COVID-19: Questions and answers for primary health care workers

Questions and answers on COVID-19 for primary health care workers including general, clinical, and infection prevention and control guidance.

Last updated: 2 October 2021

On this page:


General guidance

How do I know I am using the latest guidelines and advisories?

The Ministry of Health’s COVID-19 webpage is updated regularly with the latest advice and guidelines. Each page should have the date it was last updated.

Specific advice and resources for health care workers, are available at:

What is the current strategy to eliminate COVID-19?

The Government’s overall public health strategy for the COVID-19 pandemic in New Zealand is elimination. This means being confident we have eliminated chains of transmission in our community for at least 28 days, and we can effectively contain any future imported cases from overseas.

Our elimination strategy is a sustained approach to keep it out, find it and stamp it out, and manage the impact. We do this through a team effort.

The strategy is continually evolving to keep New Zealanders safe from COVID-19. This has become increasingly important as the country carefully engages more closely with the world.

Read more about the elimination strategy.


Healthline

What is Healthline telling patients?

The COVID-19 Healthline 0800 358 5453 is using the latest advice from the Ministry of Health to provide information to the public. All callers are asked a series of questions which help determine if they may have COVID-19, if they may require testing, and advice on how and where to access care.

Healthline staff are kept up to date with the latest testing guidance and are ready to modify their advice as the situation evolves.


Clinical

What are the precautions for vaccination with the Pfizer COVID-19 vaccine?

The safety and effectiveness of the Pfizer COVID-19 vaccination is well established. We also know having both doses of the vaccine provides the greatest protection from catching the virus and becoming seriously unwell or passing it on to others. 

There are limited medical reasons for not having the COVID-19 vaccine. The Immunisation Advisory Centre (IMAC) confirms the only medical reason for not having a COVID-19 vaccine is having a documented severe allergic reaction (anaphylaxis) to a previous dose of the mRNA-CV vaccine or any component of the vaccine.

Precaution is required, with guidance from specialist and IMAC advice, when there is documented severe allergic reaction (anaphylaxis) or complication (myocarditis, pericarditis) from the first dose of Pfizer COVID-19 vaccine.

Other hypersensitivities and allergic reactions are generally grounds for more precautions to be taken when vaccinating, but are not contraindications in themselves. Options for vaccination in a controlled environment should be considered.

Health professionals can view further advice on your HealthPathways COVID -19 Vaccination pathway.

Can border workers get an exemption for COVID-19 vaccination?

Vaccination is the best way to protect border workers, their whanau and the wider community. This is why a Vaccinations Order requires people carrying out certain roles at the border to be vaccinated.

There are limited medical reasons for not having the COVID-19 vaccine (see above).

We are aware of a small number of cases where medical practitioners have supported worker applications for exemptions, but may not have considered options such as vaccination in controlled environments (see above).  

An unintended consequence of the exemption process is that the workplace has time to train or employ a vaccinated worker to do the work, which may place the exempted worker’s employment at risk.

Who should I swab for COVID-19?

The testing criteria reflect multiple factors and may change frequently.

See the Primary Care Quick Reference Guide and Case Definition and Testing Guidelines.

The Testing guidance for the health sector provides more detailed advice and is updated every six weeks.

Is there anyone I shouldn’t swab in general practice?

Yes. Do not swab:

  • patients with severe illness
  • patients who require hospitalisation or hospital assessment
  • patients with signs/symptoms consistent with pneumonia.

These patients should be discussed with the local hospital and sent there for further assessment and management.

Should I test a patient who is asymptomatic?

There are some instances where testing of asymptomatic people is mandated or advised. The testing criteria reflect multiple factors and may change frequently.

We recommend that you frequently review the guidance on who to test on the case definition and testing guidance page.

What if a patient’s COVID-19 test result is negative?

Many people will be nervous while they wait for their result, and will staying at home or in isolation while the test result is pending. It is important to feed back negative results as soon as possible. (Note: Public health units will provide follow-up with patients who have positive tests.)

The advice to people who were sympotmatic but returned a negative result is:

  • if they are still symptomatic, they should continue to stay at home or self-isolate and follow basic hygiene measures until they have been symptom free for 24 hours.
  • if they feel fully recovered, but then develop a new illness or if their current symptoms get worse, they should call their general practice or Healthline on 0800 358 5453.
  • if they are a close contact, or they are under a Required Testing Order or Border Notice, they will be advised by a medical officer of health about the timing of their release from isolation.
  • if a patient meets the HIS criteria they should follow advice from a medical officer of health about when it is safe to return to normal activities. Otherwise they can return to normal activity according to the alert level restrictions they are living under once they have been well for 24 hours.

The advice to people who were asymptomatic and screened for surveillance purposes, returning a negative result:

  • if they are under a Required Testing Order or Border Notice, they will be advised by a medical officer of health.
  • otherwise they can return to normal activity according to the alert level restrictions they are living under.

How do we make sure we are using our Personal Protective Equipment (PPE), testing supplies and laboratory resources wisely?

Practitioners should continue to apply the testing guidance to determine who to swab. See case definition and testing guidance for more information.

For the latest advice on PPE use in health care see Personal protective equipment use in health and disability settings and advice in the Primary Care Quick Reference Guide.

Does general practice need to provide medical certificates for people who are required to self-isolate or stay at home?

No. However, COVID 19 Healthline have developed a certificate for people who are required to self-isolate or stay at home because they have been identified as a contact of a confirmed case. Patients can call COVID 19 Healthline for free on 0800 358 5453 if they require a certificate.

What do public health units do if there is a case of COVID-19 in someone in my practice?

If someone is identified as having COVID-19, the role of public health is to prevent ongoing transmission of COVID –19.  This includes isolating the person who is sick, and then involves a public health investigation to identify which staff, patients and visitors may have been exposed to the person with COVID –19 whilst they were infectious.

The public health investigation seeks out settings where people may have come into close contact with the person while they are infectious. Close contact is defined as having significant contact with a case in an enclosed space without full PPE, or living in the same household as the case

Close contacts are expected to self-isolate for 14 days from the time they were last exposed to an infectious case. This is so that if they develop symptoms, they won’t put anyone else at risk. If someone with COVID-19 visits or works in a particular high-risk public setting, additional precautions may be advised to mitigate the risk of fomite transmission. Examples include places visited by large numbers of vulnerable people or the general public, such as schools and general practices.  Close contacts will also need to be tested over their isolation period.

Depending on the circumstances and the person’s movements, the affected setting may be asked to wait until contact tracing of their staff and a terminal clean has been completed before it is safe for people to access it again.

Terminal cleans can take up to 3–4 hours to complete and your local DHB/PHU can provide advice on how to do this. In a general practice setting, a terminal clean is unlikely to be necessary if the infectious person is a patient who was managed appropriately with IPC precautions whilst in the building. It is more likely if the person was a staff member who entered most rooms in the facility including the staff common rooms.

The decisions around whether a terminal clean is required and who needs to go into self-isolation is made by the public health unit leading the investigation. It is usually a joint decision based on the circumstances related to the case of infectious COVID-19 and it is always aimed at ensuring people have safe access to health care.  

For a number of reasons, some practices may choose to close for a period (reflecting eg, staffing requirements). These decisions are not based on public health risk of COVID-19, but on the logistical implications of what is required. Your local PHU, PHO and DHB will be able to assist any practice exposed to COVID-19 in working through these considerations.

Do I need to provide a medical certificate for someone seeking an exemption to wear a mask?

No, exemptions are self-declared, with no formal paperwork required.

People who have trouble wearing a mask due to disability or health conditions are exempt. This can include people with mental health conditions, chronic respiratory problems, facial eczema, history of oral surgery, that make mask wearing impossible etc. They do not need to confirm this exemption with their health provider however some may choose to discuss their situation with their clinician.

People can apply for an exemption card for mask/face coverings from the Disabled Persons Assembly NZ, by emailing [email protected]. See more information on the Unite Against COVID-19 website.

When can someone who is a confirmed or a probable case of COVID-19 be released from isolation?

This is determined by the medical officer of Health/public health official.


Health worker infection prevention and control

Should I go to work if I have respiratory or influenza-like symptoms?

No. You should stay at home. You should not leave home if you are unwell. In this situation, you should stand down from going to work, and arrange to be tested for COVID-19.

You will need to stay at home until  the result is negative and your have been free from symptoms for 24 hours. 

What should I do if the patient’s COVID-19 status is unknown?

No matter what someone’s COVID-19 status is, you should always follow routine infection prevention and control precautions (standard as well as any transmission-based) for all care.

See ‘COVID-19 Status unknown’ on the Personal protective equipment use in health and disability care settings page and in the Primary Care Quick Reference Guide.

What are aerosol generating procedures?

Aerosol generating procedures are are interventions that can promote the generation of fine airborne particles (< 5 microns). These fine particles remain suspended in the air for longer periods than larger particles and can be inhaled resulting in a risk of airborne transmission. Aerosol generating procedures are not common in the community. They are most typically performed settings such as community dentistry. Taking a nasopharyngeal or a throat swab in the community to test for COVID-19 is not an aerosol generating procedure.

Read more about aerosol generating procedures.

When do I use an N95/P2 particulate respirator?

N95/P2 particulate respirators are only required when working with a person who is at increased risk of carrying or shedding SARS COV2 virus. This respirator filters extremely small particles.

See Personal protective equipment use in health and disability settings for role of face masks and advice according to alert level and clinical care setting.

How do masks affect the transmission of COVID-19?

See information in Personal protective equipment use in health and disability settings.

What if my practice doesn't have a single room to see a patient with symptoms consistent with COVID-19?

Each practice will have a system for treating infectious patients (such as influenza or measles) that suits their clinic and setting. Sometimes this can mean assessing the patient in a car or in a sheltered place outside. Practices are encouraged to have a red stream system for potentially infectious patients, cohorting staff to red or green stream, and dedicated physical spaces when seeing red stream.

How do I clean the room after a patient with symptoms consistent with COVID-19 has left?

The best way to prevent any potential transmission of infections in primary care is to clean the room between patients. 

After the patient has left:

  • wash your hands and put on gloves for cleaning
  • wipe down/clean hard surfaces and all items the patient has touched (eg, the examination couch) by either using:
  • detergent and water, followed by a hospital grade disinfectant, noting the dwell time of the product used and follow manufacturers’ instructions for use of any additional PPE or;
  • a 2 in 1 cleaning and disinfectant wipe that is effective against SARS-CoV-2.
  • dispose of PPE safely and appropriately in a closed clinical waste bin, followed by hand hygiene practices.

 Stand down of the room is not necessary.

 Also see: Cleaning following a confirmed or probable case of COVID-19

How is the Ministry of Health making decisions around PPE?

The Ministry is working with a Technical Advisory Group, which includes national infection control experts, public health experts and clinicians. The decisions are made on scientific evidence, international experience and current World Health Organization guidance.

How do I properly put on and take off PPE?

See Personal protective equipment use in health and disability settings.

What do we do if our primary care practice runs out of PPE?

PPE for New Zealand’s publicly-funded health workers is ordered and distributed through a nationally  coordinated approach managed by the Ministry (see COVID-19: Personal Protective Equipment Central Supply). This approach enables availability of PPE where and when it is needed during the COVID-19 response.

If you have any queries about PPE supply and distribution, email [email protected]. If there is an immediate need for the PPE, the general practice should contact their District Health Board in the first instance and alert the Ministry of Health COVID Health Supply chain team. 

What do we do if we are unable to assess or swab a suspected case, because of a lack of a single room, insufficient PPE, or we don’t have enough staff?

It is important to have an arrangement in place for patient care. This will involve working with local organisations (other practices, your PHO, or DHB) to coordinate with an agreed pathway to ensure patients can be assessed safely.

 

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