The South African Medical Association has urged all doctors working in the private sector to implement measures in their appointment booking systems to identify potential cases of the coronavirus upfront before allowing them to present in person at the practice and join the patients in a normal waiting room.

This comes after the country’s first case of COVID-19 presented at a GP practice in Hilton in KwaZulu-Natal causing the practice to close as the doctor had to self-isolate while waiting for her test results to come back and follow-ups are being done.

SAMA says similar practice closures have been happening in the United Kingdom, as the government helpline refers patients who suspect they are sick to visit their GPs – causing a number of problems at practice level.

“South Africa can ill-afford to have any health facilities shutting in the event that the infection spreads more widely. South Africa’s doctors are a scarce resource and need to be protected, to continue to serve their communities, but also have to be in a position to help patients who suspect that they may have contracted Coronavirus,” SAMA says in a statement.

It also advises the modification of online appointment booking to allow suspected patients to be dealt with appropriately.

The NICD has recommended that all suspected cases be reported to them to allow for rapid and appropriate responses.

1. Early detection is key – healthcare workers should maintain a high level of clinical suspicion

2. Suspect patients should be asked to wear a surgical mask as soon as they are identified and evaluated in a private room

3. Isolate the person under investigation (PUI) (ideally an airborne infection isolation room if available)

4. Use appropriate infection control for PUI

          a. Adequate standard precautions for all patients 
          b. Add contact and droplet precautions for all patients 
          c. Apply airborne precautions (e.g., N95 mask) and use eye protection when performing aerosol generating procedures 
          d. If available, airborne precautions can be used at all times. Limit movement of patient (e.g., use designated portable X-ray equipment)

Respiratory viruses are best isolated from material that contains infected cells and secretions. Therefore, swabs should aim to brush cells and secretions off the mucous membranes of the upper respiratory tract.

Good specimen quality (i.e.. containing sufficient cells and secretions), appropriate packaging and transport (i.e., to keep virus viable/detectable) is essential.

The NICD hotline numbers for healthcare providers are 0828839920 or 0665624021

Source: SAMA