Status:
Resolved
Health alert:
AL20012
Date Issued:
27 Apr 2020 - (Update to Alert issued 14 April 2020)
Issued by:
Professor Brett Sutton, Chief Health Officer
Issued to:
Clinicians and the Victorian public

Key messages

  • See the Victorian COVID-19 website for an updated case definition and new testing recommendations: Health services and general practice - coronavirus disease (COVID-19)
  • Up-to-date epidemiological data is also now available on the department website.
  • Testing criteria has been updated to further expand the symptoms which may be included as part of an acute respiratory infection as part of a drive to increase testing
  • The new criteria also highlight healthcare and aged care workers as priority groups for testing and note the potential for co-infection. Also noted are the specific and limited circumstances where asymptomatic testing may be considered under direction from the department.
  • 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 until 11 May 2020 to combat COVID-19 
  • A number of directions are now in force 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.

People who have arrived in Australia 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 48 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 except in special circumstances such as recovered cases wishing to return to work in a healthcare facility or aged care facility or where requested by the department as part of outbreak management or enhanced surveillance.

Patients who meet the following clinical criteria should be tested:

Fever OR chills in the absence of an alternative diagnosis that explains the clinical presentation*

OR

Acute respiratory infection (e.g. cough, sore throat, shortness of breath, runny nose or anosmia)

Note: In addition, testing is recommended for people with new onset of other clinical symptoms consistent with COVID-19** AND who are close contacts of a confirmed case of COVID-19; who have returned from overseas in the past 14 days; or who are healthcare or aged care workers

*Clinical discretion applies including consideration of the potential for co-infection (e.g. concurrent infection with SARS-CoV-2 and influenza)
**headache, myalgia, stuffy nose, nausea, vomiting, diarrhoea

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 through 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 for lower respiratory tract specimen collection.
  • Since the last CHO Alert, the department has updated guidance relating to the conventional use of personal protective equipment and use when performing clinical procedures. These are available at Health services and general practice - coronavirus disease (COVID-19).

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. 
  • Victoria’s public and private hospitals will begin doing more elective surgeries from next week. Category 2 and some category 3 elective surgeries will gradually resume from 27 April 2020.

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 re-issued on 13 April 2020. This direction requires anyone diagnosed with coronavirus (COVID-19) to isolate at home or at 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.
  • 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 or other symptoms compatible with coronavirus 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. 

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

Smartraveller website

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).