Coronavirus: Case definition, criteria set to be broadened amid concerns over test refusals

The criteria for COVID-19 testing is set to be widened by health officials amid concerns that suspected cases are being turned away from testing facilities for not meeting the current case definition

Concerns have been raised following anecdotes of New Zealanders being refused testing for not meeting potentially outdated criteria.

During the Ministry of Health's daily press conference on Tuesday, Director-General of Health Dr Ashley Bloomfield acknowledged that clinical assessments by staff at community-based assessment centres are based on a "really clear set of criteria".

"I think if the criteria broaden - and we'll see what happens with the revision of the case definition - that this would be less of an issue," he noted.

The case definition for COVID-19, which outlines when a medical practitioner should test for the coronavirus, was last revised on March 14. That latest revision broadened the initial symptoms to look out for. 

To be considered a suspected case, people must meet the current clinical criteria of a fever (minimum of 38C) or any acute respiratory infection with at least one of the following symptoms: shortness of breath, cough or sore throat with or without fever.

The person must also satisfy the current epidemiological criteria, which is either travel to or from countries or areas of concern within 14 days before the onset of illness (excluding airport transit), or close or casual contact with a suspected, probable or confirmed COVID-19 case in the 14 days before illness. 

A third case definition outlines healthcare workers with moderate or severe community-acquired pneumonia, regardless of any international travel.

As non-essential international travel is prohibited, having a travel history is only relevant to New Zealanders continuing to return from overseas. The borders, at this stage, remain open to Kiwis alone. For other New Zealanders, the borders have been closed since March 19, meaning travel history may be an outdated criteria component.

Dr Bloomfield confirmed the Ministry of Health's Technical Advisory Group convened on Tuesday morning and have been specifically asked to evaluate the current COVID-19 case definition.

"I specifically asked them to look at the definition given that we now have evidence of some community transmission," he confirmed.

"The key thing I wanted them to look at was whether we decouple the symptoms that form part of the definition from the requirement to have a travel history, or to have been a close contact of a confirmed or probable case. Notwithstanding, there was already that ability for [medical practitioners] to test someone even if they didn't fulfill those criteria. So that would be a key change."

Dr Bloomfield said he expects the advisory group's advice later on Monday.

When questioned by a reporter as to why the current case definition is only being looked at now - despite having evidence of community transmission for more than a week - Dr Bloomfield reiterated that a revision is only done when deemed appropriate. 

"We still have very low levels of what we think is community transmission, based on the testing that's been done. We're revising the definition when we think it [is] appropriate," he said.

"My sense is we've done over 21,000 tests and it's clear there has been a lot of testing of people that don't necessarily fulfill the epidemiological criteria, but the clinician felt that it was important to test them."

Speaking to the special Epidemic Response Committee, which was established to hold officials to account for their response to the COVID-19 outbreak, Health Minister Dr David Clark said he expected a test to be carried out if a GP believes it to be necessary. 

"Where we have had anecdotes of misunderstanding, it is very important that if clinicians have suspicion they are doing the testing," he said on Tuesday morning. 

Dr Bloomfield is adamant that no test requests are being rejected due to a lack of resources.