News & Events

CORONAVIRUS

Posted on by Dr Sheena Mathew (MBBCh, MMed, FCFP)
16
Mar

 

WHAT EVERY SOUTH AFRICAN NEEDS TO KNOW ABOUT CORONAVIRUS TESTING

  What is COVID-19:

Coronavirus disease 2019, caused by the virus SARS-CoV-2 from the Coronavirus family.  The virus takes its name from the Latin for crown, corona which refers to its envelope of club-shaped glycoproteins that resemble a crown.   The Coronavirus family causes illness ranging from common cold to severe respiratory diseases like pneumonia.  Past coronaviruses that caused severe human infection include the bat coronavirus (SARS-severe acute respiratory syndrome), the camel coronavirus (MERS-CoV Middle East respiratory syndrome).

How is COVID-19 spread:

  1. Respiratory droplet spread through coughing or sneezing.
  2. Contact spread through physical contact.
  3. Mean incubation period 5.2 days but up to 14 days hence quarantine of 14 days suggested for contacts and suspected cases.
  4. Majority of severe cases were in the elderly and those with underlying diseases.

  Commonest COVID-19 symptoms:

  • Fever
  • Chills
  • Cough
  • Sore throat
  • Shortness of breath
  • Body pains
  • Diarrhoea ( 3 or more loose stools in a 24 hour period)

 

Who gets tested?

Currently, you can only get tested by the NICD or any of the private laboratories if you meet the criteria for a Person under investigation (PUI).  This means if you have only flu-like symptoms but no exposure to confirmed COVID-19 contact or travel history you won’t be eligible for testing at this stage.  People without any symptoms are also not being tested at present so as not to overload the laboratory systems.  These criteria can change once there is more widespread community transmission.

Criteria for Person under investigation (PUI):

  • Persons with acute respiratory illness with sudden onset of at least one of the following: cough, sore throat, shortness of breath or fever [≥ 38°C (measured) or history of fever (subjective)] irrespective of admission status AND
  • In the 14 days prior to onset of symptoms, met at least one of the following epidemiological criteria:
  • Were in close contact1 with a confirmed2 or probable3 case of SARS-CoV-2 infection.

OR

  • Had a history of travel to areas with presumed ongoing community transmission of SARS-CoV-2; i.e., Mainland China, South Korea, Singapore, Japan, Iran, Hong Kong, Italy, Vietnam and Taiwan.

OR

  • Worked in, or attended a health care facility where patients with SARS-CoV-2 infections were being treated.

OR

  • Admitted with severe pneumonia of unknown aetiology

*2 – Confirmed case: A person with laboratory confirmation of SARS-CoV-2 infection, irrespective of clinical signs and symptoms.

*3 –  Probable case: A PUI for whom testing for SARS-CoV-2 is inconclusive (the result of the test reported by the laboratory) or for whom testing was positive on a pan-coronavirus assay.

What is a close contact?                                           

This is a high risk exposure.

  1. A person living in the same household as a COVID-19 case.
  2. A person having had direct physical contact with a COVID-19 case (e.g. shaking hands).
  3. A person having unprotected direct contact with infectious secretions of a COVID-19 case (e.g. being coughed on, touching used paper tissues with a bare hand).
  4. A person having had face-to-face contact with a COVID-19 case within 2 metres and > 15 minutes.
  5. A person who was in a closed environment (e.g. classroom, meeting room, hospital waiting room, etc.) with a COVID-19 case for 15 minutes or more and at a distance of less than 2 metres.
  6. A healthcare worker (HCW) or other person providing direct care for a COVID-19 case, or laboratory workers handling specimens from a COVID-19 case without recommended PPE or with a possible breach of PPE.
  7. A contact in an aircraft sitting within two seats (in any direction) of the COVID-19 case, travel companions or persons providing care, and crew members serving in the section of the aircraft where the index case was seated.

Management of contacts with high risk exposure:

  • Active monitoring by public health authorities, for a period of 14 days after the last exposure.
  • Daily monitoring for COVID-19 symptoms, including fever of any grade, cough or difficulty breathing.
  • Avoid social contact
  • Avoid travel
  • Remain reachable for active monitoring 

What is a casual contact?

This is a low risk exposure.

  1. A person who was in a closed environment with a COVID-19 case for less than 15 min or at a distance of more than 2 metres.
  2. A person having had face-to-face contact with a COVID-19 case for less than 15 min and at a distance of less than 2 metres.
  3. Traveling together with a COVID-19 case in any kind of conveyance.

Management of contacts with low risk exposure:

  • Self-monitoring for COVID-19 symptoms, including fever of any grade, cough or difficulty breathing, for a period of 14 days after the last exposure.
  • Public health authorities may do more, depending on the specific situation. Contacts, regardless of whether their exposure was high-risk or low-risk, should immediately self-isolate and contact health services in the event of any symptom appearing within 14 days of the last exposure. If no symptoms appear within 14 days of the last exposure, the contact person is no longer considered to be at risk of developing COVID-19.

Who can get tested:

  • Must meet PUI criteria (outlined in above passage).
  • All cases need to be discussed with NICD doctor (National Institute for Communicable diseases hotline 082 883 9920) before collecting samples. Tests done via NICD will be free of charge for patients that meet the criteria. Testing is now also available at private laboratories, but PCR tests done privately will be charged private rates.
  • For each person under investigation (PUI) a laboratory specimen submission form and a person under investigation (PUI) form has to be completed and submitted together with the specimens. PUI’s need to be quarantined for 14 days from exposure day and their contacts traced.
  • Once laboratory confirms COVID-19 infection, provincial CDCC needs to identify close contacts of the confirmed case as they will be required to self-quarantine at home for 14 days from day of exposure to the confirmed COVID-19 case and take their temperature daily. Symptomatic patients will be isolated and treated in designated hospitals around the country, such as Tygerburg Hospital in Cape Town.

How is COVID-19 diagnosed?

  1. Swab samples are collected from the nose, throat or chest.
  2. Samples along with Laboratory specimen form and Person under investigation forms are sent to NICD or private laboratory for a PCR test.

 

 Preventative measures:

  1. National state of disaster response measures as outlined by President Ramaphosa on 15th March 2020.
  2. Practice cough etiquette (maintain at least 1 m distance from others, cover your cough and sneeze with disposable tissue and throw the tissue in a bin and wash hands).
  3. Clean and disinfect touched objects and surfaces frequently.
  4. Avoid close contact with people who are sick.
  5. Avoid touching your eyes, nose and mouth with unclean hands.
  6. Stay home when sick and keep a distance of at least 1 m from others at home.
  7. Wash hands often with soap and water or an alcohol based sanitizer for at least 20 seconds.
  8. Maintain a minimum 1m distance between people in waiting areas and public areas to minimize droplet spread.
  9. The use of a normal surgical mask is recommended for use in suspected COVID-19 cases to minimize droplet spread transmission to those around them.
  10. Avoid contact with farm or wild animals (alive or dead), animal markets and animal products like uncooked meat.

Blouberg Family Practice will be implementing preventative measures of ensuring all patients use our hand sanitizer before entering the practice, disinfecting our surfaces regularly and requesting all patients who meet the criteria for PUI to inform us beforehand so we can provide masks and isolate suspected cases to minimize risk to other patients.  The practice also provides home visits, telephonic and video consultations for patients who are immobile or self-isolating.

Should you have any queries relating to COVID-19, feel free to contact our practice on (021) 023 0480 or alternatively contact the NICD Hotline 0800 029 999.  Contents of this article was verified on the date of publication but is subject to change depending on disease transmission. 

 

(Source: National Institute of Communicable Diseases, www.nicd.ac.za)