COVID-19 Primary Care Update 21/1/2022

21 January 2022

Good afternoon,

Thank you to everyone who attended the COVID-19 webinar, hosted by Adelaide PHN on Wednesday night. For those who could not attend, please find a link to the recording here.

The update on Wednesday included the GP referral process in how to access Monoclonal Antibody (MBA) infusions for patients and an update from the AMA and SA Pathology. See the updated slide set from Wednesday (PDF 4.8MB). In addition, included below is the most up to date Obstetric COVID-19 information.

Post acute sequelae of COVID-19

PASC is a condition that occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually three months from the onset of COVID-19 with symptoms, that lasts for at least two months and cannot be explained by an alternative diagnosis.

Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others and generally have an impact on everyday functioning.

Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time.

We have noticed an increase in GPs contacting us about seeing this in their patients. If someone develops new onset acute symptoms post clearance and is a known close contact, CDNA SonG advice is to seek testing, even within the four weeks post infection.

Find more information on post acute sequelae of COVID-19.

NUVAXOVID is provisionally approved as a COVID-19 vaccine

The Therapeutic Goods Administration (TGA) has granted provisional approval to Biocelect Pty Ltd (on behalf of Novavax Inc) for its COVID-19 vaccine, NUVAXOVID.

The protein-based vaccine has been approved for 18 years and older as primary two dose course, with a three week interval between doses. NUVAXOVID is provisionally approved for primary vaccination only and not booster doses or for children.

It is expected that supplies will be available from February onwards. Find more information on NUVAXOVID.

Oral COVID-19 treatments

The Therapeutic Goods Administration (TGA) has granted provisional approval to two oral COVID-19 treatments:

  • PAXLOVID (nirmatrelvir + ritonavir) - Pfizer Australia Pty Ltd·
  • LAGEVRIO (molnupiravir) - Merck Sharp & Dohme (Australia) Pty Ltd

Both of these products, which are the first oral treatments to be approved for COVID-19 in Australia, have been granted provisional approval for the treatment of adults with COVID-19 who do not require initiation of oxygen and who are at increased risk of progression to hospitalisation or death.

SA Health will be looking at how we expand the current Sotrovimab pathway to include oral therapies, noting the requirements for referral and potential side effects.

Both oral medicines should be administered as soon as possible after diagnosis of COVID-19 and within five days of the start of symptoms. LAGEVRIO is available as capsules, while PAXLOVID comprise separate tablets of nirmatrelvir and ritonavir. In both cases, the medicines are taken twice a day for five days.

COVID-19 Maternity Care

Flinders Medical Centre (FMC) is the dedicated hospital to provide care to COVID-19 positive maternity patients across South Australia for women who need hospital / acute care for birthing or assessment. This includes COVID-19 positive pregnant women who are:

  • greater than 16 weeks
  • less than 16 weeks and have pregnancy related complications 

Note: maternal-foetal-medicine women and cardiac babies will continue to be supported by specialists from Women’s and Children’s Hospital.

Patient(s) safety is paramount, COVID-19 positive or suspected COVID-19 pregnant women in established labour will be supported to give birth to their baby at the presenting hospital.

COVID-19 positive pregnant patient

Following a positive COVID-19 diagnosis, most pregnant women will be cared for in the community virtually by the COVID Response Care Team (CRCT) via the GP Assessment Team (GPAT), in consultation with an Obstetrics care team from one of the Local Health Networks (LHNs) across SA or their private health practitioner.

Women across the state who require additional social support and or monitoring due to COVID-19 symptoms will be able to access the Hospital in the Hotel facility in Adelaide. CRCT, in collaboration with the patient’s Obstetric care team, will facilitate the transfer and care of the patient during this time.

FMC Obstetrics team will coordinate any planned visits (assessment or birthing) for COVID-19 positive pregnant women. For any unplanned visits, COVID-19 positive pregnant women are asked to contact the FMC Birthing and Assessment Suite (BAS) via the FMC Switchboard on (08) 8204 5511 prior to their arrival at the hospital.

Further information for pregnant women who have tested positive to COVID-19 or are suspected COVID-19 positive, and are being admitted to Flinders Medical Centre to birth, can be found here: FMC COVID-19 Maternity Care brochure (PDF 274KB).

Suspected COVID-19 positive pregnant patient

A pregnant woman who is suspected of having COVID-19 and requires acute care will be treated at the hospital to which they present. Where appropriate, a COVID-19 test will be undertaken at the presenting hospital to determine the most suitable pathway for care.

Note, COVID-19 positive or suspected COVID-19 pregnant women in established labour will be supported to deliver their baby at the presenting hospital.

Non-Covid-19 positive pregnant patients

Pregnant women who are non-COVID-19 positive will continue to receive high quality care and be supported to birth at their designated hospital. For women living in metropolitan Adelaide, non-COVID-19 positive births will take place at the Women’s and Children’s Hospital and the Lyell McEwin Hospital. Regional non-COVID-positive pregnant women will continue to receive care and birth at their designated hospital.

COVID-19 testing requirements

A number of preventative measures are in place to keep pregnant women, their baby and those around them safe when accessing our healthcare services.

As part of this, pregnant women and their partner/support person living within the same household will be asked to undergo COVID-19 testing on arrival when in labour and at or prior to admission when undergoing a planned caesarean section or induction of labour.·

You can find information on WCHN’s testing requirements here:

You can find information on FMC’s testing requirements here:

You can find information on LMH’s testing requirements here:

Regional patients should contact their midwife or treating health professional for further information on COVID-19 maternity testing requirements for their designated birthing hospital.

Vaccination during pregnancy

It is important that GPs discuss the benefits of and strongly encourage the COVID-19 vaccination for pregnant women and their unborn babies during patient’s antenatal visits.COVID-19 vaccination may provide indirect protection to babies by transferring antibodies through the placenta (during pregnancy) or through breastmilk (during breastfeeding).

Pregnant women and their unborn babies have a significantly higher risk of severe outcomes from COVID-19 than non-pregnant people, including: 

  • 5 times higher risk of requiring a hospital admission. 
  • 2-3 times higher risk of needing treatment in a hospital intensive care unit.
  • 1.5 times higher of being born preterm or admission to a special care nursery.

It is safe to get the first, second and booster dose of the Pfizer or Moderna COVID-19 vaccines at any stage of pregnancy.

From 19 January 2022, pregnant patients are eligible to get a booster if they are aged 18 and over and had their second dose of a COVID-19 vaccine at least three months ago.

For the most up to date information regarding COVID-19 vaccine recommendations while pregnant or breastfeeding, please view the following Australian Government resource: COVID-19 vaccination decision guide for women who are pregnant, breastfeeding or planning pregnancy.

Further research and information is available from SA Health here: COVID-19 vaccination and pregnancy, planning a family, and breastfeeding.·Please find a video on this topic from Dr Emily Kirkpatrick and Professor Helen Marshall here:

COVID-19 vaccination and pregnancy, planning a family, and breastfeeding.

Maternity visitor guidelines

The health and wellbeing of the birthing family and their newborn is of paramount importance. Visitor limits are in place across all hospitals to limit the risk of COVID-19 infection. We understand that these precautions may be difficult for families, however they are only for the short term while the pandemic continues to be active in our community.

Note, exceptions may be considered for compassionate reasons. Please encourage your patient to discuss any concerns with their treating midwife or doctor at their next appointment.

LHN maternity visitor guidelines can be found on:

Regional patients should contact their midwife or treating health professional for further information on maternity visitor guidelines for their designated birthing hospital.

Please forward this update to any colleagues who may not have received it and contact us at Health.COVID-19GPLiaison@sa.gov.au to be added to our mailing list or with any other enquiries.