COVID-19 (Coronavirus disease 2019)

This page provides COVID-19 guidance for the health sector. COVID-19 information for the public is available on Better Health Channel. There you will find information on preventing COVID-19, what to do if you are unwell or have tested positive for COVID-19 or have come in contact with a case.

Notification requirement for COVID-19

COVID-19 is a routine notifiable condition under the Public Health and Wellbeing Regulations 2019. Pathology services must notify all cases to the Department of Health within 5 days. Notification is also required weekly for all tests performed in relation to COVID-19, this notification must be in writing within 5 business days of the end of that period. Medical practitioners are not required to notify cases of COVID-19.

Primary school and children's services centre exclusion for COVID-19

Children diagnosed with COVID-19 are recommended to isolate. They should not attend school or childcare until 5 days after the date of the positive PCR or rapid antigen test result for COVID-19 and until acute symptoms of COVID-19 have resolved.

Acute symptoms include:

• runny nose
• sore throat
• cough
• shortness of breath
• fever, chills and/or sweats.

Infectious agent of COVID-19

SARS-CoV-2 is the infectious agent that causes COVID-19 (coronavirus disease 2019). SARS-CoV-2 is a novel coronavirus that was first identified in humans in Wuhan, China, in December 2019.

Novel variants and sub-variants of SARS-CoV-2 have emerged since 2019, affecting transmissibility, the ability of the virus to cause infection and severe illness despite vaccine and naturally derived immunity (immune escape), clinical presentation and the performance of diagnostic and/or therapeutic interventions.

Identification of COVID-19

Clinical features

COVID-19 usually presents with symptoms similar to other acute respiratory infections (ARI) as defined by recent onset of new or worsening of acute respiratory and other symptoms, such as:

• cough
• runny nose
• breathing difficulty
• sore throat
• chills and/or sweats
• fever (≥37.5°C) can occur but is less common in the elderly.

Other symptoms may include:

• headache, muscle aches, fatigue, nausea, vomiting, diarrhoea, loss of smell and taste, loss of appetite
• In the elderly, other symptoms to consider include new onset or increase in confusion, change in baseline behaviour, falling, or exacerbation of underlying illness.

Symptoms can take days to weeks to resolve. Some people may have no symptoms.

Increasing age is the most important risk factor for severe illness, with risk significantly increasing around 60-70 years of age. People who are unvaccinated or who have not been vaccinated recently are at greater risk of severe illness.

Risk of severe illness also increases with the number, severity, and nature of comorbidities such as diabetes, heart diseases and obesity, immunosuppression, disability, and frailty. Pregnancy is a risk factor for severe illness. Males also have a higher risk of severe illness.

SARS-CoV-2 can cause severe complications including pneumonia, acute respiratory distress syndrome (ARDS), complications affecting other organ systems, and long-term health issues.

Long COVID

Long COVID is a multi-organ condition that some people have after having COVID-19. Approximately 5-10% of people infected with SARS-CoV-2 continue to experience symptoms that last beyond 3 months after the initial infection or develop new symptoms weeks to months after their diagnosis. Long COVID is most common among people aged 35 to 70 years old.

There are a wide range of symptoms, such as fatigue, shortness of breath, changes in smell or taste, chest pain, difficulty sleeping, anxiety or depression, headache, and cognitive dysfunction. A significant proportion of people experience symptoms so severe it affects their usual activities.

COVID-19 can increase the risk of serious health problems for at least 12 months after getting sick, including a significantly increased risk of heart attacks, strokes or heart inflammation, blood clots in the lungs or elsewhere, kidney damage and severe mental health issues. COVID-19 can exacerbate pre-existing conditions including diabetes and chronic lung disease.

Diagnosis of COVID-19

A ‘confirmed case’ of COVID-19 is usually diagnosed by a positive nucleic acid amplification test (NAAT) for SARS-CoV-2. A confirmed case may also be diagnosed on isolation of SARS-CoV-2 in cell culture with confirmation using a NAAT, or SARS-CoV-2 IgG seroconversion, or a four-fold or greater increase in SARS-CoV-2 antibodies.

A ‘probable case’ is diagnosed by a positive rapid antigen test to SARS-CoV-2.

In this guideline a ‘case’ refers to both confirmed and probable cases.

Repeated infection with COVID-19 can occur. If a recovered case develops new symptoms of an acute respiratory infection within one month of recovery from COVID-19, they should remain at home until symptoms resolve. Those at higher risk of severe illness should seek advice from their doctor and undertake testing for COVID-19. They should consider testing for other respiratory viruses including influenza, to ensure they can access treatment, if eligible.

For surveillance purposes, a positive test notified within 35 days of a previously positive test is not considered a new case.

Incubation period

The median incubation period of ancestral strains of SARS-CoV-2 is 5 to 6 days, with a range of one to 14 days.

Studies have shown shorter median incubation periods for both Delta and Omicron variants of concern than ancestral SARS-CoV-2. The median incubation period for Omicron variants is approximately 3 days, with a range of 0-8 days.

Public health significance and occurrence

COVID-19 is a leading cause of death and hospitalisation in Victoria. Despite vaccination and other public health measures and use of antiviral medication in those at high-risk of severe illness, sustained community transmission of COVID-19 has been associated with significant excess mortality in Victoria, particularly since 2022.

Continual viral evolution coupled with waning vaccine and naturally derived immunity have resulted in repeated waves of increased infections, hospitalisations, and deaths every 3 to 6 months.

COVID-19 continues to have broad and significant impacts on health and care service provision and disproportionately impacts communities experiencing greatest socioeconomic disadvantage, First Nations people and culturally and linguistically diverse communities.

In addition to the impacts of acute COVID-19, long term impacts include poor health related to ‘long COVID’ conditions and symptoms.

Reservoir for COVID-19

A preliminary report to the World Health Organization suggests an animal origin of SARS-CoV-2 is likely.

There is currently widespread transmission of SARS-CoV-2 in humans across the globe. Multiple animal species have also been identified as potential reservoirs.

Mode of transmission of COVID-19

SARS-CoV-2 is primarily transmitted by exposure to aerosolised particles and infectious respiratory droplets.

Exposure occurs through:

• inhalation of aerosolised particles
• inhalation of respiratory droplets, deposits of respiratory droplets and particles on mucous membranes (mouth, nose, eyes), or touching of mucous membranes with hands directly contaminated with virus-containing respiratory fluids
• fomite transmission through indirectly by touching surfaces contaminated with virus-containing respiratory fluids.

Period of communicability of COVID-19

In general, a person who tests positive for COVID-19 may be infectious for up to 10 days but are most infectious in the 2 days just before their symptoms start, and while they have acute symptoms (runny nose, sore throat, cough, and fever). Most people infected with COVID-19 are still infectious after 5 days.

Individuals with severe illness or who are significantly immunocompromised may have prolonged infectious periods.

Susceptibility and resistance to COVID-19

Immunity to COVID-19 decreases with increasing time since infection and vaccination. Reinfection with new variants characterised by increasing immune escape may occur soon after recent infection.

There is evidence for increased protection for approximately 6 months against severe illness and hospitalisation in people with a recent history of natural infection or booster doses of vaccine.

A positive COVID-19 test 5 or more weeks after a previous positive test is considered a reinfection.

Control measures for COVID-19

Preventive measures

Important measures to prevent the spread of COVID-19 and reduce risk of severe illness include:

• Face masks and other personal protective equipment: a high-quality and well-fitted mask can protect the wearer and others from the virus. In high-risk settings such as healthcare and residential care, additional personal protective equipment may be recommended, based on the situation. A fit tested N95/P2 respirator mask will offer a higher level of protection.
• Vaccination:COVID-19 vaccines are safe and effective in protecting people against severe illness, hospitalisation, and death. People should remain up to date with recommended COVID-19 vaccinations. Some workers may be required to be fully vaccinated – see vaccination for healthcare workers. Workplaces may also continue to implement their own vaccination requirements.
• Ventilation: increasing fresh air by opening windows and doors, making use of existing heating and cooling systems to bring in fresh air, considering use of portable filtration units, such as HEPA (High Efficiency Particle Air) filters, and using ceiling and pedestal fans in combination with greater airflow such as open windows.
• Testing of symptomatic people and close contacts to enable protective behaviours, such as isolation.
• Isolation of people with symptoms until symptoms resolve. See 'Further information' below for resources which contain advice on isolation of COVID-19 cases.
• Treatment with antiviral medication for those at high risk of developing severe illness – see also consumer antivirals information.

Other measures include:

• personal hygiene practices to reduce transmission, such as hand and respiratory hygiene and surface cleaning and disinfection
• physically distancing and gathering outdoors.

For further information see:

• Health advice for consumers and workplaces
• Acute respiratory infection in residential care facility guidelines
• COVID-19 infection prevention and control guidelines

Control of case

Individual cases are managed by their doctor or other clinical team if required. Antiviral medication may be used in those at higher risk of developing severe illness.

A person diagnosed with COVID-19 should:

• isolate until 5 days after the date of the positive test result for COVID-19 and until resolution of acute symptoms of COVID-19. They should not attend a workplace or education facility during this time
• not leave isolation if experiencing acute symptoms of COVID-19: runny nose, sore throat, cough, shortness of breath, fever, chills and/or sweats
• not go to a healthcare facility or residential care facility for a period of 7 days and until resolution of acute symptoms of COVID-19
• not visit people at high-risk of severe illness for a period of 7 days and until resolution of acute symptoms of COVID-19
• have a negative rapid antigen test before visiting any healthcare facility, residential care facility or person at high risk of illness, taken on the day of attendance
• wear a face mask for 7 days after a positive test when they need to leave home, and are indoors, or unable to physically distance.

A negative rapid antigen test result is a helpful tool to determine if a case is likely to be no longer infectious but should be interpreted in conjunction with the case’s symptoms and duration of illness.

Cases should notify all close contacts in their household, their workplace and/or education facility, and any social contacts if there was contact during their infectious period.

People at high-risk of developing severe illness should seek medical advice about the use of antiviral medication to reduce the risk of hospitalisation or death. They are strongly recommended to test for COVID-19 as soon as they develop symptoms as antiviral medicines are most effective if taken rapidly after diagnosis.

See further down this page for advice about special settings such as aged and disability residential care facilities.

Control of contacts

Close contacts

Close contacts are at risk of developing COVID-19 in the days that follow their last close contact with a person who was infectious with COVID-19.

Close contacts are the people in the household of a case, or people who have spent more than 4 hours in a residential setting with a case during their infectious period.

From notification of exposure to the case, close contacts should:

• test regularly – if they develop any symptoms, they should stay home and take a test
• wear a mask when leaving the house for 7 days
• not visit healthcare or residential care facilities for 7 days
• if they are workers and required to work in healthcare or residential care facilities, including providing in home care to people at high risk of COVID-19, they should be asymptomatic and should undertake rapid antigen testing 24 hours apart, for 5 days out of 7 days, after being identified as a close contact
• if they cannot avoid visiting a sensitive setting, undertake a COVID-19 test before visiting and wear a face mask.

Social contacts

Social contacts are people who are not close contacts but have spent more 2 hours in an indoor space with a case or had 15 minutes of face-to-face contact.

Social contacts are recommended to test for COVID-19 if they develop any symptoms and stay at home until well.

See acute respiratory infection in residential care facility guidelines for further information for management of contacts in residential care settings.

People who have tested positive to COVID-19 in the 5 weeks prior to contact with a case are not considered a contact.

Control of environment

Information for cases and carers on infection prevention and control measures including isolation, hygiene measures and cleaning is available here:

• Better Health Channel

For more detailed information:

• COVID-19 infection prevention and control guidelines
• Acute respiratory infection in residential care facility guidelines.

Outbreak measures for COVID-19

Public health actions focus on outbreaks in high-risk settings, in particular aged and disability residential care (see Special settings).

Outbreaks of COVID-19 within residential care facilities should be notified to the Department of Health or Local Public Health Units (LPHUs). An outbreak in a residential care facility is defined as 2 or more residents testing positive within a 72-hour period. Notification can be done online through the outbreak notification form.

See also Management of Acute Respiratory Infection outbreaks, including COVID 19 and influenza, in residential care facilities (RCFs).

Other settings including health services, workplaces and educational settings are also recommended to report outbreaks if risks related to multiple cases are identified, such as critical service failures, or cases or exposed persons are at high risk of serious disease.

Workplaces should follow advice from Worksafe.

See also the COVID-19 infection prevention and control guidelines.

Special settings

Healthcare and residential care settings

Preventive measures such as vaccination, ventilation, isolation of people with symptoms and mask use are particularly important in healthcare and residential care facilities.

Healthcare and residential care settings are strongly recommended to optimise ventilation in indoor settings to protect people at high-risk – see guidance on optimising ventilation.

Healthcare and residential care settings are also strongly recommended to manage resident/inpatient cases under appropriate precautions for at least 7 days.

In workplaces such as health services, primary care, community care, residential aged and disability care, and emergency services, if either the staff/visitor/client case or the people who interacted with a case were correctly wearing a P2/N95 mask for the duration of contact, and there are no concerns of PPE (Personal Protective Equipment) breach, they are generally considered neither social nor close contacts.

Further recommendations

There are extra recommendations for people visiting or working in healthcare and residential care settings. These are places where there are many people vulnerable to the severe effects of COVID-19, including:

• residential care facilities, including aged care, disability, and other services
• healthcare premises, including when healthcare services are provided in people’s homes
• other care facilities.

These settings should have policies to help manage the risks associated with COVID-19, including use of masks, testing prior to visiting, and management of cases and contacts.

Asymptomatic staff testing is not recommended during periods of low COVID-19 transmission risk unless required for staff working in certain high-risk areas (with high number of immunocompromised patients such as oncology wards) as determined by the health service.

Asymptomatic staff testing should be considered in specific circumstances, such as during an outbreak, during periods of high COVID-19 transmission risk or for those working in high-risk areas (i.e., oncology ward) as determine by the health service. The frequency of testing should be determined by health services in accordance with the risk posed to patients and other staff. During periods of low transmission risk, visitor restrictions and testing may not be necessary in most areas of the health service, except in areas of elevated clinical risks (i.e., visiting immunocompromised patients in oncology, dialysis wards etc.).

All visitors should have access to face masks upon entry to a health service. Surgical masks may be adequate for most areas however health services should consider P2/N95 respirators for visitors in high-risk areas as determined by health services.

Health services should advise that people with symptoms of an acute respiratory infection or who have been diagnosed with COVID-19 should not visit the health service, except in exceptional circumstances (see below).

Health services should consider implementing visitor restrictions (for example, up to 2 visitors per patient) during periods of high transmission risk or in areas of elevated clinical risk (where there are high numbers of immunocompromised patients i.e., oncology wards) to reduce COVID-19 transmission.

Additional mitigations should be in place to minimise the risk of transmission to patients and healthcare workers. These include:

Requiring a negative COVID-19 Rapid Antigen test (RAT) as a condition of visitor entry, particularly in high-risk areas,

Requiring visitors to wear a P2/N95 respirator during their visit.

Limiting the location of visitation – such as to within the patient’s room only or in outdoor spaces where feasible, avoiding indoor common areas

The decision to allow visitors to a patient suspected or confirmed to have COVID-19 should be managed on a case-by-case basis in conjunction with the treating medical team and the health service Infection Prevention and Control team where possible. If the patient is suspected or confirmed to have COVID-19, appropriate personal protective equipment (PPE) must be used by the patient and their visitors and additional mitigations put in place to reduce the risk of transmission: see Infection prevention and control resources.

Health services may request individuals should not visit anyone in healthcare settings, if they:

• have been diagnosed with COVID-19 in the last five days
• have had known contact with a person who has COVID-19 in the previous five days
• have symptoms of acute respiratory infection such as:
• a temperature higher than 37.5 degrees
• breathing difficulties such as breathlessness
• cough
• sore throat
• runny nose

In exceptional circumstances visitation may be permitted, such as to support end-of-life visitation or to care for a hospitalised child or dependent, additional mitigations should be in place to minimise the risk of transmission to staff and patients (incl. wearing a face mask – preferably an N95/P2 respirator and avoiding indoor common areas.

Masks

Staff - Health services should employ risk assessment in determining masks requirements in public facing areas (e.g., visitors enquiry desk). Health services may consider not employing mask requirements during periods of low community COVID-19 transmission risk. In periods of high community COVID-19 transmission risk health services should require public facing staff to wear masks, with the choice of mask at the individual’s or service’s discretion and in accordance with their fit test profile.

Individual staff choice to wear a mask should be maintained in other non-patient, non-public facing areas e.g., corporate support offices. Masks (both surgical masks and P2/N95 respirators) should be made available to all staff to support staff choice and risk (e.g. contacts attending the workplace).

Visitors - Surgical masks may be adequate for most clinical areas however health services may consider P2/N95 respirators for visitors in high-risk areas (i.e. wards with high numbers of immunocompromised patients) as determined by health service or during periods of increased transmission risks.

People with COVID-19 symptoms

People with COVID-19 symptoms or who have tested positive should not visit healthcare and residential care settings or with people at high risk of illness due to COVID-19 for at least 7 days after their positive COVID-19 test and until resolution of acute symptoms of COVID-19.

Close contacts

Close contacts should not visit during their 7-day close contact period.

Workers

Workers who are confirmed cases.

Health services should have a requirement that workers who are confirmed COVID-19 cases do not attend the workplace for a minimum of 5 days (return on day 6) following the onset of symptoms (or date of the first positive test if asymptomatic) and until the resolution of acute symptoms.

On the worker's return, on day 6 and until 10 days following the onset of symptoms (or date of first positive test if asymptomatic), additional mitigations should be required by health services. This includes the worker being required to use a P2/N95 respirator and have separate breakout areas, where possible. Additional RAT (Rapid Antigen Testing) testing may also be considered to support decision-making regarding a worker returning to work.

Health services can consider allowing an earlier return to work in circumstances where a worker's attendance at work is required to prevent a significant risk to safe service delivery. In these situations, a local risk assessment should be undertaken, and additional mitigations should be in place including the worker:

• wears a P2/N95 respirator
• is asymptomatic (or all acute symptoms having resolved)
• returns a negative COVID-19 RAT
• uses separate breakout areas.

Staff must never be compelled to return to work when unwell.

Workers who are close contacts

Routine isolation of workers (or patients) who are close contacts is not required. This includes workers providing in-home care to people at high risk of COVID-19.

Health services should make it a requirement for close contacts to wear a P2/N95 respirator for 7 days after the exposure (or date of diagnosis of the first case within the household if cohabitating with the first case).

Workers who are close contacts should undertake rapid antigen testing (RAT) 24 hours apart, for 5 days out of 7 days, after being identified as a close contact and test when symptomatic.

Routine asymptomatic testing of staff is not supported when COVID-19 transmission risk is low. It is recommended that individual health services consider implementing staff surveillance testing in specific circumstances, such as during an outbreak.

Healthcare worker vaccination

Health facilities should implement a COVID-19 staff vaccination program that is in line with current Department of Health guidance, see Vaccination for healthcare workers. Workers in sensitive settings are particularly recommended to keep their vaccination status up to date. Use of rapid antigen testing to manage risk

A negative rapid antigen test result is a helpful tool to determine if a case remains infectious:

• If it is essential that a case or close contact visits a sensitive setting, they should undertake a COVID-19 test prior to their visit.
• Workers who are cases should have a negative rapid antigen test prior to returning to work in sensitive settings If positive, the case should stay home and seek advice. Return to work is not recommended for a minimum of 5 days (return on day 6) following the onset of symptoms (or date of the first positive test if asymptomatic) and until the resolution of acute symptoms.
• Additional testing to determine release from isolation may be considered for those severely unwell in hospital or residential care facilities, or those with severe immunocompromise, and may also be considered for other cases in residential care settings with residents at high risk from COVID-19 infection, depending on the risk assessment of the situation.

For residential care facilities, see also Management of Acute Respiratory Infection outbreaks, including COVID 19 and influenza, in residential care facilities (RCFs).

Workplaces

COVID-19 cases should notify their workplace if they are diagnosed with COVID-19 and attended an indoor space at the work premises during their infectious period.

Workplaces should have policies to help manage the risks associated with COVID-19.

Education facilities

Education facilities include childcare or early childhood services, outside school hours care services, schools, and school boarding premises.

COVID-19 cases should notify their education facility if they are diagnosed with COVID-19 and attended an indoor space at the facility during their infectious period.

Education facilities should have policies to help manage the risks associated with COVID-19.

Cruise ships

Specific guidance is available for industry for the prevention and management of COVID-19 outbreaks on cruise vessels.

Guiding principles for visitor arrangements in healthcare settings

This information outlines the Department of Health’s (the department) guiding principles for health services to consider in developing local policies on visitor arrangements. It aims to optimise sector consistency that balances patient needs for connection with family and friends with the safety of patients, staff and visitors.

Background

Healthcare settings are at high-risk of COVID-19 transmission. This results in severe disease, death, increased demand upon healthcare resources, staff illness and absence which in turn impacts service operations. Restriction on health service visitation is an appropriate strategy, to minimise community transmission (from visitors) to patients and healthcare workers. Implementation requires consideration of patient’s care needs and the benefit provided by visitation.

As Victoria transitions to enduring COVID-19 policy settings, health services are encouraged to develop local visitation policies that are informed by the principles for visitor arrangements and underpinned by a comprehensive risk assessment.

In developing local visitation arrangements, health services are encouraged to consider the following principles:

Visitors are an essential part of the provision of care - providing patients with support from their family and loved ones to improve health and wellbeing outcomes and minimise isolation and its impacts.

Visitors provide purposeful support necessary for the patient’s emotional, physical, and mental wellbeing - maximising effective communication between clinical teams, patients, and their families.

Safety is important for patients, staff, and visitors - providing measures to optimise safety and minimise infection transmission risk for all patients, staff and visitors, including protecting vulnerable patients from potential exposure to COVID-19.

Scope

This guidance applies to visitation of all patients/residents in the following Victorian healthcare settings, including patients or residents that have or are being treated for COVID-19. The guidance acknowledges that there may be other sector specific guidance (for example, Commonwealth advice) that may also need to be considered.

• Acute/sub-acute healthcare (inpatient and ambulatory)
• Ambulance and patient transport
• Community health care
• Disability residential care
• Mental health in patient services
• Public Sector Residential Aged Care Services (PSRACS)

Health service risk assessment

In assessing COVID-19 transmission risk, health services should apply local risk assessment to guide decision making for local visitor arrangements. This should consider:

• COVID-19 activity in the community – supported by Department of Health guidance
• COVID-19's impact upon the health service – including outbreaks, hospitalisation rates, staffing and operations
• clinical vulnerability of patients
• patient’s location in the health service (i.e., high risk area such as an oncology ward)
• environmental factors such as ventilation, ward/room layout, size, and other features

The following strategies are recommended based on the outcomes of the local risk assessment:

Low transmission risk

During periods of low transmission risk, visitor restrictions and testing may not be necessary in most areas of the health service, except in areas of elevated clinical risks (i.e., visiting immunocompromised patients in oncology, dialysis wards etc.).

As per the department’s Infectious Prevention and Control (IPC) Guidelines, all visitors should have access to face masks upon entry to a health service. Surgical masks may be adequate for most areas however health services should consider P2/N95 respirators for visitors in high-risk areas as determined by health services.

Health services should advise that people with symptoms of an acute respiratory infection or who have been diagnosed with COVID-19 should not visit the health service, except in exceptional circumstances (see below).

High transmission risk including areas with elevated clinical risks

Health services should consider implementing visitor restrictions (for example, up to 2 visitors per patient) during periods of high transmission risk or in areas of elevated clinical risk (where there are high numbers of immunocompromised patients i.e., oncology wards) to reduce COVID-19 transmission.

Additional mitigations should be in place to minimise the risk of transmission to patients and healthcare workers. These include:

• Requiring a negative COVID-19 Rapid Antigen test (RAT) as a condition of visitor entry [2], particularly in high-risk areas,
• Requiring visitors to wear a P2/N95 respirator during their visit.
• Limiting the location of visitation – such as to within the patient’s room only or in outdoor spaces where feasible, avoiding indoor communal areas

The decision to allow visitors to a patient suspected or confirmed to have COVID-19 should be managed on a case-by-case basis in conjunction with the treating medical team and the health service Infection Prevention and Control team where possible. If the patient is suspected or confirmed to have COVID-19, appropriate personal protective equipment (PPE) must be used by the patient and their visitors and additional mitigations put in place to reduce the risk of transmission: see Infection prevention and control resources.

When visiting should not be permitted

Health services may request individuals should not visit anyone in healthcare settings, if they:

have been diagnosed with COVID-19 in the last five days

have had known contact with a person who has COVID-19 in the previous five days

have symptoms of acute respiratory infection such as:

• a temperature higher than 37.5 degrees
• breathing difficulties such as breathlessness
• cough
• sore throat
• runny nose

In exceptional circumstances visitation may be permitted, such as to support end-of-life visitation or to care for a hospitalised child or dependent, additional mitigations should be in place to minimise the risk of transmission to staff and patients (incl. wearing a face mask – preferably an N95/P2 respirator and avoiding indoor communal areas. This should be managed on a case-by-case basis in conjunction with the treating medical team and the health service Infection Prevention and Control team where possible

Health services should ensure that their visiting arrangements are easily accessible through multiple media channels, including on websites and social media. Any person entering a healthcare setting should comply with the conditions imposed in relation to their visit to the health service.

Notification of visitors who test positive after their hospital visit

Health services should establish a process for visitors who are asymptomatic at the time of visit but test positive for COVID-19 shortly after their visit, to enable them to inform health services of their status as soon as possible. This process needs to be clearly communicated to the visitor upon entry to the facility and be available to them once they leave the service. Health services should follow their internal Infectious Disease Guidelines to reduce risk of incursion to patients and staff.

Guiding principles for routine asymptomatic COVID-19 testing of healthcare staff

This document outlines the Department of Health’s (the department) guiding principles for health services to consider in developing local policies for routine asymptomatic COVID-19 testing of healthcare staff. It aims to optimise sector consistency that balances health service protection from COVID-19 transmission with the cost associated with testing in the context of an evolving risk landscape and a strained fiscal environment.

Background

Healthcare settings are at high-risk of COVID-19 transmission. This results in severe disease, death, increased demand upon healthcare resources, staff illness and absence which in turn impacts service operations. Targeted asymptomatic surveillance testing of healthcare workers (HCW) is a strategy to assist with early detection of transmissions, with the aim of minimising onward transmission to other HCW and patients.

As Victoria transitions to enduring COVID-19 policy settings and in consideration of the amendments to COVID-19 special leave provisions from 1 October 2023, health services are encouraged to develop local policies for routine asymptomatic testing of HCW relevant to their risk environment.

Scope

This guidance relates to the following healthcare settings, noting there may be other sector specific guidance for community health and disability residential care (for example, Commonwealth advice) that may also need to be considered as relevant to the settings.

• Acute/sub-acute healthcare (inpatient and ambulatory)
• Ambulance and patient transport
• Community health care
• Disability residential care
• Mental health in patient services
• Public Sector Residential Aged Care Services (PSRACS)

A HCW worker is someone who works in healthcare settings providing direct or indirect care to patients. Healthcare workers can be triaged into risk Category A, B and C according to the table below. It includes full time, part-time, casual, visiting and agency staff.

Guiding principles for routine surveillance testing

Rapid antigen testing (RATs) is preferred over PCR testing for asymptomatic staff testing as it provides faster results and allows for the preservation of high-cost PCR tests.

The department recommends the following HCW testing strategies in accordance with the transmission risk environment, as determined by epidemiological data (i.e., COVID-19 related hospitalisations).

Asymptomatic testing during low transmission risk

Asymptomatic staff testing is not recommended during periods of low COVID-19 transmission risk unless required for staff working in certain high-risk areas (with high number of immunocompromised patients such as oncology wards) as determined by the health service.

Asymptomatic testing during high transmission risk

Asymptomatic staff testing should be considered in specific circumstances, such as during an outbreak, during periods of high COVID-19 transmission risk or for those working in high-risk areas (i.e., oncology ward) as determine by the health service. The frequency of testing should be determined by health services in accordance with the risk posed to patients and other staff.

Historic infections

HCW with a confirmed history of coronavirus (COVID-19) should be excluded from any asymptomatic surveillance program for a period of 5 weeks following diagnosis (the collection date of the first positive of test) of the case’s most recent COVID-19 infection. However, any HCW who develops symptoms consistent with COVID-19 during this time, should undergo RAT for case diagnostic purposes.

Health services considerations

• Include appropriate record keeping and reporting, governance, and evaluation processes to manage, oversee and continuously improve the surveillance program.
• Ensure RATs are stored appropriately in a cool, dry, dark, and secure location.
• Ensure availability and use of appropriate Personal Protective Equipment (PPE) by staff is in line with the department’s IPC Guidelines regarding testing if done onsite
• Put in place support processes and procedures for staff who may need to isolate following a positive test result.
• Include access to wellbeing and support programs for staff who may report distress as result of the regular testing requirement.
• Ensure testing is being conducted in a private area at designated times.