What happens when one of your clients tests positive for COVID-19?
There are now several cases of COVID-19 among Aboriginal people in NSW and the Centre for Aboriginal Health and the Aboriginal Health & Medical Research Council are monitoring this closely.
Now that testing has been broadened to include anyone who is symptomatic and self-identifies as Aboriginal in a rural or remote community, we are likely to see additional cases around the state.
Routine infection prevention and control
ACCHSs are encouraged to integrate infection prevention and local control processes for COVID-19 into their routine practice. This includes processes like triaging patients with respiratory symptoms prior to entering the service, referral to testing facilities if unable to collect samples, safe and judicious use of personal protective equipment for staff and increased environmental cleaning and disinfecting. Further information on these strategies can be found on the CEC website.
If you strongly suspect COVID-19 as a diagnosis
- notify your local Public Health Unit (P: 1300 066 055) of the suspected case and that you intend to arrange for a swab to be taken / take a swab / have already taken a swab.
- Discuss with patient and family the steps needed to self-isolate appropriately and refer to NSW Health and AH&MRC resources if assistance is needed with home isolation until a test result is available.
If a client tests positive for COVID-19
Your Pathology provider should call the health professional who requested the test as soon as they are aware the result is positive. This is because it is the requesting clinician’s responsibility to inform the patient of the result, explain the test and to manage the patient (with support from the local PHU).
The laboratory is also legally required to notify the local Public Health Unit of the positive result.
Support for the positive client
The patient needs to be informed of their diagnosis immediately and advised to remain isolated at home, minimizing contact with anyone in their household (and not leave their house except for medical reasons).
Checking in with the case on a regular basis is necessary to ensure they have adequate food and medicines and to discuss symptom evolution and recovery.
If the case is mild, they may be appropriate for management in the community. They can be discharged from isolation when their symptoms have resolved completely for at least 3 consecutive days and it has been at least 10 days since the onset of their symptoms (as per National Guidelines).
For patients with mild illness, but for whom community follow up or home isolation may not be possible, referral for appropriate accommodation may be required. The LHD PHU should be advised that this is the case to enable referral to urgent social worker referral.
Be aware that some patients may experience an acute deterioration, more likely in their second week of illness. For patients with risk factors for severe disease who are unable to be followed up in the community, referral for admission may be required.
Testing of others in the community
Testing should be prioritized by the likelihood of having acquired the infection, largely determined by degree of contact with the confirmed case and presence of symptoms. Your local Public Health Unit can assist with identifying who these people are (you of course may already know this) because they will undertake a detailed interview by phone with the case. This assists in identifying the infectious period and all close or casual contacts with the person during that period.
The PHU will also support efforts to contact trace by notifying all close contacts who are required to self-isolate for 14 days from the time of last close contact with the confirmed case. Close contacts may also require testing for COVID-19 if symptomatic.
If any symptomatic close contacts test positive, the PHU will likewise undertake further case interviews and contact tracing for each newly identified case, as described above. This may broaden the number of people identified in the community as close contacts.
Testing criteria are changing regularly and the most up to date testing criteria is available on the NSW Health website. As of 1st April 2020 testing criteria has been broadened to include anyone who is symptomatic and self-identifies as Aboriginal in a rural or remote community (or with links to a rural or remote community). Non-Aboriginal people in rural and remote Aboriginal communities should also be tested if they are symptomatic close contacts.
Messaging to the whole community
Aboriginal people living in rural and remote communities who have the following symptoms should call ahead to their ACCHS to discuss testing:
- fever or history of fever or
- acute respiratory infection (cough, shortness of breath, sore throat)
Anyone who is suspected of having COVID-19 should be advised to self-isolate away from others, including staying home and minimizing contact with household contacts. This is required for anyone waiting for a test result until their result is known to be negative, or 14 days if they are a close contact of a confirmed case.
Once COVID-19 is present in a community it is essential that physical distancing advice is followed as much as possible to reduce the risk of transmission to others, including those most at risk (anyone over 50 and anyone living with a chronic health condition). Information on physical distancing is available on the AH&MRC website.
Key messages include the importance of remaining socially connected while avoiding work or school when unwell, avoiding social gatherings and supporting those with risk factors to remain home as much as possible. Communication resources on COVID-19 are also available on the AH&MRC website.
Media releases may assist with circulating an update on the local situation to stakeholders and community members. Key considerations include:
- not divulging any potentially identifiable information from the case
- not using any language that will unnecessarily inflame tensions or increase anxiety
- using the opportunity to reiterate important public health messages.
Your local Public Health Unit can also assist with messaging and content.