COVID-19 questions and answers for primary health care workers

This page was last updated 22 March 2020.

On this page:


General guidance

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

The Ministry of Health’s COVID-19 webpage is being updated regularly with the latest advice and guidelines.

Specific advice and resources for health care workers are available at Resources for health professionals.

If COVID-19 is similar to influenza, why are we fighting to keep it out of New Zealand like this?

Keeping the virus out of the country and minimising the number of people infected and transmitting the virus for as long as we can is important. It means that overall, less people are likely to get infected and that they are less likely to all get infected in a short period of time.

Some individuals are at higher risk from viral infections such as influenza, including those with co-morbidities. It is important to protect all New Zealanders from the spread of COVID-19 to protect these vulnerable groups. Isolation and contact tracing are proven to be the best ways to reduce the spread of infection.

Reducing the rate of spread of COVID-19 reduces the potential demand on the health sector and provides time for us to learn about the virus, ensuring that our policies and procedures will be effective as the situation changes.


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 if they have had close contact with a confirmed case, or if they have had recent travel to an area with sustained transmission of COVID-19.

Callers who fit the definition of a suspected case are requested to self-isolate, and not to present to the GP. Healthline will ring the GP directly if a caller fits the definition of a suspected case. Healthline are also calling people in self-isolation every two days to check if they have developed symptoms and to ensure people are coping in self-isolation.

Healthline staff are being kept up to date and are ready to modify their advice as the situation evolves.

Clinical

Is there anyone I shouldn’t swab in primary care?

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 swabbing and further management. 

What should I do if I am suspicious that a patient has COVID-19 but they do not technically fit the case definition?

The Medical Officer of Health can provide you with advice on how to manage a particular patient. If you suspect that a patient could have COVID-19, call your local public health unit on DHB switchboard and ask to speak to the Medical Officer of Health.

How do we make sure we are using our PPE, testing supplies and laboratory resources wisely?

COVID-19 is likely 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 must continue to apply the case definition to determine who is a suspected case and indication to test. There is no indication for the testing of asymptomatic people.

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

General Practitioners are responsible for informing patients if their COVID-19 test is negative and providing advice. (Note: Public Health Units will provide follow-up with patients who have positive tests).

The advice to patients who have negative results is:

  • they still need to complete the full 14-day isolation period if they have returned from overseas or have had close contact with someone with the virus
  • if they are still sick with the same illness at the end of the 14-day isolation period, they will need to stay in isolation until they have been symptom-free for 24 hours
  • if they are well, and have been for 24 hours, they can return to normal daily activity.

If their current symptoms get worse and they feel more unwell, they should phone Healthline for advice: 0800 358 5453. They need to let them know they have recently returned from an area of concern or had close contact with a person confirmed as having COVID-19.

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

You can direct these patients to this link for more information: What if your COVID-19 test result is negative?

Do patients who test positive for COVID-19 require admission to hospital for inpatient care?

Patients with suspected infection of COVID-19 should be managed medically according to their symptoms and clinical state. They do not need to be hospitalised unless it is clinically indicated.

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

No, Healthline have developed a self-isolation certificate for people who are medically well but are required to self-isolate and have registered with them. Patients can call Healthline for free on 0800 358 5453.

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 and how you are caring for them.

COVID-19 transmission is similar to that of the influenza virus and it is recommended that standard droplet and contact precautions are used when managing patients with suspect COVID-19 infection and those with respiratory and influenza-like illness.

Standard droplet and contact precautions include:

  • gloves
  • surgical face mask
  • disposable, fluid resistant gown
  • eye protection.

Regular hand hygiene is important.

The risk is higher when performing aerosol-generating procedures, and the PPE is slightly different when performing these procedures (see information on aerosol-generating procedures). It is not recommended that aerosol-generating procedures are undertaken in primary care.

The Ministry’s infection prevention and control advice for primary care health workers can can be found under Resources for health professionals.

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

No. You should not work in a public setting if you are unwell. In this situation, 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. 

What are aerosol generating procedures?

Aerosol generating procedures are those that produce droplets that are small enough to be widely dispersed. They pose a higher infection risk for health professionals. Aerosol generating procedures (including using nebulisers) should only be done in a hospital setting if COVID-19 infection is suspected.

They include:

  • tracheal intubation
  • non-invasive ventilation
  • tracheostomy
  • manual ventilation
  • bronchoscopy
  • sputum induction
  • high flow nasal oxygen
  • cardiopulmonary resuscitation
  • nebulisers.

Note: Taking a nasopharyngeal or a throat swab for a patient being treated in the community is not an aerosol generating procedure.

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
  • disposable, fluid resistant gown or apron
  • eye protection.

When do I use a N95 mask?

N95 masks are not required in primary care. N95 masks are required for performing aerosol generating procedures, however, these procedures will only be used in hospital settings.

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.

What if my practice doesn't have a single room to see a suspected case?

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 the patient has left?

Information on cleaning a room (including toilet) that a suspect COVID-19 patient has been in can be found in the infection prevention and control advice under Resources for health professionals.

In primary care:

  • after the patient has left, there is no stand-down period
  • PPE requirements for cleaning are gloves and gown or apron.
  • wipe down hard surfaces with detergent and water and then use hospital grade distinfectant
  • dispose of PPE safely and appropriately in a closed clinical waste bin, followed by hand hygiene practices.

Are boots, impermeable aprons, or coverall suits required as routine personal protective equipment (PPE) for the assessment of patients with suspected COVID-19 in primary care?

No – contact and droplet precautions are sufficient. These are:

  • surgical mask
  • gloves
  • disposable gown
  • eye protection.

Hand hygiene is important.

The Ministry’s infection prevention and control advice can be found under Resources for health professionals.

How are you making your 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.

Is the PPE advice for primary care the same as other countries?

Yes – this advice is consistent with other countries, for example, Australia. It is also consistent with the advice from the World Health Organization.

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

PPE should be put on in the following order:

  • hand hygiene, gown, mask, protective eyewear, gloves

and taken off in the following order:

  • gloves, hand hygiene, protective eyewear (if separate from mask), gown, hand hygiene, mask, hand hygiene.

See also the infection prevention and control guidelines under Resources for health professionals.

WHO have also produced a video showing how to correctly fit a face-mask which can be found on YouTube.

We hope to be able to share other informational videos on PPE with you soon.

What is the minimum amount of PPE my primary care facility should have?

The Ministry is currently working to estimate the volume of PPE required per population and how much each practice should have. We will provide guidance as soon as we have this information available.

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

In the first instance, contact your usual supplier to order more PPE stock. If you are unable to purchase new stock, speak with your PHO who will discuss obtaining additional equipment from the local DHB.

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?

Currently we are in a phase with low numbers of suspected cases of COVID-19, and at this time the majority of these patients will be investigated (swabbed) to determine if they have the infection. The recommended care for suspected cases in primary care includes PPE for the health care worker, and a mask and single room for the patient.

We encourage practices to maintain adequate supplies of PPE by working with their regular suppliers, or the PHO if necessary. We are aware the single rooms may not be available in many general practices, or may be insufficient for the need at times.

It is important to assess patients who are suspected cases of COVID-19 in a way that keeps them, you, and other people at the practice 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 on the updated advice for health care professionals page.

Human resources

Where can I find further information around employer’s duty of care to employees?

The Ministry of Business Innovation and Employment (MBIE) has comprehensive information (including a Q&A) sheet on employer obligations. This can be found on the MBIE website.

What advice should I give to staff travelling overseas?

The Ministry of Foreign Affairs and Trade website has the most up to date information on travel. This can be found on Safe Travel.

Other

What else is the Ministry of Health working on?

  • The Ministry is actively working to plan for the ‘manage it’ phase of COVID-19. This includes investigating if and where Community Based Assessment Centres (CBACs) may be required, and other options for supporting primary care.
  • The Ministry is working to understand employment issues such as the need for self-isolation and sickness guidance for health professionals.
  • The Ministry is considering how we can better provide up-to-date information and support to health professionals. 
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