The NSW Nurses and Midwives’ Association is providing support and advice to any members seeking information regarding the novel coronavirus (COVID-19).

Join the NSWNMA to ensure you’re covered at work.

The Commonwealth Department of Health website contains detailed guidance for health sector workers and is updated regularly.

If members are concerned their employer is not following these guidelines, the NSWNMA can provide assistance to ensure appropriate measures are in place. Contact us.

Click here for the latest Workforce Advice for NSW Health staff Click here for the latest WHS Advice for NSW Health staff

Australian Technical Advisory Group on Immunisation (ATAGI) advice on the AstraZeneca

‘Thrombosis with thrombocytopenia syndrome’ (TTS) is a newly described serious condition, with unusual blood clots in the brain (cerebral venous sinus thrombosis) or in other parts of the body, associated with low platelet levels and can cause serious long term disability or death.

The evidence that connects TTS to receipt of the AstraZeneca vaccine has been reviewed by ATAGI and the Therapeutic Goods Administration (TGA) and subsequently, ATAGI has recommended new changes to the Australian COVID-19 Vaccine Program, including a preference for the use of the Comirnaty (Pfizer) vaccine in adults aged under 50 years.

The ATAGI statement (found here) provides further information on the key considerations.  Amongst these were the following:

• TTS remains an extremely rare event among vaccine recipients. Experience in Europe has shown approximately  4 – 6 people in every one million people develop TTS in the 4-20 days after the first dose of vaccine. However higher rates have been reported in some countries, and among younger people. One person in Australia developed the syndrome after receiving the AstraZeneca vaccine.
• While Australia currently has very low or no community transmission of COVID-19, this could change. The risk of serious disease and death in Australia remains, even as border controls and other measures continue.
• The individual benefit-to-risk balance of vaccination with COVID-19 vaccine AstraZeneca in Australia varies with age. The risk of ongoing health issues and death from COVID-19 is highest in older age groups, particularly rising from 50 years of age. By comparison, the rate, and so possibility of disability and death from TTS may be higher in younger people.

ATAGI has further recommended that:

• The AstraZeneca vaccine should only be used in adults aged under 50 where the benefits clearly outweigh the risk for that individual and the person has made an informed decision based on an understanding of the risks and benefits.
• People who have had the first dose of COVID-19 Vaccine AstraZeneca without any serious adverse effects can be given the second dose, including adults under 50 years.

The Pfizer vaccine will continue to be administered as planned at NSW Health clinics.

Information about vaccinations completed by NSW Health clinics is updated daily at this link (vaccination of category 1a and 1b is not reported separately).

FAQs

Is the AstraZeneca vaccine safe?

Yes. The individual benefit-to-risk balance of vaccination with the AstraZeneca COVID-19 vaccine varies with age. This balance is based on factors including the increased risk of complications from COVID-19 with increasing age and the potential lower risk of this very rare, but serious, adverse event with increasing age. ATAGI has recommended the AstraZeneca vaccine remains safe to be given to people aged 50 years and over.

I have had my first dose of the AstraZeneca vaccine, what do I do now?

If you have had your first vaccine dose without this side effect or other serious adverse effects, you should receive your second dose as planned.

What if I am worried about side effects?

If you have recently had your first vaccine dose and are experiencing any side effects that you are worried about, see your doctor.

I’m booked in for my first dose of the AstraZeneca COVID-19 vaccine, what do I do?

If you are an adult aged under 50 years, you should only receive a first dose of AstraZeneca COVID-19 vaccine where the benefit of receiving the vaccine clearly outweighs the risk in your individual circumstance. You may wish to discuss your individual benefit-to-risk balance with your doctor.

Generally, if you have not already received a first dose of the AstraZeneca COVID-19 vaccine, then the Pfizer COVID-19 vaccine is preferred in adults aged under 50 years.

If you are 50 years of age or older, you can still receive your AstraZeneca COVID-19 vaccine.

Administration of COVID-19 vaccine

To access FAQs on administering COVID-19 vaccines, click here.

Vaccination plan

The NSW Ministry of Health recently issued advice to healthcare workers on the rollout of the national COVID-19 vaccination plan.

Vaccines are voluntary, free and offered in a phased approach (Phases 1a, 1b, 2a, 2b and 3 as set out by the Australian Government).

The first three hubs to deliver the Pfizer/BioNTech COVID-19 vaccine to healthcare workers are Royal Prince Alfred, Westmead and Liverpool hospitals.

Five major vaccination hubs and 99 regional satellite sites will open progressively across NSW starting from Monday 15 March, as the COVID-19 vaccination rollout stretches across the state.

These vaccination hubs and satellite sites will initially focus on frontline healthcare and border workers, and will eventually be followed by a wider rollout of the vaccine to the general public through the GP network.

The five major hubs and their linked satellite sites will open progressively from 15 March through to April and will be located at:

• Newcastle Hospital
• Wollongong Hospital
• Wagga Wagga Base Hospital
• Coffs Harbour Hospital
• Dubbo Hospital.

The vaccine will be dispatched from the hubs to the satellite sites.

​​​​Each hub will be responsible for vaccinating staff in a number of Local Health Districts. The hubs will not be open to members of the public during Phase 1a.

Staff identified to receive the COVID-19 vaccination in Phase 1a will be contacted directly about how, when and where they will be able to get vaccinated.

​As stated by the Ministry of Health, healthcare workers considered for prioritisation in Phase 1a of the vaccination program include:

• Ambulance and patient transport staff
• Emergency department staff
• Critical care ward staff (ICUs and HDUs, ECMO and medical retrieval teams)
• COVID clinic and COVID testing staff (public and private)
• COVID ward staff
• COVID immunisation clinic staff
• COVID pathology lab staff (public and private)
• Workers at the Special Health Accommodation facility

More hubs are expected to follow as more doses of vaccine become available.

FAQs

Do I have to take time off work to get vaccinated?
No. Health staff will be scheduled for vaccination appointments during rostered hours. If this is not possible, paid time will be offered.

What if I miss my scheduled appointment?
If a health worker in Phase 1a is unable to attend the offered vaccination appointment, it will not be their last chance to access the vaccine at a later date.

If I don’t take up the offer to be vaccinated in Phase 1a, will I be deployed to work in another location? 
As it is not mandatory, the Ministry has no current intention to seek or require staff to be redeployed who do not take up the opportunity to be vaccinated during Phase 1a.

What if I get sick from the vaccination? Can I access sick leave?
If you require to be off work due to the side effects of being vaccinated, it will be considered sick leave. If a health worker has no sick leave balance then additional paid sick leave will be made available.

I’m a regional nurse that’s been directed to go to Liverpool for the vaccination (up to a nine hour round trip in travel). Are vaccinations made available in work time or is it ‘expected’ to travel and attend in my own time (and bear the costs)? 
As noted above, vaccination should be scheduled in rostered time. While acknowledging the long distances involved, the Ministry invited regional and rural health workers early to ensure they were not unreasonably excluded from the initial Phase 1a rollout. The Pfizer vaccine, due to its storage requirements, will remain only distributable at this time from the limited three vaccination hubs at Royal Prince Alfred, Westmead and Liverpool hospitals. On the expansion to 11 hubs and rollout of the AstraZeneca vaccine, it is expected that access will be greatly improved.

Is the COVID-19 vaccine training program to be in paid time (i.e. during rostered hours) or paid time if done outside working hours for those who have been requested/directed to complete by the LHD?​​​​ 
When the Commonwealth requirement was first announced, this was raised by the NSWNMA. As it is a requirement to complete to administer vaccinations, if the LHD tasks you to this role, it is expected to occur in work time/paid time. Where it is undertaken outside or additional to normal working hours, PHS staff will be paid for the time taken to complete the course.

NOTE: If you proceed with the vaccination (first dose) then you will need to attend a relevant site for your second dose. Consider and be prepared for two trips to a vaccination hub.

Position statements and supportive evidence

As professional leaders in this area, nurses and midwives can find the NMBA’s position statement on vaccination here.

Ahpra’s position statement on Registered health practitioners and students and COVID-19 vaccination is available to view here.

The National Boards and Ahpra have published a joint statement to help registered health practitioners and students understand what’s expected of them in giving, receiving and advising on and sharing information about COVID-19 vaccines. It can be viewed here.

The ANMF’s policy on vaccination is here.

ANMF Evidence on the COVID vaccine is here.

Interstate Staff Travel for Recreational Purposes

Australian State and Territory borders are subject to rapid closures and changes to quarantine or self-isolation requirements without notice as a result of the COVID-19 pandemic. Staff are therefore asked to carefully consider interstate travel plans. Special Leave is not available for time spent quarantining or self-isolating as a consequence of recreational travel.

Interstate travel on compassionate grounds (due to death/ illness of relatives residing interstate) will be considered on a case by case basis by the employing Health Agency; in the event quarantine or self-isolation is required upon return to NSW.

Personal Protective Equipment (PPE)

CEC guidelines around Respiratory Protection in Healthcare state:

In NSW, LHDs/SHNs are required to implement respirator fit testing in their facilities for health workers (HWs) performing respiratory Aerosol Generating Procedures (AGPs) on patients with COVID-19 or providing clinical services to patients on airborne precautions in high risk areas.

When staff are directed to work with patients who are COVID-19 positive or COVID-19 symptomatic the CEC guidelines state, in all circumstances:

• staff are to wear PPE as prescribed in the CEC guidelines
• staff are not to undertake or be required to undertake tasks requiring PPE if the PPE is not available for use. Any such tasks are not to proceed until required PPE is available.

Where staff are performing tasks requiring P2/N95 mask use under the CEC guidelines and where the employee has fit checked the available P2/N95 mask sizes and these sizes are not a correct fit, then the employee is to be temporarily redirected to work which does not require the use of a P2/N95 mask until suitable masks with correct fit become available.

For more detailed advice on PPE, visit this page.

Response and Escalation Framework

The Framework contains: general principles to be applied; a risk matrix model; along with posters and FAQs in relation to each of the alert levels. Under the current Green alert, the COVID-19 precautions for health workers remain utilising standard precautions (including physical distancing in breaks), with transmission-based precautions utilised for suspected/probable/confirmed COVID-19 cases. Refer to the framework for more detailed information.

Latest COVID-19 case locations in NSW

Have you been to a potential case location? Please check this list regularly and watch for COVID-19 symptoms.

Staff who may have visited potential case locations are advised to immediately:

• Attend a clinic for testing, even if they have no symptoms
• Watch for respiratory symptoms and get re-tested should any symptoms occur
• Self-isolate and remain in self-isolation until 14 days have passed since they attended a potential case location in the specified period, even if a negative test result is received.

Where a NSW Health staff member is self-isolating on Special Leave and becomes sick for any reason, they should transition onto Sick Leave.

Special paid leave

Thanks to ongoing NSWNMA negotiations around leave entitlements, NSW Health employees have access to 20 days of paid special leave (for COVID-19) prior to a accessing their own accrued leave. This will be granted to employees who are unable to work because they are:

• Self-isolating due to travel or close contact COVID-19 exposure (exclusions apply)
• Caring for family members sick with COVID-19
• Caring for family members due to closure of school/daycare
• Unable to attend work due to transport disruptions or workplace closure
• A vulnerable health worker who, following completion of a risk assessment, is unable to be redeployed to a lower COVID-19 risk environment and is unable to work from home or self isolation

After the 20 days total paid special leave has been used, employees may access accrued leave entitlements (in accordance with normal processes).

The 20 days special leave will be provided on a pro-rata basis for part time staff.

Where an employee is self-isolating on special leave and becomes sick for any reason; at that point the employee should transition onto sick leave. Where sick leave is exhausted, Health Agencies may grant additional sick leave on a case by case basis.

Those who travelled overseas from 16 March 2020, despite current notifications, will NOT be granted paid special leave to cover isolation upon return to Australia.

Staff who have contact with a confirmed case of COVID-19

If close contact of a person confirmed to have COVID-19 has occurred

Until 14 days have lapsed from last contact, the staff member must:

• not attend work
• self-isolate other than for seeking individual medical care for 14 days from the last day of contact
• monitor symptoms for 14 days since last contact
• seek medical attention as soon as possible if fever or respiratory illness (even if mild) occur. Call the healthdirect helpline 1800 022 222 for advice or call ahead before seeing your GP or go directly to the local Emergency Department or COVID-19 clinic.

If casual contact of a person confirmed to have COVID-19 has occurred

The staff member must:

• continue to attend work if well
• self-isolate and seek assessment if they develop fever or respiratory illness.

Temporary paid accommodation

Provisions for temporary paid accommodation for health workers providing frontline health services (including hospital and ambulance staff) were announced on 6 March 2020.

Due to the changing nature of the pandemic, Public Health Organisations (PHOs) will be required to use a risk-based approach when approving access to temporary accommodation. The immediate focus will be on:

Health workers providing frontline health services including permanent, temporary, casual (with booked shifts), hospital, ambulance and community staff. This includes Visiting Medical Officers (while working for NSW Health).

Temporary accommodation can be utilised in the following circumstances:

1. Staff who have contracted COVID-19;
2. Staff awaiting COVID-19 test results and/ or in self-isolation due to close contact with a positive COVID-19 case;
3. Frontline staff living with vulnerable high-risk family members; and
4. Frontline staff working extended hours, short shift changes, extensive overtime due to COVID-19 workload.

To note:

• Use of the accommodation option is voluntary and is not mandated by the employer.
• Different arrangements will be provided for COVID-19 and non COVID-19 affected staff.  For example, if someone has COVID-19 they will be required to isolate.
• Hotels near hospitals have been identified and will be used for health worker accommodation where ever possible.
• Meals will be included.
• Booking will be undertaken by the PHO using government approved processes and not by the individual health worker.

Attendance at meetings and conferences

Up-to-date information about the requirements for events is available here.

Vulnerable Staff

The Australian Health Protection Principal Committee (AHPPC) considers that, based on the limited current evidence, the following people are, or are likely to be, at higher risk of serious illness if they are infected with the virus:

• Aboriginal and Torres Strait Islander people 50 years and older with one or more chronic medical conditions
• People 65 years and older with chronic medical conditions. Conditions included in the definition of ‘chronic medical conditions’ will be refined as more evidence emerges. The most current list can be accessed on the Department of Health website
• People 70 years and older
• People with compromised immune systems (see Department of Health website)

AHPPC recommends that where vulnerable workers undertake essential work, a risk assessment must be undertaken. Risk needs to be assessed and mitigated with consideration of the characteristics of the worker, the workplace and the work. This includes ensuring vulnerable people are redeployed to non-customer based roles where possible. Where risk cannot be appropriately mitigated, employers and employees should consider alternate arrangements to accommodate a workplace absence. In this case, those workers should be able to access the paid special leave (for COVID-19).

AHPPC recommends that special provisions apply to essential workers who are at higher risk of serious illness and, where the risk cannot be sufficiently mitigated, should not work in high risk setting. (AHPPC advice, 30 March 2020)

There is limited evidence regarding the risk in pregnant women. Currently there is no evidence of an increased risk of miscarriage, teratogenicity or vertical transmission of the COVID-19 virus. There is a possibility of an increased incidence of premature birth but there is insufficient evidence at this point in time. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommends that, where possible, pregnant healthcare workers be allocated to patients, and duties that have reduced exposure to patients with confirmed or suspected COVID-19 infection.

Other useful resources

NSW Health provides comprehensive information, fact sheets and updates about COVID-19 here.

• Personal Protective Equipment (PPE)
• Public Health Workforce Surge Guidelines

More COVID-19 / Flu clinics are being established within all Local Health Districts to assess and diagnose patients with possible COVID-19 infections and other respiratory illness, such as influenza, as winter approaches.

NSW Health has existing policies for an operational response to COVID-19 and the emergency department preparedness for an influx of patients. Both guidelines below are from the NSW Health Influenza Pandemic Plan:

• Intensive Care Guidance for COVID-19
• Emergency Department Guidance for COVID-19

Further information on PPE

Further information for private health nurses and midwives

The NSWNMA will continue to provide further updates for members as we receive them. Contact us here.