The testing criteria for Covid-19 is still limited to priority groups, despite being widened as concerns grow New Zealand is not doing enough testing to stamp out the virus.
Wellington urgent care physician Dr Kelvin Ward said without enough testing the rate of community transmission cannot be fully known, and the curve won't flatten as it has done in countries like South Korea, which is doing up to 20,000 tests a day.
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"Our current level of testing is woefully inadequate to identify the extent of community transmission," Ward tweeted this morning.
"If we do not identify it we cannot isolate or eliminate it."
New Zealanders are into day eight of an at-least four-week lockdown to prevent the spread of Covid-19.
Yesterday the case definition for testing was widened after patients and doctors reported swabs being denied by labs because they did not meet the criteria.
On March 14 the case definition was:
• Fever, shortness of breath or cough, sore throat AND overseas travel within 14 days;
• Same symptoms AND close contact with a suspect, probable or confirmed case of Covid-19;
• Healthcare worker with symptoms;
• Critically ill patients in ICU with no other cause.
Underpinning this was clinical judgment: doctors could swab if they suspected Covid-19 but the patient did not meet the case definition according to the guidelines.
Ward said that directive was ambiguous because doctors earlier required permission from an infectious diseases expert if the patient did not meet the case definition.
This appears to have been the situation with New Zealand's first Covid-19 fatality, 73-year-old grandmother Anne Guenole, who died in Grey Base Hospital on Sunday.
Guenole was initially not tested for Covid-19 but whether she was denied the test because she did not meet the previous case definition, is a question Canterbury District Health Board has not answered.
If she had been tested on admission last Wednesday, 22 staff would now not be in self-isolation because of their potential exposure to the virus.
Instead Guenole, who had chronic obstructive pulmonary disease, was swabbed but because she had not travelled or had close contact with a confirmed case of Covid-19, the virus was not tested for that day.
That decision, according to the Canterbury DHB, was made in consultation with Guenole's admitting doctors and an on-call Covid-19 specialist in Christchurch.
"It's important to note that when she was first admitted she did not meet the case definition for Covid-19," a DHB spokeswoman told the Herald.
It was suspected Guenole had the flu so staff treating her did not wear the protective eyewear needed when dealing with a potential Covid-19 case.
It wasn't until the next day that the doctors decided Guenole met the case definition for testing, though it's not clear what changed overnight.
Guenole did not have links to travel or a confirmed case. She went to the supermarket, and attended a funeral in Greymouth about 10 days before she fell ill.
It raised the question whether she was a missed case of community transmission.
On Monday Canterbury DHB told the Herald that after Guenole's death the case definition at West Coast District Health Board had been temporarily expanded.
By Tuesday the pressure came on the Government when Otago University Professor Sir David Skegg told Parliament's Epidemic Response Committee it was make or break time.
"If we don't eliminate it in the next few weeks, the shutdown will continue for many months, or we will have a series of shutdowns that will paralyse our society for a year or 18 months, and it will never be the same again," he said.
The committee grilled director-general of health Dr Ashley Bloomfield and Health Minister Dr David Clark who said testing criteria would be loosened.
Yesterday the ministry announced the case definition would be expanded to include not just those who had been in contact with a case or had links to overseas travel.
At the same time Prime Minister Jacinda Ardern confirmed testing would be ramped up across the country, with a view to reaching 5000 tests per day.
However the updated case definition, though widened, still does not include people who merely have symptoms without other criteria. It includes the original criteria plus:
• Hospital patients with symptoms;
• Essential workers with symptoms who have had contact with a case;
• Those with symptoms and living in aged care, halls of residence or other communal living;
• Deemed necessary by the medical officer of health to investigate a potential cluster;
• People with a new or worsening cough, as local testing capacity allows.
Ward said doctors had until now been "definitely constrained by the case definition".
He said although the criteria was now widened, he didn't believe it would allow the level of testing needed.
"We can only test the people we see, who walk in our doors or who are our patients.
"Beyond this, if testing numbers are to be increased there will need to be government-directed targeted testing of other groups."