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COVID-19 Testing Plan
Information
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the
Updated August 2023
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Citation: Te Whatu Ora – Health New Zealand. 2023.
Testing Plan for COVID-19 in
Aotearoa New Zealand. Wellington: Te Whatu Ora – Health New Zealand.
Published in June 2023 by Te Whatu Ora – Health New Zealand
PO Box 793, Wellington 6140, New Zealand
ISBN 978-1-99-106713-5 (online)
This document is available at
tewhatuora.govt.nz
This work is licensed under the Creative Commons Attribution 4.0
International licence. In essence, you are free to: share ie, copy and
redistribute the material in any medium or format; adapt ie, remix,
transform and build upon the material. You must give appropriate credit,
provide a link to the licence and indicate if changes were made.
Acknowledgements: Te Whatu Ora would like to acknowledge the Communicable Disease
Network Australia and the Australian Public Health Laboratory Network Revised Testing
Framework for COVID-19 in Australia for helping guide the content of this plan.
under the Official Information Act
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COVID-19 Testing Plan updated August 2023
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Contents
Introduction
4
Part One
4
Background
4
Purpose of the COVID-19 Testing Plan
4
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Factors affecting testing decisions
5
Local planning and protocols
5
Strategic context
6
Purpose of testing in response to COVID-19
6
Equity and advancing equitable access and outcomes
9
Priority access to COVID-19 Testing
9
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Data collection requirements for COVID-19 Testing for monitoring purposes
13
Part Two
15
Testing response framework
15
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Context
15
Utilisation of testing in Aotearoa New Zealand
15
the
Target groups for testing
16
Introduction to Testing Guidance
18
Testing considerations
18
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Facilities with an increased risk of viral amplification
18
Asymptomatic staff screening
19
Visitors to healthcare facilities
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Boarding schools and tertiary student residences
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Community gatherings - testing
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List of Guidance Documents for Specific Settings
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Appendix 1: Table A1: Recommended Testing by Target Group
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Appendix 2: Table A2: Surveil ance in Aotearoa New Zealand (as at date of publication)
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COVID-19 Testing Plan updated August 2023
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Introduction
The Testing Plan has been divided into two parts for ease of use:
• Part One provides the overarching and strategic information in relation to Testing
• Part Two provides an introduction to the operational testing guidance documents and
a summary of important information in relation to settings and facilities.
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Part One
Background
Aotearoa New Zealand’s COVID-19 response has continually evolved as both the virus
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and our ability to manage it has changed.
From our initial elimination strategy, we have shifted to a minimisation and protection
approach. Protecting lives and livelihoods remains the goal of the Government’s COVID-
19 response, however it is now possible to do this with fewer requirements, giving greater
certainty to people, businesses and communities. Our focus has
Official changed with the
introduction of vaccines and antivirals, and with recognition that elimination of community
transmission is no longer an appropriate objective. In response, our approach to testing
the
has changed, but remains a key tool of our response to, and management of, COVID-19.
There are no longer any COVID-19 policy settings in place. This means that, as with other
notifiable diseases, public health management of COVID-19 wil be guided by the
provisions of the Health Act, supported by best practice guidance in the Communicable
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Disease manual and national Infection Prevention Control (IPC) guidance documents.
There is recommended guidance for isolation and mask use, which can be found on the
Unite Against COVID-19 website.
Purpose of
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the COVID-19 Testing Plan
The Testing Plan for COVID-19 (the Plan), which has been revised for the May-October
2023 period, outlines target population groups and associated methods of testing.
The Plan is responsive not only to the disease prevalence, but also to its significant impact
on healthcare and other sectors of society.
COVID-19 Testing Plan updated August 2023
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For convenience, the plan generally refers to “testing” in terms of both the analytic method
used to test samples and the sample collection methodology. These two components of
the testing process are related. For example, self-collected samples used for Rapid
Antigen Testing are generally not suitable for PCR analysis or subsequent Whole Genome
Sequencing. Rapid Antigen Test methods on the other hand are intentionally designed to
facilitate self-sample collection and home testing. The plan considers the following
scenarios:
• changes in disease prevalence from low to high (peaks and troughs in case numbers)
• introduction of one or more significant variants of interest and/or concern (VOI, VOC)
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• changes to public health and infection prevention and control (IPC) measures, that
may result in changes in case rates in specific groups
• significant impact on response capacity of specific health and other systems at
national, regional, and local levels (for example, aged residential care (ARC),
hospitals, primary care, laboratories, other specific providers)
• evidence of significant impact on specific population groups (for example, Māori,
Pacific people, residents of Aged Residential Care facilities, oncology patients,
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children); and
• any scenario where there is an identified significant increase/decrease in risk, which
would require a change in the approach to testing.
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Factors affecting testing decisions
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Overall, the decision to test and which method to be used wil be influenced by:
• likelihood of the person returning a positive test result (presence of symptoms and/or
risk of exposure) under
• testing purpose (clinical care, prevention of onward transmission, public health
intelligence)
• transmission rates within a specific community or setting
• residence or work settings; and
• availability and turn-around time (TAT) of the testing method.
Guidance: Testing Technol
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Local planning and protocols
At regional and local levels and within specific settings, both the recommended advice
within this Plan, as well as specific testing guidance documents, need to be considered
COVID-19 Testing Plan updated August 2023
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link to page 6
and incorporated when implementing protocols for testing patients, employees/contractors,
and visitors to facilities.
RAT and PCR testing recommendations in local and regional documentation should align
with the Testing Plan and guidance documents across all settings and facilities.
Strategic context
Testing to detect COVID-19 remains an essential tool of the public health response under
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our current settings and in the pathways for managing COVID-19 in the community and in
hospitals.
This plan is underpinned by the following principles:
•
Preparedness: we are ready to respond to new variants with appropriate measures
when required (tools in place, including surveil ance, to inform a response)
•
Protective and resilient: we continue to maintain resilience across the system and
protect those at higher risk of severe il ness due to COVID-19. The Plan has been
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developed in conjunction with other Government guidance and plans for COVID-19,
including the
Surveil ance Strategy and
Surveil ance Plan1.
Purpose of testing in response t
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o COVID-
19
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Testing is a process which starts with the recognition of an indication for testing and ends
with an intervention undertaken based on the result of the test. As noted above, this plan
generally refers to both sample collection and analysis of the sample as part of the test but
in fact these are two distinct components of the process.
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In some instances, the same sample method can be used with different analytic methods.
Both sample collection and analytic methods have important properties, such as
sensitivity, that need to be considered when interpreting results.
The combination of sample collection and analytic method (referred to as test) as part of
this process, is partly dependent on the planned interventions - public health, infection
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prevention control measures, or clinical management - based on the result of the test.
There are two main purposes for testing, each of which has a specific aim and method to
inform decision makers. These are:
1COVID-19: Surveilance strategy 22 December 2021
COVID-19 Testing Plan updated August 2023
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•
Diagnosis of symptomatic people (for clinical and public health purposes)
•
Surveil ance (population or subpopulation level)
While these purposes for testing activity are distinct the methods are not independent. As
the NZ epidemic has progressed methods used to diagnose cases having increasingly
become the main source of human surveil ance data. This is primarily because of the
removal of asymptomatic testing at the border, for designated high risk worker categories,
or universal testing in healthcare settings. The main exemption to this trend is wastewater
testing that continues as a surveil ance only methodology.
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The recommended type of test to be performed and the breadth of testing undertaken for
each purpose wil vary dependent on the overall context of COVID-19 and public health
measures in place at the time.
1. Diagnosis
Diagnostic testing supports clinical and public health decisions by confirming or not
confirming a diagnosis. It is part of a clinical and/or public health management pathway for
an individual or population group and is undertaken based on the signs and symptoms
Information of a
disease (for example, symptoms compatible with COVID-19).
2. Surveillance
Surveil ance testing is used to monitor frequency and distribution of infections and provide
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scientific and public health intelligence to improve our understanding of the epidemiology
and presentation of a disease, efficiency and efficacy of its management, and associated
the
outcomes. It assists in supporting and informing public health decision making and actions
at national, district, and local levels within Aotearoa New Zealand.
Testing is an essential tool in providing COVID-19 intelligence, with relevant data used
alongside information sourced from other areas (e.g., clinical, behavioural insights,
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surveys and international experience).
There are several objectives of surveil ance:
• early warning of changes in epidemiological profiles
• monitoring morbidity and mortality trends
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• burden of disease on healthcare capacity to enable a proportionate response to the
continually changing status of the pandemic (e.g., healthcare workers, hospitalisations,
and intensive care unit admissions)
• monitor priority groups (e.g., Māori) and settings (e.g., borders)
• monitoring and early detection of new VOC; or
• enhanced surveil ance to monitor those at the highest risk of disease, including:
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• characterisation of variant transmissibility; severity, and immune evasion
• determining the rate of long COVID-19, and assessing contributing risk/immune
factors
• determining correlation of protection; and
• measuring antibodies to estimate cumulative population immunity compared to
reported case rate, and further understanding of immunity from infection
vs immunity.
3. Screening
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It should be noted that asymptomatic (screening) testing for COVID-19, with the exception
of close household contacts to a known case, is no longer generally recommended in
community, healthcare settings or facilities. Where appropriate, measures including
adherence to Public Health IPC practices and vaccination and hybrid immunity are
considered sufficient under the current settings.
NZ COVID-19 Surveil ance Strategy and Surveil ance
Information
Plan
There are active and passive surveil ance programmes in place in Aotearoa New Zealand
which are described in t
he COVID-19 Surveil ance Strategy and Surveil ance Plan.
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The COVID-19 Surveil ance Strategy and Surveil ance Plan, updated 22 December 2021,
are currently under review to ensure that COVID-19 surveil ance systems and
the
programmes remain fit for purpose, including community infection and seroprevalence
surveys. This Plan should be considered in conjunction with th
e Surveil ance Strategy
and Surveil ance Plan.
Variants of Interest and
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Concern (VOI and VOC)
The purpose of whole genome sequence (WGS) testing for COVID-19 positive people is to
detect and monitor variants and their impacts. Samples collected at home, or in other
settings, for analysis using a Rapid Antigen Test are not suited to further analysis with
Whole Genome Sequencing
Consequently, collection of another sample for a polymerase chain reaction (PCR) test
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may be required for symptomatic people who meet the following criteria:
• overseas travel history to areas where there are identified VOCs
• people who are hospitalised with COVID-19 infection; and
• priority population groups who are at higher risk of producing a mutation of the virus,
that creates a new variant.
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Key response measures within the Strategic Framework for
COVID-19 Variants of
Concern have been identified, as a combination of baseline measures and extra
measures that would be used with more severe VOCs.
The Plan will be updated with further information as required when the Strategic
Framework for COVID-19 Variants of Concern is updated.
Any new VOCs or VOIs wil be assessed through the Public Health Risk Assessment
process and subsequent testing response to support public health action, which will be
communicated through this process to providers.
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Equity and advancing equitable access
and outcomes
In Aotearoa New Zealand, people have differences in health management and outcomes
that are not only avoidable, but also unfair and unjust. Equity recognises that people with
different levels of disadvantage require different approaches and resources to obtain
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equitable health outcomes.
For each testing option, different approaches to service delivery and commissioning are
required to ensure they are fit for purpose. Official
Therefore, the Plan and response measures need to continue empowering and supporting
community groups and advocates to make decisions to respond directly to health and
wellbeing needs and challenges in their communities.
the
Priority access to COVID-19 Testing
People who experience the highest lev
under el of inequity and/or greatest risk of harm or poor
health outcomes are identified in the priority groups for access to COVID-19 Testing.
The Plan prioritises people who have higher rates of morbidity, hospitalisation and length
of stay, mortality, and hardship due to COVID-19. Expedited access to testing and
accurate early identification of infection in these groups allows early intervention and
treatment and support to reduce the burden of disease for individuals and their whānau.
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Priority people are defined as those who are inequitably impacted by COVID-19. People
in this group are eligible for targeted assessments regarding additional clinical and social
support. The COVID-19 pandemic has exacerbated existing inequities for specific groups,
including:
•
Māori who experience greater inequity and disadvantage due to COVID-19 resulting in
poorer outcomes.
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•
Pacific People who have had the highest age-standardised hospitalisation rates for
COVID-19, and experienced age-standardised mortality rates 2.4 times greater than
European and other population groups.
Other priority groups within our population who may also experience inequity due to poorer
health or social outcomes and/or barriers to accessing testing include:
•
Elderly (65 years and over) experience inequity as this age group collectively has the
highest rate of poor outcomes including total numbers hospitalised, average length of
stay and/or death from COVID-19. Māori and Pacific people are overrepresented in
case numbers for the 65 years and over age group as well as other age groups. Act
• There is evidence that elderly people in Aged Residential Facilities are at higher risk
than people of a similar age in independent living. This observation may not apply to
Māori or Pacific populations who are less likely to reside in ARC facilities.
•
Disabled people (including tāngata whaikaha Māori and Pacific disabled people)
experience inequities due to greater barriers to access, and for some within this group,
increased susceptibility to COVID-19 infection and/or complications.
•
People with severe mental health and addiction.
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•
Other inequitably impacted populations including refugee and asylum seekers,
remote and rural people1, rough sleepers and those in transitional housing, and those
not enrolled in primary practices.
The following groups are those at higher risk of severe il ness from COVID-19
(vulnerable
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people):
•
People with high-risk medical conditions (long-term health conditions and/or
the
immunocompromised) ar
e inequitably impacted due to increased susceptibility
to COVID-19 infection and/or complications
•
Pregnant people under
Note this group also includes Māori, Pacific people and the elderly over 65.
Te Tiriti o Waitangi and Māori
The COVID-19 pandemic has seen Māori experience greater inequity and disadvantage
resulting in poorer outcomes compared to non-Māori. It is critical that the needs of Māori,
and the commitments made under Te Tiriti o Waitangi, are central to the health and
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disability response to COVID-19.
The principles of Te Tiriti o Waitangi provide the foundations for meeting our obligations
under Te Tiriti in our day-to-day work. Al levels of our health and disability system need to
COVID-19 Testing Plan updated August 2023
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link to page 11 link to page 11
be responsive to Māori, ensuring that the principles of Tino Rangatira, Equity, Active
Protection, Options, and Partnership
2 are reflected in practice.
Specific guidance has been developed to support healthcare providers with COVID-19
testing services in relation to Māori to ensure there is continued access to services, along
with support where it is needed.
The following should be used to promote and advance culturally safe practices for all
priority groups and settings:
• proactive collaboration and formal engagement with Māori subject matter
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experts/advisors/iwi and Māori providers to inform managing delivery testing gaps for
Māori
• timely, consistent, and easily understood communication, including promoting health
literacy for individuals, whānau and community; and
• creating culturally safe environments for individuals and their whānau
Pacific People
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The COVID-19 pandemic has seen Pacific people experience the highest hospitalisation
rates for COVID-19, and experienced mortality rates 2.4 times greater than European and
other population groups
3.
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Key issues have centred on response and preparedness challenges which included
access to resources, the siloed agency conditions to support localised agile responsive
models of care, and appropriate and timely communication of public health messages.
the
Despite this, the Pacific community rallied, and Pacific providers and churches provided a
critical part of the response.
Pacific providers, churches, and communities must be actively engaged and prioritised in
local and regional tactical approaches to COVID-19 testing. A specific Pacific ethnic
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approach should be facilitated where appropriate to maximise opportunities for equity of
access to testing.
Specific guidance has been developed to support healthcare providers with COVID-19
testing services in relation to Pacific to ensure there is continued access to services, along
with support where it is needed.
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1Rural’ is defined according to th
e Geographic Classification of Healthcare, based on the location of the patients home address, in
defined regions R2 and R3.
2Te Tiriti o Waitangi | Ministry of Health NZ
3Public Health Agency. 2022. COVID-19 Mortality in Aotearoa New Zealand: Inequities in Risk. Wellington: Ministry of Health.
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Disability Community
Our objective is to provide accessible testing for disabled communities, treating its
members and their whānau with dignity and respect. Disability Support Services recipients
have been 4.2 times more likely to be admitted to hospital for COVID-19 compared to the
rest of population, and 13 times more likely to die of or with COVID-19 over the course of
the epidemic.
Close engagement with disabled people, their representative organisations and whānau,
Whaikaha, along with providers, local advisory groups, carers, and support providers will
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provide tactical advice on how both national and regional testing services can best
respond to the needs of disabled people and their whānau.
Barriers to access and disincentives
There are a range of barriers and disincentives to testing access and uptake. These are
both perceived and real, across diverse population groups including Māori, Pacific and
disabled peoples.
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Continuing to identify and understand these barriers wil support decisions and actions
aimed at enhancing more equitable and widespread national access to COVID-19 testing
across Aotearoa New Zealand.
Barriers and disincentives to testing vary by population groups, location, and type of
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testing modality, but may include:
• perceived need to test: self-assessment of severity or likelihood of COVID-19 or other
the
viruses
• the process: expectations and experience of discomfort, inability (for financial, family
obligation or other reasons) to isolate home after testing as recommended.
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• financial: perceived and real costs of testing/visiting primary care facilities (getting to
and from an appointment, the appointment itself, following recommended isolation
advice after PCR testing or positive COVID-19 test result, lack of sick leave
arrangements, financial hardship);
• visa status: new migrants, bridging and temporary visa holders may not realise they
are eligible for free testing; and
• access for disabled
Released people to get information on the time and method of testing,
physical access to testing and health facilities, access to adequate transport and
health facilities, and sensory environments.
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Community engagement in relation to Testing
Ongoing engagement with our communities is critical in ensuring the appropriate health
messages for the current health care settings are reaching all sections of the community.
In particular, it is essential we focus on those communities at greatest risk of serious
illness from COVID-19, including Māori and Pacific people, disabled people, the elderly
and the clinically vulnerable.
One way this is being achieved is through community providers supporting access to
testing services for priority people and those at higher risk of il ness from COVID-19 Act
(vulnerable people) by enabling expanded access to, and acceptability of, COVID-19
testing services within Aotearoa New Zealand.
They also play an important role for priority people in identifying positive cases and
connecting these people with the appropriate health and welfare services within their
community.
Data collection requirements for COVID-
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19 Testing for monitoring purposes
Al laboratory data information and collection requirements should be aligned with data
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privacy impact statements and Māori data sovereignty guidelines.
To understand the amount of testing being conducted for SARS-CoV-2 across Aotearoa
the
and in what settings, it is crucial to understand the:
• demographic (who is being tested)
• if testing is based on symptomology and/or absence of symptoms
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• geographic region or by facility (where testing is occurring) distribution of testing
• type of test being performed and if all results are reported
• age group
• sex/gender
• ethnicity
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• rates of testing for Māori and other ethnic groups in different settings (community,
primary care, secondary care)
• referrer type
Central collation and reporting at the national level provides a denominator for calculating
test positivity rates and informs an understanding of how equitably testing is being
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implemented and accessed nationally, regionally and at a locality level. This information
also identifies key demographic groups or geographic regions where increased public
health, and testing efforts may be required.
In addition, it is important to understand national and provider testing activity to assess
capacity and throughput and monitor service risks. The following information from tests
should continue to be assessed to support improvements in quality and service delivery:
• age group
• sex /gender
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• ethnicity
• geographic region and referrer type
• test type
• by laboratory or testing device
• referrer or provider
• tests performed by test type
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• turn-around times with KPIs
Changes in local testing regimes that impact on data
col ection
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It is essential for interpretation of laboratory information for surveil ance programmes for
the
providers to notify if they change testing regimes that may impact on data interpretation
and comparability and cumulative reporting; including targeted groups tested and use of
test modality.
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Part Two
Part two of the Testing Plan has been divided into two sections for ease of use:
• Testing Response Framework
• Introduction to Testing Guidance
Testing response
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framework
Context
Information
This section contains information on how the Plan intends to optimise utilisation of the
available laboratory testing capacity and capability and have non-laboratory tests available
to support the response as needed, whilst taking an agile approach.
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Utilisation of testing in Aotearoa New
Zealand
the
The recommended use of tests/methods wil be narrowed and widened dependant on the
impact COVID-19 is having at a given time, on our communities, healthcare services or
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within specific environments. The testing technologies available and the recommended
use of them are described in Appendix 1 - Table 1A - Recommended testing for Target
Groups
.
The below six considerations should be taken into account to determine the most
appropriate testing modality and delivery for COVID-19 and other respiratory il nesses:
•
Who is being tested
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•
Why the person is being tested (purpose). The test may be to support a clinical
decision concerning the use of antiviral medications for the individual. It may also
ensure that the case is aware of the recommendation to isolate and prevent
transmission to the high-risk population. The test result may inform actions for an
individual, whānau or community, facility or a combination of these
•
What viral or other pathogens need to be ruled in/out
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•
Which is the best test to achieve the purpose in a culturally, logistically, and equitably
acceptable way for the testing recipient, and in a practical and cost-effective way for
the system
•
Where the test
can be accessed
- ease of access to and from collection site; and
•
When the test result is needed for action - timeliness of results for public health and
clinical decision making.
These considerations must be weighed up, and underpinned, by a Te Tiriti o Waitangi and
health equity response as described in the Plan which has implications for each
consideration.
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The mode and service delivery models vary in some settings to enable access and meet
turn-around requirements for various priority population groups. Further information can be
found in the Testing Technologies and Modalities guidance.
Target groups for testing Information
For most people, symptomatic infection with SARS-CoV-2 results in a self-limiting illness.
People and populations who should be prioritised for access to testing to address
inequities are described in the
priority access to COVID-19 testing section of this Plan.
Needs of our priority populations should be considered first and foremost in any of the
target groups and settings described below. Official
The priority for testing should extend not only to those at greatest risk of serious il ness but
the
to those most likely to come in to contact with the highest risk groups. For example, this
would include children living in whanau Māori homes that include older whanau or other
household members at high-risk of hospitalisation or death due to COVID-19 such as
multigenerational households.
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In the current Plan, three groups are targeted for testing, as outlined below.
People with COVID-19-compatible symptoms
(diagnostic testing)
The purpose of testing people with symptoms is early detection of cases and improving
COVID-19-related heal
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• Access to antiviral therapeutics for thos
e eligible; and
• To identify cases so they can take action to prevent onward virus transmission in
communities and to those at highest risk of inequitable outcomes.
o A minimum isolation period of 5 days is recommended for all cases even if you only
have mild symptoms.
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o If you still feel unwell after you have completed 5 days of isolation, we recommend
you stay home until you have recovered.
o After completing the recommended isolation, we recommend you wear a mask if
you need to visit a healthcare facility or an aged residential care facility, or you have
contact with anyone at risk of getting seriously unwell with COVID-19 up until 10
days after your symptoms started or you tested positive. This is because some
people are infectious for up to 10 days.
During winter and with the re-emergence of a range of pathogens that cause similar Act
symptoms to COVID-19, consideration of alternative diagnoses is particularly important
especially for Māori, Pacific people and those at higher risk of severe il ness from COVID-
19. For example, confirmation of a COVID-19 diagnosis may lead to different treatment for
someone who otherwise would have been treated for influenza Note that people can be
co-infected with more than one pathogen.
People with known household exposure to SARS-CoV-2
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The purpose of testing people in this group is to manage any outbreaks and reduce
onward transmission of SARS-CoV-2.
Al household contacts of known COVID-19 cases are recommended to RAT test daily for
five days from the day when the first case in the household tested positive or developed
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symptoms (whichever is earliest), as they are at the greatest risk of infection.
Household contacts: for definition, testing, and management
see here.
the
People within facilities at higher risk of SARS-CoV-2
exposure or environments where disease amplification
is more likely under
The purpose of testing symptomatic people in this group is reducing onward transmission
of SARS-CoV-2 to people at greatest risk of hospitalisation and death.
This target group includes people:
• who have frequent, close, or extended contact with others who have the potential for
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greater exposure to SARS-CoV-2, including people who care for people with COVID-
19 (for example, healthcare workers and support care workers).
Testing of the above target groups is summarised in Appendix 1 - Table 1A -
Recommended testing for Target Groups.
COVID-19 Testing Plan updated August 2023
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Introduction to Testing
Guidance
COVID-19 Testing guidance documents have been developed to provide operational
information for settings and facilities regarding recommended testing for COVID-19.
A list of all the Testing Guidance documents can be found at the end of this section. Act
Testing considerations
The following should be considered when undertaking testing of patients:
• when screening, clinicians should consider the required sensitivity and specificity of
the test as determined by the individual’s susceptibility to severe outcomes from
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COVID-19 infection and balance the risk of the planned procedures against test
availability and TAT.
• assumed infection prevention control measures wil be implemented as per local
guidance (for example, streaming patients based on symptomology, known COVID-19
status and/or vulnerability) to reduce hospital-acquired infection transmission risk, and
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where not feasible, implement guidance for high transmission/surge.
• if a patient has had a known COVID-19 infection within the last 28 days of release
the
from isolation and is symptom-free, repeat testing for COVID-19 not indicated.
• if an inpatient’s length of hospital stay is more than 48 hours, consideration may be
given to repeat RAT screening during a surge in hospitalised COVID-19 cases as an
indicator of higher local transmission.
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Facilities with an increased risk of viral
amplification
Facilities where there could be an increased risk of viral amplification include aged
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residential care, community residential care, hospices, correctional and youth justice.
This is due to the close living conditions of the population groups within these types of
facilities, making them more susceptible to severe outcomes due to COVID-19 infection as
well as psychosocial impacts of isolation due to COVID-19.
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Some facilities in rural or low socio-economic locations face additional challenges in caring
for these groups, if they are affected by COVID-19 along with the staff.
People in these settings should be encouraged to test if symptomatic but should take
precautions if symptomatic and test negative, as they may have other respiratory
infectious disease.
Asymptomatic testing is not generally recommended unless considered a close household
contact. The most important protective measures against COVID-19 and other respiratory
pathogens in the workplace are ensuring that employees are supported to stay home Act
when they have onset of respiratory symptoms, there is encouragement of mask wearing
when individuals are working in close contact with others, and good hygiene practices are
promoted.
Heating, ventilation and air conditioning should be optimised within available resources.
Overcrowding should be avoided.
Some of these facilities may care for a larger proportion of priority populations, including
those at higher risk of severe il ness.
Information
Vaccinations also can play a part in helping prevent and manage transmission and
outbreaks of COVID-19 within facilities. Therefore, keeping residents (with their consent),
up to date with their COVID-19 vaccinations is important.
As many of these individuals are residing in these facilities under the direction of either a
Official
health funder or government there is an additional obligation to provide a low- risk
environment
the
Asymptomatic staff screening
In general, asymptomatic testing of healthcare workers is not recommended if they are
under
using risk assessment tools and applying systematic IPC measures which significantly
reduce the risk of workplace exposure. It is essential that healthcare workforce is
maintained to ensure ongoing care of people.
If the healthcare workforce is significantly affected by COVID-19, service providers may
undertake their own risk assessments to ensure safety of patients and the workforce which
may include a local testing protocol.
Released
Visitors to healthcare facilities
Visitors to healthcare settings should follow the advice in the Te Whatu Ora guidance on
mask use and visitor guidance for hospitals and other health disability care settings, which
can be found
here.
COVID-19 Testing Plan updated August 2023
19
Boarding schools and tertiary student
residences
Symptomatic people are included in the targeted symptomatic testing group.
In student residences, preventive measures are strongly recommended to stop onward
transmission between residents.
If there is a high incidence of COVID-19 in a specific facility, all those with symptoms Act
should be tested in line with the advice for the general population. The National Public
Health Service wil work in partnership with key agencies in the event of a large outbreak
in education settings or residences.
Community gatherings - testing
Community testing strategies may be incorporated into a localised response to protect
Information
Māori, Pacific, and other priority population groups and their whānau.
This includes the importance of collaboration and acknowledging community context which
wil ensure that the needs of their whānau and communities are central to their response.
Community groups and event planners need to work together to ensure the appropriate
Official
measures are considered when organising large gatherings to include:
• relevant public health messaging the
• COVID-19 testing advice and where to obtain RATs
• COVID-19 vaccine advice
under
List of Guidance Documents for Specific
Settings
• Guidance: Hospitals and Secondary Based Care Facilities
• Guidance: Primary Care and other Clinic-based Settings which includes:
Released
• Testing Operational Guidance for General Practice and Urgent Care
• Guide for diagnosis of COVID-19 reinfection, rebound, persistent infection and long
COVID-19
• Guidance: Aged Residential Care and Community Residential Care Facilities and
Hospices
COVID-19 Testing Plan updated August 2023
20
• Guidance: Correctional and Youth Justice facilities
• Guidance: Testing for Māori and Pacific People within Healthcare Settings
• Guidance: Community Providers
• Guidance: To support access to testing for Disabled people
• Guidance: Testing for Businesses
• Guidance: Testing of International Arrivals
• Guidance: Testing Technologies and Modalities
Act
• Guidance: Laboratory and Testing Operational Considerations
Information
Official
the
under
Released
COVID-19 Testing Plan updated August 2023
21
Appendix 1: Table A1: Recommended Testing by Target Group
Symptomology
RECOMMENDED TESTING
Factors for service managers to consider implementing testing and response to management of an outbreak: hospital bed capacity + laboratory testing capacity + capability + testing supplies +
staffing levels + demands for testing services + case rates +hospitalisation rates
Symptomatic
General population (community and
RAT
self-testing)
If RAT is negative, and COVID-19 symptoms persist, repeat
Act RAT in 24 and 48 hours
Facilities (Aged Residential Care,
RAT (to inform clinical and public health management decisions)
Community Residential Care, Hospices,
If RAT is negative, and COVID-19 symptoms persist, repeat RAT in 24 and 48 hours
Correctional and Youth Justice)
PCR where a result can influence treatment options for priority people1 and those at risk of severe il ness from COVID-19(vulnerable)2
Hospitals
(For all hospitalised positive PCR cases, refer samples for Whole Genome Sequencing WGS)
Outpatients
Emergency services
Priority People1 and those at higher risk
SELF-TEST RAT
Information
of severe il ness from COVID-19
If unable to self-test - ASSISTED RAT (Community Provider or GP)
(vulnerable)2
If RAT is negative, and COVID-19 symptoms persist, repeat RAT in 24 and 48 hours
PCR where a result can influence treatment options
Symptomatic patient presenting to General Practice (GP) – please refer to the
COVID-19 Testing Operational Guidance for General Practice and Urgent Care
Official
Symptomatic
Self-test with
RAT - if positive, get a
PCR to enable Whole Genome Sequencing (
WGS)
international
arrival
the
Asymptomatic Household contacts: for definition, testing, and management
see here
(household
No other asymptomatic testing is recommended
contacts)
under
Priority people1 are defined as those who are inequitably impacted by COVID-19. People in this group are eligible for targeted assessments regarding additional clinical and social support. The COVID-19
pandemic has exacerbated existing inequities for specific groups, including:
Māori who experience greater inequity and disadvantage due to COVID-19 resulting in poorer outcomes,
Pacific People who
have had the highest age-standardised hospitalisation rates for COVID-19, and experienced age-standardised mortality rates 2.4 times greater than European and other population groups. Other priority
groups within our population who may also experience inequity due to poorer health or social outcomes and/or barriers to accessing testing include:
Elderly (65 years and over) experience inequity as
this age group collectively has the highest rate of poor outcomes including total numbers hospitalised, average length of stay and/or death from COVID-19. Māori and Pacific people are overrepresented
in case numbers for the 65 years and over age group as well as other age groups
Disabled people (including tāngata whaikaha Māori and Pacific disabled people) experience inequities due to greater
barriers to access, and for some within this group, increased susceptibility to COVID-19 infection and/or complications.
People with severe mental health and addiction, other inequitably impacted
Released
populations including refugee and asylum seekers, remote and rural people1, rough sleepers and those in transitional housing, and those not enrol ed in primary practices.
The following group are those at higher risk of severe il ness from COVID-19
(vulnerable people)2 People with high-risk medical conditions (long-term health conditions and/or
immunocompromised) ar
e inequitably impacted due to increased susceptibility to COVID-19 infection and/or complications, Pregnant people. (Note this group includes Māori, Pacific people
and the elderly over 65).
COVID-19 Testing Plan
22
link to page 23 link to page 23
Appendix 2: Table A2: Surveil ance in
Aotearoa New Zealand (as at date of
publication)
Active SARS-CoV-2 testing surveillance
Sentinel site and
Influenza-like il ness (ILI) syndromic screening includes Act
syndromic surveil ance;
COVID-19 testing within respiratory panels.
sampling and laboratory
respiratory multiplex PCR Severe Acute Respiratory (SARI) Syndromic Surveil ance
testing
includes COVID-19 testing within respiratory panels.
Ad hoc targeted sampling and testing as directed by public
health services.
COVID-19 specific testing Whole Genome Screening for variants from border,
Information
surveil ance
community, and hospital NAAT
4 positive cases to enable
early detection of variants of concern and changes in virus.
Note the PCR testing is passive testing – collected during
the course of clinical care - but the subsequent WGS is
Official
generally active surveil ance.
Environmental - wastewater testing: targeted genotype
the
testing to monitor rates and distribution of variants within a
region(s) or targeted setting; estimate levels of infection via
quantitation; presence/absence testing where appropriate.
under
Passive SARS-CoV-2 testing surveillance
Captured as part of testing Community/Primary care: Laboratory based NAAT/RAT
5 priority groups.
results - monitoring of NAAT testing and case rates.
Hospital: Laboratory/hospital based NAAT/RAT - monitoring
of NAAT testing rates and results reporting.
Released Self-reported RATs - capture of all reported community
performed positive RAT results.
4 A Nucleic Acid Amplification Test, or NAAT, is a type of viral diagnostic test for SARS-CoV-2 that detects genetic material (specifically
the ribonucleic acid (RNA) sequences).
5 Rapid Antigen Test, or RAT, is a is a rapid diagnostic test suitable for point-of-care testing that directly detects the presence or
absence of an antigen.
COVID-19 Testing Plan
23
Document Outline
