COVID Care Preparation and Pathways
This webpage supports clinicians in helping their patients – and themselves – get COVID-Ready and outlines the supports available for COVID-19 positive patients and referral pathways.
Helping consumers to get COVID-Ready
All Queenslanders should be encouraged to write a COVID plan for themselves and their family and to pack a COVID-Ready kit in the event they test positive and need to isolate at home. This is particularly important for those patients most at risk during an outbreak due to medical or social reasons.
Please refer to the Clinicians checklist – Getting consumers COVID-Ready factsheet (PDF 808 kB) for more information.
Getting yourself COVID-Ready
To help prepare for a COVID outbreak, clinicians are encouraged to:
- talk to their patients about writing a COVID Care Plan for adults
- plan for or understand their local facility’s plan for an outbreak, such as when and how to use telehealth and virtual care options
- keep up to date with the latest PPE advice for your area
- exercise good hand and respiratory hygiene, regularly wipe down phones, ID and swipe cards, and other commonly used equipment at work
- remind patients it’s not too late to get vaccinated and encourage boosters
- subscribe to the Frontline COVID-19 Advice for the latest email updates
- follow guidelines from reputable sources such as Queensland Health and the Australian Department of Health
- ask for help from your line manager when you need it.
Most people who get COVID-19 will be able to recover at home while isolating, without the need for medical intervention. This website has tips and advice for consumers isolating with COVID-19.
The primary healthcare sector will manage most patients who require clinical support. General practitioners can refer to the Information for primary care webpage or this Primary Health Network website for information on managing COVID-19 positive patients.
Queensland Health has introduced an expanded triage system to stream COVID-19 positive patients to an appropriate care option when a higher level of care is required. This will help ensure Queenslanders are receiving the right type of care within an appropriate time frame. Under the model, consumers may be cared for virtually by a GP or other primary healthcare provider, admitted to a Queensland Health COVID-19 virtual ward and monitored remotely, or admitted to a COVID-19 ward in hospital.
A new central database and dashboard tracks the number of high-risk patients referred to each Hospital and Health Service (HHS). The virtual team will need to contact the patient within 24 hours to undertake an assessment and arrange for any remote monitoring devices to be safely delivered.
More information, diagrams and resources will be circulated soon.
- COVID-19 Virtual Care Admission (PDF 188 kB)
This form has been developed to capture clinical admission information for all patients admitted for COVID-19 management to Virtual care, Hospital-in-the-Home (HITH) care, or Inpatient care
- COVID-19 Virtual Care Review (PDF 525 kB)
This form has been developed to capture clinical review information for patients admitted for COVID-19 management in the Virtual care setting
- COVID-19 Virtual Care Discharge (PDF 186 kB)
This form has been developed to capture discharge from care information for patients that were admitted for COVID-19 management to a Virtual care setting
- COVID-19 Ward Round (PDF 175 kB)
This form has been developed to capture clinical information for patients currently admitted for COVID-19 management to Virtual care, Hospital-in-the-Home (HITH) care, or Inpatient care
Frequently asked questions
Risk stratification is the process where the consumer supplies information about themselves and their condition to find the best care pathway for them.
The Queensland Health COVID Care Self Checker, Billie the Bot automated phone service, and the National Coronavirus Helpline are all designed to screen consumers and risk stratify their symptoms to determine the most appropriate care pathway for them.
The risk stratification process follows the national guidance developed by the COVID-19 Clinical Evidence Taskforce (Pathways to care). The adult pathway to care incorporates the consumer’s symptoms, evidence of lower respiratory tract disease and other clinical indicators, and risk factors for poor outcomes. Risk factors include age, their location (I.e. remoteness/proximity to hospital), co-morbidities, vaccination status, whether they are pregnant, whether they are of Aboriginal or Torres Strait Islander heritage, and their living situation.
Based on the national definition from the National COVID-19 Clinical Evidence Taskforce:
An individual is considered at low risk of deterioration when they have no clinical features suggestive of moderate or more severe disease:
- no or mild symptoms and signs (fever, sore throat, malaise, headache, muscle pain, nausea, vomiting, diarrhoea, loss of taste and smell)
- no new shortness of breath or difficulty breathing on exertion
- no evidence of lower respiratory tract disease during clinical assessment or on imaging (if performed)
- absence of significant co-morbidities and risk factors that confer risk of greater disease severity.
It is appropriate for these individuals to manage their care at home as they would with other viruses.
Individuals considered at moderate risk of deterioration include:
- people experiencing moderate clinical symptoms such as breathlessness on mild exertion or saturations 92-94%
- people with complex social, public health or special care needs
- at risk populations
- pregnant women
- children with unwell parents
- parent/carer or child with severe mental health illness
- high density households / other environmental concerns
- geographical isolation
- presence of significant co-morbidities and/or risk factors for higher disease severity e.g. diabetes, cardiovascular disease, immunocompromised, chronic renal failure.
These consumers need to be monitored regularly. The consumer will be advised to contact their GP or other healthcare provider who can monitor their condition.
Primary healthcare providers will be notified by Healthdirect Australia if their patient has been triaged as ‘medium risk’. If a COVID-19-positive person does not have a regular GP, they will be referred to the Healthdirect Service Finder or encouraged to find a GP or local respiratory clinic which are specifically designed for COVID-19 positive patients.
In some areas where there are no or minimal primary healthcare services, Hospital and Health Services will support moderate risk consumers.
High – very high risk
Very high-risk consumers have severe symptoms of COVID-19 and signs of deterioration such as respiratory distress or respiratory failure, or other specific clinical or social risk factors that place them at high risk. These consumers will be referred to a Queensland Health hospital.
Consumers identified as very high risk by any of the screening services will automatically be referred to Triple Zero (000) or advised to attend their closest hospital emergency department. High risk / severe symptoms include:
- difficulty breathing even when moving around your home
- suddenly find it hard to breathe or your breathing has gotten worse
- coughing up blood
- significant chest pain
- collapsing or fainting.
- feeling cold and sweaty, with pale or blotchy skin
- have a rash that looks like small bruises or bleeding under the skin and doesn’t fade when you roll a glass over it
- feeling agitated, confused or very drowsy
- stopping peeing or peeing much less than usual.
Healthdirect Australia will notify GPs if their patient has been allocated to the medium risk pathway. If the GP is not managing COVID-19 positive patients, the consumer will be encouraged to find a GP or local respiratory clinic which are specifically designed for COVID-19 positive patients.
In some areas where there are no or minimal primary healthcare services, Hospital and Health Services will support moderate risk consumers.
The COVID-19 Care Pathway doesn’t replace normal referral processes already in place between primary healthcare and Queensland Health.
Consumers identified through the risk stratification process as ‘high risk’ will be referred to Queensland Health for further assessment. Hospital and Health Services (HHSs) will receive notification of these patients via a new dashboard which shows the consumer’s:
- demographic data
- answers to a series of social and clinical questions including vaccination status and co-morbidities
- date of symptom onset
- other risk factors.
The dashboard will not show whether the consumert has had a test for COVID-19 as consumers are able to be screened without a positive test result. Hospital and Health Services can determine at a local level whether a test is required and if the consumer needs to be re-screened upon receipt of the result.
The frequency of data updates on the dashboard will depend on where the data originates from:
- The Queensland Health COVID Care Self Checker – every fifteen minutes.
- Data from the Billie the Bot automated phone service – four updates per day between 8 am and 8 pm.
- Data from the National Coronavirus Helpline – every fifteen minutes.
HHSs with questions about the dashboard can contact eHealth Queensland’s CBI team.
Healthdirect Australia (or HHSs for at-risk populations) will assess and advise people of the appropriate care pathway including allocation to community-based care with GPs or Aboriginal Medical Service (AMS). Some Hospital and Health Services will also be able to provide care for COVID-19 patients where there is no GP/ primary care provider available.
The National Coronavirus Helpline also has translators and accesses the National Relay Service. Carers can also access these services on behalf of someone else.
Mob Link is an initiative of the Institute for Urban Indigenous Health to support Aboriginal and Torres Strait Islander people living in South East Queensland by linking them with health and social services. By calling 1800 254 354 Aboriginal and Torres Strait Islander people across South East Queensland can opt in to access a variety of COVID-19 related services and support plus a wide range of other health and social services.
Note: a positive test result is not required to access the screening services.
For children experiencing COVID-19 symptoms their carers are advised to visit the Children’s Health Queensland website.
If the child’s symptoms worsen, they are advised to:
- complete Queensland Health’s online COVID care self-checker on behalf of the child
- talk on the phone with automated phone service Billie the Bot (1800 845 298 for advice for children aged under 16 years)
- phone the National Coronavirus Helpline on 1800 020 080 which is accessible 24/7 (interpreters also available).
If at any time the child they are caring for experiences severe shortness of breath, is difficult to rouse, feeling faint or if they have serious concerns, they are advised to call 000.
Children less than three months of age who have a fever of 38 degrees or more are advised to present to their local emergency department within two hours.
As a consumer’s healthcare needs change, they can be moved to a different care pathway.
Escalation business rules have been developed with each Hospital and Health Service (HHS) which can be customised to suit their local environment. Further detail will be provided soon.
Discharge from a care stream will occur when the person has met the criteria for release from home isolation directions as per the national COVID-19 guidelines and are determined to have no further acute care needs. Please refer to the isolation and quarantine information below for information on leaving isolation.
For the most up-to-date information about isolation, visit the Queensland Government website.
Consumers with COVID-19 should follow the instructions on how to isolate safely. The below FAQs may also assist patients with COVID-19 or living with a diagnosed person.
If other people are living with the diagnosed person in the same household when the person takes a test, they are close contacts. They will also have to stay at home (quarantine) for seven days in case they also have COVID-19 unless they live in a separate part of the house and didn’t spend more than four hours in the same space together.
Close contacts should follow the instructions on how to quarantine safely.
Only those living with the person with COVID-19 need to quarantine. Friends and work colleagues of a close contact do not need to quarantine.
Most people can end isolation seven full days after taking a COVID-19 test.
In order to leave isolation, they must not have a fever, sore throat, runny nose, or a cough that is bad or getting worse, on day seven of their isolation. If they still have any of these symptoms they will need to remain in isolation until those symptoms have gone away.
Another COVID-19 test is not required in order to leave isolation.
If close contacts develop symptoms of COVID-19 while in quarantine, they should get tested and follow these instructions. If they test positive, they will need to spend seven days in isolation (in addition to any days already spent in quarantine).
If they do not develop symptoms, they are still required to have a COVID-19 test on day six of their quarantine. If the test is negative, they can leave quarantine.
Any person in the household who has had COVID-19 in the previous four weeks and is considered a cleared case does not need to quarantine if their close contact or household member tests positive.
All other close contacts will have to spend seven days in quarantine (in addition to any other days already spent in quarantine).
If people are worried about their mental health, they can read about when to seek help and the mental health services available.
If they need any other support while in isolation there is a guide on where to get help.
The positive PCR test result SMS and will have a link to the COVID Care website which has links to the COVID Care Self Checker. Consumers who lodge a positive Rapid Antigen Test result will also receive this advice via the confirmation email.
Information about all screening services is also linked to from the Queensland Government COVID website and will be promoted via a marketing campaign.
Consumers won’t be able to choose their own care pathway. The risk stratification process will determine the most appropriate model based on the information they provide.
Patients who do not have a regular GP will be referred to the Healthdirect Service Finder or encouraged to find a GP or local respiratory clinic which are specifically designed for COVID-19 positive patients.
In some areas where there is no or minimal primary healthcare services, Hospital and Health Services will support moderate risk consumers.
- management of risk of infection
- determining the setting of care
- baseline assessment of clinical presentation to determine disease severity and of co-morbidities and risk factors for developing more severe disease (see above algorithm/table).
- monitoring and markers of clinical deterioration, such as rapidly progressive respiratory failure and sepsis, especially five to 10 days after onset of symptoms (see above algorithm/table)
- instituting supportive therapies
- consideration of disease modifying treatments (e.g., inhaled budesonide 800mcg BD in non-hospitalised patients with mild-moderate disease within 14 days of symptom onset who do not require oxygen and have one or more risk factor for disease progression):
- consideration of contacting local Hospital and Health Service (HHS) to apply for monoclonal therapy (see below).
Please refer to the information for primary care website for additional resources.
Monoclonal therapies generally block critical spike protein interactions to help prevent disease progression in confirmed mild-to-moderate outpatients. These medications have limited availability, so they are supplied and monitored under the National Medical Stockpile tiered system of priority and control. Currently, there are two single dose, intravenous infusions available (sotrovimab and, casirivimab plus imdevimba [ronapreve]). The clinical criteria for a patient to be eligible for these drugs is in general:
- confirmed RAT/PCR positive mild-to-moderate disease within 5 days of symptom onset
- not requiring oxygen and being managed out of hospital
- not fully vaccinated (i.e. zero or one vaccination only) AND have at least one risk factor for severe disease (e.g. diabetes requiring medication, BMI > 30, eGFR < 60mL/min/1.73m2, cardiovascular disease, chronic lung disease, age > 50 years) OR be immunocompromised (primary/acquired immunodeficiency, recent chemotherapy, prednisolone >=20mg/day, DMARD therapies).
Access to monoclonal therapy infusions is via discussion with the virtual COVID-19 ward senior medical officer or infectious diseases physician and referral to the local HHS through their appropriate pathway. Please refer to the information for primary care website for information on referrals.
Sotrovimib is the preferred intravenous monoclonal therapy as it is active in cases of omicron (ronapreve is not active against omicron). Ronapreve is an alternative to sotrovimab for patients with symptom onset between days 5-7 who are not infected with omicron. Neither drug is used in pregnancy. Patients should not receive a COVID-19 vaccination for 90 days following the infusion.
Teenagers aged between 12 and 18 years may be eligible for a monoclonal infusion therapy if there is a risk of severe disease, recognising that the risk of severe disease is lower than in adults. The same referral pathway is to be used if required for these paediatric patients.
Every HHS has a phone number for GPs to call for COVID-19 advice and to expedite referral to the virtual ward or hospital, together with an array of written referral pathways. These access details are summarised on HealthPathways.
Approximately 10 per cent of patients will continue to experience symptoms beyond three months, broadly falling into three groups:
- chronic fatigue
Long COVID is defined as symptoms lasting for more than three months after acute COVID symptom onset and lasting six months or perhaps longer, not otherwise explained. It is differentiated from post-COVID syndrome when patients take a month or two to fully improve and post-ICU syndrome for patients who have experienced a critical illness, potentially with a period of ventilation, with the consequent neuromyopathic effects of this serious illness. Long symptom syndromes were also observed in SARS and MERS.
There is a range of symptoms that can affect any body system. Adults and children can be affected and in general the severity of the acute illness does not reliably relate to the development of long-COVID, but there is some sense that being older (>70 years), female, having more initial symptoms and co-morbidities might confer greater risk of developing long-COVID. Serum biomarkers at 2-3 months may be helpful e.g. CRP. Assessment will be required to differentiate exacerbation of chronic disease from new pathology and to consider multi-disciplinary management options.
The possibility of long-COVID should be identified at the outset for patients and steps taken to adjust expectations of recovery, if appropriate. A home-based, self-directed rehabilitation program endorsed by the Statewide Clinical Rehabilitation Network and reflective of the WHO: Support for rehabilitation: self-management after COVID-19-related illness policy. Additional information regarding long-COVID can be accessed on HealthPathways.
If you have had COVID-19 and during your isolation period, a household member tests positive to COVID-19, you are not considered their close contact as you have already been infected. So, you are not required to quarantine. Further information is outlined on this page.
For other household members who have not had a COVID-19 infection in the preceding four weeks, their quarantine period would recommence on the date the second or third household member becomes a diagnosed person.
Further information can be found on the ‘Exposed to COVID-19’ website.
Regular GP consults attract Medicare Benefits schedule rebates. From 1 January 2022, patient access to telehealth services will be supported by ongoing Medicare Benefits Schedule (MBS) arrangements.
For the latest list of MBS-supported consults, please visit the MBS Online website.