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Published: 27 March, 2020 | Updated: 28 March, 2020

28 March, 2020 Changes to: Case definition COVID-19


A round-up of the news for primary care

Case definition COVID-19

It had been reported from several sources that the Ministry of Health would widen the criteria for COVID-19 testing on Friday. However, this did not occur and the case definition on their website remains unchanged. The current case definition does state, in bolded text:

Note that due to the ongoing changing global and domestic situation, clinical judgement should apply as to whether someone who doesn’t quite meet the current case definition should be tested or not.

It had been expected that the formal case definition would be updated to include this clinical judgement, i.e. patients who have a fever, cough, sore throat or shortness of breath, but who do not necessarily have a connection to overseas travel or a known contact. It had also been reported that the definition would widen to include the testing of symptomatic health care workers.

We will keep you updated if any change to the case definition does occur.

Monthly dispensings for funded medicines

From Friday 27th March, community pharmacists are required to dispense medicines in one-month supplies (excluding oral contraceptives which can be dispensed in a three-month supply). This decision has been made to reduce the pressure on pharmacy stock that has arisen from stockpiling medicines. However, at their discretion pharmacists may continue to dispense three-month supplies of medicines for some patients, such as those with mobility issues, who live rurally, are immunocompromised or elderly.

Prescribers can still write usual three-month prescriptions, but these will be dispensed in monthly lots.

For more information, read the PHARMAC statement

Medicine supply information

Changes to medicine restrictions and supply are likely to occur frequently – regularly check the PHARMAC page for latest news

A list of medicine and device supply issues is available here

Special Authority restrictions on hydroxychloroquine

There have been media reports that the anti-malarial medicine hydroxychloroquine may be effective in preventing or reducing COVID-19. Currently, there is no evidence to support this and it is not a recommended treatment. To preserve the use of this medicine, PHARMAC has restricted funded access to only approved indications, i.e. malaria prophylaxis and treatment, rheumatoid arthritis and SLE.

Influenza vaccination

The influenza vaccination programme should be continued for those eligible for funded vaccination; although we are aware that many practices are having supply/delivery issues at present. The 20-minute observation period may be relaxed for some adults and adolescents if the risk of infectious disease transmission is greater than the low risk of anaphylaxis. For more information, see "The influenza immunization programme is starting early in 2020"

Some scheduled immunisations may be able to be deferred, however, do not delay the 6 week and 12/15 month immunisations (to minimise the risk of pertussis and measles outbreaks). Four-year old vaccines, adolescent vaccines shingles and non-urgent tetanus can be delayed for four weeks in most cases. Pneumovax is not funded for older people (unless they have an eligible condition), but should be encouraged.

Corticosteroids, NSAIDs and COVID-19

There has been inconsistent information about the use of NSAIDs in people with COVID-19. Expert advice is that if NSAIDs are part of a patient's usual medicine regimen, they can be continued. Paracetamol is the preferred analgesic for patients who do not usually use NSAIDs.

Corticosteroids increase the risk of infection and should be avoided if possible or taken at the lowest effective dose. COPD exacerbations should be managed with antibiotics, without the use of steroids, where possible.

ACC first consultation does not need to be in person

In addition to the news that an ARC18 can be completed without a face-to-face consultation, ACC has confirmed that the initial consultation required for ACC45 can now also be done via telehealth (the change is not yet reflected on the eACC45). The requirements for a patient’s injury to be covered by ACC remain the same.

ACC has recommended that the following statement is read out to the patient and that their response is documented in their clinical record:

  • Do you declare that you have provided true and correct information and you will tell ACC if your situation changes?
  • Do you authorise me as your (name of health profession: GP, physiotherapist, etc) to lodge your claim with ACC?
  • Do you authorise your information to be collected or disclosed to ACC to help determine cover for your claim, determine what you will be entitled to, or for research purposes (like injury prevention, or assessment, and rehabilitation?).

For further information read ACC's full newsletter here

Doctors exempt from re-certification requirements until early 2021

The Medical Council of New Zealand has announced that general and vocationally-registered doctors are exempt from re-certification programme requirements until 28th February, 2021. For more information, see the MCNZ statement


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