Potential Scenarios for COVID Testing (9 Aug 2021)

Potential Scenarios for Covid-19 Testing

9 August 2021

Key recent updates for clinicians: • Testing Guidance revised 29 July to incorporate changes to the advice around testing children.

• People should be tested if symptomatic (or subject to mandatory testing) regardless of vaccination status; • Systemic reactions to COVID-19 vaccination are common, especially after the second dose. However, new respiratory symptoms, loss of smell or taste, fever of 38 degrees Celsius or higher, or muscle aches getting worse over time, warrant COVID-19 testing as they are not consistent with a post-vaccination reaction; • People who meet the HIS criteria or are contacts of a COVID-19 case should be tested for COVID19 if they have atypical symptoms and there is not another more likely diagnosis. They should then self-isolate until they get a negative result, particularly where there are community cases in their area;

Symptomatic

Patient A:

Meets Clinical Case Definition, Meets HIS Criteria.

Diagnostic Swab Required & Funded

Requires Swab, No Examination Identify HIS Criteria on Path lab & Halcyon Forms

Virtual Assessment + Refer to Pathlab ($69)

Simple Assessment + Swab (Swab at GP) ($138)

Full PPE: Change gloves between patients.

Requires Swab & Examination Identify HIS Criteria & MOH Informed on Halcyon Form

Full Assessment ($287.50)

Full PPE: Change of PPE + full decontamination of space afterwards

Patient B: Meets Clinical Case Definition, No HIS criteria.

Surveillance Swab Offered & Funded

Requires Potential Swab, No Examination

Virtual Assessment + Refer to Pathlab (if swab needed) ($69)

Requires Potential Swab & Examination

Simple Assessment, No Swab ($69)

Simple Assessment + Swab (Swab at GP) ($138)

PPE: Gloves & Mask

If seen at practice but referred to Path lab for Swab = “Virtual, Swab Taken” in Halcyon

Swab Completed

Swab Refused

No Swab Completed

Patient must wait for negative swab result and be clinically well before returning to work/school. Patient must be in strict isolation until then.

Must be notified to Public Health.

Swab is for diagnostic purpose.

Patient must self-isolate.

GP to notify public health who will advise further steps.

Patient must wait for negative swab result and be clinically well before returning to work/school.

Full PPE: Change gloves between patients.

Swab Completed Patient must wait for negative swab result and be clinically well before returning to work/school.

General Practice Testing Strategy: Test/refer for testing anyone aged 12 or over* who is symptomatic. Test and notify to Medical Officer of Health all people with symptoms of COVID-19 who meet HIS criteria, and isolate until a negative test is obtained. Targeted asymptomatic testing – on advice from Ministry of Health and/or public health unit only. *See paragraph 24 in latest Testing Guidance for full details of testing children at Alert Level 1 HIS Criteria: any of the following 14 days prior to illness - international travel, direct contact with a person who has travelled overseas (e.g. customs and Immigration staff, staff at quarantine/isolation facilities), worked on international aircraft or shipping vessel, cleaned at international airport or maritime port in areas/conveniences visited by international arrivals, exited MIQ facility (excluding recovered cases), worked in cold store facility receiving imported chilled/frozen goods from international air/maritime port, travelled from an area with an evolving COVID-19 community outbreak, any other criteria requested by the local Medical Officer of Health.

Full PPE: recommended when taking a swab: gown or apron, surgical face mask, eye protection (such as goggles or a face shield), gloves. For guidelines on PPE requirements for interactions with people of unknown COVID-19 status, click here.

Potential Scenarios for Covid-19 Testing Advice for Testing Asymptomatic Individuals The most recent Testing Guidance does not recommend focusing on widespread asymptomatic testing of communities, unless as part of an outbreak or case investigation. The focus for surveillance testing is for NZ-based air crew and border workers.

However, consideration can be given to offering asymptomatic testing to the following groups if they present to primary care: • Health workers, including Aged Residential Care workers.

• Hospitality workers, including hotel, restaurant staff.

• Public-facing tourism workers. Public-facing transport workers (e.g. bus, taxi, uber, commuter train).

• Close contacts of border workers.

• Anyone (excluding recovered cases) who has exited a MIQ facility within the last 14 days

Asymptomatic Swab always needed for asymptomatic claim.

Patient C:

Asymptomatic (Priority Group)

Surveillance Swab Offered & Funded Requires Swab, No Assessment or Examination Triage: Virtually or in Person Funding recognises costs associated with triage, data entry, referral, and management of results

Refer to Pathlab for Swab ($69)

Swab in Practice ($69)

All Asymptomatic Testing to be claimed as “Virtual + Swab Taken” + Surveillance Code in Halcyon Full PPE: Change gloves between patients.

Swab Completed

Patient can return to work/ school while awaiting test result (unless advised otherwise by public health – e.g. close contact of confirmed case.)

Swab is for surveillance purpose.

Full PPE: recommended when taking a swab: gown or apron, surgical face mask, eye protection (such as goggles or a face shield), gloves. For guidelines on PPE requirements for interactions with people of unknown COVID-19 status, click here.