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Coronavirus (COVID 19): Advice for clinicians and Emergency Departments

  1. The objective of the Coronavirus (COVID 19) response in NSW is to detect all infected people and prevent transmission of the virus to others
  2. There are reports of Coronavirus (COVID 19) infection in people with no history of fever and who were a febrile at presentation
  3. Test for Coronavirus (COVID 19) in patients with respiratory symptoms, including mild respiratory symptoms,with or without fever,who have travelled to or transited through mainland China (excluding Hong Kong, Macau and Taiwan) in the 14 days before illness onset
  4. Patients can be discharged home in isolation while awaiting results
Situation update:
Infection can cause severe acute respiratory illness, but there is a spectrum of disease. Some confirmed cases have no history of fever and no fever at presentation, but there is no information about how commonly this occurs.
The current strategy is to broaden the testing criteria to test people who have been in mainland China (excluding Hong Kong, Macau and Taiwan) with symptoms of respiratory infection.
People who have travelled to or transited through mainland China (excluding Hong Kong, Macau and Taiwan) must isolate themselves at home for 14 days after departing China
Identify possible cases of Coronavirus (COVID 19):
1.Test patients who present with:
• A history of travel in, or transit through,mainland China (excluding Hong Kong, Macau and Taiwan) in the 14 days before illness onset, OR close contact with a confirmed case of Coronavirus (COVID 19),
• Acute respiratory infection (with at least one of the following symptoms: shortness of breath, cough or sore throat)regardless of fever.
Isolate and apply infection control precautions:
• Isolate suspect cases in a single room with negative pressure air-handling (if available).
• Use standard and transmission-based precautions (contact and airborne), including the use of a P2 mask, disposable gown, gloves and eye protection when entering a patient care area.
Arrange testing:
• Take combined nose and throat viral swabs or nasopharyngeal viral swabs; a lower respiratory tract sample (if obtainable) -sputum or an endotracheal tube aspirate; and EDTA blood and serum.
• Test for alternative causes, including respiratory viruses using multiplex PCR. Do not wait for local results before sending the Coronavirus (COVID 19) sample for testing. Even if local testing returns a positive result Coronavirus (COVID 19) testing should still be attended.
• Arrange for the specimens to be sent to Hospital.
• Seek specialist infectious disease advice on patient treatment.
Discharge home to self-isolation if admission not necessary clinically:
•Patients who clinically do not require admission who are tested can go home with advice to isolate wear a face mask and isolate themselves at home while awaiting test results. Where the home environment may not be suitable for this, discuss the situation with your local Public Health Unit. Provide the patient with information on home isolation

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