General COVID-19 Questions & Answers

In response to the promising news that a first vaccine has been approved, and more are in the pipeline for COVID-19, we wanted to provide an update to the community based on what we know today. As always, we rely on research and our medical community to advise us on health protocols for people living with cystic fibrosis (CF). 

In the matter of COVID-19, we have participated in two global studies, using our Cystic Fibrosis Registry data.The research continues to show that individuals living with cystic fibrosis do not appear to be impacted in the short-term by COVID-19 at a higher rate than the general public, nor do they experience a more severe course of the disease. However SARS-CoV-2 is a novel virus and the long-term consequences post-infection are unknown. There is for example emerging evidence that SARS-CoV-2 infections may cause heart damage in some patients. 

Given the already heavy health burden on Canadians with cystic fibrosis, we believe it necessary to shelter Canadians with cystic fibrosis from any additional risks that could be caused by SaRS-CoV2 infection, and that Canadians with cystic fibrosis should be prioritized for vaccination. We have been in contact with provincial Health Ministers across the country to share these concerns. 

We will continue to work with cystic fibrosis clinicians to identify the best course forward. If you have specific health questions regarding the vaccine, please consult your clinician.

We understand that the topic of re-integration raises some concerns for our community. Cystic Fibrosis Canada is monitoring the re-integration plans across Canada and will continue to provide updates on our Provincial Re-Integration Plans webpage as new details emerge. 

We will also be hosting our next Ask the Expert webinar on June 3^rd, 2020. The webinar will focus on re-integration in order to help address some concerns around return to work or school and other questions you might have.

Questions about your personal risk factors should be directed to your clinic team, who can help determine if you should take additional precautions and provide specific advice.

• The main increased risk group for COVID-19 is older patients and those with comorbidities (hypertension, cardiovascular disease, diabetes, lung disease).
• However older people and people of all ages with underlying health conditions - like lung disease, including CF - seem to be at higher risk of developing serious COVID-19 illness.
• The main way to reduce the spread of COVID-19 is for the entire community to practice social distancing, therefore the following recommendations apply everybody, regardless of risk status:
• stay home as much as possible
• ensure you have access to several weeks of medication in case you need to stay home for prolonged periods
• when you go out in public, keep away from people who are sick, avoid close contact with others and wash your hands often
• avoid large crowds and gatherings
• avoid non-essential travel, especially air travel and cruises.
• Questions about your personal risk factors should be directed to your clinic team, who can help you determine if you should take additional precautions and provide specific advice. 

• People who are post-transplant would be considered an increased risk group due to their immunosuppressed state.
• The CDC has issued guidelines for people who are at increased risk, which includes avoiding large gatherings and staying home as much as possible.
• The main way to reduce the spread of COVID-19 is for the entire community to practice social distancing, therefore the following recommendations apply to everybody, regardless of their personal risk status:
• stay home as much as possible
• ensure you have access to several weeks of medication in case you need to stay home for prolonged periods
• when you go out in public, keep away from people who are sick, avoid close contact with others, and wash your hands often
• avoid large crowds and gatherings of
• avoid any non-essential travel, especially air travel and cruises

Speak with your transplant team about any additional precautions you can take, but do NOT change your routine care without first consulting with your transplant team. Even if you are sick, please do not make any changes without proper consultation as this could be dangerous to your health. Contact your transplant team if you are feeling unwell.

• The same basic precautions for infection prevention being advised to the general population are also being recommended for people living with CF.
• The CDC recommends taking extra precautions to put distance between yourself and other people, including staying home as much as possible and avoiding crowds, especially in poorly ventilated areas. 
• In general, people with CF and those close to them should continue with their usual infection prevention precautions to keep themselves healthy.

In addition to recommendations for avoiding everyday germs, Health Canada has posted recommendations for how you can prepare for COVID-19.

You can also refer to regional public health authorities: 

• Alberta guidelines
• British Columbia guidelines
• Manitoba guidelines
• New Brunswick guidelines
• Newfoundland and Labrador guidelines
• Nova Scotia guidelines
• Ontario guidelines
• Prince Edward Island guidelines
• Quebec guidelines 
• Saskatchewan guidelines
• Northwest Territories guidelines
• Nunavut guidelines
• Yukon guidelines

• The CDC recommends taking extra precautions to put distance between yourself and other people, including staying home as much as possible and avoiding crowds, especially in poorly ventilated areas.
• Talk with your school administration to explore distance learning or remote options for school children.
• Adults with CF are encouraged to work remotely whenever possible. For jobs that cannot be done remotely, talk to your clinic team and explore any possible alternatives with your employer.
• Questions about your personal risk factors should be directed to your clinic team, who can help you determine if you should take additional precautions and provide specific advice. 

The Government of Canada has created a tip sheet on How to Isolate at Home WhenYou Have COVID-19. Please contact your clinic if you have any CF-related medical concerns.

The best way that people with CF can protect themselves is to take the same basic precautions for infection prevention being advised to the general population, which are also being recommended for people living with CF. 

The Centre for Disease Control recommends  taking extra precautions to put distance between yourself and other people, including staying home as much as possible and avoiding crowds, especially in poorly ventilated areas.  In general, people with CF and those close to them should continue with their usual infection prevention precautions to keep themselves healthy.

 In addition to recommendations for avoiding everyday germs, Health Canada has posted recommendations for how you can prepare for COVID-19. 

When you do have to venture out to buy groceries, pick up prescriptions, to get gas and other necessities, plan ahead and do your research. Many businesses and services recognize that good infection and control policies are good for business, so check out their websites or call them to see what they are doing to ensure the health and safety of their customers. These are just some of the grocery and retail outlets have openly made statements about their measures to protect their customers:

• Loblaw Companies Limited’s (LCL)  Executive Chairman Galen Weston Jr. has implemented changes to business practices and provides regular updates. 
• Wal-Mart Stores, Inc. (WMSI) has also adjusted business practices and is providing updates.
• London Drugs is providing regular updates. 
• Safeway Inc. has provided details on their efforts. 

You may also wish to consider having necessities like medications and groceries delivered. Many grocers and pharmacies will have this information on their websites, or you can call them to see if they provide delivery service.

The Government of Canada has created a tip sheet on How to Care for a Person with COVID-19 at Home-Advice for Caregivers. Please contact the clinic the person you are caring for attends if you have any CF-related medical concerns.

If you are caring for a person with COVID-19 and need to wear a mask, please ensure you use proper technique to protect yourself and others. For reference on how to wear a mask properly, visit the World Health Organization website for a video demonstration and further information.

What is the CERB?

The Canada Emergency Response Benefit is a taxable benefit that provides $2,000 a month, for up to four months, to eligible Canadian workers who lose their income as a result of COVID-19.

The CERB is being administered by Service Canada and the Canada Revenue Agency.

Who is eligible for the CERB?

Canadians that are 15 years of age and older, whether they are eligible for EI or not, may be eligible for the CERB if one of the following situations applies:

• Lost their job, are sick or quarantined
• Working parents who must stay home without pay to care for children who are sick or at home because of school and daycare closures
• Workers who are still employed, but are not receiving income because of disruption to their work situation due to COVID-19
• Individuals who have ceased working due to COVID-19
• Self-employed

The benefit will be available to workers:

• Who reside in Canada
• Have not voluntarily quit their job 
• Who had income of at least $5,000 in 2019 or in the 12 months prior to the date of their application
• Who are or expect to be without employment or self-employment income for at least 14 consecutive days in the initial four-week period

How do I apply for the CERB?

Applications are open online as of April 6th, 2020. Individuals are encouraged to apply according to their birth date:

• April 6: apply if born in January, February or March 
• April 7: apply if born in April, May or June 
• April 8: apply if born in July, August or September 
• April 9: apply if born in October, November or December 

You can apply here.

Applicants will be asked a few questions that help direct them to the appropriate service based on their situation.

Canadians are expected to receive payments within 10 business days of the application date by cheque, or three to five business days by direct deposit. 

Please read the CERB question and answer for more detail: https://www.canada.ca/en/services/benefits/ei/cerb-application/questions.html

April 02, 2020

As of April 6, Canadians eligible for the Canada Emergency Response Benefit (CERB) previously announced will be able to apply online. To prevent surges in applications, individuals are asked to apply on the following days based on birth date:

• April 6: apply if born in January, February or March 
• April 7: apply if born in April, May or June 
• April 8: apply if born in July, August or September 
• April 9: apply if born in October, November or December 

The government is allocating $2 billion to cover public health and medical-related equipment.

The government also announced details on the proposed emergency wage subsidy of 75% to help qualifying businesses, for up to three months, keep Canadians in their jobs. The details are as following:

• The program would be in place for a 12-week period, from March 15 to June 6, 2020
• The subsidy would apply at a rate of 75% of the first $58,700 normally earned by employees, representing a benefit of up to $847 per week
• Eligible employers who suffer a drop in gross revenues of at least 30% in March, April or May, in comparison to the same month in 2019, would be able to access the subsidy
• Eligible employers would include employers of all sizes and across all sectors of the economy, with the exception of public sector entities, as well as not-for-profit organizations and charities
• An eligible employer’s entitlement to this wage subsidy will be based entirely on the salary or wages actually paid to employees
• Applications will be through a Canada Revenue Agency online portal 

Organizations that do not qualify for the Canada Emergency Wage Subsidy may continue to qualify for the previously announced wage subsidy of 10% of remuneration paid from March 18 to before June 20, up to a maximum subsidy of $1,375 per employee and $25,000 per employer.

More at: https://www.canada.ca/en/department-finance/news/2020/04/government-announces-details-of-the-canada-emergency-wage-subsidy-to-help-businesses-keep-canadians-in-their-jobs.html

March 26, 2020

The government introduced the Canada Emergency Response Benefit (CERB) to support workers and help businesses keep their employees. This taxable benefit would provide $2,000 a month, for up to four months for workers who lose their income as a result to COVID-19. 

• The CERB will cover Canadians who have lost their job, are sick, quarantined, or taking care of someone who is sick with COVID-19, and working parents who must stay home without pay to care for children who are sick or at home because of school and daycare closures.
• Workers who are still employed, but are not receiving income because of disruptions to their work situation due to COVID-19 would also qualify for CERB.
• All Canadians who have ceased working due to COVID-19, whether they are EI eligible or not, will be able to receive the CERB.
• CERB payments will begin to be received within 10 days of application, which is expected to become available early April. 

Additional measures to support Canadians, under the COVID-19 Emergency Response Act, include:

• Temporarily boosting Canada Child Benefit (CCB) payments to provide additional assistance to families with children.
• Special top-up payment under the Goods and Services Tax (GST) credit to provide additional assistance to individuals and families with low and modest incomes.
• A pause on the repayment of Canada Student Loans for all borrowers currently in repayment, for a six month moratorium.
• Providing eligible small employers a temporary wage subsidy for a period of three months.
• Reducing required minimum withdrawals from Registered Retirement Income Funds by 25% for 2020.
• One-time funding of $500 million through the Canada Health Transfer to support provinces and territories with a COVID-19 Response Fund for their critical health care system needs and to support mitigation efforts as needed
• Government authority to make regulations to address any future shortages of therapeutic products, including drugs and medical devices required to treat COVID-19.

The information above and more is available at: https://www.canada.ca/en/department-finance/news/2020/03/the-covid-19-emergency-response-act-receives-royal-assent0.html

Employment Insurance (EI) Sickness Benefits
Effective as of March 15th 2020, the Government is temporarily waiving the following:

• one-week waiting period for people in imposed quarantine that claim Employment Insurance (EI) sickness benefits and,
• the requirement to provide a medical certificate to access EI sickness benefits Emergency Care Benefit

The new Emergency Care Benefit will become available in April 2020 and is expected to provide income support of up to $900 bi-weekly, for up to 15 weeks, for:

• Workers, including the self-employed, who are quarantined or sick with COVID-19 but do not qualify for EI sickness benefits
• Workers, including the self-employed, who are taking care of a family member who is sick with COVID-19, such as an elderly parent, but do not qualify for EI sickness benefits.
• Parents with children who require care or supervision due to school closures, and are unable to earn employment income, irrespective of whether they qualify for EI or not.

Note, application for the Emergency Care Benefit once available will require applicants to re-attest every two weeks to reconfirm their eligibility.

Emergency Support Benefit
For Canadians who lose their jobs or face reduced hours as a result of COVID-19 and are not eligible for EI, the Emergency Support Benefit delivered through the CRA will provide up to $5.0 billion in support to workers who are not eligible for EI and who are facing unemployment.

EI Work Sharing Program
For Canadians who lose their jobs or face reduced hours as a result of COVID-19 and are not eligible for EI, the Government is implementing the EI Work Sharing Program, which provides EI benefits to workers who agree to reduce their working hour as a result of developments beyond the control of their employers, by extending the eligibility of such agreements to 76 weeks, easing eligibility requirements, and streamlining the application process.

Additional supports:
Income support for low and modest-income families: The Government is proposing to provide a one-time special payment by early May 2020 through the Goods and Services Tax Credit (GSTC) The average boost to income for those benefitting from this measure will be close to $400 for single individuals and close to $600 for couples.

Income support for families with children: The Government is proposing to increase the maximum annual Canada Child Benefit (CCB) payment amounts, only for the 2019-2020 benefit year, by $300 per child as part of their May payment.

For additional information, read the Federal Government’s COVID-19 Economic Response Plan: Supports for Canadians and Businesses

Cystic Fibrosis Canada is reviewing the recommendations proposed in the Ontario Health Clinical Triage Protocol for Major Surge in COVID Pandemic and is working closely with our CF clinician community that is lending support as required. The health and well-being of our CF community remains the highest priority for Cystic Fibrosis Canada during the outbreak of COVID-19.

Provincial governments may have differing clinical protocols from one another in place. Cystic Fibrosis Canada continues to monitor guidelines developed for health care providers across the country.

We recommend you have access to several weeks of medicine supplies in case you need to stay home for prolonged periods of time. This is a standard recommendation at all times. We do not advise stockpiling of antibiotics.

We consulted with Canadian CF clinicians and are not currently aware of any CF medication shortages caused by COVID-19. We are monitoring the situation.

Presently, in relation to COVID-19, the CDC recommends wearing a facemask if you are sick and you are around other people. The CDC states that you do not need to wear a mask if you are not sick unless you are caring for somebody who is sick and they can't wear a facemask.

If you need to wear a mask, please ensure you use proper technique to protect yourself and others. For reference on how to wear a mask properly, visit the World Health Organization website for a video demonstration and further information.

You can also refer to the CF Canada infection prevention policy for further information about infection prevention.

We encourage people who have questions of this nature or concerns to contact their CF clinic care team directly for accurate and updated information.

As you may already know, an updated Cystic Fibrosis Foundation (U.S.A) Infection Prevention and Control Guideline for people with CF, their families and health care professionals was published in the Society for Healthcare Epidemiology of America’s Infection Control and Hospital Epidemiology journal in July 2014. The updated Infection Prevention and Control Guideline for Cystic Fibrosis, which include recommendations for CF clinics and other ambulatory settings, have been endorsed by CF Canada’s Healthcare Advisory Council, amongst others, and the recommendations for healthcare professionals were shared with CF clinics in Canada.  

All CF clinics in Canada have an infection prevention and control system in place and follow protocols (ex: wearing gowns and gloves). Many of the measures taken by healthcare professionals and staff at CF clinics have been in practice much before the COVID-19 outbreak to minimize the risk of cross-infections. CF clinics in Canada maintain a high standard of care and follow isolation precautions to ensure the health and safety of all patients.

People living with cystic fibrosis should continue to maintain their regular daily care regimens.

CF clinics maintain a high standard of care and follow isolation precautions to ensure your health and safety.

As the situation evolves, if clinic scheduling needs to change, your clinic team will contact you to make alternative arrangements for your care. You can also talk with your clinic team about options for postponing routine clinic visits during this time. 

You should continue to follow CF Infection Prevention and Control Guidelines which recommend that people with CF wear a surgical mask in health care settings to reduce the risk of cross-infection from CF germs.

We understand that the UK government has provided guidance on shielding and protecting people defined on medical grounds as extremely vulnerable, including people with CF, for COVID-19. The recommendations may differ from country to country and sometimes even province to province based on a variety of factors such as the interpretation of number of new cases by local public health authorities. We recognize that the facts of COVID-19 are still emerging and are in the process of consulting CF experts to determine and provide further guidance for people with CF in Canada. 

There are new developments related to COVID-19 every day, which we are closely monitoring and providing updates through our Q&A for COVID-19, clinic information by province, and government supports both federal and provincial, webpages to keep you informed. 

• The Government of Canada has provided travel advice with regards to COVID-19 advising people to avoid non-essential travel outside of Canada until further notice and to avoid all cruise ship travel. 
• All travellers from outside of Canada are recommended to self-isolate for 14 days after return to Canada. These efforts will contribute to slow the introduction and spread of COVID-19 in Canada.
• Please refer to the Official Global Travel Advisory for the latest information on affected areas.

Federal and provincial public health leaders are now recommending that all people returning from international travel should self-isolate for 14 days. If you have recently been to an at risk area, notify your clinic team, monitor yourself for symptoms and self-isolate for 14 days. If you start having symptoms, contact your public health authority and notify your CF clinic team.

If you have been in contact with someone who has a confirmed case of COVID-19, you should self-isolate per Canada Health guidelines, and let your clinic team know so that they can monitor you closely. If you start having symptoms, consult with your public health authority and let your clinic team know.

The processes and guidelines for COVID-19 testing vary by region. Information on testing sites and procedures continues to evolve and is made available through most provincial government websites. Most provinces also have an online COVID-19 symptom self-assessment tool to get you started.

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We are all aware of the challenges posed by the current COVID-19 outbreak to the care of our patients and to the continuation of the quality research performed in our Network. Practices will vary depending on the prevalence and spread of the COVID-19 virus in different geographic areas of the country. This means that situations may arise where we will need to modify our practices in order to safeguard the well-being of individual patients and the CF community. For those presently participating in a clinical trial this may include, visits outside the hospital, virtual visits, local lab testing, and/or shipping of drugs.  At this time, no new patients are being enrolled in clinical trials.  

The leadership of the CF CanACT Executive/Steering Committee would like to take this opportunity to inform our community that while we are committed to promoting continued excellence in research we will make the safety of our patients the number one priority. If you have any questions regarding how clinical trial activities may be affected by COVID-19 you may reach out to us at clinicaltrials@cysticfibrosis.ca; or contact your study research coordinator.

Here are links to public health authority websites for each province and territory:

Alberta

British Columbia (BC Centre for Disease Control)

Manitoba

New Brunswick

Newfoundland and Labrador

Nova Scotia 

Ontario 

Prince Edward Island

Quebec 

Saskatchewan 

Northwest Territories

Nunavut

Yukon