200625 COVID Update for Practices FINAL

Update on COVID-19 Testing Services as at 5pm 24th June 2020

The surge in demand for COVID-19 testing since the beginning of last week has resulted in significant pressure on assessment and swabbing capacity across the Bay of Plenty. We would like to acknowledge the Herculean effort that has been required to manage this demand alongside managing non-COVID related provision of services to your enrolled population.

The Ministry of health has today released a revised COVID-19 criteria and case definition. https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid19-resources-health-professionals/case-definition-covid-19-infection

The key points are as follows and a Question & Answer document is also attached: 1. The introduction of a ‘Higher Index of Suspicion’ (HIS) Category Individuals must either, in the 14 days prior to illness onset, 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.

2. The clinical criteria has not changed – individuals reporting the following symptoms should be further assessed for their risk.

Any acute respiratory infection with at least one of the following symptoms: new or worsening cough, sore throat, shortness of breath, coryza 1, anosmia 2 with or without fever.

Some people 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 meet the HIS criteria then test.

3. The case definition has been amended to remove 'suspect' case definition.

4. A recognition that there is a priority for testing: • •

The highest priority for testing is those who are symptomatic and meet the HIS criteria Others presenting to health services with symptoms consistent with COVID-19 MAY BE OFFERED tested for surveillance purposes – to help ensure that we don’t have community transmission in New Zealand

5. A change to the self isolation requirements: Only those meeting both the clinical and the HIS criteria will be asked to self-isolate while awaiting test results. Other people should remain home whilst unwell and follow the advice of their health practitioner on when they can return to work or school

1 WBOP PHO Covid Testing Update 25 June 2020

Update on COVID-19 Testing Services as at 5pm 24th June 2020 6. A change in the reporting requirements to the Medical Officer of Health (Toi Te Ora): •

ONLY those meeting both the clinical and the HIS criteria will need to be notified to the Medical Officer of Health on presentation Notification can be done through the BPAC ereferral

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Pathlab Update: Swabbing: • Patients referred will be contacted by Pathlab within 12 to 24 hours of receipt of referral • It is important that referrals contain the contact details for patients and their preferred collection facility • Swab booking will be the same day or the following day Please note - where referred patients decline to come in for swabbing, the referring practice will be informed of this outcome.

Results: • • •

Once the swab is collected the current wait time for receiving a test result is on average 3 days but could be up to 5 days in some cases due to the recent influx in testing.

Pathlab have added extra shifts to try to keep up with testing demand. Hoping to return to a 48 hour turnaround next week with increased capacity of 750 swabs per day.

Please note: all COVID-19 results will be reported to the requesting clinician as soon as they are available. For confidentiality reasons, the laboratory cannot give results directly to patients, with these calls also interrupting / slowing workflow within the laboratory.

Urgent requests: e.g. repatriation testing or high index of suspicion (HIS) category • •

Highlight this on the request form Practice MUST collect the testing fee from the patient and will be invoiced by Pathlab

Inform your patients of expected timeframes to manage their expectations and avoid anxiety.

Remind patients that they will be contacted by your practice for results and not to contact the laboratory for their COVID-19 results.

Managing Demand for COVID Assessment and Swabbing: The recent change in criteria and case definition should allow more flexibility to triage and manage your patient population assessment and swabbing demand within your practice.

Same day swabbing may not be possible, please prioritise demand clinically and by using the updated criteria and case definition document.

Please DO NOT routinely refer your patients to Accident and Healthcare at 2nd Ave as they are struggling to manage their current demand volume.

ONLY refer your patients to another practice for assessment and swabbing where you have an existing arrangement in place to do so – call the practice first in ALL cases to make appointments.

2 WBOP PHO Covid Testing Update 25 June 2020

Update on COVID-19 Testing Services as at 5pm 24th June 2020

Halcyon COVID-19 Assessment Form: Updates are already underway to include the Higher Index of Suspicion’ (HIS) and surveillance testing in this form.

In the interim note in the “Travel history and potential sources of infection” free text box: • which HIS criteria is meet OR • Surveillance Claiming and payment: The current process still applies.

BUT we are expecting changes and will update practices as soon as we have any new information.

Repatriation Information: See email from Phil Back on 23 June 2020 for details.

Contact Tracing: Please ensure that if a client comes for a test (and they may be asymptomatic) and notes they have been requested to do so either through the DHB or Health line, that they are tested and that the test is free of charge. These patients will usually not have any written evidence and may be accepted and swabbed on a trust basis.

Communication with the PHO: Regular communication with practices has been invaluable to assess where additional support is required and to update the wider community (e.g. DHB, Pathlab) on how primary care is responding to the daily changes in demand.

We are planning to send out a quick two minute survey every morning to allow a check in with how you are doing and to communicate any updates. Within each practice it would be appreciated if one person in the team could take time to respond to this survey each day by 10am.

PHO Portal Resources: The Setting up a Testing Service COVID-19 guide has recently been updated to include Alert Level 1 infection control, use of PPE guidance and information for patients following their swab.

We anticipate that following the release of the updated criteria and case definition there will be updates to the advice leaflets from Toi Te Ora. Supporting Documentation and Updates pending: • • • • •

Higher Index of Suspicion (HIS) triage guide Updated advice letters from Toi Te Ora Updated and standardised Pathlab test order form Update to Halcyon Form Changes to claiming

Communication from DHB to the Public regarding the change Covid-19 testing criteria: •

Media release and via Social Medial 3

WBOP PHO Covid Testing Update 25 June 2020