The outbreak of COVID-19 spread far and wide in a relatively short space of time. Almost all affected countries have implemented strategies to curb the rate of infection. As a private practice, you may have experienced a surge in patient visits from patients concerned about their health. While not everything about COVID-19 is understood, guidelines state clearly that a suspected case should be identified as quickly as possible and preferably before visiting your practice. 

Based on available information to date, we’ve put together a quick guide to help you keep your staff and patients safe. 

Which patients are at risk?

Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19.

Conditions that could put people at high-risk include:

• People with chronic lung disease or moderate to severe asthma
• People who have heart disease with complications
• People who are immunocompromised
• People of any age with severe obesity (body mass index [BMI] ≥40) or certain underlying medical conditions such as diabetes, renal failure, or liver disease, particularly if not well controlled
• People who are pregnant should be monitored since they are known to be at risk with severe viral illness, however, to date data on COVID-19 has not shown increased risk

In the South African context (but not limited to SA), several conditions can cause a person to be immunocompromised. This includes cancer treatment, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, TB and prolonged use of corticosteroids and other immune weakening medications. 

What criteria must patients meet before being sent for tests?

The current test criteria are listed below but are subject to changes over time as more information becomes available. 

At this stage, testing is only available to patients who have been assessed by their doctor or healthcare provider and it’s been determined that they require a COVID-19 test. These patients must meet the COVID-19 case criteria which includes: 

• An acute respiratory illness, with fever or history of fever and cough with pneumonia, or
• Have acute respiratory distress syndrome (based on the clinical signs or X-ray findings) that requires them to be admitted to hospital

And:

• They have a documented travel history to any country where COVID-19 has occurred within 14 days before symptoms start, or 
• Have had close physical contact with a person with COVID-19 while they had symptoms, or 
• Have had close contact with patients with severe acute respiratory infections, or
• If you, as a healthcare professional have been dealing with patients who have severe acute respiratory infections and where the cause of the patients’ symptoms hasn’t been confirmed.

If your patient meets the criteria for testing, you can place an order for COVID-19 testing (“Novel Coronavirus COVID-19”) from the National Health Laboratory Service (NHLS) or private laboratories. It’s imperative that you work with your local and provincial health departments to coordinate testing and results. 

Ultimately, you should use your judgement to decide whether a patient has signs and symptoms compatible with COVID-19. Many patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g. cough, difficulty breathing, etc.). Doctors are also strongly encouraged to test for other causes of respiratory illness.

What should you do if your patient suspects they have COVID-19?

If your patient suspects that they have contracted COVID-19 they may well try to visit your practice and by extension, put others at risk. It’s best to communicate to all patients about the correct process to follow if they are concerned about their health. Here are some guidelines you can share with patients that require non-urgent medical care: 

• If you suspect you have been exposed to or infected with COVID-19, please do not visit your doctor’s consulting rooms, even if you have made an appointment. Visiting your doctor’s rooms puts other patients at risk. 
• Ask for a virtual or telephonic consultation with your doctor, whereby he or she can assess whether you meet the criteria for testing. Schedule this appointment as you would an in-person appointment. 
• Unless your doctor advises you otherwise, stay at home and avoid contact with others. Follow your doctor’s advice to treat symptoms while waiting on the test results and reduce the risk to others.

Click here to access a COVID-19 patient communication toolkit for help with this. 

How is COVID-19 treated?

Not all patients with COVID-19 will require hospitalisation. Clinical management for hospitalised patients with COVID-19 is primarily focused on supportive care of complications. This could include advanced organ support for respiratory failure, septic shock, and multi-organ failure. Empirical testing and treatment for other viral or bacterial aetiologies may be warranted.

Corticosteroids are not routinely recommended for viral pneumonia or ARDS and should be avoided unless they are indicated for another reason (e.g. COPD exacerbation, refractory septic shock following Surviving Sepsis Campaign Guidelines).

There are currently no antiviral drugs licensed by the U.S. Food and Drug Administration (FDA) to treat COVID-19. Some in-vitro or in-vivo studies suggest potential therapeutic activity of some agents against related coronaviruses, but there are no available data from observational studies or randomized controlled trials in humans to support recommending any investigational therapeutics for patients with confirmed or suspected COVID-19 at this time. Trials of other potential therapeutics for COVID-19 are being planned. For more information, see the Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease 2019 (COVID-19). 

Who should healthcare providers notify if they suspect a patient has COVID-19?

As mentioned above, if you suspect your patient has COVID-19, it’s imperative that you communicate with your provincial health department to ensure due process is followed. The same applies if a patient with COVID-19 visits your practice to ensure the testing and control of the spread of the disease among your staff and other patients present. Sanitation of the practice is advised, in addition to following the most stringent hygiene practices at all times. 

For more information visit the NICD website or download their criteria checklist here.