Context

Recommendations

All alternatives to visiting the community should be explored including:

If there are any feasible alternatives to visiting a lower prevalence area, they should be pursued. All HCWs entering a lower prevalence area from a higher prevalence area are potentially symptomatic or asymptomatic carriers of COVID-19. It is therefore critical in these settings to be ambitious about prevention and minimise transmission risk, despite the additional burden this may place on services.

The median incubation period for COVID-19 is estimated at 5 to 6 days (1). Most studies report a maximum incubation period of 14 days. International quarantine policies are based on the 14-day incubation period. However, one case study indicates that the incubation period may be as long as 24 days (2). If the incubation period can be greater than 14 days, an extended quarantine duration may be required to minimise the spread of COVID-19 (2).

Based on current best available evidence (3):

Given the risks associated with providing care while a symptomatic or asymptomatic carrier of COVID-19, HCWs should only travel from a higher prevalence area to a lower prevalence area if a visit is considered absolutely necessary. For example, this may include when a health service cannot meet the needs of the communityusing the combination of available staff providing in-person services and telehealth services by other HCWs, where relevant.

If a visit is considered absolutely necessary:

We recommend that to travel a higher prevalence area to a lower prevalence area for exemption, HCWs must not have experienced any of the signs or symptoms of COVID-19 (fever, chills, night sweats, or acute respiratory infection – including sore throat, cough, or shortness of breath) over the period of 14 days prior to entry. The rationale for including symptoms over the 14 day period prior to entry is that, under current guidelines, HCWs should be tested for COVID-19 if they have a fever (≥38°C, or history of fever) or acute respiratory infection (4).

HCWs should be aware of other symptoms of COVID-19 as they are identified. The Centre for Evidence-Based Medicine provides a ‘COVID-19 Signs and Symptoms Tracker’ that is updated as data emerges (5).

There are currently no guidelines specific to Aboriginal and Torres Strait Islander communities or to Australia on risk assessment on COVID-19 risk after exposure in the health care setting. Until local guidelines are developed, HCWs can assess their risk using the CDC (6) or WHO (7) risk assessment tools. 

If a visit is considered absolutely necessary:

As above, the Communicable Disease Network Australia (CDNA) COVID-19 guidelines (10) recommend that HCWs be tested for COVID-19 if they have experienced fever or respiratory symptoms. If HCWs have experienced symptoms in the last 14 days but return a negative PCR test for COVID-19 and are no longer symptomatic, they may enter a lower prevalence area, noting that: ‘A risk assessment should be undertaken for suspected cases who initially test negative for SARSCoV-2. If there is no alternative diagnosis and a high index of suspicion remains that such cases may have COVID-19, consideration should be given to continued isolation and use of the recommended infection control precautions, pending further testing’ (4).

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References

1.    Del Rio C, Malani PN. COVID-19—New Insights on a Rapidly Changing Epidemic. JAMA. 2020.

2.    Bai Y, Yao L, Wei T, Tian F, Jin D-Y, Chen L, et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA. 2020.

3.    Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Annals of Internal Medicine. 2020.

4.    Communicable Diseases Network Australia. Coronavirus Disease 2019 (COVID-19): CDNA National Guidelines for Public Health Units v. 2.5. Available from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htm. Communicable Diseases Network Australia. 2020. 26 March 2020.

5.    Centre for Evidence-Based Medicine. COVID-19 Signs and Symptoms Tracker. Available from: https://www.cebm.net/covid-19/covid-19-signs-and-symptoms-tracker/ Oxford, United Kingdom: Centre for Evidence-Based Medicine. 2020

6.    Centers for Disease Control and Prevention. Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19) 2020 [updated 7 March 2020]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html.

7.    World Health Organization. Health workers exposure risk assessment and management in the context of COVID-19 virus. 2020. 19 March 2020.