22 Apr 2020

Epidemic Response Committee challenges government's health response

2:32 pm on 22 April 2020

The Epidemic Response Committee has heard today from those in health and care services about whether they have been well served in the government's response to Covid-19.

Watch the Epidemic Response Committee meeting here:

Today, the NZ Medical Association, Aged Care Association, Pharmacy Guild, Disability Support Network and Dental Association have made submissions to the Committee, which assesses the government's response to the coronavirus.

The ERC is chaired by opposition leader Simon Bridges.

GPs worried about low number of consultations

NZ Medical Association chair Kate Baddock says people fear catching the virus and do not perceive the importance of continuing to be seen for other conditions, so have not been getting consultations.

She says as far as she knows "cancer screening is not being carried out currently".

"My much greater concern is that patients are not coming forward because of the restrictions and their perception that their problems can wait."

Yesterday, general practitioners said the government had backtracked on the funding it had promised them, and was only providing half the $22m it said it would to help with costs related to the virus.

Dr Baddock says because that third tranche was held back by Cabinet, some practices will likely not survive.

She says there are some GPs who are going to be out of work by the end of the week.

"We are very much hand to mouth in terms of cash flow ... when that cash no longer flows because we have delayed payments because of virtual consultations ... that cashflow which funds out staffing requirements is just not there."

She said the ministry, DHBs and minister all agreed on the funding before lockdown but "have reneged on that expectation".

The flu vaccine supply issue "was a complete debacle", Dr Baddock said. "There's absolutely no doubt about that".

She said because flu vaccines were held back for those who were more vulnerable, it meant GPs were unable to access them - even though they served many who were vulnerable.

She said they held a couple of days supply and it got resupplied every couple of days, but the ministry needed to be managing the supply more closely.

"I don't want to see what happened with flu, happen with a Covid-19 vaccine."

The Auditor-General also announced a review of the government's management of personal protective equipment (PPE).

The move was welcomed by the E tū and nurses' unions, who said supplies of PPE had been a problem since the outbreak began, and although DHBs had been active in responding to complaints it was a shame they had to be raised - either directly, or in the media - in the first place.

Dr Baddock says there is now much clearer communication about use of PPE, and much better supplies, but GPs have struggled to deal with that in the last four weeks.

Michael Woodhouse has asked about the recycling and reuse of PPE in Auckland hospitals. Dr Baddock says they know N95 masks have been resterilised overseas where supplies are low. "Is that best practice? Obviously not." She says it's unclear from overseas evidence whether the recycling of masks is effective and safe.

Labour list MP Dr Liz Craig, a former practising doctor, thanked Dr Baddock for the quick transition to virtual consultations, and asked about what has been learned from it and what would be good to retain as the alert level drops.

Dr Baddock said it was clear that many consultations - about 50 percent - could be easily had remotely. She said about 80 percent of consultations are being held remotely under level 4.

"My best guess would be in a post-Covid world that it would be more like 50-50 ... for those that are less technology literate the telephone is a very good tool."

She says some people have said they find they can be more candid in telephone consultations with things they might be embarrassed about face to face.

She reiterated that her main concern is that people are putting off consultations during the lockdown.

Call for aged care residents to get testing: 'Why would you not test?'

Aged Care Association chief executive Simon Wallace says they are concerned that residents and staff are not being routinely tested when they do not have symptoms.

The people in their care may not have a cough or a sore throat but they often have a range of underlying health conditions and should be tested, he said.

He says Austria is testing all aged care residents.

"Why wouldn't we be doing this if we have the capacity for our most vulnerable population".

"If the likelihood is low but the severity is high, as it is with Covid-19, why would you not test. Test, test, test."

"It just seems that it is completely crazy to me that we are not testing these people".

He says the Aged Care Association's position on testing is for testing all new admissions before they come in and testing all front-line workers.

Wallace says many members are still not able to access PPE, and some have had to buy it themselves at considerable cost.

He says the association had to agitate "DHB by DHB" to get access to PPE. He says the situation is much improved but there are still one or two pockets or DHBs where members have still been unable to get PPE.

They still have no detail about the $26m announced for provision of PPE supplies on Saturday, he says.

Wallace says what's pressing for the industry is not so much about income - the income stream has probably stayed much the same - but the aged care sector is facing much increased costs relating to dealing with Covid-19.

National MP Tim Macindoe asked whether three audits the aged care sector is facing are not endangering staff and residents.

Wallace says some of the audits have been so confrontational that aged centre managers were in tears and it was placing a huge amount of stress on services as well as increasing risks of infection. In one case the auditors arrived without wearing any PPE themselves.

Wallace says the association's decisions to apply 14-day isolation and to go into lockdown were in fact followed by the Ministry for the rest of the country.

ACT leader David Seymour asked about how the association's dealings with the Ministry of Health. Wallace said they had been working very closely with the ministry.

He said aged care homes were not likely to lower their lockdown restrictions regardless of the lowering of alert levels.

"We will be in lockdown until there are no new cases."

Wallace said there were also 500 internationally recognised nurses waiting for visa conditions to allow them to start work with aged care centres and they were still waiting on them to be able to work.

Green co-leader Marama Davidson asked about how aged care workers can be valued better. Wallace says the settlement brought in by the previous government for aged care workers was hugely helpful but nurses in aged care are paid about $10,000 less than a comparable position in a DHB.

He says the government has a responsibility to pay nurses equitably.

Pharmacies 'in the red ink'

NZ Pharmacy Guild chief executive Andrew Gordon said community pharmacies had incurred significant costs and seen income drop significantly.

Pharmacists have not heard from the Health Minister or the Director-General of Health, he said, and were not able to communicate with the ministry until several days into alert level 2.

"Pharmacies ... most of them are in the red ink and it's only so long before they can't afford to pay the bills, they can't afford to pay staff."

He said community pharmacies have faced 'years of neglect' because sale margins for medicines are very low. He says retail is down about 20 percent.

"It needs attention immediately. We thought it needed attention three weeks ago. We're pulling our hair out."

National MP Michael Woodhouse has asked about the advice about PPE for pharmacists. He said guidance provided by the ministry seemed inconsistent and no PPE was advised for dealing with people who had not Covid-19 symptoms.

Gordon said that in a lot of situations they did not need to have PPE but it took a lot of effort and time to update the advice on PPE for pharmacists.

He said pharmacists were very concerned at the inconsistent advice initially and had to iron the wrinkles out with the ministry.

Gordon also said pharmacists have had to deliver medicines to vulnerable populations.

Disability Support short on PPE and staff

Disability Support Network chief executive Garth Bennie said disability support workers' status as essential workers continued to be challenged by police and others, and they have been facing contradictory advice about PPE.

"We do not have a national PPE distribution system, what we have is 20 distributions systems," he said, referring to the DHBs.

Providers are experiencing delays in accessing PPE, the amounts they order via DHBs are not being provided in full, and there has been reluctance from some DHBs to provide PPE in places where there have been no symptoms.

"This has led to many investing in their own PPE because of uncertainty about funding and uncertainty about supply."

He said they had so far seen no details about how disability support workers could even be reimbursed for supplying PPE themselves.

Support workers "absolutely" should be considered essential and should be given access to supermarket priority queues.

He said although they did not always wear uniforms or carry photo identification, they had been given letters to allow them to access these queues but they have not always been accepted by police or supermarket workers.

"The risk for many disabled people is very similar to those in the aged care sector ... those with underlying health conditions, and the attention on the disability sector has not been what it needs to be."

He said residential services are homes for disabled people as well as workplaces, and the management of the expansion of bubbles under level three is going to have to be managed very carefully.

He said early ministry advice on leave subsidies was that disability support workers not be reimbursed for leave and many - because of age or vulnerability - had not been working or been paid, which led to some providers losing 30 percent of staff.

He said this loss of workforce has been the greatest costs services have faced, and compounded with longstanding funding shortfalls is set to create significant financial difficulties.

Dental Association: Delayed oral surgeries may mean 'public health crisis'

NZ Dental Association president Katie Ayers said lower socio-economic groups would often leave dental treatment until oral disease was well advanced, which poses a crisis in public health.

She said Māori, Pacific and new immigrant populations face significant barriers to accessing good oral health, especially in rural and remote locations.

She said there was now at least one patient in intensive care because of delays to oral surgery, and had four operations under general anaesthetic to control an infection in his mouth and neck.

"The mouth is just another part of the body, and can also need treatment."

Because dentists were unable to do more minor procedures to preserve teeth under level four, she worried people would resort to tooth removal.

Dental practices did not have advice about what dental practice would be allowed under level 3, Dr Ayers said, and were still facing PPE supply problems.

She said full PPE was required even for treating things like mild toothache, and if treatment is delayed that can get much worse.

DHB supplies of PPE have been patchy and delayed. At least 80 sets of full PPE would be required for dental work per day, and some DHBs had not provided any PPE to dental services in some areas.

In the middle of March, N95 masks imported from the US were about $2, but now were costing about $6 and coming from China, some of which had been proven to be ineffective.

The cost to produce enough PPE for a single use was about $80, she said, and while it was not fair to lump this onto patients, dental practices also cannot sustain the costs.

While 12 percent of dental practices have made staff cuts, 45 percent expected to do so in the next couple of weeks, and many practices faced bankruptcy within a month.

Eliminating Covid-19 would be among 'NZ's greatest achievements'

Finishing today's ERC meeting, Sir David Skegg said New Zealand has made considerable progress in the past three weeks, border restrictions have been improved, testing criteria have been broadened and widespread testing rolled out and deficiencies have started to be addressed.

He said perhaps the most important development was the government clarifying its goal to elimination of the virus, not just control or suppression of it.

"We would see elimination, I hope, as a permanent thing. Suppression is not."

Several measures would be essential to elimination, he said:

  • "Active surveillance" - testing across the population
  • Contact tracing must be ramped up
  • Progress must be made on a technological solution - an app or similar to augment contact tracing. An 'opt-out' option would be far more valuable than an opt-in
  • Fourth, perhaps most important as all, the behaviour of New Zealanders.

Sir David said he could not help feeling that most of the problems talked about today would disappear if the country was successful in eliminating the disease.

However, the fact clusters like the country's worst - the Bluff wedding which has infected 96 people and led to two deaths - was proof that the public health systems in New Zealand had in part failed.

Australia's health guidelines and systems seemed to be ahead of New Zealand's, he said.

"That is hardly surprising because Australia has not run down its public health capacity as has been the case in New Zealand both by Labour and National governments."

Despite New Zealand's low-ranking health system, high social cohesion and acceptance of the far more stringent lockdown measures meant New Zealand was now in a position to be able to eliminate.

Australia was also hoping to also progress towards elimination, he said, but it was now out of reach for the US and Europe.

"If we are successful, this will be one of New Zealand's greatest achievements."

He says the initial community testing was not well planned and needed to be done more carefully. He said bigger sample sizes and more targeted testing were needed, but did not advise using antibody tests yet.

He warned against complacency, saying in some of the earlier meetings he had talked about how well Singapore was doing, but in recent days had gone to 900 new cases in a day.

He said many of the clusters were in migrant worker populations there, and New Zealand had some similar problems with people in deprivation.

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