The supply of protective gowns for medical workers at the Covid-19 frontline appears to be in turmoil.
A major supplier has told RNZ demand has "gone through the roof" since the lockdown was announced on Monday.
The supplier said late yesterday the Ministry of Health had just asked it to urgently find half a million gowns but it can't because supply from China is badly disrupted.
This was after Director-General of Health Ashley Bloomfield yesterday said personal protective equipment (PPE) supplies - masks, gloves, gowns, visors - were plentiful and steady and distribution was being made "rock-solid".
"First thing is just to reiterate, we have really good supplies of PPE," he said. "The second thing is, we are working hard over today to make sure it is out with everybody who needs it, in whatever clinical situation they're in, whether that's in a pharmacy, a midwife out in the community, obviously in primary care - they already have good supplies - and within DHB settings."
Bloomfield said 200,000 masks were being produced locally each day.
As for gowns, however, the major supplier described the situation to RNZ as "bedlam".
"National demand has gone through the roof," the supplier said, speaking to RNZ on condition of anonymity.
"Every avenue of supply is being explored."
Normal demand was 1000 cartons a week, but they had gone through five times that - 250,000 gowns - since Monday. The catalyst was the lockdown announcement.
They are meant to keep three months of stock in demand, but if demand continued like this, they would run out by the end of next week, they said.
As well, the ministry had come to them yesterday, wanting half a million gowns to be flown, rather than shipped, out of China.
It had asked them for another 200,000 gowns which DHBs could put into PPE kits also containing gloves and a mask to give to community health workers. The DHBs have been supplying other parts of the workforce, such as GPs.
But the supplier has told the ministry they can't find a factory able to make it, or a plane able to bring it here.
They believe other suppliers are telling the ministry the same thing.
The gowns protect health workers' clothes from droplets that might contain Covid-19.
Yesterday, in a new daily 11am Covid-19 forum that began this week, unions raised medical workers' worries with district health boards.
The unions have expressed concerns of doctors, nurses, midwives and other health professionals that there was not enough equipment or it was not being distributed properly.
They demanded the DHBs by last night put out clear national guidelines on what protective gear who should wear, and when.
The ministry did not do that, but is understood to be working on it. It responded yesterday by releasing 600,000 masks to DHBs - or eight masks for every DHB worker.
- If you have symptoms of the coronavirus, call the NZ Covid-19 Healthline on 0800 358 5453 (+64 9 358 5453 for international SIMs)
Dr Bloomfield told Morning Report that national pandemic reserves of PPE were available, in addition to existing stock and district health boards' own pandemic reserves and own existing supply chains.
He said they were running through a process to ensure the supply could be released as required, but that not all elements of PPE needed to be released yet because there was enough stock on hand around the country.
"One of the points I think has been raised is the need to make sure it is where it needs to be and we have seen - as that supplier has said - a lot of gowns have been ordered this week. Our job ... is to make sure it's where it needs to be, so we'll take a national view to that from now on.
"What we want to make sure is not only that we have the stock but we are getting it out to protect all frontline health workers ... and also that we are leaving no stone unturned to replenish that stock from around the globe."
A range of suppliers had been contacted to keep stock replenished and senior private sectors with strong global networks were also being used to get offers of PPE, he said. Air New Zealand and Defence Force are among those who could help bring in those supplies, he added.
"There is a global crunch and the WHO has identified that, we had reserves onshore in addition to our usual stock so we were prepared in the first place.
"That's what you're hearing, I think, with that supplier. We've reached out and said 'go for it, find every available channel and start to work out how we can replenish our stocks so we don't run out'."
In regards to concerns on who should wear PPE, Dr Bloomfield said a draft of clinical guidance on when PPE needed to be used, by whom, and how it complements other procedures (like handwashing), was expected to be finalised today.
"The guidance is designed to make sure anyone who might be at risk dealing with patients in patient-contact situations has got the right PPE and it is being used properly but there will also be many situations in a hospital or other clinical setting ... where a mask is not appropriate and in fact could cause additional problems."
Cromwell GP Anya Beale said the DHB had supplied seven PPE kits, with seven gowns, to her practice last week.
"I'm concerned because we serve a population of 5000 patients. Currently, we have [left] four full sets of gowns, eyewear, gloves and masks.
"So we're currently only able to test four patients because all of the gear is disposable. Once those kits are used, we currently don't have any more. And we're unsure when they're going to arrive."
"So we feel that we're limited to deal with things if they escalate further."
Three people in Central Otago have tested positive for Covid-19.
Feilding health support worker Angela Beenen said she had lab-testing experience, so knew to buy her own protective gear, including goggles from Bunnings, as they did not have enough equipment.
"Coming from a laboratory setting, it's a bit of a joke really, especially if we're supposed to be taking this seriously," Beenen said.
Manawatū has five confirmed cases of the virus.
Beenen is worried her colleagues don't know how to properly wear the little protective gear they have been provided by the home care agency.
She got four masks, five pairs of gloves, a small bottle of sanitiser, and a plastic apron - "that looks like a rubbish sack you cut up the side and put on" - to last till further notice. She visits 10 clients most weekends.
"The director said 'This is all we've got. We've divvied up what we have in the place and we haven't been given anything by the district health board yet'," Beenen said.
RNZ has approached the agency for comment.
Beenen said the lack of gear exposed to risk their many elderly and vulnerable clients.
Each care worker should have a proper protective gown they left at each house they visited, she said. She had bought her own gowns years ago.
Supply not arriving fast enough to meet demand
The major supplier to the DHBs told RNZ the difficulty getting gowns was despite New Zealand health authorities lifting the cap on what they are willing to pay for PPE by between 10 and 80 percent.
The World Health Organisation declared a global shortage of protective equipment stocks weeks ago.
This was forcing up prices, pitting one country's supplier against another or against deep-pocketed multinationals, the supplier said.
Many Chinese factories that had made gowns were now making masks as this was more profitable.
Factories in Wuhan which had restarted work on gowns had then closed again when a worker tested positive for Covid-19, they said.
Wuhan is both the epicentre of Covid-19 and the world's major manufacturing site of gowns.
Of 30,000 cartons of gowns the major supplier had on order, just 1600 were on a ship, and another 1900 were due to leave China by sea at the end of next week. That meant that of 15 containers on order, only one or two containers could make it per week.
"It will take a long time to catch up," the supplier said.
However, it might be the DHBs were just replenishing stocks at present, and once that was done, the spike in demand would settle back down, they said.
Or if the ministry were to authorise the 20 DHBs to release their pandemic reserves, then that might be enough to tide the country over till the Wuhan factories came back up to speed, they added.
The ministry last night refused to answer RNZ's questions about the pandemic reserves of protective gear, how much is in them, or if they are being released.
The ministry said Bloomfield had addressed the PPE issues at yesterday's briefing when he said supplies were fine.
Its spokesperson said health workers needed to only use protective gear in certain situations, "appropriately".
"That doesn't mean everybody working in a hospital needs to at all times be wearing a mask or be in PPE."
A second PPE supplier told RNZ that finding gowns was "challenging", but they would not elaborate.
As for masks, the local manufacturer the ministry relies on, QSI in Whanganui, has on its website a mask shortage alert saying its stocks of procedural and surgical masks are "nearly out". The alert is dated late January.
RNZ has been unable to contact QSI so far.
Prime Minister Jacinda Ardern said yesterday there were millions of face masks available but she was seeking assurances the distribution chain was working, after seeing comments about this.
Bloomfield told the briefing the ministry was making sure the distribution chain was "rock solid" by putting it under national control.
The Nurses Organisation has called for all nurses in hospitals and primary care to be given personal protective equipment, with some nurses saying they don't feel safe at work without it.