Potential Scenarios for Covid-19 Testing
(19 Nov 2020)
Key points/ updates for clinicians: Advice remains - “test all people with symptoms” • It is critical to encourage all patients presenting with symptoms consistent with COVID-19 to be tested. • The essential groups for community testing remain unchanged, as is the case definition. • The Higher Index of Suspicion (HIS) criteria have changed, to add an additional category – anyone who has exited a MIQ facility in the last 14 days (excluding recovered cases). • Update to isolation requirement for non-HIS patients (isolate until negative test result confirmed) • Please see potential scenario flowcharts (inc. costs) for symptomatic (p.1) and asymptomatic (p.2) testing.
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.
Essential Groups for Community Testing: Symptomatic and meets HIS criteria; Meets HIS Criteria and has one or more less typical symptoms; (fever, diarrhoea, headache, myalgia, nausea/ vomiting, confusion/irritability) with no other diagnosis; Symptomatic but does not meet HIS criteria. HIS Criteria: Anyone who has exited an MIQ facility within the last 14 days (excluding recovered cases). In the 14 days prior to onset of illness patients has had: contact with a confirmed or probable case, international travel, direct contact with a person who has travelled overseas (includes Customs and Immigration & quarantine/isolation facilities staff), worked on an international aircraft or shipping vessel or cleaned at an international airport or maritime port in areas/conveniences visited by international arrivals, or any other criteria requested by the 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 full guidelines on PPE requirements for interactions with people of unknown COVID-19 status, see: https://www.health.govt.nz/system/files/documents/pages/hp7372-level-2-ppe-guidelines-for-unknown-covid-status-130820.pdf
Potential Scenarios for Covid-19 Testing Advice for Testing Asymptomatic Individuals Priority Groups for Asymptomatic Testing Those who do not have symptoms of COVID-19 but are: • 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) • Close contact of border worker group • Border worker groups: those working at managed isolation and quarantine facilities (HIS Criteria) • Close contacts of confirmed or probable case (HIS Criteria) • New Zealand based Air Crew (HIS Criteria)
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 full guidelines on PPE requirements for interactions with people of unknown COVID-19 status, see: https://www.health.govt.nz/system/files/documents/pages/hp7372-level-2-ppe-guidelines-for-unknown-covid-status-130820.pdf