Questions over Covid-19 testing criteria
Changes to Covid-19 testing criteria may see fewer New Zealanders being tested - but there is some confusion about how the rules are being applied
Health Minister Chris Hipkins has promised to put officials on notice about providing Covid-19 tests for those who want them, following confusion after changes to clinical criteria.
One doctor says the new, higher bar for testing appears to provide only a thin layer of protection, with mixed messages to GPs about the level of discretion they have to test.
Auckland woman Melissa Brinsden contacted Healthline on Thursday afternoon, after developing flu-like symptoms earlier in the week.
When she called to ask about undergoing a Covid-19 test, Brinsden said she was not asked to describe any of her symptoms but instead told it would be difficult to be tested as testing facilities such as community-based assessment centres (CBACs) had been shut down.
“I said, ‘Oh should I be trying to get a test?’, and [the Healthline operator] said ‘Oh, there’s no community transmission at the moment so no, we’re not following up on any of these’...
“She just said that she would let me know if there was any community transmission in the future, and then I could maybe think about finding a way to get tested then.”
When Brinsfield pushed the matter, asking whether she should be pursuing a test through her GP, she was told it was “not really necessary” given the lack of community transmission.
“To me, it sounded like it wasn’t going to be able to get a test if I wanted one; even if I had said, ‘No, I really think I should get tested’, the way she described it was, ‘We don’t have any testing stations open at the moment and so you just need to treat it like a normal flu and get over it'.”
While she was confident health officials would act swiftly if someone was hospitalised with serious Covid-like symptoms, Brinsfield said her Healthline interaction raised some questions about the approach being taken.
Clinical criteria changed
Last week, the Ministry of Health announced changes to the Covid-19 case definition to reflect the fact that the greatest risk of the virus’ reintroduction was at the borders.
Patients who were symptomatic and met higher index of suspicion (HIS) criteria - including contact with a confirmed or probable case, international travel, direct contact with someone who had travelled overseas, or anyone who worked on an international aircraft or shipping vessel - had to be tested.
Others with clinical symptoms consistent with Covid-19, but who did not meet the HIS criteria, could be tested for surveillance purposes at the discretion of a medical professional.
However, one Auckland doctor - who spoke to Newsroom on condition of anonymity - described the HIS criteria as "a thin layer of protection", saying they did not cover household contacts of border workers or airline workers, along with anyone working in aged care facilities or healthcare.
The doctor said a GP friend had provided a testing referral for an aged care facility worker with respiratory symptoms and loss of smell, only for the CBACs to send the patient away without a test.
Another Auckland clinician had referred fellow staff who were casual contacts of a Covid-19 case, but the CBAC turned them away after a wait of one to two hours.
“There is this political narrative that the Government wants to portray that is not consistent with the reality: they went out and said, ‘Test test test’, but for some reason the health authorities don’t want to do that but nobody is prepared to backtrack on their position."
ProCare, which represents more than 180 GP practices across Auckland, had sent a message to its members in early July saying there was "no need to swab" unless a patient met the HIS criteria. After concerns were raised, a separate message to Auckland GPs from the region's district health boards confirmed they could test people outside that narrow band using their clinical judgement.
It had been confusing for GPs to receive contradictory messages, but the public was also getting a misleading impression about their ability to get a test should they want one, the doctor said.
National Party health spokesman Michael Woodhouse said he was concerned about mixed messaging from the Government.
While Woodhouse in principle supported the new, stricter testing criteria given comments from health professionals about the need to tighten up as the country headed into cold and flu season, there appeared to be confusion about how those were being applied.
“There is this political narrative that the Government wants to portray that is not consistent with the reality: they went out and said, ‘Test test test’, but for some reason the health authorities don’t want to do that but nobody is prepared to backtrack on their position…
“It shouldn’t be a difficult question to answer. If I have symptoms and I don’t meet the criteria, do I need a test or not? And the answer appears to be no, but they’re not prepared to say it.”
While health officials seemed to be deferring to the judgment of GPs on the matter of when to test a patient, Woodhouse said there were still cases of people being referred to CBACs by their doctor only to be turned away.
National Telehealth Service chief executive Andrew Slater said the advice line was applying the Ministry of Health’s new criteria for testing, which included Healthline teams “using their clinical judgment when doing a telephone triage”.
The new guidelines also meant far fewer people would be referred to a CBAC and would instead be directed to their GP for assessment.
However, Slater encouraged Brinsden to contact Healthline if she wanted it to review her call in detail, “as some elements of what is outlined would appear not to follow our standard operating procedures”.
Hipkins, who has just taken the Health portfolio from David Clark, said it was appropriate for doctors and nurses to use their clinical judgment when deciding whether to administer a Covid-19 test, given there was no community transmission in the country.
“It is, however, my expectation that anyone who presents with flu-like symptoms and wants a test should be able to get it,” Hipkins said, adding: “I will be making my expectations clear with officials.”
Speaking after her Labour Party conference speech on Sunday afternoon, Prime Minister Jacinda Ardern said it was right for clinicians to make a judgement as to whether or not a test was needed, but confirmed the Government was keen for testing rates to stay high to provide a degree of community surveillance.
"If we just had 10,000 asymptomatic people tested in Auckland, that wouldn't be particularly beneficial for us in terms of insight and data, so the minister is working with the ministry on how to spread some of the asymptomatic testing."
Newsroom understands the Government and health officials believe a daily average of around 4500 tests would be a sufficient rate to cover community surveillance as well as new arrivals at the border and others who must be tested.
The primary concern appears to be not testing capacity, but the flow-on effects if GPs and primary care practitioners were diverted from their usual work to conduct an unnecessarily high number of tests.
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