20211202_Managing_cases_household_contacts_in_primary_care_(2)

Managing cases and household close contacts in primary care Version 03, 2 December 2021 Given the rapidly moving nature of COVID-19 and public health response, this document will change and be updated as necessary.

Toi Te Ora contacts: • Non urgent: ttoimtclinicalcaseadvisor@bopdhb.govt.nz (8am - 5pm, 7 days a week) • Urgent: On call COVID-19 Clinical Case Advisor: 027 336 9159 (8am – 5pm, 7 days a week).

• After Hours: On call Health Protection Officer: 0800 221 555 Medical Officer of Health: via Tauranga Hospital switchboard

Covid-19 Cases Cases are referred from Toi Te Ora via referral form to PHO Single Point of Contact. Every referral includes household contacts (statistically about half of all household contacts become cases).

Isolation time period: • •

Fully vaccinated* cases: 10 days isolation (and symptom free for 72 hours before release) Unvaccinated cases: 14 days (and symptom free for 72 hours before release)

Day 0 is the first day of symptoms. If the case has been completely asymptomatic, Day 0 is the day of the swab. The clinical referral from Toi Te Ora includes the day 0 date.

Testing: • Once a person returns a positive swab result there is no point in having a further swab as the individual is likely to remain PCR positive for up to several months

Release: • • •

Occurs the day after the isolation period to ensure completion of isolation.

Primary care releases case, (letter template available).

Email TTOCRG.CCAAdmin@bopdhb.govt.nz with completed release checklist so we can update their national records.

Please contact Toi Te Ora if: • • •

Case is going to hospital or for palliative care Any public health concerns, ie compliance, questions about isolation/testing.

Case remembers a new location of interest they attended, especially if high risk, eg marae, hospital, prison, aged care facility.

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Household Close Contacts These are people that live with the case and have ongoing exposure with the case.

Primary care is responsible for following up household close contacts.

If household contacts can isolate completely away from case (ie in a room with separate bathroom, separate building, or caravan), their follow up will be by a public health provider (eg Healthline) who will do daily follow up and release phone calls.

Isolation and testing requirements are outlined in POL-002 (attached), ie isolate for 10 days following the last exposure to the case, and test immediately, on days 5 and 8 post exposure.

The only acceptable reasons for a contact to leave their place of isolation are • to get one of the required follow-up swabs, or • to access urgently needed health care.

A contact cannot attend a vaccination clinic during their period of isolation.

Isolation time period: •

Close contacts isolate during the case’s isolation PLUS for 10 days after the case is recovered and released from isolation.

Testing of Household members: • • •

Test immediately when case is identified and on case’s day 5 Test on days 5 and 8 after case released If symptoms develop at any time, get an additional test immediately

Release: • Occurs the day after the 10 days of isolation that started when the case left isolation, provided no • •

new or worsening symptoms AND negative day 8 test Note that a day 7 test is not acceptable for release, it must be day 8 or later.

Primary care releases contacts.

If there are new cases in the household: •

•

If a household contact becomes a case, Toi Te Ora will investigate the new case and send a referral for the new case to the PHO Single Point of Contact. The entire management plan is then repeated for the household contacts, ie everyone has to isolate for another 10 days and require additional swabs (immediate, days 5 and 8). In other words, the ten-day isolation clock for household contacts is reset to zero.

Primary care continues to follow up contacts and to ensure swabs are taken on the required days.

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Q&As Who takes the clinical lead if an isolating case/contact moves out of their DHB region and away from their usual GP due to accommodation issues?

Currently the referral goes to the PHO/GP where the case/contact usually lives. The PHO decides if this is appropriate as they have best clinical knowledge and rapport with the case/contacts. If the PHO recommends follow up by the PHO of new location, Toi Te Ora can help facilitate this.

Who takes the lead for an elderly close contact isolating at home with welfare and medical needs?

If the contact is isolating with a case they are included with the case for follow up.

If the contact is isolating alone, they will be followed up by a public health provider, eg Healthline, with daily phone calls. If welfare and medical needs are identified, the provider notifies Toi Te Ora and Toi Te Ora refers as required.

• If clinical concerns, Toi Te Ora will refer for PHO/GP assessment. The public health provider or Te Ora will continue to follow up (ie isolation, testing and release information) unless the PHO/GP advises or is requested to do daily follow up for clinical reasons. This will be referred as required.

Once a case has recovered, should the household contact stay with the GP or go back to Healthline for follow up?

The household contact stays with the GP as they are likely to become a case and the GP has rapport with them.

When a household contact leaves the house, what should the GP do?

Advise Toi Te Ora via email (ttoimtclinicalcaseadvisor@bopdhb.govt.nz) so that follow up can be organised (either by Healthline, Toi Te Ora, or another public health provider).

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