Rapid antigen test (RAT) supply
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We’re pleased to advise that the MoH has allowed distribution of RATs to UCCs, and included urgent care in its planning for the omicron outbreak.
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Advice from the Ministry on rapid antigen test ordering and distribution is copied below. Attached are account application forms.
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- User Guide for ordering MOH PPE Supplies
- HCL Credit Application
- Onelink Credit Application
- Omicron is now well established in New Zealand, and case numbers are expected to grow rapidly.
- The MoH has reacted by announcing the need for “a proactive approach”
- Vaccinations including boosters will be targeted at the most vulnerable groups
- The Ministry will be “frontloading” supervised and unsupervised RATs to general practices, urgent care centres and pharmacies. We think “frontloading” means supplying RATs in advance of demand.
- Unsupervised tests (for staff)- UCCs may order an initial supply calculated at 5 per staff member + 10%. These are for the clinic to deploy as it sees fit to detect COVID-19 infection in staff, guide isolation, and so help sustain the health workforce.
- Supervised tests (for patients) - UCCs may also order that number of tests which is “commensurate with the high needs population”. In the case of urgent care, we suggest this be taken to mean an estimate of the number of vulnerable patients who might attend seeking a RAT, based on clinic patient demographics.
- In time, and in keeping with usual international practice, the Ministry expects to make unsupervised tests available to the general public via distribution outlets still TBC. It’s still working on its RAT distribution plan.
- RAT ordering information and supervised test instructions are copied below.
Some general comments on RATs
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- Generally effective in detecting infectiousness, and arguably better than PCR for this purpose, especially when PCR access is poor and delays long. RATs may miss early pre-infectious cases and late or historic cases that a PCR can detect.
- There have been reports of RAT failure to detect a case in the very early infectious period. A repeat test the following day can be considered if clinically indicated.
- A small improvement in case detection has also been found when the nose and throat are swabbed rather than nose alone https://www.medrxiv.org/content/10.1101/2022.01.08.22268954v4
- Adding a throat swab (or PCR if available) could be considered for cases that are RAT negative despite strong clinical suspicion. Note that a throat swab is NOT part of the manufacturer’s recommendations nor any regulatory authority’s.
Australia like NZ, has a high vaccination rate and low levels of prior covid infection.
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Queensland could be considered the most comparable state, with a population of 5.2m of whom 2.5m live in the largest city, or South Australia (1.8m / 1.4m)
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Queensland cases may have peaked at just under 4,000 cases per million per day, 30 days after the omicron outbreak began.
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South Australia cases may have peaked at around 1,800 per million per day, again around a month after the outbreak began.
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The eastern states allowed spread to proceed rapidly causing severe stress on the health care system and supply chains. We hope New Zealand does not have the same experience.
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The urgent care experience
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We contacted an Australian UC doctor about omicron. He reports as follows:
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- RATs were in high demand and difficult to source – keep a supply.
- EDs were using UC for overflow
- UCCs are keeping waiting rooms as empty as possible, using telehealth where possible and screening and triage before entering the building – measures we’ve already recommended many times.
- Large numbers of sick staff are adding to system stress
We are again planning to approach the government calling for:
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- an official recommendation for and wide distribution of N95s (or equivalent) to the general public
- advice on N95 reuse
- wide distribution of RATs to the general public
- a plan for early treatment; consider UCCs for administering parenteral treatment.
- GP-led home care of isolees, with support
- a delay in primary and intermediate school reopening until children have had the opportunity to be vaccinated
- HEPA filtration of classrooms and other public spaces
- public education on airborne transmission
- public education about long covid, and official recognition of and allowance for long covid in pandemic planning and decision-making.
We think these measures would reduce case numbers and severity and reduce the strain on our facilities and staff, the healthcare system generally and supply chains.
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We’ve repeatedly recommended N95s, red and green streaming, seeing patients in whole or part by telehealth, triage by phone or at the door, ventilation and the use of HEPA filtration.
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In addition to these earlier recommendations, it may be worth talking to staff about avoiding infection both inside and outside the clinic, particularly over the next two months, as by avoiding high risk public indoor locations, and if unavoidable, wearing an N95. It’s unfortunately common to see members of the public and even healthcare workers wearing masks at the tip of the nose or even under it
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This advice could be reinforced with messaging about the advisability of avoiding covid, risks of covid and long covid, and that an N95 excludes ten times more virus than a cloth or surgical alone, per CDC figures.
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The MoH has advised RNZCUC of a booster shot mandate for HCWs. So far two deadlines for the necessary legislation to be passed have expired. We haven’t heard a new date, nor confirmation of whether or not this mandate is going ahead. We will advise of any updates.
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David Gollogly, Jasmine Mackay, Richard Chen, Kelvin Ward
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Pandemic Response Subcommittee
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