COVID-19 (Coronavirus disease 2019)

Notification requirement for COVID-19

COVID-19 is a routine' notifiable condition and must be notified by pathology services in writing within 5 days of laboratory confirmation. This is a Victorian statutory requirement.

In addition, pathology services are required to submit a weekly written notification of all COVID-19 tests performed, within five business days following the end of each reporting 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 stay at home and not attend school or childcare until their acute symptoms have resolved.

Infectious agent of COVID-19

SARS-CoV-2 is the virus that causes COVID-19 (coronavirus disease 2019).

Novel variants and sub-variants of SARS-CoV-2 have emerged since 2019. Variants are monitored and assessed for their potential to cause new waves and impact public health actions.

Identification of COVID-19

Clinical features

COVID-19 usually presents with symptoms similar to other acute respiratory infections, such as:

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

Other symptoms may include headache, muscle aches or pains, fatigue, nausea, vomiting, diarrhoea, loss of smell or taste and loss of appetite. In the elderly, symptoms may include changes in baseline behaviour or mental status, increased falls or exacerbation of underlying illness.

Symptoms usually resolve within days to weeks.

COVID-19 can lead to hospitalisation and cause complications including pneumonia, acute respiratory distress syndrome, other organ system impacts and long-term health issues.

Diagnosis

COVID-19 is diagnosed via:

• a nucleic acid amplification test (NAAT) for SARS-CoV-2
• isolation of SARS-CoV-2 in cell culture with confirmation using a NAAT
• a rapid antigen test (RAT), which can be readily accessed within the community.

COVID-19 re-infections can occur. If symptoms of acute respiratory illness recur, even if within one month of recovery, patients should stay at home until symptoms resolve. Those at higher risk of severe illness should seek medical advice and consider testing for COVID-19 and other respiratory viruses, such as influenza, to support timely access to treatment.

Incubation period

The incubation period of ancestral strains of SARS-CoV-2 is 5 to 7 days, and ranging from 1 to 14 days. Omicron-lineage variants have shorter incubation periods, usually averaging 3 to 4 days.

Reservoir for COVID-19

While the exact origin of SARS-CoV-2 is not fully understood, the World Health Organization considers the likely origin to be zoonotic. . Sustained person to person transmission is responsible for the spread of COVID-19 within the community.

Mode of transmission of COVID-19

SARS-CoV-2 is most commonly transmitted from person to person through the inhalation of aerosolised particles or respiratory droplets. Less commonly, transmission can occur from contact with contaminated fomites and surfaces.

Period of communicability of COVID-19

In general, people with COVID-19 are considered infectious from 48 hours prior to symptom onset (or positive test if asymptomatic) until they are free of acute symptoms, which may be up to 10 days.

People who are asymptomatic may still shed the virus and infect others over this period. People with severe illness or who are immunocompromised may have prolonged infectious periods.

Susceptibility and resistance to COVID-19

People can develop immunity against COVID-19 through infection and vaccination. This immunity wanes over time, particularly with immune-evasive variants and depending on individual factors.

Risk factors for severe illness and death from COVID-19 include:

• older age, with risk increasing significantly above 65 years
• chronic medical conditions such as diabetes, obesity, cardiovascular disease, respiratory disease, neurological disease, liver or renal disease, cancer and immunocompromising conditions
• pregnancy
• living in a residential aged or disability care facility
• living with disability
• Aboriginal or Torres Strait islander people.

Public health significance and occurrence

In Victoria, cases of COVID-19 occur throughout the year, with epidemic waves typically observed twice annually. Unlike other respiratory viruses such as influenza, COVID-19 does not currently follow a clear seasonal pattern. Instead, activity is influenced by ongoing viral evolution and the level of immunity in the population from vaccination and past infection. These factors contribute to repeated waves of increased infections, hospitalisations and deaths.

Since its identification in humans in late 2019, the novel coronavirus SARS-CoV-2 has undergone continual genetic evolution, resulting in the emergence of new variants and subvariants. These changes can affect the ability of the virus to spread, evade existing immunity and alter disease severity. Variants continue to be monitored globally and interventions such as COVID-19 vaccines need to be updated and administered to maintain population protection.

Control measures for COVID-19

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

• Vaccination: COVID-19 vaccines are safe and effective in protecting people against severe illness, hospitalisation, and death. Everyone is advised to remain up to date with recommended COVID-19 vaccinations.
• Face masks and other personal protective equipment: a high-quality and well-fitted mask can protect the wearer and others from SARS-CoV-2 virus. A fit tested P2/N95 respirator mask offers a higher level of protection. In high-risk settings such as health and residential care, additional personal protective equipment may be recommended.
• Ventilation: increasing ventilation in indoor spaces by opening windows and doors and using heating and cooling systems, ceiling and pedestal fans or portable filtration units such as HEPA (High Efficiency Particle Air) filters can reduce SARS-CoV-2 transmission.
• Testing: Testing symptomatic people to diagnose COVID-19 enables protective behaviours, such as staying at home and avoiding contact with others while unwell.
• Staying at home: people with symptoms should stay at home until acute symptoms resolve.
• Treatment with antiviral medication: people at increased risk of severe illness are recommended treatment with antiviral medication – see consumer antivirals information.

Other measures include:

• personal hygiene practices, such as hand washing and respiratory hygiene
• cleaning, disinfection or disposal of contaminated surface and objects
• physically distancing and gathering outdoors.

For further information see:

• Coronavirus (COVID-19) Victoria | Better Health Channel
• Acute respiratory infection in residential care facility guidelines
• COVID-19 infection prevention and control guidelines

Control of case

People with COVID-19 are managed by their treating doctor. Antiviral medication may be recommended for those are at increased risk of severe illness and is most effective when given early.

A person diagnosed with COVID-19 is strongly recommended to:

• stay at home until their acute symptoms have resolved (usually 5 to 7 days).
• wear a face mask when leaving the home while symptomatic.
• not visit people at increased risk of severe illness for 7 days and until acute symptoms have resolved.
• not visit people in hospital or a residential or disability care facility for 7 days and until acute symptoms have resolved
• inform people they were in contact with during their infectious period, including household, social, workplace and education facility contacts, of their potential exposure.

Most people with COVID-19 can be managed with supportive care including rest, staying hydrated and simple over-the-counter anti-pyretic and analgesic medication.

Control of contacts

The risk of developing COVID-19 increases with the duration and level of contact with an infectious case. People who have had close or prolonged contact with a case, such as household and household-like contacts, have the highest risk of developing COVID-19.

People exposed to COVID-19 are recommended to:

• monitor for symptoms for at least 7 days following their last contact with the case. If symptoms develop, seek prompt testing and stay at home until acute symptoms resolve.
• avoid visiting hospitals and residential or disability care facilities for at least 7 days. If this cannot be avoided, do a COVID-19 test (such as a RAT) before visiting and wear a face mask.
• practice good hand washing and respiratory hygiene.

Contacts working in hospitals and residential or disability care facilities should follow workplace policy and guidance on testing, mask-wearing and other precautions.

Long COVID

Long COVID,also known as post COVID-19 condition, is a chronic condition where people experience persistent symptoms after having COVID-19. Symptoms usually start within 3 months of the initial illness and last at least 2 months. Most long COVID symptoms resolve within months but some people may have persistent symptoms lasting up to years and other long-term health impacts.

While data are limited, the chance of developing long COVID appears to be lower now than earlier in the pandemic. It is estimated that 5% of people who have had COVID-19 may develop long COVID.

There are a wide range of symptoms. The most common include fatigue, muscle or joint pain, shortness of breath, coughing, chest pain, headaches and changes in smell or taste. People can also experience depression or anxiety as well as memory, concentration and sleep problems. These symptoms may affect someone's capacity to do their usual activities and impact their quality of life. Long COVID may also have long-term impacts on the lungs and heart and increase the risk of blood clots and diabetes.

There are no definitive diagnostic tests for long COVID and treatment is based on the management of symptoms through multi-disciplinary care.

Risk factors for long COVID are likely multifactorial and include older age, female sex, smoking, chronic medical conditions (such as asthma, chronic obstructive pulmonary disease, ischaemic heart disease, diabetes, obesity, chronic kidney disease, immunosuppression, anxiety and depression), previous hospitalisation or recurrent infection with COVID-19 or socioeconomic disadvantage. Younger age, vaccination and potentially antiviral treatment are thought to be protective factors.

Outbreak measures for COVID-19

Outbreaks of COVID-19 in residential care facilities should be notified to the relevant . An outbreak in a residential care facility is defined as 2 or more residents testing positive within a 72-hour period.

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

Healthcare, workplaces and educational settings can also report outbreaks if assistance is required. Workplaces should also follow advice from Worksafe Victoria.

Special settings

Health and residential care settings

Preventive and control measures are particularly important in healthcare services and residential aged or disability care facilities due to the high proportion of people present who are at increased risk of severe illness and the risk of transmission in these settings.

Services and facilities should implement and maintain policies, plans and practices to prevent and mitigate COVID-19 transmission risk in their settings:

• Vaccination: health and residential care workers are strongly advised to stay up to date with recommended COVID-19 vaccinations. Healthcare services are recommended to have staff vaccination programs in line with current Department of Health guidance, see Vaccination for healthcare workers.
• Ventilation: facilities should optimise ventilation in indoor settings, see guidance on optimising ventilation.
• Personal protective equipment (PPE): facilities are advised to consider workplace policy around the use of face masks or P2/N95 respirators and other PPE for staff, patients, clients and visitors based on the clinical context and transmission risk. This may include education and training on the use of PPE and mask fit testing for staff.
• Hygiene and cleaning practices: facilities should encourage good hand and respiratory hygiene practices and cleaning and disinfection practices.
• Case and contact management: facilities should consider the need for precautions in staff, patients, clients and visitors diagnosed with or exposed to COVID-19.

Further information specific to residential care settings is available in the Management of acute respiratory infection outbreaks, including COVID-19 and influenza, residential care facilities.

Further information on infection, prevention and control is available in the COVID-19 Infection Prevention and Control Guidelines.

Other workplace settings

General workplace settings are expected to maintain COVID-19 risk management policies in line with occupational health and safety obligations. Further information can be found at WorkSafe Victoria.

Cruise ships

Advice around the management of acute respiratory infections, such as COVID-19, on cruise ships is available on the prevention and management of COVID-19 outbreaks on cruise vessels guideline.

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, 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.