200625 COVID Case Definition QA v3 final

25th June 2020

Version 3 - final

COVID-19 Response New Criteria and Case Definition A new case definition for COVID-19 in New Zealand was released on 24th June 2020. The intent of the new case definition is to swab all people who are defined as being at high risk of COVID-19. People who are in this high risk group have the clinical symptoms of COVID-19 AND in the 14 days previous to the onset of the illness have: •

had contact with a confirmed or probable case

•

had international travel

•

had direct contact with a person who has travelled overseas (eg Customs and Immigration staff, staff at quarantine/isolation facilities)

•

worked on an international aircraft or shipping vessel

•

cleaned at an international airport or maritime port in areas/conveniences visited by international arrivals, or

•

any other criteria requested by the local Medical Officer of Health

The number of people meeting these conditions is likely to be very small at present in the Bay of Plenty.

How should we assess people presenting with symptoms consistent with COVID-19?

The clinical criteria for COVID-19 remain unchanged: Any acute respiratory infection with at least one of the following symptoms: new or worsening cough, sore throat, shortness of breath, coryza, anosmia with or without fever.

Anyone one presenting with any of these symptoms should screened to see if they meet the Higher Index of Suspicion (HIS) criteria as above. If they do then they should have a swab and follow current rules on self-isolation until the result is back.

What should we do with people with symptoms who do not meet the HIS criteria?

PPE guidance is provided in the document produced a week ago by MOH https://www.health.govt.nz/system/files/documents/pages/hp7372-alert-level1-ppe-guidelines-forunknown-covid-status-v5.pdf - ask the patient to wear a mask; if going within 1m you should wear a mask; as always practice good hand hygiene.

The person can be offered a swab for surveillance purposes but there is no need to swab. Follow standard practice. Clinical judgement can be used. If a person requests a swab and is symptomatic they should have one.

Whether swabbed or not there is no defined stand down period. People who are unwell should stay away from work/school until they are better.

BOPDHB EOC – COVID-19 Response

Joe Bourne – Incident Controller

25th June 2020

Version 3 - final

Can a person who does not have the clinical criteria get a swab?

No. There is no public funding for asymptomatic swabbing unless the swab has been requested by a public health unit.

People requesting testing for repatriation or employment reasons, who are not symptomatic, need to fund their own assessment and testing.

What PPE should be worn when taking a swab?

If a swab is being taken full PPE should be worn. This is the same as happened with surveillance throughout the response. PPE does not need to be changed between swabs for low risk people.

Do people need to pay for assessments and testing?

There are currently no co-payments for people presenting with symptoms consistent with the clinical criteria for COVID-19 – see case definition. At present this applies whether a person is swabbed or not – the level of payments is under review Is it necessary to still capture clinical data for all assessments – HIS and non HIS? Yes, at present the data requirements remain. There is an option to indicate that a patient was assessed but not swabbed.

When can people return to work?

Anyone meeting the HIS criteria must stay off work until they receive their swab result and have no symptoms for 48 hours.

People who do not meet the HIS criteria can return to work as soon as they are better. If they have been swabbed for surveillance purposes they do not need to wait for the result. Some people may have persistent symptoms that in ordinary circumstances they would work through. If this is the case they may wish to get a swab and wait for the result before returning to work.

What about a healthcare workers?

In general the same rules apply to healthcare workers as apply to the rest of the population. If you are swabbing a healthcare worker please record this on the Pathlab form and the swab will be prioritised. Healthcare workers should contact their manager to establish whether there are any additional occupational health requirements.

Who should self-isolate?

Only people meeting HIS criteria need to self-isolate while awaiting a swab result. For details on what selfisolation means please see here.

If people are unwell but do not meet HIS criteria it is recommended that they stay home and limit interactions with others.

BOPDHB EOC – COVID-19 Response

Joe Bourne – Incident Controller

25th June 2020

Version 3 - final

Where can people get a swab?

If someone meets the HIS criteria it is recommended that they visit as few facilities as possible. If the person is in front of you and you are able to do the swab then you should do it. For payment this would count as a complex case. If the person is being assessed on the phone and does not need an in-person consultation then they can be referred to Pathlab but the HIS status must be on the form.

Whose swabs are prioritised for testing?

HIS swabs will be tested first, followed by hospital inpatients. Healthcare workers will be processed next. Please indicate on the test form whether people meet these criteria.

Do I need to notify public health when organising a test for COVID-19?

If a patient meets the clinical criteria and the HIS criteria you must notify public health through the standard notification process. This is now available through a BPAC eReferral.

If HIS criteria are not met there is no need to notify public health, if a swab is taken it is for surveillance purposes only.

Funding for assessments in general practice?

The funding mechanism for general practice is being reviewed. The letter of agreement will be updated to reflect the new case definition. In the meantime it is anticipated that practices will only submit a complex assessment claim for those patients that meet the HIS criteria and are swabbed.

Complex claims should not be submitted for those people who are assessed but not swabbed.

More detail will be provided as soon as we have it.

How should we manage patient flow in our department/practice?

Please contact your PHO/infection control if you would like guidance on how you might manage patient flow with the new case definition.

Who should I contact for more information or advice?

In the first instance please contact your PHO for general practice / portfolio manager for community providers / line manager for DHB employees if you have any questions. They will escalate to the Emergency Operations Center (EOC) if needed.

BOPDHB EOC – COVID-19 Response

Joe Bourne – Incident Controller