Status:
Active
Health alert:
AL20012
Date Issued:
05 Apr 2020 - (Update to Alert issued 1 April 2020)
Issued by:
Adjunct Clinical Professor Brett Sutton, Chief Health Officer
Issued to:
Clinicians and the Victorian public

Key messages

  • See the Victorian COVID-19 website for updated case definition, guidance and testing recommendations at Health services and general practice - coronavirus disease (COVID-19) as well as Chief Health Officer updates.
  • Up-to-date epidemiological data is also now available on the department website.
  • Victoria’s testing criteria for COVID-19 have changed, effective immediately.
  • Doctors who are requesting COVID-19 testing are asked to ensure that a current contact phone number for the patient is included on all pathology request forms. 
  • Advise all patients who have clinical symptoms but do not meet the testing criteria to remain home and not attend work, school or any public places until symptoms have completely resolved.
  • Notification is required, by telephone, for all confirmed cases of COVID-19. The department is following-up all close contacts of confirmed cases.
  • A State of Emergency has been declared in Victoria from 16 March 2020 until 13 April 2020 to combat COVID-19.
  • A number of directions are now in force with requiring important physical distancing interventions, issued in accordance with emergency powers arising from the declared state of emergency.
  • Self-assessment guidelines are available for the public together with guidelines for healthcare and residential care workers on Coronavirus disease (COVID-19) page of dhhs.vic website
  • Any person with a fever or respiratory symptoms is advised to ring the 24-hour hotline 1800 675 398.
  • Healthcare workers who have had close contact with a confirmed case, or who are diagnosed with COVID-19, can now access free accommodation to support their isolation and quarantine if required.
     

What is the issue?

Coronavirus disease (COVID-19) has been declared a Public Health Emergency of International Concern by the World Health Organization.  A state of emergency was declared on 16 March 2020 to help reduce the spread of coronavirus in Victoria.

COVID-19 is a notifiable condition under the Public Health and Wellbeing Regulations 2019 and all confirmed cases must be notified to the department. All people meeting the testing criteria should be tested.

Any person who has travelled overseas prior to 28 March 2020 is required to quarantine until 14 days after arrival in Australia. People who have arrived after midnight on Saturday 28 March 2020 are subject to mandatory quarantine in specified hotels for 14 days. 

Who is at risk?

The situation is evolving rapidly as we find out more about this disease. Most countries are now reporting rapid increases in cases.

As such, travellers returning from any country outside Australia should now be considered at high risk and therefore should be tested for COVID-19 and immediately isolated if they present with a clinically compatible illness.

People of all ages have been diagnosed with COVID-19, but those most at risk of severe illness are elderly people and those with pre-existing medical conditions.   

Symptoms and transmission

Reported symptoms include fever or respiratory symptoms such as cough, sore throat and shortness of breath. Recent information on the transmission of the virus suggests that cases may be infectious up to 24 hours before the onset of symptoms, until at least 24 hours after symptoms resolve.

The World Health Organization has confirmed that the main driver of transmission is from symptomatic patients through coughing and sneezing. Transmission by people without symptoms is possible, but is likely to be rare.

Who should be tested? 

  • People without symptoms should not be tested.
  • Patients who meet at least one clinical AND at least one epidemiological criterion should be tested:

Clinical criteria:

Fever (≥38°C) or history of fever (for example night sweats, chills)

OR

Acute respiratory infection (for example, shortness of breath, cough, sore throat).

Epidemiological criteria:

Close contacts of confirmed COVID-19 cases with onset of symptoms within 14 days of last contact

OR 

Travelers from overseas with onset of symptoms within 14 days of return

OR

Cruise ship passengers or crew with onset of symptoms within 14 days of disembarkation

OR

Paid or unpaid workers in healthcare, residential care, and disability care settings

OR

People who have worked in public facing roles in the following settings within the last 14 days:

  • Homelessness support
  • Child protection
  • The police force
  • Firefighters who undertake emergency medical response
  • Childcare and early childhood education
  • Primary or secondary schools

OR 

Any person aged 65 years or older

OR

Aboriginal or Torres Strait Islander peoples 

OR

Patients admitted to hospital where no other cause is identified

OR

Any person in other high-risk settings, including: 

  • Aged care, disability and other residential care facilities
  • Military operational settings
  • Boarding schools
  • Correctional facilities
  • Detention centres
  • Settings where COVID-19 outbreaks have occurred, in consultation with the department.

Clinical judgement should be exercised in testing hospitalised patients. 

All patients being tested for COVID-19 should home isolate until test results are available. All patients should attend an emergency department if clinical deterioration occurs.

Notify the department of confirmed cases as soon as practicable by calling 1300 651 160, 24 hours a day. A confirmed case is a person who tests positive to a validated SARS-CoV-2 nucleic acid test or has the virus identified by electron microscopy or viral culture.

Recommendations

Advice for clinicians 

Detailed information for medical practitioners is on the Health service and general practice page of DHHS website and the key guidance documents are the GP quick guide and checklist and more detailed Health Services and General Practitioner guide.

If you have a patient who meets the testing criteria above, key actions include:

  • Place a surgical mask on the patient and isolate the patient in a single room with the door closed.
  • Use droplet and contact precautions (single-use surgical face mask, eye protection, gown and gloves). 
  • Undertake testing in your hospital or with your primary pathology service: 
    – Take a single nasopharyngeal swab for viral testing. To conserve swabs the same swab that has been used to sample the oropharynx should be utilised for nasopharynx sampling.
    – Take blood in a serum tube for storage at VIDRL.
  • After a national expert review, it has been determined that there is negligible risk of aerosolisation from taking a nose and throat swab in a patient with an acute respiratory infection. This means a single use facemask (surgical mask) is now recommended for taking a nose and throat swab. 
  • If the patient has symptoms and signs suggestive of pneumonia, however, there is a possibility that the viral load might be higher. These patients should be referred to hospital for treatment, and airborne precautions, including a P2 respirator, should be used when collecting nasopharyngeal or oropharyngeal samples.

Advice for healthcare workers

  • Anyone who works in healthcare or residential care who has been overseas should not attend work for 14 days since leaving that country. As of midnight, 28 March 2020, all travellers arriving into Melbourne from overseas will be quarantined for two weeks in hotel rooms and other accommodation facilities. Interstate travellers can return to their home state after fulfilling the mandatory quarantine requirements in Victoria.
  • Any healthcare worker who has compatible illness, whether having travelled internationally or not, should not attend work and seek medical attention for consideration of testing for COVID-19.
  • It is recommended that medical practitioners do not test or treat themselves and instead should seek medical care from another medical practitioner.
  • Confirmed cases of COVID-19 and close contacts who are healthcare workers will be provided with free accommodation to support their isolation and quarantine, if required. They may choose to undertake their isolation or quarantine period at home, however. 
  • From midnight on 25 March, category three surgeries will not take place in public hospitals in Victoria until further notice. 

Advice for patients

  • Remember to practice physical distancing at all times. If you can stay home, you must stay home.
  • An isolation (diagnosis) direction was signed on 25 March 2020. This direction requires anyone diagnosed with coronavirus (COVID-19) to isolate at home or another suitable location to slow the spread of the disease.    
  • Anyone who has been in close contact with a confirmed case of COVID-19 should  remain in quarantine at home until 14 days after their last contact. More information will be provided to close contacts by the department.
  • All travellers who have returned from overseas in the past 14 days are required to be in quarantine until 14 days after entering Australia. 
  • In addition, as of midnight on 28 March 2020, all travellers arriving into Melbourne from overseas will be quarantined for two weeks in hotel rooms and other accommodation facilities.
  • Interstate travellers can return to their home states after fulfilling the mandatory quarantine requirements.
  • If a person in quarantine feels unwell and develops a fever or an acute respiratory illness (for example cough or shortness of breath) they should seek medical attention.
  • Call ahead to your GP or emergency department and mention your travel history.
  • Please keep triple zero (000) for emergencies only. 
  • As the virus is predominantly spread through coughing and sneezing, the best way to protect others is to practice good cough hygiene and regular hand washing. 

More information

Clinical information

Health service and general practice page on the DHHS website 

Consumer information

About coronavirus (COVID-19) page on the DHHS website

World Health Organization coronavirus page

Contacts

A public information hotline is provided by Nurse-on-Call – 1800 675 398.

Medical practitioners needing clinical information can contact the Department of Health and Human Services Communicable Diseases Section on 1300 651 160 (24 hours).