Managing COVID outbreaks in North Coast RACFs

Residential Aged Care Facility (RACF) outbreak numbers across the region have reduced by 50% in the last few weeks providing a small period of recuperation for all.

Over 85% of RACFs have had an outbreak or exposure, and as we move into outbreaks being part of business, as usual, the learnings from the last month assist to function in the new normal.

Supporting this approach, the Commonwealth Govt. has updated the National Guidelines for Prevention, Control and Public Health Management of COVID-19 Outbreaks in Residential Care Facilities.

The most significant changes are summarised below.

The definitions of an outbreak or exposure are now:

• A RACF COVID-19 exposure is defined as:
  • any case of COVID-19 in staff, residents or a visitor at the facility during their infectious period that does not meet the definition of an outbreak.
• A RACF COVID-19 outbreak is defined as either:
  • two or more residents of a residential care facility who have been diagnosed with COVID-19 via RAT or PCR test within 5 days and has been onsite at the residential care facility at any time during their infectious period; or
  • five or more staff, visitors and/or residents of the residential care facility diagnosed with COVID-19 through RAT or PCR test within past 7 days who worked/visited during their infectious period.

Declaring an outbreak over:

• The source of infection and transmission is understood within the facility, and there is no further risk of transmission.
• No further resident cases identified within past 7 days from when the last case was effectively isolated.
• Where residents identified as a case or close contact are able to effectively isolate, and there is no ongoing risk, the RACF can consider a staged return to business as usual.

This week, NSW Health will update the local jurisdiction advice to guide practice in relation to the above. Until then, the RACFs are working to the current definitions.

Antiviral medications have been delivered to all RACFs; because of the short time period to commence the treatment, we encourage GPs to work with the RNs and coordinate anticipatory orders for residents that meet the criteria.

The CEC Medication Safety Updates provides:

• information on both treatments; Molnupiravir and Nirmatrelvir/Ritonavir
• consent forms for residents
• declaration form to be completed.

Until the antivirals are on the PBS the RACF will restock supplies used in an outbreak through the Commonwealth Case Managers.

Australian Defence Force

The Australian Defence Force (ADF) is currently in our region supporting one of the outbreaks, and feedback has been extremely positive.

NSW has 10 ADF teams providing support to RACFs, particularly in rural and remote areas. The teams predominantly provide general support with administration, screening, companionship, cleaning, etc.

There are two teams with clinical personnel available. The focus is not only during an outbreak but on fatigue management after an outbreak to assist with recovery.

Healthy North Coast acknowledges the hard work of all the RACFs, Public Health Unit and Local Health Districts involved in the outbreak management across the region.