Letter to General Practitioners and Primary Health Organisations from Ministry of Health National Health Coordination Centre

Kia ora e te whanau,
It has been another busy week – thank you for your hard work and support. Some updates:

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1. Government approach

The Prime Minister gave an address to the nation Saturday 21.03.20 at midday https://www.rnz.co.nz/news/national/412280/live-coronavirus-prime-minister-jacinda-ardern-gives-address-to-nation-on-the-covid-19-response Please take the time to watch the clip and understand the approach the government will be taking at various alert levels.

1. Case definition and investigation

There has been no change in the case definition. https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-novel-coronavirus-information-specific-audiences/covid-19-novel-coronavirus-resources-health-professionals/case-definition-covid-19-infection However, it remains under active review as the situation evolves, and we encourage to check this daily.
Laboratory capacity and swabbing supplies are at critical levels. Please continue to apply this case definition when considering whether a patient requires swabbing for investigation in any setting (i.e. general practice, urgent care, or CBAC). There is no indication to swab asymptomatic people, irrespective of their travel history, contact history, workplace or profession.
The NZ Microbiology Network has revised their swabbing protocol. Please see below from the Network.
Swabbing procedure when testing for COVID-19
On the basis of available scientific information and in the interest of preserving resources, the New Zealand Microbiology Network (NZMN) recommends the following swabbing procedure when testing for COVID-19.

•    Use a single nasopharyngeal swab (NPS) to swab the nasopharyngeal space
•    To ensure adequate collection, the swab tip must extend well beyond the anterior nares until some resistance is met
•    Place the swab in viral transport media (VTM) and transport to the laboratory

Specimen collection guidance is available from local laboratories.

1. Personal Protective Equipment

We recommend that health care workers who cannot maintain 2 metres contact distance from people with COVID-19 symptoms (according to the clinical criteria of the case definition) and are going to be in contact with them for more than 15 minutes (or are undertaking a physical exam or swabbing) use Personal Protective Equipment (PPE). This is irrespective of a patient’s travel history or risk of contact with a confirmed case.
PPE in primary care includes gloves, gown, medical/surgical mask and eye protection.
There is pressure on our PPE resources. We expect to be able to provide new guidance on the rational use of PPE this week. Note that the PPE calculator sent to Primary Health Organisations last week to guide the volumes required for General Practices will also be revised over the coming days.

1. Guidance on respiratory symptoms/influenza-like illness in health care workers

General practitioners, primary care providers, and other health care professionals should not work in a public setting if they are unwell. In the current context, if you are sick, you should stand down from work, self-isolate, and be assessed as a patient by a medical professional.
General practitioners and healthcare workers with respiratory or influenza-like symptoms who are in close contact with patients (i.e. less than 2 meters distance for more than 15 minutes) should be tested for COVID-19 and other potential causes of their illness.
There is guidance on the interpretation of results in the ‘Updated Advice For Health Professionals’ document.

1. Minimising face-to-face contact with patients

Wherever possible, reduce face-to-face and close contact with your patients, and reduce the number of patients physically attending your centres. This may involve using telephone and video consults, e-prescription and e-messaging, physical distancing, and adjusting the timing and setting of certain activities (such as vaccination).
We recognise this may be ethically and logistically challenging for many, and ask that you work together to share ideas and support your community healthcare partners. The RNZCGP, Ministry of Health, District Health Boards, and Primary Health Organisations are all working hard to be able to provide various tools, software, hardware, and pathways to support you.
To note, we understand that in some regions people with COVID-19 symptoms are being directed to CBACS or designated testing centres in the first instance, in order to reduce the presentation of these patients to general practices. Please familiarise yourselves with the local protocols and provide this information to your patients.

1. Financial support

The Ministry of Health has been working on a financial package to support general practices and primary care providers. The details of this are likely to be finalised and released over the course of this week.
Finally, can we pass on our gratitude to you all for your commitment to your patients and the community at this time. The last week has required significant effort from general practice, public health units, Primary Health Organisations, District Health Boards, and other community practitioners (including nurse practitioners, urgent care, and rural healthcare providers). Thank you for your teamwork in this response.

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