Lack of 'recovered' COVID-19 patient testing prompts rethink at Ministry of Health

The Ministry of Health's advisors are meeting to discuss the current COVID-19 guidance, which at this stage does not recommend clearance testing after a patient has been symptom-free for 48 hours.

A spokesperson for the Ministry of Health told Newshub the technical advisory group is meeting on Friday and "this is one of the things that will be discussed with them".

The current advice to the Ministry of Health is that a person who gets the coronavirus COVID-19 is considered 'recovered' if they are symptom-free for 48 hours, or two days. But after that, they are not required to be tested again.

A person is considered recovered from COVID-19 if it has been at least 10 days since the onset of symptoms and at least 48 hours since the symptoms stopped, and it's then at the "discretion of the clinician" whether they are clearance tested.

"COVID-19 came to our attention less than three months ago," the spokesperson said. "Our knowledge of this novel coronavirus is constantly improving and the Ministry of Health continues to work with our technical advisory group to update the COVID-19 case definition, as required."

Director-General of Health Ashley Bloomfield said on Thursday the 48-hour symptom-free definition is based on "international practice", but the leading national public health institute in the United States, the CDC, says a patient should be symptom-free for three days.

Australia also requires patients to be symptom-free for three days.

In response, the Ministry of Health spokesperson told Newshub the advisory group is providing advice that is "pertinent for the New Zealand setting".

New Zealand has far fewer cases of the virus than Australia where more than 5000 people have contracted it. But New Zealand also had a big jump in confirmed cases on Thursday - 89 more than Wednesday - bringing the total to more than 790.

The definitions of 'recovered'

The Ministry of Health provided Newshub with a breakdown of the two definitions of 'recovered' COVID-19 patients, as New Zealand's list of recovered surpassed 80 this week.

The first definition relates to those cases who have mild illness and do not require hospitalisation - kind of like US actor Tom Hanks.  

Those patients are considered recovered after at least 10 days have passed since the onset of symptoms, and there has been "resolution of all symptoms of the acute illness" for the previous 48 hours.

The other definition relates to those cases where someone has experienced more severe illness and has been discharged from hospital.

They can be released from isolation, at the discretion of health professionals, if at least 10 days have passed since the hospital discharge, if there have been no symptoms for 48 hours, and if they have no major 'immunosuppression', for example if they recently had chemotherapy.

How is New Zealand coping?

The Government's response to the pandemic has been praised by some for how it acted quickly to put the country into lockdown, before the health system became inundated as seen in Italy and Spain.

Professor Michael Baker from the Department of Public Health at the University of Otago told The AM Show New Zealand is looking like the only Western country with a chance of eradicating COVID-19 because of early action. 

But concerns have been raised about testing capacity, as well as the distribution of personal protective equipment (PPE) such as masks and gloves, as the number of confirmed cases continues to grow.

The Ministry of Health has responded by changing the testing criteria so that anyone can get tested if they show symptoms, regardless of whether they have come into contact with a confirmed case of the virus or returned from overseas.

Before the change, doctors were given discretion to test people for the virus if they felt there was a need, but people complained that they were still being turned away, so the Government officially changed the criteria this week. 

"New Zealand's testing capacity per capita is double what the UK; in fact, it's 50 percent higher than what South Korea's is. So, we have good testing capacity," Dr Bloomfield said on Thursday.

"The case definition was updated and it's clear that even prior to that there was a lot of testing happening for people who didn't have that international travel history and now there is no requirement for that."

He said there are more than 100,000 swabs in the country for testing and the Government is now moving from "a peacetime distribution system to a wartime distribution system", to make sure that the swabs are where they're meant to be.

Labs across the country have processed 2563 tests bringing New Zealand's total to more than 26,000 tests processed to date, and next week the total number of labs testing will increase from eight to 10.

The total volume that the Ministry of Health can now process is more than 4000 tests a day, and over the last seven days, the average number processed has been 1848 tests per day.

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