The BOP COVID-19 Community Case Management in Adults Model

The BOP COVID-19 Community Case Management in Adults Model

Pathlab notifies both Toi Te Ora AND the patient’s GP of a positive case

Safe to isolate at home Toi Te Ora:

- Notifies Patient they are positive - Safety Assessment and Contract Tracing - Identify where patient will isolate Not safe to isolate at home

CIQ

Refer to Covid Primary Response Team to co-ordinate clinical response

Refer to Community Hub to co-ordinate welfare care In EBOP the clinical and welfare response will be coordinated by Quay Street Community Hub

General Practice undertakes Initial Virtual Assessment.

Identified as Level 1 (Asymptomatic / Mild), Level 2 (Moderate Symptoms / At risk of complications) Refer to hospital if High Risk

Patient sent information pack and pulse oximeter and/or welfare supports if applicable.

Version One. 25 November 2021.

10-14 days, provided the previous 72 hours are symptom free Level 1: regular virtual health check Level 2:Regular more frequent virtual health check, supported by multi-disciplinary team.

Discharge and Follow Up

5

Process for COVID-19 patient care in the community

The current process is for people with COVID-19 to be cared for in a Community Isolation and Quarantine (CIQ) facility, or in the community (either at home or a temporary accommodation) under Community-supported Isolation and Quarantine (C-SIQ).

Positive Test Result and Public Health Role

• When a person tests positive for SARS-CoV-2, the lab notifies Public Health and the patient’s GP. • Public Health then:

• contacts the patient to assess their public health risk, initiate contact tracing and decides if the patient can isolate at home under C-SIQ or needs to go to an CIQ facility. • makes a manaaki/welfare referral to the Community Hub if required, e.g. for food, care of pets, mental health and disability support. • refers the patient to the CPRT to coordinate their clinical review if they are remaining in the community.

Community Management – Covid Primary Response Team (CPRT)

• The CPRT will contact the practice where the patient is enrolled, or identify a service who can deliver care to a patient that is not enrolled locally, to initiate the virtual clinical assessment process • Ideally, patients will be cared for by their usual primary care practitioner. Where this is not possible an alternative provider will be identified for their covid related care. Where there are multiple patients isolating at the same address a single provider will be identified, where possible, to ensure continuity of care to the household. • Following virtual assessment the practice will send an email to the CPRT confirming the Provider delivering care, the Level of Care (1 or 2), and whether a pulse oximeter is required. Note, a practice can report Shared Care if they are running a daily Doctor on Duty model. • The CPRT will co-ordinate delivery of the pulse oximeter to the patient if required.

Community Management - Practice Role

• Following referral from the CPRT, the practice starts the process of regular clinical review of patients who can safely isolate at home or in temporary accommodation.

• Ideally the initial assessment should be undertaken by an NP or GP, ongoing assessment can be delegated to the nursing team with NP/GP oversight as required. • Clinical care and assessment tools, based on Midland HealthPathways are provided in this document. • Inform the CPRT team via email confirming the Provider delivering care (this could be a shared care model), the Level of Care (1 or 2), and whether a pulse oximeter is required. • Patients identified over the weekend will be managed by an alternate provider until formal handover can be made.

• Weekend review of known patients should ideally be managed by the practice.

Where this is not possible care will need to be handed over to an alternate provider (details on this process TBC) • If your patient is also under the care of other services, eg Hospice, District nursing please can you let these teams know, where possible.

• If you suspect the patient is not known to Public Health (or has not yet been contacted by Public Health) advise patient and their household to self isolate immediately while waiting for input from Public Health staff and

Contact Public Health.

• If you identify unmet social or welfare needs, contact the Community Hub. • Ensure the patient has been provided with the Covid Community Care Patient handbook - can be sent electronically or from the Community Hub. • For non urgent virtual advice contact the on call medical SMO via switchboard

WBOP 07 579 8044

Discharge from Hospital Care

1. Following hospitalisation with COVID-19 a patient may be discharged back into community self isolation to complete their recovery. The hospital will inform Public

Health and the CPRT at discharge. The CPRT will liaise with the relevant general practice to ensure ongoing care in the community.

2. These patients are automatically COVID-19 Care 2 for the remainder of their review period. The referring clinician will advise where the patient is in their illness. ToC is done at discharge, the patient will have a copy and the GP will be sent this electronically. Patient’s will also be provided with information packs for community care at point of discharge. 3. Recommend that unvaccinated or partially vaccinated patients have COVID-19 vaccination 4 weeks after recovery or, asymptomatic patients have vaccination 4 weeks after the first confirmed positive COVID-19 test, unless contraindicated. a. The duration of protection from COVID-19 infection is unknown. b. It is uncommon to become re-infected with COVID-19 within 6 months of infection, and the risk is further reduced by vaccination.

Release from Community Monitoring

Patients are cleared for release from self-isolation by the team providing their community management care, once they have met the relevant criteria. For:

• Fully vaccinated cases, the isolation time is 10 days, provided the previous 72 hours were symptom free. • Unvaccinated cases, the isolation time is 14 days provided the previous 72 hours were symptom free.

The counting of the days starts from the day of diagnosis which is day 0. Day 0 is the first day of symptoms, or day when positive covid test was done, whichever comes first. The handover from public health will include day 0 date for each case.

Please inform your local Covid Primary Response Team when cases are released. They will then coordinate with Public Health who will update the National contact tracing system.

Any queries about release from community management should be directed to Public Health.

Please also inform To Te Ora if there are any public health concerns, i.e. compliance issues, questions about isolation/testing.

Release from Isolation

If there are others in the house also self-isolating then there is an additional 10 days self isolation at the end of the recovery time of the positive case to ensure no new positive

cases develop amongst the household. The recovered patient has to remain in isolation throughout this time as well.

There may be instances where people are isolating in the same ‘household’ but doing so in complete isolation from the case. In this scenario, the additional 10 days isolation does not apply.

• An example where this might apply would be if they live on a farm and the household close contact is isolating in a separate building to the case. Everyone will need to follow public health advice to make sure there is absolutely no contact with the case(s) till case(s) are recovered.

Household contacts only have to isolate from their last exposure day and they require 10 days isolation and a swabbing regime which is immediate, day 5 and day 8.

From a contact tracing perspective, Toi Te Ora do their best to complete a thorough investigation over multiple phone calls but there are instances when cases remember more/new details regarding where they have been. If cases are report that they have been somewhere while infectious, and they forgot to tell public health during our interviews, please inform Toi Te Ora, generally via the email above. Call if deemed urgent, or high risk places. i.e. high risk places: hospitals, prisons, age care facilities etc.

Long term Management Following Covid Infection

Long term care following Covid-19 infection is not covered within this guide. It is recommended that any patient who required hospital admission has a telephone or inperson follow-up within 6 weeks of discharge for patients to assess trajectory of recovery.