which you provide services to minimize transmission of the virus. A risk-informed decision-making for social sector organizations during the COVID-19 pandemic is forthcoming.

Preventing COVID-19
SARS-CoV 2 (the virus that causes COVID-19) is spread through respiratory droplets.
The most important thing you can do to prevent infection is to wash your hands regularly and avoid touching your face.
To help reduce your risk of infection:
• Wash your hands often with soap and water for at least 20 seconds. Using soap and water is the single most effective way of reducing the spread of infection. See the attached handwashing poster to post in your organization.
• If a sink is not available, alcohol-based hand rubs (ABHR) can be used to clean your hands as long as they are not visibly soiled. If they are visibly soiled, use a wipe and then ABHR to effectively clean them.
• Do not touch your face, eyes, nose or mouth with unwashed hands.
• Cover your mouth and nose with a disposable tissue or the crease of your elbow when you sneeze or cough.
• Regularly clean and disinfect frequently touched surfaces.
• Do not share food, drinks, utensils, etc.

Advice on Continuity of Service
We do not recommend suspending social services. We encourage social service organizations to continue providing their important services, and consider adapting them as much as possible to support:
• Social distancing (i.e., having space of 2 metres, or two arm lengths, between individuals)
• Hand washing facilities
• Minimum twice daily cleaning of high contact surfaces (e.g., doorknobs, faucet handles, computer keyboards, light switches etc.)
Organizations should consider that they may experience greater than normal absenteeism of staff and volunteers. We advise organizations to identify services that may be postponed or discontinued in order to free up staff and volunteer resources to provide essential services.

Advice for Persons at Higher Risk of Severe COVID-19
Certain groups of people are at higher risk of developing more severe illness:
• Elderly persons
• People with chronic illness and/or weakened immune systems
Anyone at risk of more severe COVID-19 should:
• Practice the things mentioned above – frequent hand-washing, maintain a distance of 2 metres from other people, avoid touching their hands and face, and have frequent disinfecting of high contact surfaces.
• Avoid crowds > 5 people

Advice on Wearing Masks
Masks should be used by sick people to prevent transmission to other people. A mask will help keep a person’s droplets in.
It may be less effective to wear a mask in the community when a person is not sick themselves. Masks may give a person a false sense of security and are likely to increase the number of times a person will touch their own face (e.g., to adjust the mask).

Advice on Self-Isolation
We now recommend that:
• People returning from travel outside of Canada stay home or self-isolate for 14 days after they return to Canada. They should monitor themselves daily for symptoms (fever, cough, muscle aches, difficulty breathing).
• People who have been in close contact with someone who has been diagnosed with COVID-19 by laboratory testing should self-isolate for 14 days after their last encounter.Individuals should monitor themselves daily for symptoms (fever, cough, muscle aches, difficulty breathing).
• People who have been in close contact with someone who has been showing symptoms (fever, cough, muscle aches, difficulty breathing), should monitor themselves daily for symptoms.

Advice for Those Who Have Respiratory Symptoms
For anyone who develops fever, cough, muscle aches, difficulty breathing, and can be managed at home (i.e., doesn’t need to go to the hospital), self-isolate for at least 14 days after onset of their symptoms. After 14 days, if their temperature is normal and they feel better, they can return to their routine activities. Coughing may persist for several weeks, so a cough alone does not mean they need to continue to self-isolate for more than 14 days.

Advice on Cleaning and Disinfecting
Cleaning and disinfecting objects and surfaces that are frequently touched (e.g., high touch surfaces such as doorknobs, faucet handles, computer keyboards, etc.) will help to prevent the transmission of viruses from person to person through contaminated hands. These surfaces should be cleaned and disinfected at least two times per day. If household or commercial disinfection products are not readily available, hard surfaces can be cleaned of visible dirt and then disinfected using a mixture of 1-part bleach and 9-parts water.
Organizations should also consider increasing the number of hand wash stations (or alcohol-based sanitizer stations) around the institution, as well as providing tissues and waste receptacles.

Coronavirus Disease (COVID-19): Resources for BC Public Agencies:
Vancouver Coastal Pandemic Response Planning Checklist for Homeless & Housing Services Providers: https://sneezesdiseases.com/assets/uploads/1584050040ueDrQ4uF2STpj0uScxV9XTftm9T8.pdf

Latest Public information about the disease:
The BC Centre for Disease Control (BCCDC) website contains the latest information about the disease, particularly as it relates to the health and well-being of British Columbians. Relevant BCCDC resources and channels include:
• Information for the public: www.bccdc.ca/covid19
• COVID-19 Self-Assessment Tool: https://covid19.thrive.health/

BCCDC channels to follow:
• Twitter: @CDCofBC
• RSS feed: http://feeds.phsa.ca/bccdc-news.xml

Other regional, provincial and national resources about the virus:
• Vancouver Coastal Health: http://www.vch.ca/about-us/news/vancouver-coastal-healthstatement-on-coronavirus
• Fraser Health: https://www.fraserhealth.ca/health-topics-a-to-z/coronavirus#.Xk7Y975KiUk
• Interior Health: Ministry of Health Office of the 4th Floor, 1515 Blanshard Street
Provincial Health Officer
PO Box 9648 STN PROV GOVT
Victoria BC V8W 9P4
Tel: (250) 952-1330
Fax: (250) 952-1570
http://www.health.gov.bc.ca/pho/
https://www.interiorhealth.ca/YourEnvironment/CommunicableDiseaseControl/Pages/Breaking-News-and-Info.aspx
• Island Health: https://www.islandhealth.ca/learn-about-health/diseases-conditions/novelcoronavirus-information
• Northern Health: https://www.northernhealth.ca/health-topics/current-outbreaks
• HealthLink BC: https://www.healthlinkbc.ca/health-feature/coronavirus-covid-19
• Public Health Agency of Canada: https://www.canada.ca/en/publichealth/services/diseases/2019-novel-coronavirus-infection.html

Sincerely,
Bonnie Henry
MD, MPH, FRCPC
Provincial Health Officer

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