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: 24 September 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 Resources for health professionals.

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. We do this through a team effort:

  • controlling entry at the border
  • disease surveillance
  • physical distancing, staying home if unwell, hygiene measures (hand hygiene and cough etiquette), and personal protective equipment where appropriate
  • people with symptoms presenting for testing and being tested  
  • establishing asymptomatic testing of border staff
  • isolating cases and their close contacts
  • testing of close contacts
  • broader public health controls depending on the alert level we are in.

Healthline

What is Healthline telling patients?

Healthline is using the latest advice from the Ministry of Health to provide information to those who call the COVID-19 dedicated 0800 number. 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

Who should I swab for COVID-19?

The testing criteria reflect multiple factors and may change frequently.

We recommend that you frequently review the guidance on who to test.

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 (or CBAC, depending on severity), and sent there for swabbing and further management.

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

COVID-19 is likely to continue to be with us for some months and it is important that we ensure the availability of supplies for the coming stages and support laboratory capacity. Practitioners should continue to apply the testing guidance to determine who to swab. This may include testing asymptomatic people. 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 care .

Should I test a patient who is asymptomatic?

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

We recommend that you frequently review the guidance on who to test. See case definition and testing guidance for more information.

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

General practice teams are responsible for informing patients if their COVID-19 test is negative and providing advice. Many people will be nervous while they wait for their result, and will be off work or staying away from others while the test result is pending, so 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 patients with a negative result is:

  • to stay at home while they feel unwell and follow basic hygiene measures
  • to discuss with their general practitioner/primary care provider about when it is safe for them to return to work or their usual daily activity (based on assessment of the severity of the illness and concerns around infectivity).

If a patient has symptoms and meets the HIS criteria and has a negative test but there is reason to question the negative result (e.g. based on exposure history and symptoms), discuss management and any repeat testing with the Medical Officer of Health.

If a patient has been directed to isolate due to recent travel or after close contact with a confirmed or probable case, all pre-existing isolation requirements continue to apply. That means a patient who is in self-isolation/quarantine should complete the full 14-day isolation period, irrespective of the negative test result. If they are still sick with the same illness at the end of the 14-day period, they will need to stay in isolation until they have been advised they are safe to return to usual daily activity by their clinician.

If their current symptoms get worse and they feel more unwell, they should phone Healthline for advice: 0800 358 5453

If they feel fully recovered, but then develop a new illness while in self-isolation, they should call Healthline on 0800 358 5453.

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

No. However, 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 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 ensure no-one else becomes exposed to COVID-19. This starts out with isolating the person who is sick, and then involves a public health investigation to find out who else may have been exposed before the person went into isolation.

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 within a closed space, within 2 metres for more than 15 minutes. Other criteria include performing aerosolising procedures on the case without appropriate PPE for that procedure, and 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.

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.

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

No. However, Healthline have developed a self-isolation certificate for people who are required to self-isolate because they are close contacts. Patients can call Healthline for free on 0800 358 5453 if they rquire a certificate.

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


Health worker infection prevention and control

As a health care worker, what is my risk of catching COVID-19?

The risk of catching COVID-19 from a confirmed case largely depends on the patient, the setting, and how you are caring for them.

Depending on the work you’re doing or the patient you’re caring for, you may need to wear PPE. For guidelines and advice on when PPE should be used and the type of PPE, see Personal protective equipment use in health care page.

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

No. You should stay at home. You should not work in a public setting if you are unwell. In this situation, you should stand down from work, and be assessed as a patient by a medical professional.

It may be appropriate for you to be tested for COVID-19. This will be determined by your health care provider after consideration of the current testing criteria.

There is guidance on the interpretation of results in the Updated Advice For Health Professionals document. 

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.

If a person’s COVID-19 status is unknown, there are some risk assessment questions you need to ask ideally ahead of any interaction, or if not possible, while maintaining at least 1 metre physical distancing.

What are aerosol generating procedures?

Aerosol generating procedures are a set of interventions involving the upper and lower respiratory tract that can generate droplets that contain infectious respiratory secretions which are small enough to be widely dispersed. They pose a high infection risk for health professionals. They pose a higher infection risk for health professionals.

Aerosol generating procedures are not typically performed in general practice, but may be required in other 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.

Aerosol generating procedures should only be done in a hospital setting if COVID-19 infection is suspected.

Read more about aerosol generating procedures.

I understand the list of aerosol generating procedures has changed. Why is this, and what does this mean for me?

The list of medical procedures associated with increased risk of aerosol transmission of infectious respiratory particles, and therefore requiring airborne precautions, no longer includes nebulisation of medication. This change reflects recent evidence and the international consensus of bodies such as the WHO and NHS Scotland, and was approved by the Ministry of Health COVID Technical Advisory Group. 

The decision to remove nebulisers is based on the rationale that it is the biological fluid aerosols that are the concern rather than all aerosols. While nebulisers do produce profuse aerosols of sterile fluid and medication, there is evidence that nebulisation does not result in an increased risk of patient-generated aerosols. 

What this means is that airborne precautions are not required when nebulised medication is administered to patients who are a probable or confirmed COVID-19 case, or who meet the clinical and Higher Index of Suspicion criteria (noting that contact and droplet precautions are still required).  

Given that nebulisers can incite coughing and infectious droplets, clinicians may choose to defer practical nebulisation in favour of metered dose inhaler and spacers, depending on patient tolerance and severity of exacerbation. 

What mask do I wear when I take a nasopharyngeal or throat swab?

Taking a nasopharyngeal or throat swab for a patient being treated in the community is not an aerosol-generating procedure. Health practitioners can wear the standard PPE when doing these procedures, which is:

  • gloves
  • surgical face mask
  • long-sleeved impervious gown
  • eye protection.

More information is available on the Personal protective equipment use in health and disability care settings page.

When do I use an N95/P2 particulate respirator?

N95/P2 particulate respirators are only required when working with a person who is a confirmed (or probable) case of COVID-19. This respirator filters small particles produced during aerosol generating procedures.

More information about the role of face masks.

How do masks affect the transmission of COVID-19?

We have created a document that discusses this in detail – see Transmission of COVID-19 and the role of face masks in health settings.

As above, there is Ministry of Health advice around who wears a mask, when they wear it, and what type. What if I want to wear masks in a different way than you recommend?

Our website gives guidance around when to wear a mask, according to the risk of the patient and how health care workers are interacting with them. Two key links are here: Risk assessment questions if COVID-19 status is unknown, PPE for taking COVID-19 naso/oropharyngeal swabs and others are available on this page.

With respect to masks, we ask that your use of this resource is guided by the risk assessment questions, and that you continue to practice all tenants of our IPC advice including physical distancing.

At Alert Level 1, the Ministry of Health does not support the universal use of masks in primary care. This is consistent with advice from the WHO.

At Alert Level 2 due to the high transmissibility of the Delta variant, and particularly in shared spaces some masks settings have been strengthened. Masks are now required by health care workers or support workers providing care in all health care settings. This includes workers providing care to people in their own home and in aged residential care facilities. In addition, non-medical masks and face coverings are mandatory for visitors to a health care facility.

If a provider wants to or suggests the wearing of PPE above and beyond the Ministry’s IPC guidance, then it is incumbent on those decision makers to resource this decision.

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, although this is not best practice. Practices are encouraged to keep a room free for potentially infectious patients, however we appreciate this is not always possible.

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
  • use detergent and water, followed by a hospital grade disinfectant, or use a 2 in 1 product and wipe down/clean hard surfaces and all items the patient has touched (eg, the examination couch)
  • note the dwell time of the product used and follow manufacturers’ instructions for use of any additional PPE
  • 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.

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 WHO guidance.

How do I properly put on and take off the PPE?

See information about the use of PPE for health care workers.

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 national approach to coordination managed by the Ministry (see COVID-19 Personal Protective Equipment Central Supply). This approach enables PPE to be available 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 assess patients who are confirmed (or probable) cases of COVID-19, or those with clinical and Higher Index of Suspicion criteria in a way that keeps them, you, and other people at the practice or community setting safe. If that is not possible at your practice at a given time, 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 establish a pathway to ensure patients can be assessed safely.

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

This information is available in the updated advice for health care professionals

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