gp assessment and management of patients with suspected ... · title: gp assessment and management...

Version: 1.29 Effective date: 24 December 2020

If the patient attends the practice – Isolate them

Provide a surgical maskDirect the patient to a single room and close the doorUse dedicated or disposable equipment

Assess clinical status using appropriate PPE

If the patient has severe symptoms suggestive of pneumonia, they should be referred to the local Emergency DepartmentContact and droplet precautions are recommended for routine care of patients with confirmed or suspected COVID-19

Arrange Investigations

Preferably with your local pathology provider, fever clinic, or respiratory clinic (if available)6

In your practice, if PPE8

available and you are confident collecting adequate upper respiratory samples for PCR testing (i.e. a deep nasal swab and an orophrayngeal swab)

Referral and communication

•Notify your local public health unit2 of suspected, confirmed and historical cases of COVID-19 (fax preferred)

•If referring patient for Emergency Assessment, notify Emergency Department and QAS in advance to ensure appropriate infection control precautions are in place

•If patient does not require hospital care:

•Suspect cases should isolate until a negative test is returned AND symptoms have resolved. Provide the person with surgical mask and fact sheets on home isolation3 and information for people with a suspected case4

•If you have concerns about the ability of a patient to self-isolate, call your local public health unit2

•It is the responsibility of the requesting clinician to inform the patients of their test results

GP assessment and management of patients with suspected COVID-19 Place alerts on practice website and alert signage at entrance to practice. If possible, assess patients initially by telephone triage and/or telehealth consultation. (COVID-19 MBS telehealth items http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-TempBB)

Does the patient meet the epidemiological AND clinical criteria1 for COVID-19? Confirmed case A person who tests positive to a validated specific SARS-CoV-2 nucleic acid test; OR has the virus isolated in cell culture, with PCR confirmation using

a validated method

Historical case A person who undergoes a seroconversion to, or has a significant rise in, SARS-CoV-2 neutralising or IgG antibody level (e.g. 4-fold or greater rise in titre) OR has detection of SARS-CoV-2 neutralising or IgG antibody AND has either clinical OR epidemiological evidence and is not a confirmed case

Suspect case

A person who meets epidemiological AND clinical criteria

Isolate until a negative test is returned AND symptoms have resolved

Clinical and public health judgement should be used in assessing if patients who do not meet the clinical or epidemiological criteria should be considered suspect cases

Testing in Queensland Test anyone with any COVID-19 symptoms, no matter how mild: fever or history of fever, cough, shortness of breath, sore throat, loss of smell, loss of taste, fatigue, runny nose, acute blocked nose (congestion), muscle pain, joint pain, diarrhoea, nausea/vomiting, loss of appetite

Clinicians should have a high level of suspicion for COVID-19 in the general population, and a low threshold for testing

A person with a clinically compatible illness should isolate at home until a negative test is returned AND symptoms have resolved

Epidemiological criteria Clinical criteria Action

In the 14 days prior to illness onset: Close contact with a confirmed case International travel Passengers or crew who have travelled on a cruise ship Healthcare, aged or residential care workers and staff with direct patient contact People who have lived in or travelled through a COVID-19 hotspot5

Fever (≥37.5oC) or history of fever (e.g. night sweats, chills) OR acute respiratory infection (e.g. cough, shortness of breath, sore throat) OR loss of smell or loss of taste Other reported symptoms of COVID-19 include fatigue, runny nose, acute blocked nose (congestion), muscle pain, joint pain, diarrhoea, nausea/vomiting and loss of appetite Clinical and public health judgement should be used to determine if individuals with sudden and unexplained onset of one or more of these other symptoms should be considered suspect cases

Test (PCR)

Isolate until a negative test is returned AND symptoms have resolved

Do not order testing for asymptomatic persons

In certain high-risk outbreak settings public health units may consider testing asymptomatic contacts to inform management of the outbreak

High-risk settings are defined as a setting where there is evidence of a risk for rapid spread and ongoing chains of infection

High risk settings may include, but are not limited to:

Places where people reside in groups e.g. Residential settings such as aged care facilities, congregate disability accommodation, military residential groups, boarding schools, boarding

houses, homeless shelters, correctional facilities, remote industrial sites with accommodation, migrant workers accommodation, remote communities

Workplace settings where previous outbreaks have shown large scale amplification e.g. Abattoirs, Hospitals, Nightclubs and bars

1For further information on the latest case and contact definitions, laboratory testing and infection control recommendations, please refer to the current COVID-19 CDNA National Guidelines for Public Health Units: https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htm 2Contact details for local public health units: https://www.health.qld.gov.au/system-governance/contact-us/contact/public-health-units 3Fact sheets: https://www.health.qld.gov.au/__data/assets/pdf_file/0026/951065/covid19-self-isolation-requirements.pdf 4Information for people with a suspected case https://www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-for-people-with-a-suspected-case_3.pdf 5COVID-19 hotspots https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/current-status/hotspots-covid-19 6Qld fever and Respiratory Clinics https://www.health.qld.gov.au/__data/assets/pdf_file/0027/953730/fever-respiratory-clinics-list.pdf 7Chief Health Officer public health directions https://www.health.qld.gov.au/system-governance/legislation/cho-public-health-directions-under-expanded-public-health-act-powers 8 COVID-19 guidance on use of PPE https://www.health.gov.au/resources/publications/coronavirus-covid-19-guidance-on-use-of-personal-protective-equipment-ppe-in-non-inpatient-health-care-settings-during-the-covid-19-outbreak

Unless exemption criteria are met as per Chief Health Officer public health directions7, 14 days quarantine is required for all persons entering Queensland who have: been overseas in the last 14 days (excluding travel on a quarantine free flight from a safe travel zone country) been in a COVID-19 hotspot5 in the last 14 days or since the hotspot was declared (whichever is shorter), and the place is a

COVID-19 hotspot at the time the person enters Queensland been in close contact with a confirmed case of COVID-19