COVID-19 Doctors Resources

The World Health Organisation (WHO) was informed about a cluster of pneumonia cases of unknown aetiology in Wuhan City, Hubei Province, China on 31 December 2019. On the 7th of January 2020, a Novel Coronavirus (2019-nCoV) was identified as the causative virus by the Chinese authorities.

The Novel Coronavirus is formally named SARS-CoV-2. The disease caused by the virus is now referred to as COVID-19.

Suspected COVID-19 case definition:

Any person presenting with an acute (≤14 days) respiratory tract infection or other clinical illness compatible with COVID-19, or an asymptomatic person who is a close contact1 of a confirmed2 case.


  • Symptoms include ANY of the following respiratory symptoms: cough, sore throat, shortness of breath, anosmia (loss of sense of smell) or dysgeusia (alteration of sense of taste), with or without other symptoms (which may include fever, weakness, myalgia or diarrhoea)
  • Atypical manifestations are increasingly being recognised, including large vessel strokes in young patients, diabetic ketoacidosis/hyperglycaemic hyperosmolar syndrome, unexplained abdominal pain, various dermatological manifestations and, a multisystem inflammatory syndrome in children
  • An acute exacerbation of a chronic pulmonary condition (e.g. COPD or asthma) should also be regarded as potentially being due to COVID-19

1Close contact:

  • A person having had face-to-face contact (≤1 meter) or been in a closed space with a confirmed case for at least 15 minutes. This includes, amongst others, all persons living in the same household as a case, and people working closely in the same environment as a case.
  • Healthcare workers or other people providing direct care for a case, while not wearing recommended personal protective equipment (PPE) e.g. gowns, gloves, N95 respirator and eye protection.
  • A contact in an aircraft sitting within 2 seats (in any direction) of the case, travel companions or persons providing care, and crew members serving in the section of the aircraft where the case was seated.

2Confirmed case:

  • A person with laboratory confirmation of SARS-CoV-2 infection (using an RT-PCR assay), irrespective of clinical signs and symptoms.
  • Symptomatic cases are considered infectious from 2 days before symptom onset to 10 days after symptom onset

How do patients present and what is the differential diagnosis?

The clinical spectrum of COVID-19 ranges from an asymptomatic or mild flu-like illness to a severe pneumonia requiring critical care. The most common clinical symptoms are fever and cough with a few patients presenting with difficulty in breathing and bilateral infiltrates on chest X-rays. Treatment is supportive.


The differential diagnosis for this syndrome is broad. Consider the possibility of influenza (Southern Hemisphere influenza season normally begins in May or June), bacterial pneumonia, tuberculosis, or Pneumocystis jirovecii (PCP) if immunosuppressed, and manage accordingly.

Who should be tested for SARS-CoV-2/COVID-19?

COVID-19 is a category 1 notifiable medical condition that poses a significant public health risk thus private clinicians and laboratories are requested to follow the guidelines issued by the NICD and the DOH. Only patients who meet the current NICD case definition and/or who have been assessed by a clinician (in person or telephonically) will be tested at Ampath.

Resources:

Where can I get a Contact Tracing form

The NICD contact tracing form must be completed to ensure appropriate testing and contact tracing of COVID-19 positive patients. Ampath is not able to process any COVID-19 test requests without this completed form.


Click here to download this form.

Testing asymptomatic persons

When testing asymptomatic persons it is important to note that:


  • A negative laboratory test does not mean that a person is uninfected.
  • A negative laboratory test does not shorten the 10 day quarantine/isolation period. Patients who are asymptomatic and test negative are likely to interpret this as being COVID-free and not self-quarantine. They may go back to work, go to the mall and travel while having an early infection and spread the virus to any close contacts.

What safety measures should I implement in my consulting rooms?

In order to contain further transmission of the virus, additional safety measures are needed from clinicians when consulting with patients with suspected COVID-19 infection:


  • Ideally implement a screening process in order to avoid an infectious patient entering your rooms and exposing other patients and staff to the pathogen.
  • Ensure that you have sufficient PPE in your rooms to protect yourself during the consultation.
  • Please refer to the following link for the NICD’s “COVID-19 Quick Reference for Health Workers” for guidance for the necessary guidelines.
  • Ensure that the patient dons a surgical mask prior to entry to protect other people in your consulting area. Ensure that the patient uses a hand sanitiser before entering your rooms.

What specimen should be collected for a COVID-19 PCR?

For out-patients, a single nasopharyngeal (preferred), nasal mid-turbinate,, nasal or oropharyngeal swab is required for COVID-19 PCR testing. Please refer out-patients to a designated COVID-19 testing centre rather than collecting specimens in your rooms to limit exposure to you and your patients. A lower respiratory tract specimen is preferable for hospitalised patients as upper respiratory tract specimens in these patients can give false negative results.

Resources:

Ordering COVID-19 PCR and Antibody tests

COVID-19 PCR and Antibody tests can be ordered using your general test request forms (write the test required in the Other Test block), or you can order specific COVID-19 PCR and Antibody test request forms from your Ampath Marketer. Should you utilise our APR electronic results App, you can order these tests electronically.

Where can I refer an out-patient for COVID-19 testing?

Ampath has identified a number of Ampath sites country-wide as designated COVID-19 collection centres. Some of these are “drive-through” type of collection facilities and some are temporary sites. The purpose of these is to provide patients with testing facilities outside of our healthcare environments to minimise the risk of spreading the infection to other patients. Please do not send patients to any laboratory located in a hospital.


Click here to view Ampath’s designated COVID-19 collection centres.

How long will the test take and what is the cost?

The COVID-19 test is an RT-PCR (reverse transcriptase PCR) test and will take up to 48 hours (depending on travel distance from sampling site to performing laboratory, the volume of samples awaiting testing at the laboratory and the patient priority) before you receive a result. You will receive your results immediately on completion via sms and our Ampath Doctors Results App if you are registered. To register please go to: Lab Results


There is a single exit price in place for all patients of R850.00 incl. VAT. Medical schemes are reimbursing and will be billed at the negotiated scheme rate.

The interpretation of negative and positive COVID-19 results

Ampath will inform you of both PCR COVID-19 positive and negative results via sms and will electronically send the contact tracing form to the NICD and DOH along with the Ampath laboratory result. COVID-19 is a category 1 Notifiable Medical Condition and thus all Doctors are legally required to notify the DOH of any positive patients in their care. The NICD notification forms can be found on their website.


What does it mean if a patient tests negative for COVID-19?

A negative COVID-19 PCR result means that your patient is very unlikely to have active COVID-19. However, it is possible that they are very early in their infection and are already infectious, as the test only becomes positive after a few days. It is also possible that they could have become infected with COVID-19 after the test was taken. It is also possible for subjects with active COVID-19 infection (many of whom have no or only mild symptoms) to test negative during the course of their infection. Thus, even if your patient tests negative, they should still take precautions to protect themselves and others.

What does it mean if a patient tests positive for COVID-19?

A positive COVID-19 PCR result confirms that your patient is infected with SARS-CoV-2. Many individuals with active COVID-19 are asymptomatic and the potential for a positive result in someone that is not infected with COVID-19 (a false positive test result) is extremely unlikely.

Moreover, a negative COVID-19 result in a second test would not invalidate the positive result of the first test. With respect to COVID-19 tests in general, a negative test result is far less reliable than a positive result (getting a false negative is far more likely than getting a false positive). This is because it is well established that patients infected with COVID-19 can intermittently test negative during the course of their illness. In addition to the ever-present potential for inadequate sampling, shedding of the virus can be intermittent and a specimen taken at the time when the virus is not actively being shed may give a false negative result.

Thus there is no point in having a second test to check: a negative result would not invalidate the positive result previously obtained. Hence, in the interests of your patient’s health and the health of those with whom they may come into contact, a positive test result should be managed as such even if they are asymptomatic.

Should you have any queries regarding COVID-19 test result, please contact your local Pathologist or consult the CDC website: www.cdc.gov/coronavirus/2019-ncov/testing/diagnostic-testing.html

Please provide the following advice to PCR positive patients:

Outpatients with mild to moderate disease should be instructed to self-isolate at home for 10 days and be given appropriate advice about reducing possible transmission to others:

  • Patients should stay in a specific room and use their own bathroom (if possible). Patients should avoid unnecessary travel and unnecessary contact with other people.
  • Where contact is unavoidable, the patient should wear a facemask, and maintain a distance of at least 1 metre (preferably 2 metres) from other people.
  • Patients should clean their hands with soap and water frequently. Alcohol-based sanitizers may also be used, provided they contain at least 70% alcohol.
  • Patients should practice good cough and sneeze hygiene, by using a tissue, and then immediately discarding the tissue in a lined trash can, followed by washing hands immediately.
  • Patients should not have visitors in their home. Only those who live in their home should be allowed to stay.
  • At home, the patient should stay in a specific room and use his/her own bathroom (if possible). If they live in shared accommodation (university halls of residence or similar) with a communal kitchen, bathroom(s) and living area, they should stay in their room with the door closed, only coming out when necessary, wearing a facemask if they do so.
  • Patients should avoid sharing household items like dishes, cups, eating utensils and towels. After using any of these, the items should be thoroughly washed with soap and hot water.
  • All high-touch surfaces like table tops, counters, toilets, phones, computers, etc. should be appropriately and frequently cleaned. If patients need to wash laundry at home before the results are available, then they should wash all laundry at the highest temperature compatible for the fabric using laundry detergent. This should be above 60° C. If possible, they should tumble dry and iron using the highest setting compatible with the fabric. Disposable gloves and a plastic apron should be used when handling soiled materials if possible and all surfaces and the area around the washing machine should be cleaned. Laundry should not be taken to a laundrette. The patient should wash his/her hands thoroughly with soap and water after handling dirty laundry (remove gloves first if used).
  • Patients should know who to call if they develop any worsening symptoms, so that they can be safely reassessed.

Do Clinicians have to notify the NICD of COVID-19 positive cases?

Yes, Clinicians should notify the NICD of any COVID-19 positive cases identified, via the following link: COVID-19 Case Notification Form

In addition, probable and confirmed cases of Paediatric Inflammatory Multisystem Syndrome (PIMS), should be reported either via the NMC Portal at the following link: https://www.nicd.ac.za/notifiable-medical-conditions/ or alternatively by means of the following downloadable NMC case reporting form for Multisystem Inflammatory Syndrome.

Please refer to the following NICD document for the current WHO Case Definition of Multisystem Inflammatory Syndrome and more information in this regard.

SARS-COV-2 Antibody Testing

Ampath have validated laboratory-based SARS-CoV-2 (COVID-19) antibody tests and following SAHPRA’s approval, we can now offer these tests to our Doctors and Patients.

Please note that due to insufficient sensitivity of COVID-19 antibody tests in the first 14 days after disease onset, the test cannot be used to confirm or rule out current COVID-19. Please submit a respiratory specimen for a SARS-CoV-2 PCR if current COVID-19 is suspected. COVID-19 antibody tests should only be used to measure previous exposure to COVID-19 at least 14 days after disease onset or a previous positive SARS-CoV-2 PCR.

For more information on the test and recommendations for use, please refer to the COVID-19 Antibody AmpathChat

The SARS-CoV-2 antibody test will only be performed on doctor referral. This test can be ordered using your general Ampath Test Request Form by writing COVID-19 Antibodies in the OTHER TEST space, or, you can use our special SARS-COV-2 Antibody Request Form available on request.

A serum sample can be sent into the laboratory or your Patients can be directed to any of our Ampath Depots to have their sample collected. These are available at our designated collection sites and our collection depots. The test turn-around-time should be 24 to 48 hours once it has reached the testing laboratory.

The cash price of the test is R230.00. Claims will be submitted to Medical Aids until such time as further information is received from the schemes.

Notification of disease by Clinicians is not required for individuals who test positive for antibodies, unless associated with Paediatric Inflammatory Multisystem Syndrome (PIMS).

What is the clinical management of suspected or confirmed COVID-19 disease?

Please refer to the NICD’s “Clinical management of suspected or confirmed COVID-19 disease” guideline. This can be accessed at: Clinical Management of COVID-19 disease

When can a patient with COVID-19 de-isolate?

Current data based on small numbers of patients investigated, suggests that viable virus is shed up until approximately day 8 following onset of symptoms in SARS-Cov-2- infected patients. Viral RNA may be detected by PCR for longer (typically up to 12 days) although shedding of viral RNA does not always equate to shedding of viable and infectious virus.


Current guidelines recommend that asymptomatic persons de-isolate 10 days after they tested positive. With mild and moderate COVID disease, de-isolate 10 days after the onset of symptoms. COVID-patients with severe disease will shed virus at higher loads and for longer and thus should only de-isolate 10 days after clinical stability has been achieved (e.g. 10 days after supplemental oxygen was stopped).


In summary, the recommendation has changed from two consecutive negative results to no testing with the following de-isolation criteria:


Patients can be de-isolated:


  • 10 days after their initial positive test in asymptomatic patients; or
  • 10 days after the onset of their symptoms in mild cases, or
  • 10 days after achieving clinical stability in severe disease

Click HERE for the NICD Clinical Management of Suspected or Confirmed COVID-19 Disease

What should I advise a patient who requests a medical certificate to certify them “COVID-19 free”

  • An employer cannot force a patient to have a laboratory test to prove that they are not infected before you can work. A negative lab result does not mean that a patient may not be infected. Anyone with possible exposure who is asymptomatic should self- quarantine for 10 days.
  • A negative laboratory test result, if performed on a person who is well, does not constitute a medical certificate to certify a patient COVID free. There is no such thing as a “COVID-free medical certificate”.

External Resources

The National Department of Health and National Institute of Communicable Diseases (NICD) have developed clinical guidelines for health workers. You can also find more information on the NICD website: Clinical management of suspected or confirmed COVID-19 disease guideline


Please also see the WHO for daily situation reports with affected countries.


You can also find more information on the NICD website COVID-19 Resources


For additional assistance or information, kindly contact your local Ampath Pathologist.