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Published: 16 April, 2020

A round-up of the news for primary care


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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