Copied below is an email from the MoH advising:
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- A *nationwide* suspension of the earlier requirement for clinics to fit test staff, as a precondition of N95 and other particulate respirator supply.
- How users can check mask fit themselves
- How to order more PPE
- Particulate respirators will be available to those general practice and urgent care clinics that are undertaking swabbing and assessing patients in close contact with anyone with symptoms and meets the HIS criteria
We’ve asked the Ministry to clarify the last point (‘meets the HIS criteria’) and in the meantime advise members to use full PPE (gloves, gown, N95, eye protection) when swabbing and assessing all patients with symptoms consistent with Covid-19, per earlier Ministry guidelines applicable under level 4 lockdown.
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Symptoms of the delta variant
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UK data indicates the top five symptoms in unvaccinated people with Covid delta variant are, in order, headache, sore throat, runny nose, fever, and persistent cough, with anosmia now the 9th most common.
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MoH recognises Covid is airborne
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On July 22nd, the Ministry updated its website advice on spread. It now fully acknowledges airborne transmission of Covid 19 and lists this modality first.
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Preventing airborne spread
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We repeat our recommendation that patients with Covid19 symptoms be ‘red streamed’, ideally seen outside the clinic, as practicable. That could mean seeing patients in cars initially, for quiet practices which don’t see many URTIs, then bringing them inside if a closer look is needed, or it could mean streaming patients and seeing them in the safest possible place inside a facility, taking measures to ensure the briefest possible stay within the facility. The thoroughness of the consultation must not be compromised.
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Our earlier advice to members and clinics is excerpted below:
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We refer to spread of COVID-19 by small persistent viral particles that may travel beyond two metres.
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Based on our assessment of the literature (see review, prepared by Kelvin Ward) and WHO and CDC guidelines, we believe airborne transmission is an important mode of spread and strongly advise clinics to take whatever practicable measures they can against it – please see this document.
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This can include advice to patients about ventilation – opening doors and windows when possible in at-risk indoor situations, meeting outside if possible, avoiding crowded indoor spaces, and wearing a mask when indoors in a public area.
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From ‘this document’ above:
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Other measures against airborne spread
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1.Ventilate the facility and rooms where practicable
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- Check whether the air-conditioning system recirculates air or changes it; add HEPA filtration if practicable; open doors and windows to the facility and to rooms if possible and practicable; direct any fans in use to an open window (and not to recirculate air in a facility)
- ‘Red stream’ cold and flu patients at all levels, and see them in the area that has the lowest potential for spread – outdoor portacabin, ground floor car park if well ventilated, otherwise-unused part of the facility, room near to a rear door, etc.
- Try to ensure their stay in the facility is as brief as practicable.
- Use telephone triage, telehealth in accordance with MCNZ guidelines, a sign at the door or triage at the door to enable cold and flu patients to be taken immediately to the treatment area and seen promptly.
- Inform patients opportunistically of measures they can take to avoid airborne transmission, including mask use in indoor public areas, and opening doors and windows if practicable; avoiding crowded indoor spaces; meeting outside if possible.
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Required opening hours under lockdown
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Please refer to an email from ACC copied below confirming contractual opening hours under lockdown.
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Fit testing declaration form
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Click here to download the attachment referred to in yesterday’s email.
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David Gollogly, Jasmine Mackay, Richard Chen, Kelvin Ward
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Pandemic Response Subcommittee
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Ministry of health email on suspension of fit testing requirement
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Apologies for the late update to this information. As you can imagine the situation is rapidly evolving as we learn and understand more of the setting and circumstance of the community case identified today.
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The advice has changed as below following the Alert Level 4 announcement made by the Prime Minister at 6:00pm 17 August 2021.
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Effective immediately, the Ministry of Health will make an exemption to the fit testing requirements nationwide for general practice and urgent care clinics, and community based assessment centres for access to Ministry of Health centralised supply of N95/P2 particulate respirators for the initial period of the next 14 calendar days.
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Particulate respirators will be available to those general practice and urgent care clinics that are undertaking swabbing and assessing patients in close contact with anyone with symptoms and meets the HIS criteria during an evolving community outbreak or Alert Level 3 or 4. This acknowledges the change status of COVID-19 with an identified community case. Please refer to the COVID-19 Primary Care site for more information.
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This exemption notes the risk the Ministry of Health can not predict the protection an ill fitted N95/P2 will afford. A particulate respirator itself does not have a high filtration efficiency, unless a tight seal is achieved.
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The Ministry of Health has made N95/P2 particulate respirators available under exemption.
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The exemption period may be extended pending decisions on Alert Level status and how things progress.
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We will not be undertaking a push order. General practice and urgent care who hold an account for PPE with Onelink or HCL can order directly. We will review orders twice daily and expedite the distribution of PPE.
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3M 9320A+ Aura Particulate Respirators and 3M 1870+ particulate respirators will be available to general practice and urgent care clinics.
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Fit checking is a minimum requirement under this exemption. To fit check the particulate respirator users can either perform a positive-pressure or negative-pressure seal check:
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- A positive-pressure check means covering the respirator surface on a filtering facepiece, usually by using your clean hands, and trying to breathe out. If slight pressure builds up, that means air isn’t leaking around the edges of the respirator.
- A negative-pressure check involves covering the respirator surface on a filtering facepiece, typically using your clean hands and trying to breathe in. If no air enters, the seal is tight.
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COVID-19 Health Supply Chain
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ACC email re: Urgent Care Clinic Opening Hour Requirements at Different COVID-19 Alert Levels
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Under the Urgent Care Clinic contract, clinics are required to be open from 8am – 8pm every day.
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The recent COVID-19 outbreak in Auckland has highlighted the need for ACC to clarify its expectations around opening hours at different COVID-19 Alert Levels. This takes into account the number of ways UCCs are impacted by COVID-19, and expectations there may be a future need re-escalate in Alert Levels.
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We would like to thank the Royal New Zealand College of Urgent Care (RNZCUC) for working with us to develop this guidance.
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General Requirements Across All Alert Levels (1-4):
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- UCCs are permitted to close fully if converted to a Community Based Assessment Centre (CBAC) / Community Testing Centre (CTC) at the request of their local DHB or MOH.
- UCCs must inform their patients and the local community (e.g. St Johns, DHB, PHOs - for UCCs that also function as enrolling General Practices etc.) of any changes impacting access to services.
- UCCs must fully comply with their obligations under the RNZCUC Urgent Care Standard and UCC contract.
- Exemptions will be considered but must be requested and agreed by ACC and RNZCUC in advance of any changes being made.
- For regions that have de-escalated to Level 2, there must be a return to operating from 8am – 8pm within two weeks.
- UCCs are permitted to determine their own operating hours as they deem appropriate. However, UCCs must inform ACC and the RNZCUC as soon as practicable where there are departures from their obligations under the Urgent Care Standard and ACC UCC contract.
We hope this helps clarify expectations.
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