We’ve received a few questions about the urgent care response to what looks like an evolving Covid delta wave.
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We update Ministry expectations of UC below, and restate earlier advice on coping with Covid in urgent care.
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The MoH has approved booster doses for severely immunocompromised patients. More widespread use of booster doses is under consideration. An Israeli study shows a 19.5 fold reduction in serious illness, and an 11-fold decrease in infection following a booster shot, given at least six months after the second.
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Full details of the MoH announcement are copied below.
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Covid19 community response framework
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The MoH has recently updated its Covid19 community response framework, which outlines its expectations of urgent care during times of community spread. We appear to be at alert level yellow, heading for orange. We suggest you read this.
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Per earlier advice, the principal means of transmission of covid is via inhaled viral particles, ie airborne transmission. Airborne particles can be long-lived and infection is more likely when viral concentration is high.
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A higher initial infectious dose inhaled is associated with a more severe disease. Effective masking is therefore paramount.
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The current MoH advice states:
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“N95/P2 particulate respirators can be used and in Alert Level 2 when swabbing, undertaking a clinical assessment or for interactions where there are clinical symptoms consistent with COVID-19 (including less common symptoms).”
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The full MoH symptom list is as follows:
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New or worsening cough; sneezing and runny nose; fever; temporary loss of smell or altered sense of taste; sore throat; shortness of breath. Less common: diarrhoea, headache, muscle aches, nausea, vomiting, malaise, chest pain, abdominal pain, joint pain or confusion/irritability.
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As previously advised, the UK ZOE symptom tracker group finds that headache is the commonest or second commonest symptom of Delta.
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Based on MoH advice, it would be reasonable to use N95s or similar when patients with the above symptoms are in a clinic or have recently attended.
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Coping with current or future N95 mask shortages
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Per our earlier emails, the CDC advises:
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1) Masks can be recycled in the event of a shortage
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2) As an alternative to an nN95, wearing a well fitting cloth mask (or a mask fitter) over a surgical mask reduces virus transmission (inhaled or exhaled) over 5 fold, compared to a surgical or cloth mask alone.
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An N95 reduces transmission tenfold.
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Some Auckland clinics have designated themselves ‘red’, for treating only patients with covid symptoms, and others ‘green’, for treating patients without covid symptoms.
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We suggested this in April 2020; other clinics or clinic groups may like to consider this arrangement as part of their preparations for operating in times of widespread community transmission.
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David Gollogly, Jasmine Mackay, Richard Chen, Kelvin Ward
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Pandemic Response Subcommittee
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Third Primary Dose and Booster Vaccines
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- The COVID-19 Technical Advisory Group has recommended that individuals aged 12 and older with severe immunocompromise receive a third primary dose of the Pfizer COVID-19 vaccine.
- More information will be provided in the coming week about eligibility requirements and how to access a third primary dose.
- Individuals who are severely immunocompromised are at higher risk of severe outcomes from COVID-19 and might not produce a sufficiently strong immune response after two doses of the Pfizer COVID-19 vaccine. A third primary dose may be beneficial.
- The third primary dose is optional but recommended.
- There are specific criteria for who can qualify for a third primary dose, this includes individuals who were undergoing immunosuppressive therapies prior to or at the time of their first or second dose.
- Information will be made available on the Ministry of Health website.
- A primary third dose is different to a booster dose for the general population.
- Under the current immunisation programme, you cannot receive a booster dose of the Pfizer vaccine in New Zealand unless you qualify under the criteria for a third primary dose.
- The Ministry is reviewing the research as it becomes available and expects to make a decision about booster doses for the general public in the coming months.
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