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Published: 3 April, 2020

A round-up of the news for primary care


New case definition

The Ministry of Health case definition for COVID-19 has been widened. A new definition was published online on 1st April and it was updated again on 2nd April, 2020.

Read the full case statement here, and we advise regularly checking the page for updates. Local DHBs or PHOs may also have their own recommendations for allocating testing resources.

A suspect case is someone who satisfies the following clinical criteria:

  • Fever (≥38oC) AND/OR any acute respiratory infection with at least one of the following symptoms: cough, sore throat or shortness of breath

The definition states that: “Ideally all people meeting the suspect case definition for COVID-19 would be tested to confirm or exclude a diagnosis. The following groups of people have been prioritised for testing at this stage.” (our emphasis)

The priority groups that are referred to are as follows:

Suspect cases (who meet the clinical criteria) and they or one or more of their household/bubble, meet one or more of the following criteria should be tested:

  • People who have travelled overseas in the last 14 days, or have had contact, in the last 14 days, with someone who has recently travelled overseas
  • Hospital inpatients
  • Health care workers
  • Other essential workers if they have had close or casual contact with a probable or confirmed COVID-19 case
  • People who reside in (or are being admitted into) a vulnerable communal environment including aged residential care, or large extended families in confined household/ living conditions
  • People who may expose a large number of contacts to infection (including barracks, hostels, halls of residence, shelters, etc)

In addition, testing may be required:

  • On advice from the local Medical Officer of Health, when an outbreak or cluster is suspected, or being investigated

As local testing capacity allows:

  • Consider suspect cases presenting with new or worsening cough

Testing of individuals who are asymptomatic is NOT recommended unless it is requested by the local Medical Officer of Health.

Close contacts of confirmed cases that meet the clinical criteria should be considered a probable case and DO NOT require testing (but should be notified to the Medical Officer of Health). The exception to this is healthcare workers, who should be tested if symptomatic.

There is further information within the case definition document on how to manage contacts of suspect cases or cases under investigation and on managing contacts of probable or confirmed cases in terms of physical distancing, hand and cough hygiene and isolation.

Care for people with diabetes during the COVID-19 pandemic

There is no evidence to suggest that people with diabetes have an increased risk of contracting COVID-19 infection. However, if infected, they have an increased risk of serious complications, including acute respiratory distress and mortality. In particular, older age, co-morbidities and a history of poor diabetes management are correlated with worse clinical outcomes following COVID-19 infection. No difference in clinical outcomes has been identified between people with type 1 or type 2 diabetes. The emphasis for patients should be on maintaining good control of their blood glucose levels.

In terms of medicine supply:

  • There are currently no known issues with supply of insulin, insulin pens and insulin pumps in New Zealand
  • Check that patients using insulin pumps have adequate consumable supplies and spare basal insulin in case of pump failure and that patients using a continuous glucose monitoring device have a back-up blood glucose monitoring kit
  • Temporary changes have been made to the Special Authority criteria for insulin pump consumables: any relevant practitioner can apply for SA renewal and the patient's most recent HbA1c value on record can be used
  • There is a supply issue with Glucobay (acarbose) 50 mg and 100 mg tablets; an alternative brand is available fully funded - Accarb 50 mg and 100 mg

People with diabetes are considered to be in a higher risk category for COVID-19 and therefore some organisations have recommended that anyone with diabetes should stay home, including those working in essential services. Advice from occupational health specialists is that many people with diabetes will continue to be able to work if required, if they are otherwise well and their diabetes is well-controlled, and provided they are not working in a role that exposes them to a high risk of COVID-19 transmission (e.g. a clinical staff member in an emergency department, intensive care unit or acute assessment unit). People with diabetes and co-morbidities such as cardiovascular disease should be considered more conservatively regarding their occupational risk during the pandemic.

Contraception during the COVID-19 pandemic

From, 1 April, community pharmacists are required to dispense Norimin (combined oral contraceptive- COC) and Noriday (progesterone-only pill – POP) in one-month supplies due to short-term supply issues (not related to the COVID-19 pandemic). Other brands of oral contraceptives can continue to be dispensed in a three-month supply.

General Practitioners may find they have requests for contraception from patients who usually attend Family Planning Clinics as they are not providing face-to-face consultations during the Level 4 lockdown. However, Family Planning are providing some telephone consultation services, including for emergency contraception and termination of pregnancy.

Family Planning has provided some advice about essential contraceptive services. Key points include:

  • Given the supply issues with Norimin, consider changing patients to a different COC
  • If a POP is initiated, prescribe Microlut first-line (fully funded) or Cerazette (not funded). Consider changing those taking Noriday to an alternative POP.
  • Depo Provera can be delayed for up to 14 weeks after the last injection i.e. it can be given up to 2 weeks late. Those requiring a repeat can be offered a POP as an alternative to attending the practice for an injection. No additional contraceptive precautions are required if the POP is started within 14 weeks of their last injection.
  • Jaydess and Jadelle should not be extended beyond their licensed use as they may not provide effective contraception. Those requiring a replacement can be offered a POP or condoms.
  • The Mirena failure rate increases around six years after insertion, so in most instances the change of device can wait until after the lockdown. A POP or condoms can be offered if additional protection is required.
  • Patients with an expiring five-year copper IUD require additional contraception (e.g. condoms or a POP). There is limited data that ten-year IUDs may be extended to 12 years, so additional contraception may not be required.

For further information about contraceptive options, see: Contraception: which option for which patient?

World statistics

One of our readers has recommended another excellent site for those interested in tracking world COVID-19 statistics, from Johns Hopkins University

This Bulletin is supported by the South Link Education Trust

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