A guide for primary care clinical management of COVID-19 in the community Version 3

A guide for primary care clinical management of COVID-19 in the community For Bay of Plenty General Practice Providers

Version Three

07/03/2022

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A guide for primary care clinical management of COVID19 in the Community Version 3 Summary of Changes

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Introduction

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Directory of Local Services and Contact Numbers

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Public Health – Toi Te Ora

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Bay of Plenty Covid Primary Response Team (CPRT)

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Community Co-ordination Hub

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Specialist Clinical Advice or Secondary Care Referral

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Palliative Advice

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Immunisation Advisory Centre helpline (national)

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COVID-19 Clinical Advice line (national)

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COVID-19 Healthline (national)

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Process for Covid-19 patient care in the community

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Testing

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Positive Test Result

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Self-Isolation

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Self-Management

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The Covid Clinical Care Module (CCCM)

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Community Management: General Practice Role

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Acuity Score and Clinical Risk Assessment

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Ordering and Delivery of Pulse Oximeters

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Providing Prescriptions to Patients Isolating - No Cost Access

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Covid-19 Treatments

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Care for Pregnant Women

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Release from Community Monitoring

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Community Management: Covid Primary Response Team (CPRT) Role

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Out of Hours Care

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Community Management: Public Health Unit (Toi Te Ora) Role

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Community Management: Community Coordination Hub

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Referral to and Discharge from Hospital Care

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Covid-19 Vaccination Updates

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Useful Resources

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Resources for Clinicians

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Ministry of Health Guidance for critical health services during an Omicron outbreak

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Ministry of Health Summary of changes for Phase 2 and 3 of Omicron response

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Health Pathways COVID-19 Answering Common Questions

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Health Pathways Covid Case Management in Children

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Health Pathways Pregnancy and Postnatal Care in a Covid-19 patient

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Health Pathways Covid-19 Palliative Care

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Health Pathways Factors the influence the risk of complications

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Health Pathways Factors that influence the risk of complications in children

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Health Pathways Clinical Status Checklist - Covid-19 patients

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Health Pathways Severity Assessment

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Health Pathways Post Covid-19 Conditions (Long Covid)

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Resources for Patients

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Covid-19 Rapid Antigen Testing Guide

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Health Navigator information for patients

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Ministry of Health Isolation and Care information for patients

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Health Navigator Diary for patient

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Covid-19 positive: How to manage your symptoms

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Health Navigator Positions to make breathing easier

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Summary of Changes

Date

Section

Summary of Changes

07/03/22

Testing

Updated Testing section to include Rapid Antigen Tests (RAT) guidance

07/03/22

Positive Test Result

New section

07/03/22

Self-Isolation

Updated section

07/03/22

Self-Management

New section

07/03/22

The Covid Clinical Care Module (CCCM)

New section

07/03/22

Community Management: General Practice Role

Updated section

07/03/22

Community Management: Covid Primary Response Team (CPRT) Role

Updated section

07/03/22

Community Management: Public Health Unit (Toi Te Ora) Role

Updated section

07/03/22

Community Management: Community Co-ordination Hub

Updated section

07/03/22

Out of Hours Care

New section

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07/03/22

Referral to and Discharge from Hospital Care

Updated section

07/03/22

Release from Community Monitoring

Updated section

07/03/22

Covid-19 Vaccination Updates

New section

07/03/22

Providing Prescriptions to Patients Isolating - No Cost Access

Updated section

07/03/22

Acuity Score and Clinical Risk Assessment

New section, introduced to respond to Omicron.

07/03/22

Covid-19 Treatments

Direct to Midlands Healthpathway COVID-19 Case Management in Adults pathway

07/03/22

Care for Pregnant Women

Updated section

07/03/22

Ordering and Delivery of Pulse Oximeters

Updated section

07/03/22

Covid-19 Vaccination Updates

New section

07/03/22

Useful Resources

Updated section

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Introduction Version Three of this guide, produced with clinical oversight from both Dr Claire Isham, Clinical Director, WBOP PHO, and Dr Rachel Shouler, EBOP Covid Clinical Lead (Community), provides additional localised information to complement the COVID-19 Case Management pathways provided on the Midland Health Pathways portal.

The Adult pathway can be accessed here: https://midland.communityhealthpathways.org/728651.htm The Child pathway can be accessed here: https://midland.communityhealthpathways.org/931295.htm Username: midlanduser Password: midlandpassword You can download this guide on the PHO Covid Portal Page: http://portal.wboppho.org.nz/covid-19/ The Ministry of Health is leading the ongoing development of our Covid-19 response. Please continue to visit the Ministry of Health website for updates: https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19information-health-professionals/covid-19-primary-care

PLEASE NOTE: Information changes rapidly. If you are printing off this document, please continue to check the MOH and Health Navigator websites for updates.

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Directory of Local Services and Contact Numbers These numbers are for clinical teams only, not to be shared with patients.

Public Health – Toi Te Ora For public health related (e.g. Covid-19 policy & protocols / isolation & quarantine) queries in office hours (8am – 5pm, 7 days a week): Call: 027 336 9159 or Email: ttoimtclinicalcaseadvisor@bopdhb.govt.nz Please also the see range of online Covid-19 information & resources: COVID-19 | Toi Te Ora Public Health For questions related to management of clinical illness in individual Covid-19 patients please use usual clinical referral pathways (e.g. Med reg, Infectious Diseases Physician).

Please report other notifiable disease in the usual way, see: Notifiable Diseases and Hazardous Substance Injuries | Toi Te Ora Public Health

Bay of Plenty Covid Primary Response Team (CPRT) For support on the clinical management of patients in the community, this covers enrolled and unenrolled patients in both the Eastern and Western Bay of Plenty.

Email: cprt@healthbop.org.nz Phone: (07) 577 3234

Community Co-ordination Hub For health navigation and connecting with welfare local providers.

Support with oximeter delivery, complex isolation needs (e.g accommodation) and home visits for patients whom you haven’t been able to contact and are concerned about. If a patient is isolating out of town the Community Co-ordination Hub can connect with the appropriate hub for welfare support provision.

Western Bay of Plenty Email: welfare.referral@bopdhb.govt.nz Phone: 0800 798 729 7

Eastern Bay of Plenty Email: ebopcovid@bopdhb.govt.nz Phone: 0800 633 277 Available 8am-8pm, 7 days

Specialist Clinical Advice or Secondary Care Referral For urgent advice contact the on call medical SMO or Paediatrician via switchboard WBOP 07 579 8044 EBOP 07 3060777 or ED SMO 0272927084 (24 hrs) For non-urgent virtual advice contact the same service: on call medical SMO via switchboard WBOP 07 579 8044 EBOP 07 3060777 or ED SMO 0272927084 (24 hrs)

Palliative Advice For palliative advice regarding patients with Covid dying at home, the palliative care team have set up a phone service to call: 07 5575737 or 306 0710 (the later number diverts to the first number and the phone is carried by the palliative care team in Tauranga).

Alison Rowe is a Palliative specialist in EBOP and available to assist EBOP clinicians with queries Monday to Friday, phone 0272 767020.

Immunisation Advisory Centre helpline (national) For COVID-19 vaccination and adverse reaction management advice.

Available weekdays, 8 am to 8 pm.

Phone: 0800‑466‑863

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COVID-19 Clinical Advice line (national) A dedicated phone line for community health providers, offering general advice about management of COVID-19, peer review of presenting problems, and advice on specialist referral or connection to other services.

Available Monday to Saturday, 8 am to 7 pm (except public holidays).

Phone: 0800-177-622. Do not give this number to the public.

COVID-19 Healthline (national) General patient advice about COVID-19 and self-isolation registration.

Phone: ● ●

0800‑358‑5453 +64 9 358‑5453

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Process for Covid-19 patient care in the community New Zealand moved to phase 3 of the Omicron response at 11.59 pm 24 February 2022. https://www.health.govt.nz/covid-19-novel-coronavirus/covid-19-response-planning/omicroncommunity-what-means-you#3

Testing Refer to the Testing Operational Guidance for General Practice (effective 2 March) available for download via the PHO Covid Portal [see link below]. This guidance covers testing principles, testing types, test results, recording of RAT test results, and funding. Localised information about distribution is mentioned below. Note further updates to this guidance may be made. http://portal.wboppho.org.nz/images/documents/Testing_Operational_Guidance_for_General _Practice_2_March_2022.pdf ORDERING AND DISTRIBUTION RATs can continue to be ordered through the Ministry’s PPE portal. Any queries relating to HealthLink and IT support can be directed to the HealthLink service desk on 0800 288 887.

Emergency stock can be ordered by emailing bop.rats@bopdhb.govt.nz For businesses requiring RATs under the critical worker exemption scheme, workers are able to order RATs online using the MoH form: Request a RAT | Ministry of Health NZ (covid19.health.nz). Critical workers must still meet the criteria to be eligible for funded RATs. They can pick up via a Community Collection Point listed via Health Point https://www.healthpoint.co.nz/covid-19/

Positive Test Result From 16 February 2022 people who test positive for COVID-19 will get a text message notifying them that their test is positive. The message will provide a link to a self-assessment form so they can share their information securely online, instead of completing a case interview over the phone or in person.

The form lets people share: ● Further symptoms they may have development (or remember) ● Details of their household contacts ● Instructions on how to share their NZ Covid Tracer diary and Bluetooth data 10

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Details of any high-risk locations and close contacts.

It also had health questions to identify the need for extra health support and a link to MSD for welfare support.

Covid-19 Contact Tracing Form

Self-Isolation At Phase 3 of the Omicron response only positive cases and their household contacts are required to isolate. The Ministry of Health advice provided at this link follows.

Omicron in the community: what this means for you | Ministry of Health NZ Cases: ●

Isolate for 10 days (self-release after 10 days)

Household contacts of a Case: ●

Isolate until Case completes 10 days. Test Day 3 and Day 10 of the case’s isolation, or if symptomatic.

Close Contacts: ● ●

No requirement to isolate. Self-monitor for 10 days and test if symptomatic.

Extra support in place for health and critical workforces.

Day of infection: Asymptomatic with positive result – Day 0 is the day the positive test was taken.

Symptomatic with positive result – Day 0 is the day symptoms started.

This information needs to be accurately determined, as it affects the release date from isolation.

Self-Management If a patient is in the self-management pathway and their condition deteriorates, this is the escalation pathway that is included in the information texted to them at the point where they are notified they are a positive case: 1) For urgent or emergency care phone 111 11

2) If you have a healthcare provider such as a GP or Hauora you can phone them 3) You can also phone Healthline 24hrs on 0800 611 116 for health advice 4) If you’re not sure who to call, contact the BOP health navigator team between 8am-8pm, 7 days a week and they can point you in the right direction, West BOP: 0800 798 729 and East BOP: 0800 633 277

The Covid Clinical Care Module (CCCM) CCCM Training and Guidance Supporting training materials have been updated to reflect recent changes and can be accessed using the links below: 1. CCCM via PMS Quick Reference Guide The Quick Reference Guide provides an overview of the key tasks you will complete the CCCM. 2. CCCM via Full Training Guide The Full Training Guide provides a detailed step by step guide of the tasks you can complete within the CCCM. Please note - the national guides recommend the use of Tasks & Flags in a certain way, however Regionally across BOP we are not using these. A reminder on our regional approach is below: Tasks ● Please do not use tasks in CCCM to request welfare, oximeters or home visits.

Please continue to use the welfare.referral@bopdhb.govt.nz email. The team have decided not to use tasks for this purpose as many hubs across the country have found issues using this system and it is no longer standard practice.

Flags ● ●

Please do not use Flags to indicate clinical care needed for a patient over the weekend. This can be done by emailing CPRT@healthbop.govt.nz directly.

You may however find the use of ‘flags’ to be useful within your own practice management of the case - e.g. to flag a reminder to follow up with the patient.

MOH Training Sessions: Covid Clinical Care Module Virtual Training Sessions (General Practice Specific) Tuesday 12:00pm-1:15pm (weekly) & Wednesday 5:30pm-6:15pm (weekly) Hosted via Teams

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Community Management: General Practice Role Once a positive result has been entered, the enrolled practice will receive a PHU transfer of care document in their inbox and a CCCM case will be created.

Practices will be able to see all their enrolled active cases through a dashboard view of CCCM accessed via the website (not the PMS).

Patients will be receiving ‘Self-Assessment’ texts to allow the opportunity for selfmanagement. To support this option, and to protect practice capacity, it is advised practices manage COVID positive patients based on clinical priority.

There is no expectation that teams will contact every positive case.

Please prioritise based on your knowledge of patient demographics and risk.

Use of CCCM is encouraged where the patient may be interacting with other agencies who have CCCM access (for example, a high risk patient who may need out of hours review from a third party).

As an alternative to CCCM, information should be recorded in the PMS. If you have any concerns about a patient, please escalate this to the local welfare team.

This includes inability to contact a patient where there is a clinical need or concerns about ability to isolate safely in their current location.

If there are concerns about the ability of the case or household contacts to comply with isolation requirements, contact Toi Te Ora. If you are notified about a patient who is not known to your service, please advise CPRT so that the care can be transferred.

Acuity Score and Clinical Risk Assessment Where indicated, establish an initial care plan with the patient. Use clinical judgement and follow the relevant acuity score flowchart to determine acuity score and if appropriate enter it into the acuity rating on CCCM (in Regular Health Check section, page 2). These Acuity

Acuity score flowchart ● Māori ● Pacific ● Other ethnicities

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Ordering and Delivery of Pulse Oximeters For all practices – please send all Pulse Oximeter Requests and Welfare Requests to: Welfare.Referral@bopdhb.govt.nz for Western Bay of Plenty and EBOPcovid@bopdhb.govt.nz for Eastern Bay of Plenty. ● ● ● ●

Patient NHI Patient name Address for dispatch (which might not always be the residential address if they are isolating elsewhere) Cell Phone number of patient

Providing Prescriptions to Patients Isolating - No Cost Access Covid related pharmacy needs are funded, please contact your local pharmacy.

Charging for care for COVID cases isolating at home: COVID related vs regular care.

Previously clinicians were likely to be including any required repeat prescriptions as part of their regular reviews with COVID cases. However, with the shift to Phase Two then Phase Three of the Omicron strategy not all COVID cases will require regular reviews and there may be requests from isolating patients for non-COVID related care (including repeat prescriptions for long-term medications).

All COVID related care should be free to patients, however usual care (i.e. review of long term medication and repeat prescriptions) should come under the patient’s GP where possible and standard fees applied as this is unrelated to COVID. There should be no additional costs to the patient over their usual costs (i.e. no delivery fee from the pharmacy if this service is required) Following is a table summarising actions for potential different scenarios:

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BOP Community pharmacies request all prescriptions for covid patients or those in isolation to be coded as H. This alerts pharmacies that facilitation is required for medication pick-up or delivery. Please annotate with "needs to be delivered" or alternatively if there is an allocated person who will collect e.g. "isolating but neighbour will collect". All pharmacies have the capacity to either deliver prescriptions or arrange delivery with the Welfare team. Please ensure a current patient/carer telephone number is provided to enable safe contactless delivery of medication.

If there is not an option to amend the A4 code to H (e.g. e-script) then practices can add the text information and add H Code into the ‘Comments/Notes’ section to let the pharmacy know.

Covid-19 Treatments Refer to the Midland HealthPathways COVID-19 Case Management in Adults pathway. This pathway can be accessed here: https://midland.communityhealthpathways.org/728651.htm

Care for Pregnant Women If the patient is pregnant, ensure their LMC is aware and where able, record patient care in CCCM. Guidance depending on gestation and clinical risk stratification can be found on the Care Framework for pregnant women and people isolating in the community for COVID-19 MOH web page: https://www.health.govt.nz/covid-19-novel-coronavirus/covid-19-information-healthprofessionals/covid-19-maternity And Midland HealthPathways https://midland.communityhealthpathways.org/952638.htm

Release from Community Monitoring A reminder that no further testing is required for anyone who tests positive for COVID. Patients do not need retesting or clinical review before being released from isolation after 10 days.

Community Management: Covid Primary Response Team (CPRT) Role This seven day a week service is provided by a team consisting of management, clinical and administrative staff.

A positive Covid result (PCR or positive reported RAT) automatically activates a record in the National Contract Tracing System (NCTS).

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The CPRT monitor the NCTS daily and allocate patients for the Bay of Plenty based on the following: ● The record for the patient is complete ● Enrolled practice is known (as recorded in NES) ● Unenrolled patients are referred to external support services (Tunstall & Evolve) Once the positive case is reported it will appear in CCCM via the Health Link form interface in the Practice Management System (there can be a slight delay). This patient won’t appear in the practice’s CCCM web version patient list until they have been allocated, however the practice can still search by NHI and find the patient.

CPRT follows up on any incomplete records, implements any new process flows, liaises with the DHB, Toi Te Ora, other PHOs and the Community Co-ordination Hub. They are available for queries from practices and stakeholders regarding clinical management of cases.

CPRT attend thrice weekly COVID BOP Partners Hui and provide regular reporting to the DHB and Ministry of Health.

Out of Hours Care Care of existing High Risk Covid Positive Patients over weekend: If your practice has a covid positive patient, you are worried about who needs a call over the weekend and you have no capacity: ● ● ●

Email Covid Primary Response Team: cprt@healthbop.org.nz by 3pm Friday to provide patient details and advise that weekend clinical care is required.

CPRT will then transfer patient care to Tunstall - ideally this patient should have notes in CCCM to support Tunstall in their care.

Tunstall can transfer patient care back to practice on Monday.

New Referrals for Unenrolled Covid Positive Patients New patients with no GP will continue to be referred directly onto Tunstall at the weekend.

New Referrals for Enrolled Covid Positive Patients All other patients will be automatically allocated directly to their enrolled practice. If practice does not have any staff checking referrals at the weekend, the case will have 24hrs to complete self-assessment then will be picked up on Monday by regular GP. This process change is due to capacity given higher case numbers, and the move to patients being more self-managing Phase 3: ● ● ●

CPRT have no way of identifying High Risk referrals with no PMS access Self-Assessment Triage tools are not feeding through, no current risk assessment tool to overlay the information.

Safest way for patient triage is for enrolled practice to receive referral as soon as possible.

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Reminder that patients are provided with information about where to seek assistance, if required, when they receive their positive result text.

Community Management: Public Health Unit (Toi Te Ora) Role Digital technology continues – a self-serve model – with cases supported to self-notify close contacts. Focus on support for those not digitally enabled.

Cases: ● Identified via positive PCR or RATs or symptoms ● Notified by text and directed to complete COVID-19 Contact Tracing form online Selfinvestigation tool targets very high-risk exposures, narrowing the numbers of contacts identified Contacts: ● Contacts automatically notified from online self-investigation and option for cases to self-notify their contacts. ● Only highest risk contacts will be traced and required to isolate ● Limited use of push notifications, locations of interest or Bluetooth ● Close Contact Exemption Scheme using RATs for asymptomatic healthcare and critical infrastructure workforce who are household contacts.

Community Management: Community Coordination Hub ●

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● ●

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In the first instance welfare and manaaki support should be requested through MSD in the regular assessment. Ask the patient if they are already engaged with a welfare provider and note this in the free text field. Make sure to ask the patients permission to share their information with MSD. For more complex isolation needs such as accommodation, or those with complex social, clinical or living situations you can request support from the Community Coordination Hubs.

If you are not able to contact a patient and you have clinical concern, you can contact the Community Co-ordination Hub who are able to provide a home visit to check in.

For oximeter delivery, make sure you follow the latest guidelines on who requires an oximeter (available via HealthPathways) and request through the hubs via email.

Make sure to include the person’s name, phone number and address.

The community co-ordination hubs have health navigators and registered nurses who are experienced in working with high risk whānau and are well connected in the community. Whānau may be referred on, with permission, if a more appropriate welfare provider is identified (e.g. iwi). The hubs work collaboratively with community providers to ensure a cohesive and co-ordinated response.

Western Bay of Plenty Email: welfare.referral@bopdhb.govt.nz Phone: 0800 798 729 17

Eastern Bay of Plenty Email: ebopcovid@bopdhb.govt.nz Phone: 0800 633 277

Referral to and Discharge from Hospital Care Acute Covid-19 Assessment 1. Check the criteria: ● Suspected COVID-19 and acutely unwell requiring hospital admission ● Known COVID-19 and serious symptoms e.g., increasing breathlessness, suspected pneumonia, dehydration, renal failure, sepsis 2. Contact the appropriate specialist and advise them that the patient has known or suspected COVID-19: ● Western Bay: Phone the appropriate specialist via Tauranga Hospital switchboard (07) 579‑8044: i. Adult – On-call General physician in APU (8 am to 4 pm) or medical registrar (after hours) ii. Child aged ≤ 15 years – Paediatrician ● Eastern Bay: Phone the appropriate specialist via Whakatāne Hospital switchboard (07) 306‑0777 or ED SMO 0272927084 (24 hours) ● Adult – On-duty physician ● Child aged ≤ 15 years – On-duty paediatrician 3. If possible, give the patient a surgical mask to wear to hospital.

Where possible please annotate in CCCM that a referral to secondary care has been made.

Following hospital admission patients should be managed as Acuity 6 (see Midland HealthPathway Acuity score) for the remainder of their illness and receive regular calls from the practice team, as well as have access to a pulse oximeter.

A Transfer of Care summary will be sent to the enrolled practice, along with a discharge referral form, which is sent to CPRT at the point of the patient’s discharge. CPRT will forward this straight to practice.

For WBOPPHO Practices - Current admissions will be visible through your Current inpatient Thalamus report.

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Covid-19 Vaccination Updates There is a change in advice around getting vaccinated after becoming positive with COVID. IMAC advice follows: People should be offered vaccination regardless of their history of symptomatic or asymptomatic SARS-CoV-2 infection; this includes people with prolonged post-COVID-19 symptoms. It is recommended they wait at least 3 months/12 weeks* from resolution of acute symptoms or from the first positive test if asymptomatic. Current evidence suggests that the risk of SARS-CoV-2 reinfection is low in the months after initial infection but may increase with time due to waning immunity. *For temporary exemptions, Category 1A allows 12 weeks.

There is no indication to do serological testing before vaccination.

People with a history of multisystem inflammatory syndrome (MIS-A or MIS-C) with their COVID infection should consider delaying vaccination until they have recovered from their illness and for 90 days after the date of diagnosis of MIS-C or MIS-A, recognizing that the risk of reinfection and, therefore, the benefit from vaccination, might increase with time following initial infection. If the MIS occurred after receipt of COVID vaccine, they should be discussed with a medical advisor at IMAC. Medical and nurse practitioners may apply for temporary exemption on behalf of unvaccinated or partially vaccinated patients. Strict criteria apply, and supporting documentation is required. The turnaround time for the application to be processed can be delayed when there is high demand. It is recommended that the application is made as soon as the case is confirmed positive and you are made aware that they are going to need an exemption - e.g. those needing to return to work under a vaccine mandate.

https://www.health.govt.nz/covid-19-novel-coronavirus/covid-19-response-planning/covid-19mandatory-vaccinations/covid-19-exemptions-mandatory-vaccination#temp-exempt

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Useful Resources Note: Many of these resources are provided via Midland Health Pathways. You will need to enter the username: midlanduser and password: midlandpassword to access the links.

Resources for Clinicians Ministry of Health Guidance for critical health services during an Omicron outbreak Guidance for critical health services during an Omicron outbreak | Ministry of Health NZ

Ministry of Health Summary of changes for Phase 2 and 3 of Omicron response Omicron in the community: what this means for you | Ministry of Health NZ

Health Pathways COVID-19 Answering Common Questions https://midland.communityhealthpathways.org/957118.htm

Health Pathways Covid Case Management in Children https://midland.communityhealthpathways.org/931295.htm

Health Pathways Pregnancy and Postnatal Care in a Covid-19 patient https://midland.communityhealthpathways.org/952638.htm

Health Pathways Covid-19 Palliative Care https://midland.communityhealthpathways.org/730929.htm

Health Pathways Factors the influence the risk of complications https://midland.communityhealthpathways.org/files/Resources/FactorsThatInfluenceTheRi skOfComplicationsInAdults.pdf

Health Pathways Factors that influence the risk of complications in children https://midland.communityhealthpathways.org/files/Resources/HealthPathwaysFactorsTh atInfluenceTheRiskOfComplicationsChildren.pdf

Health Pathways Clinical Status Checklist - Covid-19 patients https://midland.communityhealthpathways.org/files/Resources/ClinicalStatusChecklistCOV ID-19Patients.pdf

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Health Pathways Severity Assessment https://midland.communityhealthpathways.org/files/Resources/SeverityAssessmentCOVID19Patients.pdf

Health Pathways Post Covid-19 Conditions (Long Covid) https://midland.communityhealthpathways.org/783098.htm

Resources for Patients Covid-19 Rapid Antigen Testing Guide COVID-19 Rapid Antigen Testing Guide (health.govt.nz)

Health Navigator information for patients https://www.healthnavigator.org.nz/health-a-z/c/covid-19-positive-community-care-topics/

Ministry of Health Isolation and Care information for patients Isolation and care | Unite against COVID-19 (covid19.govt.nz)

Health Navigator Diary for patient https://www.healthnavigator.org.nz/media/15254/141-covid-19_symptom_diary.pdf

Covid-19 positive: How to manage your symptoms https://www.healthnavigator.org.nz/health-a-z/c/covid-19-positive-managing-yoursymptoms/

Health Navigator Positions to make breathing easier https://www.healthnavigator.org.nz/health-a-z/c/covid-19-positive-breathing-positions-andmanaging-breathlessness/

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