COVID-19

New Zealanders who are up-to-date with their COVID-19 vaccinations are now able to download an updated My Vaccine Pass. The legal requirement for businesses to use My Vaccine Passes has been removed, however some businesses may be voluntarily keeping MVP requirements as a condition of entry. The updated pass will have a slightly different look to the current version, can be requested at any time, and will expire six months from the date of issue.

There have been a number of reports of people testing positive again for COVID-19 within 90 days of a COVID-19 infection. In dealing with these cases, please note the following.

• Reinfection with COVID-19 is possible, particularly with a different variant. For example: Delta to Omicron.
• Omicron to Omicron reinfection is thought to be uncommon and probably related to Omicron sub-variants. Omicron to Omicron reinfection was noted in 0.01 percent of individuals over nine weeks in a Belgian study (Nevejan, L. et al. 2022). 

Diagnosing reinfection may be significant for several reasons:

• to enable provision of wrap-around support/manaaki
• for access to COVID-19 therapeutics
• to allow protection of vulnerable family members, workmates, clients, and businesses
• to enable compliance with isolation requirements, such as access to financial support
• to allow notification and monitoring of COVID-19
• it may allow identification of new variants of concern.

The MOH offers the following advice for symptomatic individuals after COVID-19 infection.

• People who are low-risk and have symptoms consistent with COVID-19 within 90 days of a COVID-19 diagnosis, should stay at home whilst symptomatic, and are advised not to use a Rapid Antigen Test (RAT) to self-test.
• People with underlying health conditions, and/or who have deteriorating symptoms consistent with COVID-19, after a recent COVID-19 diagnosis, should seek further advice from their healthcare provider, who may decide to test with a supervised RAT or PCR.

NOTE: Individuals will not be able to upload a positive RAT result on My Covid Record within 90 days of previously doing so. If an individual attempts to upload a positive RAT result, they will be notified that they are not considered a case and given automated advice to isolate and contact a health provider if symptoms worsen.

This is an area of rapidly changing guidance and processes. The MOH has released interim clinical guidance on testing for possible COVID-19 reinfection within 90 days (published 5 May for review by 31 May).

COVID-19 vs post acute COVID-19 (4-12 weeks) vs long COVID-19 (12 weeks plus)

Agreed definitions and codes have been determined for Covid-19 and long COVID-19.

Please use the code for 'long covid' for symptoms beyond 12 weeks as this will give a good indication for the workload involved in caring for these people.

Accurate information helps advocate for adequate resources.

There has been some misunderstanding regarding the announcement of the extension of the freezer expiry of the Pfizer paediatric vaccine. The vaccine has been approved to be stored in freezers at the wholesaler depots for nine months rather than six months. This will affect the expiry printed on the label of vials. 

The vaccine box expiry is the correct expiry date to follow.

With adult and paediatric Pfizer vaccines, the expiry on the vaccine box supersedes the expiry on the vaccine vial label, as the expiry on the vial reflects expiry when vials are stored in the freezer. Whereas a new expiry is generated once they are removed from freezers as the vaccines have only 31 days when stored at 2-8 degrees. This is the label the wholesalers produce and put on the vaccine boxes.

At no time should anyone alter the expiry written on the vaccine vial box, this change is only relevant for wholesalers to change processes. 

Further clarification has been provided in the IMAC April toolkit.

Local information can be found on HealthPathways about manaaki services for COVID-19 positive cases and households, relating to accommodation, safety, income/benefits, kai/food, power, telecommunication access, data, pets, whānau/family, and connection.

If an issue is urgent please advise the patient to phone the free COVID-19 welfare line 0800 512 337 (8am-5pm Monday to Friday and 8am-1pm Saturday, Sunday and public holidays).

The Ministry of Health is now publishing weekly summary reports of COVID-19 data for Māori and Pacific peoples.

The reports include summaries of cases identified as whānau Māori and as Pacific ethnicities from the beginning of the COVID-19 pandemic in Aotearoa New Zealand until the present.

The recently announced new mask exemption process (beginning 31 May) is designed to make accessing businesses and services easier for exempt people and reduce problems faced by businesses. The following information clarifies the situation and what can be expected from 31 May. 

Communication Card – this is the current process until 30 May

A 'Communication Card' from the Ministry of Health can be shown when accessing businesses and services, saying the holder does not have to wear a mask.

People can apply for a Communication Card online by selecting from a range of options as to why they cannot, or choose not, to wear a mask. Under the Covid Protection Framework Order, the only option that qualifies them for exemption is that they have a physical or mental illness or condition or disability that makes wearing a face covering unsuitable. Those who complete a form and state that this option applies to them will receive a Communication Card. 

Advice is offered to people who select any of the remaining options that do not qualify them for an exemption. 

The Ministry will stop issuing Communication Cards after 30 May, but people who have obtained a card by that date can continue to use it if they wish to. However, people will be encouraged to apply for the new Exemption Pass because the pass will be individualised and provide conclusive legal evidence of a person’s exempt status, which the current Communication Cards do not. 

New exemption pass – available from 31 May 

Following thorough review, the Government announced a new personalised face mask exemption pass, with an application process requiring a legal declaration, will be available through the Ministry of Health website or phoneline from 31 May. There will be no charge for the passes, and they will be issued on the basis of self-declaration. 

The Exemption Pass will be issued to the individual named on the pass, which will be anchored to that person’s NHI number. This is a check against misuse. Applying for an Exemption Pass will be straightforward. People will be able to apply via the Ministry of Health website, and there will also be a free 0800 number which people can use if they require assistance.  

When presented, the pass will provide conclusive legal evidence of that person’s legitimate exemption under the Covid-19 Public Health Order 2021. People will not have to provide additional evidence, such as a medical certificate. This makes the new Exemption Pass much more legally robust than the existing Communication Cards. 

The new process is designed to support affected communities and businesses by removing any ambiguity as to whether a person is legally required to wear a face mask on a business’s premises. Businesses will continue to have a right to exclude customers from their premises on the grounds of their behaviour where this is threatening, rude or disruptive. 

Leading up to 31 May a social awareness campaign will be run to help educate businesses and the public about their legal responsibilities, the application process and to reinforce the reasons behind some people’s need for an exemption. 

Please contact Bruce Asher, Principal Policy Advisor, COVID-19 Policy for information or discussion.

• Due to so many cases per day, focus of PCR testing is on priority populations.
• Symptomatic people may use a RAT for diagnosis - positive test results do not need to be confirmed with a PCR unless advised.
• Close Contact Exemption Scheme using RATS for asymptomatic healthcare and critical workforce who are household contacts.

See our resource page for more information on RATs in general practice.

When can a PCR test still be used?

PCR tests should be targeted to those who are at higher risk of severe illness, including members of priority populations, and provided to arriving travellers who test positive with a Rapid Antigen Test (RAT) after entering the country. 

Situations where PCR testing may be considered include:

• when an individual cannot self-administer a RAT and a supervised RAT is not available
• if a patient returns a negative RAT test but symptoms are persistent, a PCR test could be considered if confirmation of the diagnosis will inform the clinical management and care of an individual, for example, if they are immunosuppressed and confirmation of diagnosis will determine if therapeutics can be used. (For lower risk patients, a repeat RAT can be used instead.)

A PCR is required:

• if a traveller entering New Zealand returns a positive RAT test. 

• In order to keep New Zealand operating, critical workers have a pathway to keep working when there is significant Omicron spread.
• The critical worker close contact exemption scheme will allow critical workers to be exempt from health orders requiring them to isolate due to being close contacts.
• This means that as a health worker if you are a close contact, asymptomatic and your vaccination is up to date, you can return to work by if you have a negative RAT result each day for the period of isolation. You can only travel to work during the isolation period (i.e. cannot go to supermarket etc). 
• Healthcare businesses do not have to register as a critical worker on the MBIE site.

Cases

• Identified via positive PCR or RATs or symptoms.
• Notified by text and directed to complete COVID-19 Contact Tracing form online.
• Self-investigation tool targets very high-risk exposures, narrowing the numbers of contacts identified.
• Symptomatic household contacts a probable case, test not required.

Contacts

• Contacts automatically notified from online self-investigation and option for cases to self-notify their contacts.
• Only highest risk contacts will be traced and required to isolate.
• Limited use of push notifications, locations of interest or Bluetooth.
• Close Contact Exemption Scheme using RATs for asymptomatic healthcare and critical infrastructure workforce who are household contacts.

The isolation period for confirmed cases of COVID-19 and their household contacts is 7 days.

Household contacts need to have a rapid antigen test (RAT) on day 3 and day 7 of their isolation period. If they become symptomatic, they should also get a test, and if the result is positive, they are required to isolate for seven days from that point.

If a person is isolating and still has symptoms after 7 days, they are advised to stay home until 24 hours after symptoms resolve.

Recovered cases no longer need to self-isolate if they become a household contact within 90 days after having the virus.

For household contacts, after their initial isolation period ends there is a 10-day window during which they are not re-classified as a household contact if a new household member tests positive, so they do not need to re-isolate unless they test positive themselves.

After that 10-day window the usual rules apply, so if a new household member tests positive, all household contacts who have not yet become cases themselves, must isolate for 7 days.

Cases can self-release after completion of seven days of isolation when risk of deterioration is very low (resolution of acute symptoms). The following are good points to consider covering if you make contact initially as this may be your only contact. 

• Explain recovery is gradual.
• Recommend that unvaccinated or partially vaccinated patients have COVID-19 vaccination 4 weeks after recovery or, asymptomatic patients have vaccination 4 weeks after the first confirmed positive COVID-19 test, unless contraindicated.
• The duration of protection from COVID-19 infection is unknown.
• It is uncommon to become re-infected with COVID-19 within 6 months of infection, and the risk is further reduced by vaccination.
• Ask the patient to have an in-person clinical review at 6 weeks after COVID-19 illness, irrespective of whether-or-not they have any residual symptoms (funded). Use this as an opportunity to engage the poorly engaged with the benefits of quality primary healthcare. 
• Your advice truly matters. See the article 'Health Care Professionals’ Advice Can Increase COVID-19 Vaccination'. This is also proven in smoking cessation.

There is a bug in CCCM where the initial assessment filter is not returning patient records if the patient has already completed their Case Self-Serve Survey (CSS). This is causing interference with filter options and patient call backs.

Interim workaround

1. From the CCCM dashboard click into the 'sort by' drop down box.
2. Select 'ascending creation date' from the menu.

This will sort the cases by most recently created and will allow both assessments to be visible regardless of their status. (This will sort the records based on the time and date of creation, even though the day count shown is based the symptom onset day.)

It has also been reported that the CSS Survey is marking the health check for today as “Done” in CCCM regardless of whether symptoms have been declared or not. The product team is aware of this, is investigating alternative options and working hard resolve these issues.

You can view and download Unite Against COVID-19 branded assets and resources through the COVID-19 Resource Toolkit. You can also order FREE printed copies of COVID-19 collateral for your practice. Read about how to access all of this on the Unite Against COVID-19 website. 

 Please see our COVID-19 PPE guidance news page.

The Ministry of Health has confirmed there is no centralised advice or support for travellers, but there are some generic guidelines. Different airlines, countries, businesses, universities and schools overseas will have different requirements. People who are travelling are advised to check their requirements carefully. 

• Private COVID-19 testing is available in all districts, contact your lab for guidance on availability and processes.
• Some pharmacies now have a contract for supervised RAT testing for the purposes of international travel. 
• Swabs taken for travel purposes cannot be claimed via Primary Options.
• You can charge the patient as you see fit.
• This is not an ordinary consultation for the purposes of any fee capping for VLCA practices.