Testing Guidance for 3 Feb to 16 Mar 2022 - FINAL

Testing Guidance for the health sector Implementing the Aotearoa New Zealand COVID-19 Testing Strategy Effective 3 February to 16 March 2022 Note: This testing guidance is intended for the health sector administering testing as part of the current community outbreak management of COVID-19 and includes guidance for when all of New Zealand or any regions are at COVID-19 Protection Framework (CPF) Red or Orange. Specific updates may be issued with new guidance from the Ministry of Health in response to changing CPF (also known as the “traffic light system”) levels. This Testing Guidance may be superseded by any further guidance issued by the Ministry of Health to reflect changes in outbreak status or CPF levels. There may also be revisions to this Guidance when operational details of the Reconnecting New Zealand programme are confirmed.

Purpose 1.

This Guidance is aligned with our Omicron Plan which the Ministry of Health developed in response to the emergence and now increasing prevalence of the Omicron variant of the virus.

2.

It is to be implemented for the period 3 February to 16 March 2022, and replaces the COVID-19 Testing Guidance previously in force from 16 December 2021.

3.

It takes into account the current situation in Aotearoa New Zealand and globally, including the current CPF colour and border status, local events and community factors.

4.

It is intended to ensure we continue to: a. Identify, where feasible, and manage any cases of COVID-19; and b. Provide ongoing reassurance that the border is secure through ongoing mandatory testing.

Context 5.

New Zealand has been operating under the COVID-19 Protection Framework (CPF) – also known as the “traffic light system” – since 3 December 2021.

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All of New Zealand moved to Red: Phase I at midnight on Sunday 23 January after the Omicron variant was confirmed to be spreading in the community in Auckland and Nelson. This follows Omicron first being detected at the border on 16 December and then in the community on 29 December.

7.

As of 31 January, with the number of Omicron community cases expected to increase significantly within a short period, moving to Red: Phase 2 appears imminent with a subsequent move to Red: Phase 3 likely not long thereafter.

The testing approach 8.

Testing – namely, who should be tested and via which testing mode – varies significantly across Red: Phases 1, 2 and 3. In particular, at Phases 2 and 3 when case numbers are increasing rapidly and

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particularly in the community, PCR1 testing will become more targeted, with rapid antigen tests (RATs) used for many people who would previously have been given a PCR test. At Phase 3, RATs will be used for diagnostic testing for some groups, whereas at Phases 1 and 2 RATs are authorised only for surveillance testing and a PCR testing is required to confirm diagnosis for a positive RAT result. In addition, at Phase 3 some people – such as symptomatic household contacts of cases – will not be tested, but it will be assumed they have COVID-19. This is to ensure lab PCR processing can focus on priority testing to ensure it continues to operate sustainably.

9.

Phases 2 and 3 are designed to respond to an outbreak of the Omicron variant where new daily cases rise to much higher levels, including in the thousands, and a containment approach is no longer viable.

During these Phases the purpose of testing shifts away from finding cases in the community to protecting people from severe disease and/or death, ensuring equity and limiting the impact on society through protecting critical infrastructure.

10.

The testing regime for border workers (including MIQ workers), as mandated by the COVID-19 Public Health Response (Required Testing) Order 2020, continues unchanged through all Phases.

Key features and testing approach of Red: Phase 1 (Stamp It Out) 11.

There is a small number of cases in the community, and most are connected. The objective of the testing approach is to contain and eliminate.

12.

Testing focuses on the following groups: •

PCR testing for symptomatic people and close contacts via GPs or CTCs

•

Existing border surveillance testing continues

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PCR testing for border workers and international arrivals

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Mixed model of RAT and PCR testing for asymptomatic surveillance testing of healthcare workers, if necessary

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Anyone who is required to be tested under a Section 70 notice or a Border Order must be tested, unless exempted by a qualified health practitioner or a Medical Officer of Health.

•

PCR testing to confirm diagnosis for all positive RAT results.

Key features and testing approach of Red: Phase 2 (Flatten The Curve)

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13.

Case numbers are increasing significantly and there is growing, but still manageable, pressure on the health system. The objective of the testing approach is to reduce the rates of community transmission and to transition system responses.

14.

Testing focuses on the following groups: •

Move ongoing asymptomatic surveillance testing to RATs e.g., healthcare workers or cease testing

•

Continue use of PCR testing for border workforce and international arrivals (possibly with different timing/frequency)

•

Engage stakeholders to prepare for transition to Phase Three

•

“Test to return” to work if needed for asymptomatic critical workforce who are close contacts using RATs

•

Anyone who is required to be tested under a Section 70 notice or a Border Order must be tested, unless exempted by a qualified health practitioner or a Medical Officer of Health.

A PCR test can be via either a nasopharyngeal swab or a saliva sample, but with the caveat that saliva sample testing may not be readily available in some regions of New Zealand, particularly rural or remote settings. For those who cannot tolerate a nasopharyngeal swab, a combined oropharyngeal and bilateral anterior nasal swab can be considered as an alternative– particularly if there is concern about tissue fragility.

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•

PCR testing to confirm diagnosis for all positive RAT results.

Key features and testing approach of Red: Phase 3 (Manage It) 15.

There are widespread community cases, and changes in case management are needed to manage pressure on health services. The objective of the testing approach is to protect vulnerable communities, and critical services and infrastructure.

16.

Testing focuses on the following groups: •

Focus PCR testing on priority populations

•

Continue use of PCR testing of border workforce

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Symptomatic people or priority populations may use a RAT for diagnosis

•

“Test to return” to work if needed for asymptomatic healthcare and critical workforce who are close contacts using RATs

•

Anyone who is required to be tested under a Section 70 notice or a Border Order must be tested, unless exempted by a qualified health practitioner or a Medical Officer of Health.

•

RATs are available at GPs, Pharmacies, CTCs or workplaces for symptomatic or critical workers.

Testing and vaccination status 17.

COVID-19 vaccination status of a person or their household members do not change the need or decision to test for SARS-CoV-2.

Sending test swabs to ESR for whole genome sequencing 18.

To support the collection of timely and accurate information from SARS-CoV-2 genomic surveillance, the Ministry of Health and ESR have established a robust sampling and sequencing strategy to guide laboratories to determine which positive swabs should be forwarded to ESR for whole genome sequencing (WSG).

19.

Positive swabs from the following groups should be prioritised for forwarding to ESR: a. All border related cases (international travellers, border workers and MIQ workers to monitor introduction of new variants); b. People from previously COVID-19 free areas, to facilitate contact tracing and monitor incursions across the country; c. Suspected re-infection to monitor variants that might invade host immunity; d. Suspected healthcare acquired cases and cases at high-risk settings to facilitate investigations; e. Case from high-risk groups such as immunocompromised patients; f.

Upon clinician request for cases with severe disease or unusual presentations, particularly among the vaccinated or immunocompromised populations;

g. Cases with target gene dropouts.

20.

Secondary to the swabs from the above priority groups, a sample of randomly-selected positive swabs which are representative of the the underlying population should also be forwarded to ESR, focusing on: a. geographic location, identified by DHBs or postcode b. ethnicity c. age groups 3

d. representative cases of major outbreaks e. sociodemographic status f.

21.

vaccination status

Laboratories are also requested to ensure they do not forward non-contributory samples – that is, repeat patient samples, multiple samples from the same household or multiple samples from established epidemiological clusters. This will assist ESR to make the most efficient use of their sequencing capacity.

Isolation and quarantine At Red: Phase 1 •

Cases must isolate for 14 days (release by health official)

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Household contacts must isolate for 14 days and close contacts for 10 days (test on days 5 & 8, but test immediately if symptomatic)

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Isolation in community is encouraged for community cases, but there will be some limited availability of MIQ to support.

At Red: Phase 2 •

Cases must isolate for 10 day

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Household contacts must isolate for 10 days and close contacts for 7 days (test on day 5)

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Critical infrastructure/health workforce capacity will be supported by public health guidance to enable close contacts to work, this includes “test to return”.

At Red: Phase 3 •

Cases must isolate for 10 days

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Household contacts must isolate for 10 days and close contacts for 7 days (test if symptomatic)

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Critical infrastructure/health workforce capacity will be supported by public health guidance to enable contacts and if appropriate cases to work, which may include asymptomatic surveillance testing using RATs

Testing sites 22.

The Ministry will continue working with DHBs, PHUs and community health providers to support equitable access to testing for Māori and Pacific peoples, and those in hard-to-reach and remote locations.

23.

In developing local approaches, lessons learned to date need to be considered, including: a. One size does not fit all — different approaches are needed for the different communities that require targeted testing. b. Clear messaging for communities is needed, including what to do while waiting for a result and the implications of a positive test for the person, their close contacts and family. This has been an area of confusion for people at times, so alignment with Ministry guidance and consistency of messaging is important. c. There should be clear public messaging around when and where testing is available, and also what testing is appropriate for a person’s situation (e.g. when a rapid antigen test is or is not appropriate).

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d. Public health information provided for mass events should include testing information.

24.

DHBs and PHUs should ensure information in Healthpoint is kept up to date for the location of testing sites and their opening times.

COVID-19 symptoms vs post-vaccination reactions 25.

As COVID-19 vaccines are potentially reactogenic, people may present with symptoms postvaccination. Post-vaccination symptoms have generally been more pronounced after the second dose of the vaccine, and they may also be more pronounced after a booster dose. The systemic reactions to the vaccines can include fatigue, headache and muscle aches and pain, which are all also common symptoms of COVID-19 infection.

26.

Because vaccine effectiveness is less than 100%, COVID-19 infection should ALWAYS be considered as a possible cause of symptoms, particularly for those at higher risk of exposure such as MIQ, healthcare or frontline border workers.

27.

When endeavouring to distinguish COVID-19 symptoms from reactions to vaccines, refer for testing – PCR at Red: Phase 1 and 2, and RAT at Red: Phase 3 – anyone who presents with one or more of the following symptoms within 48 hours of receiving the first or second dose of ANY vaccine: a. loss of the sense of smell or taste b. respiratory symptoms (e.g. sore throat, cough, shortness of breath, sneezing/runny or blocked nose) c. generalised muscle aches which are worsening with time d. fever of 38 degrees Celsius or higher.

28.

People with fatigue, headache, localised (not systemic) muscle aches and pain, and low-grade fever/chills in the 48 hours after any vaccination, who do not have the specific symptoms listed in paragraph 39 above, generally do not need to be tested for COVID-19. There may be exceptions, guided by public health advice.

Other considerations 29.

Consistent with the Testing Strategy this Testing Guidance recommends focusing on risk-based testing of higher-risk groups rather than widespread, random asymptomatic testing of communities. However asymptomatic testing may be directed as part of an outbreak or case investigation, and can be considered for people who work in public facing roles if they present to primary care, or as directed by a Medical Officer of Health.

30.

Recovered cases do not need to be tested for up to three months since being considered recovered.

This is because a person who has recovered from COVID-19, and so is no longer infectious, will continue to have fragments of SARS-CoV-2 (the virus that causes COVID-19) in their system for up to several months beyond their infectious period. Although these fragments are neither alive nor infectious they would produce a positive result if the person had a PCR test given that the PCR test is designed to detect SARS-CoV-2 genetic material but cannot distinguish between alive and dead genetic material.

31.

It is vitally important that key public health messages for all New Zealanders stay consistent. a. Get fully vaccinated and then get a booster as soon as you are eligible. b. Wash your hands regularly. c. Observe physical distancing. d. Cough and sneeze into your elbow or a tissue.

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e. In indoor settings where you cannot physically distance or where you are at home with people you don’t know, at Red: Phases 1 & 2 wear a reusable, well-fitted mask (three-layer minimum) or disposable medical mask at Red: Phases 1 and 2, and at Red: Phase 3 wear a medical mask that meets New Zealand standards with the option of layering a reusable face mask on top. f.

Stay at home if you are unwell.

g. Ring Healthline or your GP for advice if you are unwell. h. Further advice on face masks and PPE for essential workers, health workers and higher-risk health and border workers will be issued by the Ministry of Health.

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