November 24 2021
The managed isolation system at NZ's border is being dismantled for fully vaccinated Kiwis and travellers will be able to bypass it from early next year. It comes as officials announced there are 215 Covid-19 cases today.
The Health Ministry says people cannot be refused health care because of their vaccination status, and there is no need for routine testing of unvaccinated patients before they see a doctor.
"Access to health care is a fundamental right," the ministry said last Friday in response to concerns from clinicians and providers about the treatment and testing of people who are not inoculated against Covid-19.
"An individual seeking health care cannot be refused care because of their beliefs. In this case an individual who believes that a vaccine is harmful cannot be refused care for the belief."
It also said a practitioner must not allow their opinion of a patient who refuses to be vaccinated to influence the care they offer that person.
Routine testing of asymptomatic patients would identify some infections and reduce transmission, the ministry said, but the feasibility, cost and effectiveness of this has not been determined and could divert scarce testing resources from urgent work.
There are ways to reduce the risk of transmission from any asymptomatic individual and these must be used before introducing additional ones.
The Royal New Zealand College of General Practitioners and others the Herald spoke to agree with the ministry's position.
Medical director of the Royal New Zealand College of General Practitioners Dr Bryan Betty. Photo / RNZ
"Unvaccinated patients do need to be seen and treated, and there is no requirement legal or otherwise for a pre-consult covid test," said medical director of the College Dr Bryan Betty.
But there is a difference between vaccinated and unvaccinated individuals in terms of their ability to catch and potentially spread Covid, he said.
"There's been worry about this. How do you keep elderly patients, for example, who have co-morbidity, or are immuno-compromised separate from what could be an increased risk - that is, a patient who is unvaccinated and may be asymptomatic with Covid?"
He said there may be a process within surgeries and practices to keep a degree of separation between vaccinated and unvaccinated patients.
The ministry says there is no need to set up an alternative, high-risk pathway just for unvaccinated patients at general practices and medical centres.
Putting unvaccinated people on an alternative pathway is "highly likely to negatively impact access to care, which must be balanced by a demonstrable benefit", it said.
Children form a large part of the unvaccinated population so clinicians need to consider how an alternative pathway affects their care, the ministry said.
Dr Kath Rollo, a GP at Broadway Health Kaitaia in Northland, says she has heard chatter in the medical community about refusing care and acknowledged the compassion fatigue health care workers in the US and Europe are feeling towards unvaccinated patients.
But she believes most doctors here will do the right thing. "Refusing to see unvaccinated patients will disproportionately affect Māori and other vulnerable groups who, for whatever reason, decide against getting vaccinated," she said.
"We have a duty of care to all our patients regardless, just like we have a duty of care to be fully vaccinated."
Associate Dean at the University of Auckland's Pacific Faculty of Medical and Health Sciences Dr Collin Tukuitonga said the guidelines are useful for managing unvaccinated patients who present a risk to health care workers, and the aim is to ensure treatment is provided in safe way.
The college has issued guidelines to GPs for managing risks around unvaccinated patients, including masks, personal protective equipment, triage at the front door, tele-consultations and separation of patients if necessary.
