The document provides information on SARS-CoV-2, the virus that causes COVID-19, including its origins and symptoms. It discusses NSW Health's response to an outbreak of the virus in Australia, including procedures for identifying and managing cases, infection control strategies, and guidance for healthcare workers. The document also contains technical details about the virus and disease.

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2. • What is SARS-CoV-2
• Update on Outbreak
• NSW Health Response
• Testing
• Infection Prevention and Control
• Additional Resources

3. • Coronaviruses are a large family of viruses, some cause illness in
humans, and others cause illness in animals, such as bats, camels, and
civets.
• Human coronaviruses cause mild illness, such as the common cold
• Severe acute respiratory syndrome (SARS) is a viral respiratory illness
caused by a coronavirus, called SARS-associated coronavirus (SARS-
CoV)
• Previous Coronaviruses have included SARS- CoV and MERS-CoV
• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a
new strain of coronavirus that has not been previously identified in
humans.

4.  The most likely ecological
reservoirs for coronaviruses are
bats, but it is believed that the
virus jumped the species barrier to
humans from another intermediate
animal host.
 This intermediate animal host
could be a domestic food animal, a
wild animal, or a domesticated wild
animal which has not yet been
identified.

5.  Coronaviruses belong to the
Coronaviridae family in the Nidovirales
order
 Corona represents crown-like spikes on
the outer surface of the virus; thus, it
was named as a coronavirus
 Coronaviruses are enveloped viruses,
minute in size (65–125 nm in diameter)
and contain a single-stranded RNA as a
nucleic material, size ranging from 26
to 32kbs in length

6.  The virus that causes COVID-19 is known as SARS-CoV-2
It appears to have first emerged in Wuhan, China, in late 2019.
 The outbreak has since spread across China to other countries around the world. By the
end of January, the new coronavirus had been declared a public health emergency of
international concern by the WHO.
 The most commonly reported symptoms include a fever, dry cough and tiredness, and
in mild cases people may get just a runny nose or a sore throat.
 In the most severe cases, people with the virus can develop difficulty breathing, and
may ultimately experience organ failure. Some cases are fatal.


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12.  February 2020 NSW Health responded to an outbreak of a coronavirus
(COVID-2019), first reported in China in December 2019.
 The WHO has declared that the official new name for the virus that also
formerly went by the names “2019 novel coronavirus” or “2019-nCoV”
is now to be known as “SARS-coV-2” which causes COVID-19.
 This name change is to differentiate it from other coronavirus
outbreaks that include the common cold, but also the severe acute
respiratory syndrome (SARS-CoV) and Middle East Respiratory
Syndrome (MERS-CoV) which have previously afflicted the world.

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14.  Infection with COVID-19 is a notifiable
condition under the NSW Public Health
Act, so all cases and suspected cases
must be reported by doctors and
pathology to NSW Health
 NSW Health have implemented a range of
measures to promptly identify cases of
COVID-19 infection and prevent
transmission in NSW
 Leading & Coordinating a Statewide
Response

15.  Should a person in NSW be confirmed to have COVID-19 infection, NSW Health has procedures in place to
identify people they have been in close contact with. Those people are provided with advice about self-
isolation to minimise spread of the infection. NSW Health response included:
• establishing a NSW COVID-19 Clinical Council and 30 Clinical Communities of Practices across key clinical
specialities to support the response to COVID-19
• providing advice to GPs, pharmacists, emergency departments, and the broader health system on the
situation as it evolves to enable possible cases to be rapidly identified, diagnosed and managed
• developing diagnostic tests through public health laboratories to rapidly diagnose cases
• offering testing at public COVID-19 clinics throughout the state
• managing any cases with appropriate infection prevention and control and public health measures to
minimise the risk to health care workers and the community
• providing regular updates to the community, through media briefings, media releases and social media
including in community languages

16.  A person who:
 i. tests positive to a validated specific SARS-CoV-2 nucleic acid test;
 OR
 ii. has the virus isolated in cell culture, with PCR confirmation using
a validated method;
 OR
 iii. undergoes a seroconversion to or has a significant rise in SARS-
CoV-2 neutralising or IgG antibody level (e.g. four-fold or greater
rise in titre).

17.  Fever (≥37.5°C) or history of fever (e.g. night sweats,
chills)
 OR
 acute respiratory infection (e.g. cough, shortness of
breath, sore throat)
 OR
 Loss of smell or taste

18.  A person who has detection of SARS-CoV-2 neutralising or
IgG antibody AND has had a compatible clinical illness
AND meets one or more of the epidemiological criteria
outlined in the suspect case definition

19.  Clinical and public health judgement should be used to
determine the need for testing in hospitalised patients and
patients who do not meet the clinical or epidemiological
criteria.

20.  In the 14 days prior to illness onset:
• Close contact with a confirmed or probable case
• International or interstate travel
• Passengers or crew who have travelled on a cruise ship
• Healthcare, aged or residential care workers and staff with direct
patient contact
• People who have lived in or travelled through a geographically
localised area with elevated risk of community transmission, as
defined by public health authorities

21.  A close contact is defined as requiring:
• face-to-face contact in any setting with a confirmed or probable case,
for greater than 15 minutes cumulative over the course of a week, in
the period extending from 48 hours before onset of symptoms in the
confirmed or probable case, or
• sharing of a closed space with a confirmed or probable case for a
prolonged period (e.g. more than 2 hours) in the period extending
from 48 hours before onset of symptoms in the confirmed or
probable case

22. Infection Prevention and
Control Strategies

24. • Early recognition of patients who have suspected, probable or
confirmed COVID-19
• Physical distancing during COVID-19 outbreak
• Respiratory hygiene and cough etiquette
• Management of patients with acute respiratory symptoms and/or
suspected or proven COVID19
• Application of Standard Precautions for all patients at all times
• Implement Transmission-Based Precautions based on risk
assessment

25. • Standard precautions, including hand hygiene (5 Moments) for all
patients. Patients and health workers should observe respiratory
hygiene and cough etiquette.
• Transmission-based precautions for patients with suspected,
probable or confirmed COVID-19:
 Contact and droplet precautions for routine care of patients.
 Contact, droplet and airborne precautions for respiratory
aerosol generating procedures (AGPs).

26.  Aerosol generating procedures (AGPs) are defined as any medical and
patient care procedure that results in the production of airborne
particles (aerosols) less than 5 micrometres (µm) in size which can
remain suspended in the air, travel over a distance and may cause
infection if they are inhaled.
 Examples of
 AGPs can be found on Coronavirus Disease 2019 (COVID-19)

27.  Generally, SARS CoV-2 is spread by larger respiratory particles of
liquid referred to as droplets. These larger droplet particles tend to
fall on adjacent surfaces (e.g. floor, tabletop) relatively quickly and
do not travel long distances.
 Travelling over long distances on air currents is generally not a
significant factor in the spread of this infection.

28.  Contact and droplet precautions
 Addition of airborne precautions for respiratory AGPs
 Hand hygiene
 Environmental cleaning
 Cleaning of shared patient care equipment

29. o given a surgical mask to put on, and
o placed in a single room (ensuring air does not circulate to
other areas)
o placed in a negative pressure room (in the event of AGPs
being performed).
o If transfer outside the room is essential, the patient should
wear a surgical mask during transfer and follow respiratory
hygiene and cough etiquette.

30. • For close contact <1.5meter between health worker and patients the
following PPE is safe and appropriate and should be put on before
entering the patient’s room:
o An apron or a long-sleeved impervious gown
o surgical mask
o Safety glasses or face shield
o disposable nonsterile gloves when in contact with patient (hand
hygiene before donning and after removing gloves)

31. • P2/N95 respirators are used for airborne precautions when
respiratory AGPs are conducted on patients with suspected, probable
or confirmed COVID-19 and must be discarded following the AGP
along with
• Fluid resistant long-sleeved or isolation gown
• Eye protection - safety glasses or face shield
• Disposable nonsterile gloves when in contact with the patient (hand
hygiene before donning and after removing gloves)

32.  Unless used correctly, i.e. with fit-checking, a P2/N95 respirator
(mask) is unlikely to protect against airborne pathogen spread.
 An air-tight seal may be difficult to achieve for people with facial
hair.
 Fit checking with a range of P2/N95 respirators must occur to assess
the most suitable one to achieve a protective seal. If a tight seal
cannot be achieved, facial hair should be removed.

34. 
• Environmental Cleaning using a hospital grade and TGA approved disinfectant.
• Waste Management follows routine clinical and non-clinical waste processes
• Utensils follows routine cleaning process
• Linen Management follows normal processes.
• Hand Hygiene using ABHR and/or hand washing.
• Respiratory hygiene and cough etiquette principles apply
• PPE Transmission based precautions

35. • Staff education for donning and doffing PPE is undertaken for staff managing cases
• Opportunity to ensure training of staff is up to date - Limited stocks of PPE should
not be used for training and other models of training should occur
Removing PPE
There are a variety of ways to safely remove PPE without contaminating your clothing,
skin, or mucous membranes with potentially infectious materials.
See two examples below:
Example 1
1. Gloves
2. Gown or Apron
3. Goggles or Face shield
4. Mask or Respirator
Example 2
1. Gown and Gloves (in a
combined motion)
2. Goggles or Face shield
3. Mask or Respirator
Perform hand hygiene immediately after glove removal, before removing face protection,
before removing mask/respirator and after removal of any contaminated item
Hand
Hygiene

36.   Staff needed (and suitability) to be trained in high level PPE for COVID-19
  Training schedule and staff training in high level PPE –combined precautions
  Consumables required available, easy to locate and accessible to staff.
  Emergency Department trained and up to date with PPE competency and
combined precautions
  Intensive Care/Critical Care Department trained and up to date with PPE
competency and combined precautions
  Pandemic plan in place - reviewed and updated

38. • NSW Health recommends that any HW, healthcare student or volunteer with
respiratory symptoms or unexplained fever (≥37.50C) should be tested for
COVID-19 and immediately self-isolate. They should not return to work duties
until they have been tested and cleared from COVID-19 infection
• Symptoms of COVID-19 include fever (≥37.50C), cough, sore/scratchy throat and
shortness of breath. Other reported symptoms of COVID-19 include loss of smell,
loss of taste, runny nose, muscle pain, joint pain, diarrhoea, nausea/vomiting and
loss of appetite.
• The HW, healthcare student or volunteer must also follow the home isolation
guidance for people suspected to have COVID-19. There are a number of COVID-
19 Testing Clinics throughout NSW. General Practitioners and Emergency
Departments can also perform COVID-19 testing

39. • If a HW, healthcare student or volunteer is tested positive for COVID-
19 they must follow the NSW Health Release from Isolation criteria
before returning to work.
• If a HW, healthcare student or volunteer has tested negative for
COVID-19 and continues to experience respiratory symptoms or
unexplained fever, they should be medically assessed prior to
returning to work duties
• If a HW has been informed that they are a close contact for COVID-
19 by either the healthcare facility or local Public Health Unit, they
must inform their manager or supervisor.