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Published: 8 April, 2020

A round-up of the news for primary care


Case definition: further update

As reported in the last bulletin, the Ministry of Health updated the case definition of COVID-19 on April 1 and April 2. The definition was further updated on April 3, clarifying the clinical criteria:

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, coryza1, anosmia2 with or without fever.

1Coryza – head cold e.g. runny nose, sneezing, post-nasal drip 2Anosmia – loss of sense of smell

A further clause has also been added to the following statement:

Ideally all people meeting the suspect case definition for COVID-19, or where the clinician has a high degree of suspicion3, would be tested to confirm or exclude a diagnosis. The following groups of people have been prioritised for testing at this stage.

3Some people may not meet the suspect case definition but may present with symptoms such as only: fever, diarrhoea, headache, myalgia, nausea/vomiting, or confusion/irritability. If there is not another likely diagnosis, and they have a link to a recent traveller, a confirmed, or probable case, consider testing.

The priority groups for testing remain unchanged.

Influenza vaccine: priority groups

The Ministry of Health has announced that the timeframe for priority-only influenza vaccines is being extended until late April. Vaccination should only currently be given to people in these groups:

  1. People aged 65 and over, pregnant women, people with certain chronic conditions and young children with a history of severe respiratory illness (see list of those eligible for funded vaccines)
  2. Healthcare and other frontline workers, including emergency services, social services, police, defence, and border control but not supermarket workers

DHB immunisation co-ordinators are working to ensure that vaccine stocks are re-distributed to practices that are in need. A new brand of vaccine, Influvac Tetra, is now available: practices can order this via the normal method. Read the full statement here

Reducing non-essential laboratory testing

Laboratory services have redirected resources to COVID-19 testing, including restricting tests that use the same molecular reagents and swabs. Clinicians have been asked to reduce the frequency of laboratory tests that are non-essential, discretionary, routine, or can be safely delayed.

Examples of these types of tests include:

  • Screening tests (e.g. HbA1c, lipids)
  • Thalassaemia screens in non-anaemic patients, unless pregnant
  • Routine liver function tests or thyroid tests in patients on stable treatment
  • Faecal tests, especially Helicobacter pylori antigen and faecal calprotectin

Further information is available here

The National Microbiology Network advised on 20 March that testing for chlamydia and gonorrhoea was restricted to the following groups:

  • Symptomatic patients, i.e. those with urethritis or discharge (excluding candida or bacterial vaginosis), unexplained PV bleeding, proctitis, etc.
  • Cases of sexual assault
  • Pre-termination of pregnancy
  • Antenatal screening

However, due to different platforms used some laboratories have been able to continue with chlamydia and gonorrhoea screening at this time.

Clinical details outlining the indication for testing should accompany the request. Patients who are contacts of known cases should be treated empirically without testing.

Guidance on contract tracing is available from the NZSHS

Guidance on antibiotic choice is available from the bpacnz Antibiotic Guide

Admission to aged-care residential facilities

Aged residential care facilities are accepting new admissions, after the following screening has been undertaken by a general practitioner or community-based COVID-19 assessment service:

  • The person has not been overseas or had contact with anyone who has been overseas in the last 14 days
  • The person does not have any acute respiratory symptoms (cough, fever, sore throat), is not awaiting COVID-19 test results and has not been in contact with a confirmed/suspected or probable COVID-19 case

People admitted to an aged-care facility will be required to undertake physical distancing and daily monitoring for symptoms for 14 days. Family are unable to visit during the Level 4 lockdown, except for residents receiving palliative care, where it will be considered on a case-by-case basis.

As of 27 March 2020, all planned respite care is cancelled. If there is concern about a person’s vulnerability, contact your local Needs Assessment Service Co-ordinator.

More detailed information about aged residential care is available from the Ministry of Health.

Guidelines for resuscitation

The New Zealand Resuscitation Council (NZRC) has released flowcharts for adult and paediatric advanced life support for patients with COVID-19.

Ambulance services will continue to resuscitate patients in cardiac arrest, as per usual treatment guidelines, but with additional personal protective equipment and precautions with airway management.

Coding COVID-19

This Ministry of Health page explains how to code COVID-19 on your patient management system using SNOMED-CT or ICD-10 codes.

Healthcare worker exposure to COVID-19

We have adapted the following information from Canterbury Health Pathways; local pathways may provide their own advice.

This Bulletin is supported by the South Link Education Trust

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