COVID-19 Primary Care Update 08/06/2022
08 June 2022
Updated SA guidelines for access to National Medical Stockpile (NMS) COVID antiviral medications
The SA Health COVID-19: Medication Management of Mild Illness in the Outpatient setting Clinical Guideline has been updated and is now available on the COVID-19 Mild illness: Treatments and Referrals webpage. Of particular interest is a clearer alignment with PBS oral antiviral eligibility criteria and identification of which patients may benefit from access to NMS stock via online referral.
Resources for PBS prescribing of COVID oral antiviral medications
Please see the COVID Oral Antiviral Assessment Template (DOCX 26KB) which provides a basic autofill/acronym expansion that can be utilised in your practice software.
This template aims to assist with decision making and documentation of patient eligibility for PBS funded COVID oral antiviral medications. It is based on current PBS criteria and can be copied and customised within your own medical record software for use in consultations with COVID positive patients. It is not designed to provide a comprehensive assessment of symptoms, escalation criteria for acute illness or clinical suitability for specific medications but is targeted to assessing eligibility for access.
It should be noted that PBS criteria and SA guidelines for NMS medication may change over time and will necessitate updating of decision tools if/when this occurs.
Further tools are being developed to collate resources on clinical assessment for medication suitability and escalation of care.
Combined Influenza, respiratory viral panel and COVID 19 testing
With increasing incidence of influenza in our community, GPs are encouraged to consider referring appropriate patients for full respiratory panel testing (including COVID-19 and Influenza A/B).
Symptomatic patients who are at high risk of complications of respiratory illness or who work in high risk settings (eg aged care workers) should be considered for early definitive diagnosis.
While non-referred COVID-19 testing is still available via SA Health’s testing sites, multiplex respiratory panel tests can be requested by GPs in a variety of ways, including via electronic referral or with request forms that patients can present at drive through sites across all three providers (SA Path, Clinpath and ACL).
Importantly, COVID results will still be provided to patients via text message but other respiratory virus test results will be forwarded to requesting practitioner for interpretation and notification to the patient.
Clinpath self-collection swab kits
Clinpath have developed a respiratory viral PCR swab self-collection kit to increase access to testing for COVID-19, Influenza A & B, RSV and 8 other respiratory viruses.
These kits can be delivered to practices on request to your local area Clinpath liaison and contain instructions for patients on how to correctly perform the swab. Completed swabs can be handed back at any collection centre by the patient/their representative but must be accompanied by a GP referral/request form.
Clinpath drive through testing sites are still operational and COVID-19 only or full respiratory panel testing can be done on the same swab. Respiratory panel testing does require a GP referral for any symptomatic patient either via paper form or telehealth barcode.
Australian Clinical Labs testing update
Australian Clinical Labs continue to perform COVID-19 PCR testing at ACL drive through locations and a number of their collection centres. A doctor’s referral is required for all respiratory viral PCR panels when testing for influenza and turnaround time is generally within 24 hours.
There are also options for electronic requests to enable telehealth consultation referrals.
Royal Adelaide Hospital testing clinic
A reminder that there is still a RAH testing walk-in clinic, located at level 3, in the south-east corner of the hospital, closest to SAHMRI and North Terrace.
No referral or appointment is required and it is accessible to pedestrians. Entry is direct from North terrace, not from within the hospital. This service is available from 8:30 am to 4:30 pm, 7 days a week, including public holidays. This site will test COVID-19 and respiratory panel with referral only.
The Minister for Health and Wellbeing has declared monkeypox virus infection a notifiable and a controlled notifiable condition under the South Australian Public Health Act 2011. This is effective for 6 months unless declared otherwise by the Minister, or changes are made to the South Australian Public Health (Notifiable and Controlled Notifiable Conditions) Regulations 2012.
For further information please see here.
Doctors are advised to:
- Be alert for cases with clinical features of monkeypox especially in anyone arriving from international travel.
- Discuss suspected cases with an infectious diseases physician for appropriate management
- Notify suspected cases to CDCB urgently by phoning 1300 232 272 (24 hrs/7 days).
- Contact SA Pathology on-call microbiologist on 8222 3123 to discuss appropriate testing.
Rebound COVID after treatment with Paxlovid
There has been emerging data on cases of “rebound” COVID-19 symptoms in COVID-19 patients treated with Paxlovid® (Nirmatrevir plus Ritonavir). Rebound symptoms can recur between 2 and 8 days after initial cessation of symptoms or completion of the oral treatment. They are reported to resolve within 3 to 5 days.
In SA, we have seen patients experiencing rebound COVID with mild symptoms and no known cases here of progression to severe disease occurring. Currently, there is no recommendation to extend or repeat the course of Paxlovid® or add any other specific antiviral treatment.
Resources: COVID-19 Vaccine Patient FAQs Do I Need A COVID-19 Vaccine If I’ve Already Had COVID-19?
COVID-19 vaccines are still recommended for people who have had COVID-19 before. This is because you can catch COVID-19 a second time. You should not get a COVID-19 vaccine until 90 days after your COVID-19 illness.
People with ongoing COVID-19 symptoms (also known as ‘long COVID’) should speak to their regular GP before getting vaccinated. Your regular GP can also speak with a specialist immunisation service for extra advice about COVID-19 vaccination if needed.
You do not need to get another COVID-19 test before your vaccination. What If I Received Medication to Treat COVID-19? You should still wait 90 days before getting a COVID-19 vaccine even if you received a COVID-19 treatment during your illness. Some common COVID-19 treatments include Nirmatrelvir-Ritonavir (Paxlovid®), Molnupiravir (Lagevrio®), Remdesivir (Veklury®), Sotrovimab (Xevudy®), Baricitinib (Olumiant®), and Tocilizumab (Actemra®).
You should not get a COVID-19 vaccine until you speak to your doctor if you were given Tixagevimab-Cilgavimab (Evusheld®). This is because Evusheld® may reduce the effectiveness of the COVID-19 vaccine. What about other Vaccinations?
COVID-19 vaccines can be given at the same time as most other vaccinations, including the flu (influenza) vaccine. You do not need to delay getting the flu vaccine if you get COVID-19.
You can receive the flu vaccine as soon as you recover from your COVID-19 illness. Speak with your regular GP about what other vaccinations you should receive, and when.
Please forward this update to any colleagues who may not have received it and contact us at Health.COVID-19GPLiaison@sa.gov.au to be added to our mailing list or with any other enquiries.
Dr Emily Kirkpatrick
Deputy Chief Public Health Officer Deputy Chief Medical Officer
Department for Health and Wellbeing