The RACGP has released its COVID Community Care Guidelines. They can be accessed here: https://www.racgp.org.au/clinical-resources/covid-19-resources/other-health-issues/covid-19-home-care-guidelines
Department of Health resources:
The Department of Health has published several collections of resources about COVID-19 vaccination, vaccine rollout, and clinical guidance from the Australian Technical Advisory Group on Immunisation (ATAGI). These resources are updated when new information is available, so GPs should ensure they have access to the latest versions.
Covid-19 Vaccine Rollout Primary Care update
Medical exemptions
Whilst medical contraindications can be reported to Australian Immunisation Register (AIR) as a medical exemption for receiving a full primary course of COVID-19 vaccines, there are very few situations where a vaccine is contraindicated and, as such, a medical exemption is expected to be rarely required.
Accepted medical contraindications include:
· anaphylaxis to any component of the vaccine, including Polyethylene Glycol (PEG); and
· serious adverse event attributed to a previous dose of a COVID-19 vaccine (and without another cause identified) that has been determined following review by, and/or on the opinion of, an experienced immunisation provider/medical specialist taking into account whether the repeat vaccine doses would be associated with a risk of recurrence of the serious adverse event.
Temporary medical exemptions may be considered for those:
· with a PCR-confirmed history of SARS-CoV-2 infection in the last 6 months; or
· recent or complex cardiac illness.
Permanent and temporary contraindications should only be reported for individuals where there is no suitable alternative COVID-19 vaccine available. The Australian Technical Advisory Group on Immunisation (ATAGI) has developed supporting clinical guidance for reporting medical contraindications for COVID-19 vaccines. In line with ATAGI guidance, vaccination providers are no longer able to report a medical contraindication to a COVID-19 vaccine for pregnancy in the AIR.
Inappropriate or False Medical Exemptions
The Department of Health (the Department) and the National COVID Vaccine Taskforce (NCVTF) take allegations of Medicare non-compliance by health care providers very seriously and all tipoffs will be reviewed in accordance with the Department's compliance assessment procedures.
The NCVTF is actively monitoring all COVID-19 data (including exemptions) and if outliers are identified, the NCVTF will look to refer these Practices or Practitioners to the relevant health regulatory body or law enforcement for appropriate action.
The Department is working with Services Australia on enhancements to the AIR that will allow individuals with a valid medical contraindication to COVID-19 vaccines to generate a COVID-19 Digital Certificate. In the meantime, individuals who have a medical contraindication reported for COVID-19 vaccines can use their Immunisation History Statement (IHS) as vaccination evidence. The IHS displays all vaccinations, or medical contraindications, that have been reported to the AIR.
Moderna Expansion in General Practice
Participating general practices are able to indicate their interest in receiving the Spikevax (Moderna) vaccine. More than 1100 practices have already requested an allocation and have been invited to commence in November.
New assessment flowchart - Pathways to Care
The National COVID-19 Clinical Evidence Taskforce has published a new assessment flowchart, Pathways to Care for Adults with COVID-19. This is the Australian guidelines for the clinical care of people with COVID-19.
Adult with confirmed or presumed COVID-19 will be categorised into three groups based on their clinical presentations: asymptomatic or signs and symptoms of MILD disease, signs or symptoms of MODERATE disease and signs or symptoms of SEVERE disease. In the assessment, there are some risk factors to consider including over 65 years of age, vaccination status, Aboriginal and/or Torres Strait Islander group, pregnancy status, comorbidities and concerns about personal safety or access to care.
The assessment will lead to three actions: care at home on COVID specific care plan, transfer to hospital and immediate ambulance transfer to hospital.
This update is part of an ongoing review of all 11 clinical flowcharts, with the Management of adults with mild COVID-19 and Management of adults with moderate to severe COVID-19 flowcharts next to be revised.
New recommendation on the use of pulse oximeters
In anticipation of the increasing number of people who will be treated in the primary care setting, the Primary and Chronic Care Panel has made a new consensus recommendation on the use of pulse oximeters.
People with risk factors for deterioration, who are being cared for at home, should be offered monitoring of oxygen saturation with pulse oximetry. Risk factors for deterioration include:
· older age, e.g. over 50 years for Aboriginal and Torres Strait Islander people, or otherwise over 65 years
· unvaccinated or partially vaccinated
· pregnant
· concerns about personal safety or access to care
· Comorbidities (lung disease, including COPD, asthma or bronchiectasis, cardiovascular disease, including hypertension, obesity (BMI > 30 kg/m2), diabetes, renal failure, and immunocompromising conditions).
Pulse oximetry will assist in assessing and monitoring the severity of respiratory symptoms and detect early deterioration in adults. Medical practitioners should also provide patients with education on how to self-monitor using pulse oximetry and when to call a GP or triple 0.
Be aware that different pulse oximeters have different specifications, and that some can under or overestimate readings especially if the saturation level is borderline. Overestimation has been reported in people with darker skin.
For guidance on when to escalate care, please refer to the Pathways to Care Flowchart.
Booster doses of the COVID-19 vaccine
A COVID-19 booster dose is now recommended by the Australian Technical Advisory Group on Immunisation (ATAGI) for people who:
· are 18 years and older, and
· have had their second dose of their primary dose course of COVID-19 vaccination at least 6 months ago.
Booster doses are not mandatory, but are recommended to maintain immunity against COVID-19.
ATAGI is not currently recommending booster doses for:
- people aged 12 to 17 years OR
- people who are severely immunocompromised and have already had a third dose.
Read ATAGI's advice on COVID-19 booster doses.
Resources for third doses for the immunocompromised
On 8 October 2021, the Australian Technical Advisory Group on Immunisation (ATAGI) released advice recommending a third dose of COVID-19 vaccine as part of the primary course in individuals who are severely immunocompromised. These resources will assist GPs with patients requiring a third dose:
· Provider guide to immunocompromise
· Immunocompromise shared decision making guide
· Eligibility declaration form
Requirements for workers in health care settings who are exposed to COVID-19
The Australian Health Protection Principal Committee (AHPPC), with advice from the Communicable Diseases Network Australia (CDNA) and the Infection Control Expert Group (ICEG), has endorsed a Worker Permissions and Restrictions Framework for Workers in Health Care Settings.
The framework outlines nationally agreed recommendations that will support safe decision making when determining appropriate workplace restrictions and permissions for a worker exposed to COVID-19. The framework provides guidance on how GPs and practice staff can avoid having to isolate after a patient who attended the practice later tests positive to COVID-19.
The Worker Permissions and Restrictions Framework is available here.
Vaccine product information
· ATAGI and the Cardiac Society of Australia and New Zealand (CSANZ) have released joint guidance on the risk of myocarditis and pericarditis following Pfizer vaccination following an observed risk observed in overseas studies, especially in males under 30 years of age after the second doses. The Pfizer Product Information has been updated to reflect this.
· The Product Information (PI) for the AstraZeneca vaccine has been updated to include Capillary Leak Syndrome (CLS) as a contraindication for the AstraZeneca vaccine. Providers should be aware of the information contained in the PI and individuals with a known history of CLS should not be vaccinated with AstraZeneca.
Consent forms
1. Consent form: https://www.health.gov.au/resources/publications/covid-19-vaccination-consent-form-for-covid-19-vaccination
Patient information sheets
2. Information on AstraZeneca: https://www.health.gov.au/resources/publications/covid-19-vaccination-information-on-covid-19-astrazeneca-vaccine
3. Information on Pfizer: https://www.health.gov.au/resources/publications/covid-19-vaccination-information-on-covid-19-pfizer-comirnaty-vaccine
4. After your AstraZeneca: https://www.health.gov.au/resources/publications/covid-19-vaccination-after-your-astrazeneca-vaccine
5. After your Pfizer: https://www.health.gov.au/resources/publications/covid-19-vaccination-after-your-pfizer-comirnaty-vaccine
6. Provider information on consent: https://www.health.gov.au/resources/publications/covid-19-vaccination-consent-information-for-providers-covid-19-vaccination-consent-and-faqs
7. Frequently asked questions on the Taskforce Ivermectin recommendation: https://covid19evidence.net.au/wp-content/uploads/NC19CET-Ivermectin-FAQs-20210826.pdf
Clinical guidance and decision guides
8. ATAGI Clinical guidance: https://www.health.gov.au/resources/publications/covid-19-vaccination-atagi-clinical-guidance-on-covid-19-vaccine-in-australia-in-2021
9. COVID-19 vaccine - Clinical considerations: https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/information-for-covid-19-vaccination-providers/covid-19-vaccine-clinical-considerations
10. Selection of second dose in specific circumstances: https://www.health.gov.au/resources/publications/covid-19-vaccination-clinical-advice-on-the-use-of-a-different-covid-19-vaccine-as-the-second-dose
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