Published: 16 April, 2020
A round-up of the news for primary care
Contents
Apply a low threshold for COVID-19 testing
The advice from Director General of Health, Dr Ashley Bloomfield, for the remainder of our period in Level 4 lockdown
is to test all people presenting with
"cold or flu" symptoms. The COVID-19
case definition from the Ministry of Health remains unchanged from the last update on 8 April*. Pragmatic
advice, as recommended by the RNZCGP,
is to “test all suspect cases if you have the capacity and focus on testing the priority groups if you have limited
capacity”.
* A suspect case satisfies the following clinical criteria: Any acute respiratory infection
with at least one of the following symptoms: cough, sore throat, shortness of breath, coryza, anosmia with or without
fever.
Advice for managing patients with a negative COVID-19 swab result
In general, decisions regarding the management of patients with a negative COVID-19 swab result should be made on
a case-by-case basis depending on their particular circumstances. However, the Ministry of Health has provided
some guidance:
- Patients still need to complete a full 14-day quarantine period if they have returned from overseas or
have had close contact with someone with the virus
- If patients are still unwell with the same illness at the end of the 14-day isolation period,
they will need to stay in isolation until they have been symptom-free for 48 hours
- If patients are well, and have been for 48 hours, they can return to normal daily activity
Noriday supply: update
We previously reported that there is a short-term supply issue with the progesterone-only oral contraceptive pill
(POP) Noriday. PHARMAC is aware of this issue and has advised that further supply is expected during April. Microlut
is a fully funded POP that can be used as an alternative to Noriday; PHARMAC report that there are currently no supply
issues with this product. There should be no clinical concern with transitioning from Noriday to Microlut, however,
patients should be informed that a change in bleeding pattern may occur.
You can access more information about this on the PHARMAC
website.
Family Planning has provided some advice
to clinicians about contraception options during Level 4 lockdown.
For further information about all contraceptive options, see: Contraception:
which option for which patient?
Second week deterioration in patients with COVID-19
Although many patients with COVID-19 being managed at home have a self-limiting mild viral illness for around one
week, it is reported that a small number continue to have fever, cough and other respiratory symptoms during the second
and third weeks. In these cases, it can be unclear whether this is due to COVID-19 virus, secondary bacterial pneumonia,
or a combination of the two. In addition, some patients clinically deteriorate in the second week with rapid onset
of acute respiratory distress syndrome (ARDS) due to systemic immune responses, e.g. sepsis or cytokine release syndrome.
ARDS is reported to be the most common cause of intensive care unit admission and mortality in patients with COVID-19. Read
more here.
The "take home message" is: ensure patients managing COVID-19 at home are well-informed about symptoms
and signs to look out for and know to phone the practice if their symptoms persist or worsen.
Drivers licence expiration dates will be extended for six months
The
New Zealand Transport Agency (NZTA) has temporarily extended the expiry date on all New Zealand driver’s licences
for an additional six months if they expired on or after 1 January 2020. Drivers aged over 75 years can continue to
drive using their existing licence, i.e. they do not have to undergo a medical assessment to renew their licence at
this time.
NZTA will revise this decision once driver licencing services resume; the extension may be applied for a longer period
and it is also likely they will take into consideration when face-to-face consultations in general practice have resumed
routinely.
This Bulletin is supported by the South Link Education Trust
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