This document provides guidance for healthcare workers, staff, healthcare students and volunteers in NSW Health facilities who are returning from overseas travel, have been diagnosed with COVID-19, have been in contact with a COVID-19 case, or who develop an acute respiratory illness.

Travelled overseas in the past 14 days

From 11.59pm Saturday 28 March 2020, all travellers arriving in Australia from overseas are required to undertake a mandatory 14 day quarantine at designated facilities arranged by the NSW Government. Travellers will be transported directly to designated facilities after appropriate immigration, customs and enhanced health checks at the airport.

Confirmed COVID-19 case

Healthcare workers, staff, healthcare students and volunteers who have been diagnosed with COVID-19 should follow the home isolation guidance for people confirmed to have COVID-19 infection.

Contact with a COVID-19 case

All healthcare workers, staff, healthcare students and volunteers who have been in close contact with a confirmed case of COVID-19 in the previous 14 days must:

• self-isolate at home other than for seeking individual medical care for 14 days from the last day of contact
• monitor symptoms for 14 days since last contact
• if fever or respiratory illness (even if mild) occur, seek medical attention as soon as possible. Call the healthdirect helpline 1800 022 222 for advice or call ahead before seeing your GP or go directly to the local Emergency Department or COVID-19 clinic.

Acute respiratory illness in staff who have not travelled overseas in the last 14 days

Healthcare workers with acute respiratory illness should not work while they are symptomatic. This includes mild respiratory symptoms of recent onset and unexplained fever.

Healthcare workers who have fever or respiratory symptoms must immediately self-isolate and should not return to duties until medically assessed. The need for testing and further isolation should be assessed on a case by case basis.

Healthcare workers who have fever and respiratory symptoms must immediately self-isolate and should not return to duties until tested and cleared from COVID-19.

All local health districts must have systems in place to arrange for the rapid medical assessment and, if recommended, testing of health care workers for COVID-19.

Supervisors and managers must ensure that procedures are in place to ask every staff member at the beginning of each shift whether they have recent onset of respiratory symptoms or fever, and if so, to ensure staff who have symptoms are either excluded from work or assessed for COVID-19 and, if COVID-19 testing is recommended, to self-isolate until COVID-19 is excluded.

Australian Health Protection Principal Committee recommendations for managing vulnerable workers (30 March 2020)

The Australian Health Protection Principal Committee (AHPPC) on the advice of the Communicable Diseases Network Australia (CDNA) today considered provisions for essential workers who are considered to be most at risk of acquiring COVID-19 and at higher risk of serious illness if they become unwell.

Excluding healthcare settings where appropriate PPE and precautions are adhered to, the AHPPC considers that, given the transmission characteristics of the virus, the following settings are at higher risk of outbreaks of COVID-19:

• Correctional and detention facilities
• Group residential settings

AHPPC considers that, based on the limited current evidence, the following people are, or are likely to be, at higher risk of serious illness if they are infected with the virus: (1, 2, 3, 4)

• Aboriginal and Torres Strait Islander people 50 years and older with one or more chronic medical conditions
• People 65 years and older with chronic medical conditions.(5) Conditions included in the definition of ‘chronic medical conditions’ will be refined as more evidence emerges. The most current list can be accessed on the Department of Health website.
• People 70 years and older
• People with compromised immune systems (see Department of Health website)

There is limited evidence at this time regarding the risk in pregnant women.

AHPPC recommends that where vulnerable workers undertake essential work, a risk assessment must be undertaken. Risk needs to be assessed and mitigated with consideration of the characteristics of the worker, the workplace and the work. This includes ensuring vulnerable people are redeployed to non-customer based roles where possible. Where risk cannot be appropriately mitigated, employers and employees should consider alternate arrangements to accommodate a workplace absence.

AHPPC recommends that special provisions apply to essential workers who are at higher risk of serious illness and, where the risk cannot be sufficiently mitigated, should not work in high risk setting.

References

1. CDC COVID-19 Response Team. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep. ePub: 18 March 2020. https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm
2. Onder G, Rezza G, Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. JAMA. Published online March 23, 2020. doi:10.1001/jama.2020.4683
3. Zhonghua Liu Xing Bing Xue Za Zhi. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. CMAPH. Published online February 17, 20202. doi: 10.3760/cma.j.issn.0254-6450.2020.02.003
4. Australian Institute of Health and Welfare 2018. Australia's health 2018. Cat. no. AUS 221. Canberra: AIHW.
5. Recent evidence suggests the risk previously attributed to those over 60 is particularly in those over 65 and accordingly advice has been updated to recommend an age cut off of 65 with chronic disease.