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Last updated 3 February 2021.
This pathway guides primary care management of COVID-19 in the State of Queensland. See also COVID-19 Information.
This pathway has been endorsed by State Health Emergency Coordination Centre (SHECC) and the Queensland Public Health Incident Management Team (COVID-19 IMT), activated in January 2020 by Dr Jeannette Young, Chief Health Officer.
We would like to acknowledge and thank the Queensland HealthPathways Community, Streamliners NZ and SHECC for this resource.
Key links
Clinical editor’s note
The greater Brisbane restrictions have eased as of 1.00 am, Friday 22 January. LGAs affected by the Brisbane lockdown have returned to a low-risk category for PPE recommendations making the whole of Queensland a low-risk category.
For PPE recommendations based on risk category, see Queensland Health – PPE in Community health services (Table 1).
An outbreak of a new strain of coronavirus called SARS-CoV‑2, originating in Wuhan City, Hubei Province, China, began at the end of 2019. On March 11, the World Health Organization (WHO) declared the outbreak of COVID-19 a pandemic. In response, the Australian Federal Government designed the Australian Health Sector Emergency Response Plan for Novel Coronavirus (the COVID-19 Plan) to guide the national health sector response.
Coronaviruses are viruses found worldwide in humans and animals. They can spread from person to person, most likely by contact with respiratory secretions. They cause respiratory illnesses similar to the common cold, but can also cause serious diseases e.g., severe acute respiratory syndrome (SARS).
There is no known pre-existing immunity to this virus and susceptibility to infection in humans is considered universal.
Transmission of COVID-19:
Presentation of COVID-19:
This pathway has been endorsed by State Health Emergency Coordination Centre (SHECC) and the Queensland Public Health Incident Management Team (COVID-19 IMT), activated in January 2020 by Dr Jeannette Young, Chief Health Officer.
2. Ensure that the patient and practice staff are observing infection control measures. If infection control measures cannot be implemented (e.g., no access to surgical masks or other personal protective equipment (PPE)), direct the patient to another practice, the Gold Coast emergency department or dedicated COVID-19 clinic (e.g., GP respiratory clinic, or hospital or community-based fever clinic).
Ensure that all patients suspected of infection or exposure to the virus are managed according to the latest recommendations by the relevant health authorities.
Implement standard contact and droplet precautions.
PPE is a valuable resource. Use outside of guidelines can lead to depleted supplies.
Contact and droplet precautions
RACF, Emergency Department, and inpatient settings that require use of contact and airborne precautions
Personal protective equipment (PPE) for contact and airborne procedures should be put on before entering a patient’s room:
P2 and N95 respirators should be used only when required.
Recommended resources on infection control measures and PPE
3. Consider providing telehealth consultations by telephone or videoconference (preferred) using MBS items for COVID-19 for all patients (restrictions apply).
Telehealth consultations
COVID-19 telehealth item numbers are available for general practitioners, practice nurses and Aboriginal health workers. Health providers can use their usual billing practices, but patients must be bulk-billed if the patient is:
Patient:
Telehealth item numbers:
Additional item numbers are available for mental health including eating disorder management, chronic disease management, health assessments for ATSI people and pregnancy support. For more information, see MBS Online – Temporary Telehealth Bulk-Billed Items for COVID-19.
MBS bulk-billing incentive items can be co-claimed, if eligible:
4. Take a history:
Most patients with COVID-19 infection will present with:
Frail or elderly patients may have atypical presentations including:
Children generally present with milder symptoms than adults:
Epidemiological criteria
In the 14 days before illness conset:
Casual contacts
A casual contact is anyone who has been in the same setting with a confirmed case during their infectious period, but does not meet the definition of a primary close contact.
Historical case definition
A person with one of:
Laboratory confirmed evidence
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).
Laboratory suggestive evidence
Has detection of SARS-CoV-2 neutralising or IgG antibody.
Confirmed case definition
A person who meets any of the following criteria:
Close contact
A close contact may be primary or secondary.
For surveillance purposes, additional criteria for contact definition apply. See Department of Health – Coronavirus Disease 2019 (COVID-19): Interim Advice to Public Health Units (identification of contacts, close contact definition).
High-risk setting
High-risk settings are defined as a setting where there is evidence of a risk for rapid spread and ongoing chains of infection. They include but are not limited to:
Vulnerable populations
Risk of severe disease due to Aboriginal and Torres Strait Islander descent
Aboriginal and Torres Strait Islander people are at increased risk of transmission and severity of COVID-19 due to:
Disability
Although having a disability per may not necessarily put a person at higher risk for COVID-19, people with disabilities tend to have poorer health and more complex health-care needs than the general population and specific co-morbidities that make them at higher risk of severe disease.
Risk of severe disease due to pregnancy
Children
5. If a child presents with fever, abdominal pain, tachycardia and rash, consider the possibility of paediatric inflammatory multisystem syndrome (PIMS-TS).
Paediatric inflammatory multisystem syndrome (PIMS-TS)
Paediatric inflammatory multisystem syndrome (PIMS-TS) is a novel post-infectious systemic hyperinflammatory syndrome, that has been reported in children two to six weeks after infection with SARS-CoV-2.
The initial infection with SARS-CoV-2 may have been asymptomatic.
For more information, see Victorian Agency for Health Information – Alert: Paediatric Inflammatory Multisystem Syndrome.
If suspected, seek immediate paediatric emergency medicine advice.
6. Examine the patient:
7. Determine severity – see Australian Guidelines for the Clinical Care of People with COVID-19
8. Check criteria for testing
Criteria for testing
9. Investigations:
Respiratory swabs in child with features of croup
Appropriate testing location
If the patient does not need hospital transfer, arrange testing at appropriate location:
Sample collection in general practice and RACFs
There are no special requirements for transport of samples. They can be transported as routine diagnostic samples for testing (i.e., Biological substance, Category B).
Self-collected nasal and oropharyngeal swab using a single swab
Self-collection broadens the use of swabs available, reduces infection risk to the health care worker providing the collection, and also reduces requirements for PPE. Data reviewed by Public Health Laboratory Network (PHLN) suggests that self-collected swabs are equivalent to combined nasal and throat swabs in detecting SARS-CoV-2.
See also PHLN – PHLN Guidance on Laboratory Testing for SARS-CoV-2 (page 3).
Respiratory samples
Collect upper respiratory sample:
Collect sputum if possible (i.e., if patient with productive cough, and sputum does not have to be induced):
Investigations
Specific locations offering SARS-COV-2 IgM testing
10. Determine whether the patient is suitable for isolation at home.
11. If the patient is asymptomatic and is seeking advice about potential exposure and for contact management, determine if criteria for potential exposure is met. Testing of asymptomatic patients is not recommended (unless specifically advised by public health authorities).
Criteria for potential exposure
For surveillance purposes, additional criteria for contact definition may apply. See Department of Health – Coronavirus Disease 2019 (COVID-19): CDNA National Guidelines for Public Health Units.
See also Queensland Government – Current Status and Contact Tracing Alerts – Coronavirus (COVID-19).
Consider contacts of suspected cases for contact management if there is likely to be a delay in confirming or excluding infection in the suspected case e.g., delayed testing.
Healthcare workers and other contacts who have taken recommended infection control precautions, including the use of full personal protective equipment (PPE), while caring for a symptomatic confirmed or probable COVID-19 case are considered to be at low risk for exposure.
If there are any concerns about incomplete or correct use of PPE, carry out an individual risk assessment (ideally in consultation with public health officials). See Department of Health – Coronavirus Disease 2019 (COVID-19): CDNA National Guidelines for Public Health Units (page 38, chapter 13: Special risk settings/Healthcare workers).
A patient may be allowed to remain in their home if you can follow up test results and escalate treatment at short notice if needed, and the patient:
A Community Recovery Hotline has been activated by the Queensland Government to assist people who:
Community Recovery Hotline staff will be able to work with partner organisations to arrange non-contact delivery of essential food and medication, and other assistance.
The Community Recovery Hotline can be contacted on 1800‑173‑349.
1. Manage in the appropriate location.
2. If the patient is suitable for management in the community, and:
Discuss risks with the patient and household contacts (if relevant):
Advise the patient to:
Give patient information and discuss additional recommendations:
A Community Recovery Hotline has been activated by the Queensland Government to assist people who:
The Community Recovery Hotline can be contacted on 1800‑173‑349.
Community Recovery Hotline staff will be able to work with partner organisations to arrange non-contact delivery of essential food and medication, and other assistance.
Note that strict isolation while awaiting test results is not required in these patients but should be considered on a case by case basis.
3. If the patient cannot guarantee compliance with isolation requirements, seek advice from your local emergency department or dedicated COVID-19 clinic (e.g., GP respiratory clinic, or hospital or community-based fever clinic).
4. Advise on self-quarantine recommendations for household contacts of suspected cases.
Self-quarantine recommendations for household contacts
5. Arrange follow-up of patient being tested.
6. If the patient has a positive test result, contact the local public health unit or emergency department or dedicated COVID-19 clinic, if available, to discuss where the patient will be managed and who will be responsible for their care (e.g., Hospital and Health Service).
7. If the patient has a negative test result, and:
Given the low pre-test probability of people in the community who have no epidemiological risk factors, patients generally do not need to be re-tested during the same illness if their first result is negative.
Clearance from COVID-19 has not yet been exactly defined. Consider advice from medico-legal associations:
8. If any other concerns, seek advice from the local public health unit.
9. Be sure to monitor your own health.
Healthcare workers who care for the patient with COVID-19 should carefully monitor and document their own health until 14 days after the last known contact with the patient, regardless of PPE use.
If the healthcare worker develops any acute illness or signs or symptoms such as a sore throat, fever, cough, or shortness of breath they should immediately:
1. Check local service arrangements with your Hospital and Health Service for the management of patients in the community. The role of the general practitioner in the management of COVID-19 patients in the community varies by region.
2. Consider management at home (or RACF) if the patient is a confirmed case, and is suitable for isolation at home, and any of the following apply:
In some regions, patients may continue to be managed in their homes by the hospital as part of a hospital substitute treatment (e.g., virtual ward, hospital in the home) and the role of the general practitioner in managing these patients will vary. Additional information will be provided as these services are formalised and rolled out in each region.
3. Educate the patient and family about the nature of the illness, importance of isolation and infection control measures that prevent the transmission of COVID-19. See Department of Health – What You Need to Know about Coronavirus (COVID-19).
4. Discuss and ensure patient, family and carers understand self-manage in isolation recommendations:
5. Advise on self-quarantine recommendations for household contacts.
6. Manage risk of deterioration:
Disease progression may occur over the course of a week with shortness of breath generally occurring after day 5 from symptom onset. Acute respiratory distress syndrome (ARDS) may develop within hours from the onset of dyspnoea.
Develop an escalation plan for the patient:
Discuss how treatment will be escalated and where it will be provided in accordance with patient’s wishes:
Develop a management plan for the patient’s contacts – if a patient’s contact becomes symptomatic:
7. Manage medications.
Prophylactic anticoagulation
Low molecular weight heparin (LMWH) preferred (e.g., enoxaparin 40 mg once daily or dalteparin 5000 IU once daily). In patients with renal insufficiency (acute or chronic), consider unfractionated heparin or renally adjusted dose of LMWH (e.g., enoxaparin 20 mg once daily or dalteparin 2500 IU once daily)
8. Follow up:
9. Inform the patient about clinical criteria for release from isolation.
Note that additional requirements apply to people infected with a SARS-CoV-2 variant of concern. See Department of Health – Coronavirus Disease 2019 (COVID-19): CDNA National Guidelines for Public Health Units (see section 4, Case Management, Release from Isolation).
Patients may be in home isolation because they:
Patients with asymptomatic infection may be released from isolation if they meet the following criteria:
Patients with mild illness not requiring hospitalisation or admission to hospital for reasons not directly related to acute COVID-19 (e.g., infection control), including those returning to a high-risk setting), may be released from home isolation if they meet the following criteria:
High-risk setting
Patients with more severe illness (where severity would warrant hospitalisation, regardless of whether or not the patient was hospitalised), including those returning to a high-risk setting, may be released from home isolation if they meet the following criteria:
Significantly immunocompromised patients may be released from home isolation if, in addition to meeting the appropriate criteria described in points above, they have also had two consecutive negative SARS-CoV-2 PCR tests, where respiratory specimens were collected at least 24 hours apart at least 7 days after symptom onset.
For people with pre-existing respiratory symptoms (e.g., COPD), the treating clinician should determine whether the signs and symptoms of COVID-19 have resolved.
The discharged person should be advised to continue to be diligent with hand hygiene and cough etiquette, and practice physical distancing, as is indicated for the rest of the community.
10. If asked to provide a clearance certificate for return to work or school:
11. If any concerns, seek advice from the local public health unit or infectious diseases specialist, as relevant.
12. In case of death, if asked to provide a death certificate for a COVID‑19-related death, see the Coroners Court of Queensland Information Sheet.
13. Be sure to monitor your own health.
Healthcare workers who care for the patient with COVID-19 should carefully monitor and document their own health until 14 days after the last known contact with the patient, regardless of PPE use.
If the healthcare worker develops any acute illness or signs or symptoms such as a sore throat, fever, cough, or shortness of breath they should immediately:
Advise the patient or health care worker that if they have a history of travel in the past 14 days (internationally, on a cruise ship, or through a designated COVID-19 hotspot), or have had close contact with a confirmed case:
Provide information sheet and discuss. See
Advise the patient that:
Advise the patient that:
See Department of Health:
RACF residents and people with disabilities in group residential care
Infection control measures in residential aged care and other group residential facilities
Aboriginal and Torres Strait Islander people
Risk of severe disease due to Aboriginal and Torres Strait Islander descent
Aboriginal and Torres Strait Islander people are at increased risk of transmission and severity of COVID-19 due to:
Social and cultural impacts on health outcomes
Factors that may enhance health and wellbeing
Isolation and quarantine
Pregnant women
Children
Cases of paediatric inflammatory multisystem syndrome (PIMS-TS) have been reported in children in Victoria. For additional information, see Victorian Agency for Health Information – Alert: Paediatric Inflammatory Multisystem Syndrome.
See other links related to COVID-19 and children:
Refugees and people seeking asylum
For health professionals
Further information
For patients
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