The COVID-19 outbreak constitutes a public health emergency and risk to practitioners, patients and more broadly, the well-being of the South African community. The declaration made by the honourable president on the 16th March 2020, followed by regulation R43107 published on 18th March 2020 and the declaration of a nationwide lockdown on the 23rd March 2020 all indicate that South Africa is faced with a grave situation previously unseen in recent memory.
The Health Professions Council of South Africa (HPCSA) is required to play a critical role in this regard, that is, by providing policy guidance and a framework for the continued delivery of healthcare. This should still be done while adhering to applicable legislation and regulations albeit with the constraints imposed by the current situation.
This guidance is being issued for that consideration.
Responsibilities of practitioners
The HPCSA’s professional standards provide a framework for ethical decision making in a wide range of situations, including emergencies, and these should be adhered to as far as it is practical in these circumstances.
As this situation unfolds, practitioners may be required to depart from their established procedures, although this should be done responsibly, reasonably and in the best interest of patients. Except in emergency situations, practitioners should perform professional acts for which they are adequately educated, trained and sufficiently experienced. Also, practitioners should provide information in a manner that patients will understand.
Who should be tested?
From the moment COVID-19 is suspected, the Person Under Investigation (PUI) should be isolated, and infection control measures immediately instituted. Only PUI for suspected COVID-19 should be tested.
Rapid collection, transport and testing of appropriate specimens from PUI is a priority. Clinical specimens should be collected as soon as possible after the onset of symptoms, ideally within 7 days. If the patient presents after 7 days from symptom onset and is symptomatic, respiratory and serum samples should be collected.
Guidance on the application of telemedicine guidelines during the COVID-19 pandemic
The exponential increase in the number of reported cases of COVID-19 in South Africa led to the declaration of the National State of Disaster by the government. Key basic measures that could help prevent the further spread of the disease, mainly are, self-isolation and social distancing. Practitioners are faced with an ethical dilemma of how to contribute to the national endeavours of self-isolation and social distancing and continue to be accessible to their patients within the current Telemedicine framework of the Health Professions Council of South Africa (HPCSA).
In view of the current national state of Disaster, the announcement of a 21 days nationwide- lockdown and recognizing that practitioners render essential services which must be carried out with reasonable skills and/or competency and safety to both the practitioner and patients, the HPCSA hereby provides the following guidelines in the application of the Telemedicine Guidelines as contained in Booklet 10 of the Guidelines For Good Practice in the Healthcare Professions:
- “Telemedicine” is hereby replaced with “Telehealth” which includes amongst others, Telemedicine, Telepsychology, Telepsychiatry, Telerehabilitation, etc., and involves remote consultation with patients using telephonic or virtual platforms of consultation.
- “Telehealth” is only permissible in circumstances where there is an already established practitioner-patient relationship, except where Telepsychology and/or Telepsychiatry is involved, in which case telehealth is permissible even without an established practitioner-patient relationship.
- Practitioners may charge a fee for services rendered through a telehealth platform.
- Where practitioners are in doubt whether a telehealth consultation will be in the best interest of the patient, they are encouraged to advise patients to present themselves for a face-to-face consultation to seek assistance at a health care facility closest to them.
This guideline is only applicable during the COVID-19 pandemic. The HPCSA shall, soon after the end of the pandemic, inform practitioners of when this guidance will cease to apply.
Practitioners should always endeavour to ensure that they always adhere to the provisions of Ethical Rule 27 A of the Ethical Rules of Conduct for Practitioners Registered Under the Health Professions Act.
Healthcare practitioners confirmed or suspected of occupational exposure to COVID- 19 should refer to the NICD guidelines for COVID-19. Lists of healthcare workers with occupation exposure should be compiled by the respective health facilities. Practitioners with exposure should be actively monitored for symptoms and rapidly isolated and tested should they develop symptoms.
Personal protective equipment
Employers and employing institutions should take all necessary steps to ensure that staff members are always suitably equipped and afforded personal protective equipment (PPE). Employers also have a responsibility to provide staff with the right information to minimise the risk of transmission.
Should PPE not become immediately available, information on what to do may be sought from the NICD’s clinical guidance on COVID-19. In this regard, factors to consider include, but are not limited to:
● whether treatment can be delayed
● whether additional steps can be taken to minimise the risk of transmission
● prioritisation of practitioners at a higher risk of infection
● identification of action likely to result in the least harm under the circumstances.
Practitioners should bring concerns regarding their conditions of work and therefore risk to their health, to the attention of their employers, HPCSA or the Office of Health Standards and Compliance as soon as possible.
Quarantine – which entails separating asymptomatic individuals potentially exposed to disease from non-exposed individuals in order to slow down pathogen transmission – should be used. This may require considerable use of resources and infringement to human rights.
Quarantine should be distinguished from isolation, which is the act of separating a diseased individual with a contagious disease from healthy individuals without the disease. Quarantine may be voluntary (e.g. asking contacts of infectious cases to stay at home or a designated facility for 14 days) or involuntary (i.e. using legal powers to enforce quarantine against a person’s will). However, if a healthcare worker that was not wearing appropriate PPE was to be exposed to a confirmed case, the healthcare worker would be allowed to return to work and self-quarantine after hours. Quarantine may be applied at an individual patient level or at the level of a group or community of exposed persons.
Continuous Professional Development
Practitioners are expected to continue updating their professional knowledge and skills in order to effectively manage patients in the context of the COVID-19 pandemic, as well as other health conditions of public health importance.
Expectations by patients and other health service users
Practitioners may be under considerable pressure due to the impact of coronavirus and are advised to refer to NICD FAQ when attending to queries from the public.
Registrations and Annual Renewals
Council considers all activities related to registration as essential services and practitioners should continue to submit their applications for registration and/or restoration, electronically to firstname.lastname@example.org. All applications will be processed within 10 days.
Practitioners are also reminded that annual fees are due on 1 April 2020 and practitioners should utilize the online portal for the renewal of their registration.
National Institute of Communicable Disease. Covid- 19 Guidelines Available from www.nicd.ac.za/diseases-a-z-index/covid-19/covid-19-guidelines/ Accessed on 22/03/2020
National Department of Health. Corona Virus (Covid-19) – Updated. Available on www.health.gov.za/ Accessed on 22/03/2020
Medical Council of New Zealand. Current Standards. Available on www.mcnz.org.nz/our-standards/ Accessed on 22/03/2020
General Medical Council. Ethical Guidelines. Available on www.gmc- uk.org/ethical-guidance/ethical-hub Accessed on 22/03/2020
Last Updated on 30 March 2020 by HPCSA Corporate Affairs