ALERT #12 Coronavirus disease 2019 (COVID-19) - CDC PHU NT
Change in case definition, risk stratification of countries that pose risk of transmission and new travel and contact management actions and inclusion of Aboriginal and Torres Strait Islander community advice section in the SoN
Dear Clinicians,
This is an update on the novel coronavirus disease 2019 (COVID-19). The advice offered here regarding COVID-19 may change depending on the progression of the outbreak.
Current Situation
As of 4 March the global cases of COVID-19 numbered 92,761 including 3,197 deaths. Of the total cases, most are from China with the other 12,491 cases reported across 78 countries. There are 45 confirmed cases in Australia, 10 cases including 1 death associated with returned travellers from the Diamond Princess in Japan, 12 cases with a direct/indirect travel link to Iran, 5 cases with a travel to other countries and 3 cases with no history of overseas travel (1 healthcare worker, 1 contact of this case and 1 aged care worker). On 4 March a tourist in Darwin with recent travel in Singapore and Jakarta, tested positive and was hospitalised at RDH with mild symptoms. There are a limited number of contacts.
What has changed since the Alert #11?
The COVID-19 National Guideline for Public Health Units, updated on 03 and 04 March, has changed the Case Definition substantially so
- there are now 3 categories (A, B and C) for suspect cases whereas before there was just A.
- there is no longer a category of persons under investigation and
- in the list of countries that pose a risk of transmission clinicians should note the criteria includes persons who have travelled ‘or transited through’ a country that poses risk for transmission in the past 14 days and who have a clinically compatible illness.
Additionally the list of countries that pose a risk of transmission are now stratified to higher and moderate risk.
Higher risk countries are: Mainland China, Iran, Italy and South Korea.
Moderate risk countries: Cambodia, Hong Kong, Indonesia, Japan, Singapore, Thailand.
Case Definition
Confirmed case - Person who tests positive to a specific SARS-CoV-2 PCR or has virus identified by electron microscopy or viral culture, at a reference laboratory.
Suspect case - requires epidemiological and clinical criteria to be met.
Epidemiological criteria
- Travel to (including transit through) a country considered to pose a risk of transmission in the 14 days before the onset of illness OR Close or casual contact* in the 14 days before illness onset with a confirmed case of COVID-19
Clinical criteria
- Fever, OR
- Acute respiratory infection (e.g. shortness of breath or cough) with or without fever or history of fever
If the patient has severe community-acquired pneumonia (critically ill) and no other cause is identified, with or without recent international travel, they are classified as a suspect case.
If the patient has moderate or severe community-acquired pneumonia (hospitalised) and is a healthcare worker, with or without international travel, they are classified as a suspect case.
*For close or casual contact definition see National Guidelines
For ALL people who meet the Case Definition CALL NT CDC 08 8922 8044 (or via RDH switch 08 8922 8888 after hours and at weekends) for testing and isolation advice. If you think a patient who does not fulfil the case definition should be tested, contact CDC as above.
These changes have a flow on affect for management of travellers and healthcare workers returning from countries considered to pose a risk which is summarised in Table below. Also, there is now advice included under section ‘7. Special situations’ for Aboriginal and Torres Strait Islander communities.
Table: Actions for travellers and healthcare workers returning from countries considered to pose a risk of transmission.
| Risk | Country | General Actions | Action for Hospital and/or Residential/Aged Care facilities* |
|---|---|---|---|
| Higher Risk |
Mainland China Iran | Self-quarantine for 14 days | No work for 14 days |
| Higher Risk |
Italy South Korea |
Self-monitor for 14 days Practise social distancing Isolate if unwell | No work for 14 days |
| Moderate Risk |
Cambodia Hong Kong Indonesia Japan Singapore Thailand |
Self-monitor for 14 days Practise social distancing Isolate if unwell | Can return to work if well |
*People working in hospitals or aged/residential care facilities who have patient contact
Important points for clinicians to note:
- A person who does not have clinical symptoms should NOT be tested
- Do NOT send patients who do not need hospitalisation to hospital EDs to get tested. Please call CDC 89228044 for assistance.
- Well returned travellers who have finished 14 days of self-quarantine do NOT need clearance letters. See page 12 in the COVID-19 National Guidelines for Public Health Units
How do you manage a suspect case?
- If you suspect a patient has COVID-2019 you should:
- Place a surgical mask on the patient and ask them to perform hand hygiene.
- Use contact and droplet precautions, including close attention to hand hygiene.
- Use a P2/N95 mask, if available (being very precautionary), or surgical mask if not available.
- Isolate the patient in a single room with the door closed, or if in hospital in a negative pressure room where available.
- For respiratory specimen collection use airborne transmission precautions with a P2/N95 mask and disposable gown, gloves and eye protection. See National Guidelines for details.
- Patients with clinical signs suggestive of pneumonia should have specimen collection done in a negative pressure room in a hospital.
- Routine tests for acute pneumonia/pneumonitis should be performed where indicated, including bacterial cultures, acute and convalescent serology, urinary antigen testing and extended virus PCR panel for respiratory viruses.
- DO NOT USE NEBULISERS with people under investigation, suspect or confirmed cases, use a spacer.
What specimens are best?**
- 2 upper respiratory samples, details included in latest SoNG (always get 2 swabs-1 x nose and 1 x throat).
- Lower respiratory tract sample if the lower tract is involved (sputum, tracheal aspirate, bronchoalveolar lavage, pleural fluid).
- On pathology form write ‘COVID-19 PCR’ +/- other viral PCRs as indicated.
Samples are to be sent for testing to RDH pathology laboratory. For GPs this involves contacting your usual specimen collector who will then transport the specimens to RDH.
**Whole blood/serum collection for storage and future testing where possible (currently not for children under 15 years of age)
Make sure you have called NT CDC on 08 8922 8044 or after hours through RDH switchboard on 08 8922 8888 so NT CDC staff are aware of suspect cases and the RDH laboratory is prepared for testing.
Suspect case patients not requiring hospitalisation who are awaiting laboratory results should be within 1 hour drive (preferably by sealed road) from Alice Springs, Katherine, Nhulunbuy or Darwin and should NOT go to remote Aboriginal Communities and should seek accommodation elsewhere. Call NT CDC on 08 89228044 to discuss.
Who should be quarantined or isolated and where do they stay? And what about workers in hospitals and residential/aged care facilities?
People who are well and have either returned from mainland China or Iran or have been a close contact of a confirmed case in the last 14 days need to self-quarantine at home for 14 days. New actions for travellers and workers in hospitals and residential/aged care facilities are summarise in the Table as above.
People in self-quarantine should remain within 3 hours drive (preferably by sealed road) from Alice Springs, Katherine, Nhulunbuy or Darwin. They should NOT go to remote Aboriginal communities. Those who reside further than 3 hours away from these towns or in remote Aboriginal communities should seek accommodation elsewhere. Call NT CDC Public Health Unit on 08 89228044 to discuss.
Returned travellers or close contacts who fulfill the suspect case definition should be isolated and managed according to the current recommendations for a suspect case as above.
For more information:
- Visit the Australian Government Department of Health webpage at https://www.health.gov.au
- The general public who want more information or are concerned about their health can call the COVID-19 health direct line on 1800 020 080 or visit https://www.healthdirect.gov.au/coronavirus
- GPs can access further information at the RACGP website https://www.racgp.org.au/coronavirus
- For NT level patient management enquiries call the NT Centre for Disease Control at 08 8922 8044.
Yours sincerely,
Dr Vicki Krause
Director, Centre for Disease Control-Environmental Health, Public Health Unit, TEHS, Darwin