Primary healthcare news, information & resources


Novel coronavirus (COVID-19 - formerly 2019-nCov)


The Ministry of Health advice is under active review and is updated daily. Please use their website is the source of correct and up to date information at all times - 
https://www.health.govt.nz/our-work/diseases-and-conditions/novel-coronavirus-2019-ncov


Effective from Thursday 30 January 2020 'novel coronavirus capable of causing severe respiratory illness' will be added to Section B of Part 1 of Schedule 1 of the Health Act 1956. This will make 2019-nCoV an infectious disease notifiable to the medical officer of health. 

NOTE: There are no confirmed cases of COVID-19 (formerly 2019-nCov) in New Zealand at this time but the likelihood of importing a case is high.

The Ministry of Health (MOH) state the risk of an outbreak in New Zealand is low, but we need to be prepared. 

Advice for our practices - get prepared

Pinnacle has set up an internal team that meets three times a week to work with our DHB partners in this preparatory phase.

We are also working with GPNZ, the RNZCGP and other PHO clinical leaders to inform the MOH's national response.  

We are aware that some items of equipment are already difficult to source for practices. The MOH holds a national stock of personal protection equipment (PPE) which, in the event of a pandemic, is released to DHBs.

In the event of a significant outbreak it is likely that regional centres would be set up and any potential patients directed to them.

At this point in time to protect practice staff our advice is to have a stock of:

  • ear loop surgical masks
  • disposable gloves
  • hand sanitiser (although washing with soap and water is better).

Recommendations for minimum stock per health site (please note these are estimations only)

Each health site should have TWO sets of full PPE (this includes gloves, mask, eye protection and gown) in the event of any highly suspicious patients needing to be assessed.

Based on an assumption that 1:3 people attending a practice have respiratory symptoms, we estimate a daily stock of:

  • 10 masks and 10 sets of gloves for every 30 patients a day that you see (to be given to the symptomatic in the event of an outbreak)
  • 4 masks and 4 sets of gloves for each patient facing staff member for each working day (based on an eight hour day, changing mask and gloves every two hours).   

P2/ N95 masks (they are the same) are NOT NEEDED at this point in time. (It is a good idea to have these masks for each patient facing staff member in your health and safety equipment stock - they are useful when there is lots of ash/smoke and other particles in the air that need excluding).  

It is important to put measures in place to immediately identify and manage any patients presenting with upper and/or lower respiratory tract infection symptoms and with a history of travel from China in the last 14 days - particularly for practices with high Asian populations. 


A poster on the door to alert those who have recently travelled from China to alert staff immediately can be downloaded here. (Or this Chinese version has been kindly supplied by one of our member practices.)


Any such patients should immediately be provided a mask to wear and be seen in a separate room with the door closed, or an isolation room where available. Further communication with the patient should ideally be by phone - so check the isolation space has a phone! Ideally your isolation room should have a private bathroom, commode chair or other solution to this need.

The next step should be to contact the local public health medical officer for advice on clinical assessment, any laboratory testing and further management.

Health care personnel entering the room or attending a patient with a high likelihood of having Covid-2019 should be wearing full personal protection equipment (gloves, ear loop surgical mask, eye protection and a gown).

Please also review procedures to help ensure that patients do not expose other patients in a waiting room or corridor areas, and if possible that you could identify patients who might have been exposed in such places.

Prevention

Evidence confirms coronavirus is spread by droplets. This means that when an infected person coughs, sneezes or talks, they may generate droplets containing the virus. These droplets are too large to stay in the air for long, so they quickly settle on surrounding surfaces.

Droplet-spread diseases can be spread by:

  • coughing and sneezing
  • close personal contact
  • contact with an object or surface with viral particles on it and then touching your mouth, nose or eyes.

That's why it's really important to practice good hygiene, regularly wash and thoroughly dry your hands and practice good cough etiquette.

For more information


Questions from practices

We're sharing some of the questions we've had from practices which we think will be useful reading for others. You'll also see these in the Pinnacle GP discussion group. 

Are you able to offer any advice on what we do with the room the patient with suspected Coronavirus has been in? Do you shut the room for two hours? Do you clean it, and if so what would be the recommended cleaning agent? 

Coronavirus is relatively easy to kill on surfaces any hospital grade disinfectant is usually sufficient. Most suppliers of wipes and chemicals have put out updated testing of their product against coronavirus - just check the website of the product you are using for disinfection. The WHO recommends the below if you are unsure if your current product may be ineffective. 

Environmental cleaning in healthcare facilities or homes housing patients with suspected or confirmed COVID-19 infection should use disinfectants that are active against enveloped viruses, such as COVID-19 and other coronaviruses. There are many disinfectants, including commonly used hospital disinfectants, that are active against enveloped viruses. Currently WHO recommendations include the use of:

  • 70 per cent ethyl alcohol to disinfect reusable dedicated equipment (such as thermometers) between uses
  • sodium hypochlorite at 0.5 per cent (equivalent 5000ppm) for disinfection of frequently touched surfaces in homes or healthcare facilities.

Ideally the patient will be identified before entering into the medical clinic and a surgical mask will be supplied for the patient to wear.  

This will give staff a chance to remove extra items from the clinic room to decrease potential contamination for example, removing extra clinical supplies, and to move the patient's chair about two meters from workstations.

Once the person leaves the clinic room the surfaces touched by the patient or health care worker will need to be cleaned with detergent and then disinfected with an appropriate disinfectant. There is no stand down of room discussed in either the WHO or MOH information currently - so once it has been cleaned it can be reused.

In terms of waiting rooms your general cleaning should be sufficient. If a suspect case was in your waiting room a clean of the area where they were sitting is enough.

A quick query about the gowns. Are they full sleeve, round neck gowns? Just don't want to order inappropriate items?

Yes, full sleeve, disposable is what the MOH is asking about - round neck makes sense as opposed to V neck that leaves exposed skin.

We think each practice needs at least two FULL sets of PPE - full sleeve, disposable gowns, eye protection (either face shield or goggles), ordinary surgical masks, and gloves.

We believe it is starting to make sense for practices to always have this level of PPE available.

In addition, we think it would be worthwhile having N95/P2 masks (they mean the same thing) for any future issues. This type of mask is not required with what we currently know about COVID-19, but given the levels of international travel, the rapidity with which these events develop it would be useful to have some available in your practice.


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