Covid-19 definition may be broadened over test fears

A new committee set up to oversee the Government's Covid-19 response has held its first meeting - with testing criteria under the microscope

Health officials are set to expand the criteria for coronavirus testing, amidst concerns of suspected cases being turned away at testing facilities.

The Government has also been pressed on the supply of personal protective equipment (PPE) for health workers during the first meeting of a committee set up to scrutinise the official response.

The Epidemic Response Committee, chaired by National leader Simon Bridges, held its first meeting on Tuesday morning after it was set up following the suspension of Parliament during New Zealand’s lockdown period.

Concerns have grown about whether sufficient testing is being done for potential Covid-19 cases. Stuff journalist Tom Kitchin was twice refused a test before becoming a confirmed case, while Bridges said he had heard from a woman who had not been able to get a test despite her GP treating her as a probable case.

Speaking to the committee, Director General of Health Ashley Bloomfield said the case definition for Covid-19 - setting out when a medical practitioner should test for the virus - was last revised on March 14, with the symptoms to look for broadened from the initial approach.

Bloomfield said the Ministry of Health technical advisory group overseeing the case definition was meeting later on Monday, and was likely to revise the guidelines again to include all cases of lower respiratory tract infections.

Health Minister David Clark, appearing alongside Bloomfield, said it was his expectation that a test should be carried out on a person if their GP believed it should happen, and the case definition could change to reflect that.

“Where we have had anecdotes of misunderstanding, it is very important that if clinicians have suspicion they are doing the testing.”

No capacity constraints

Clark said there were no capacity constraints on testing, with 35,000 test kits (enough for 20 days) currently on hand, another 30,000 arriving later this week, and “quite significantly more” coming the following week.

While there was strong international demand for reagents and other consumables used in the testing process, major laboratories producing the chemicals were using an allocation model to ensure countries received necessary supplies without being able to stockpile.

Asked whether staff at community testing centres should be able to overrule a GP, Bloomfield said they were also health professionals overseeing every referral for possible Covid-19 cases and would also be using their clinical judgment.

However, he was adamant no test requests were being rejected due to a lack of equipment.

Asked why not all new arrivals were being tested given the border controls in effect and the spread of coronavirus overseas, Bloomfield said the virus’ long incubation time meant there was a risk of false negatives that gave people unearned confidence.

“The key intervention here is to identify close contacts ... isolate them and monitor them daily for symptoms.”

Woodhouse asked Bloomfield to “clear up the apprehension among thousands” of home care workers and other health professionals who have been told they do not need PPE despite close contact with those they care for.

Bloomfield said the ministry had been working with workers’ unions over the weekend, with the “fundamental principle” being the safety of frontline workers.

He defended the guidelines on when such workers should and should not use PPE, saying it came from experts in infection control and prevention and was needed to ensure the equipment was used properly.

However, Bloomfield acknowledged access to masks was an important part of people feeling safe, and it was hard for frontline health workers to hear they did not need the equipment - only to go to supermarkets and see it in use there.

Supplies were being sent to DHBs with a clear message to distribute them to all care organisations and pharmacies.

“We don’t want to flatten the curve, we want to flat-line the curve.”

David Skegg, an epidemiologist acting as a special adviser to the committee, told MPs New Zealand still had a chance to eliminate Covid-19 rather than simply reducing its impact, due to the country’s early action on border closures and lockdown relative to other nations.

“Because our Government acted at an earlier stage, we still have a window of opportunity but only if we lift our game quickly.”

Skegg said the lockdown had to be as comprehensive as possible to eliminate person-to-person spread, as he questioned whether the criteria for essential businesses was too loose.

Far more testing also needed to be carried out so cases could be detected and isolated.

“A lockdown on its own is not enough - it’s like pressing the pause button on your device ... once we’ve suppressed transmission we have to go after the virus.”

Elimination still needed to be the goal, he said, expressing concern that the Government appeared to be moving away from that objective in its public messaging.

“We don’t want to flatten the curve, we want to flat-line the curve.”

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