It took two days after the first confirmed cases at Rosewood rest home for Canterbury DHB staff to visit. David Williams reports
The first case of Covid-19 at Christchurch’s Rosewood rest home was confirmed on April 3, a Friday, late in the afternoon.
The Rosewood case was “reported”, in healthcare parlance, about 24 hours after the specimen arrived at the lab.
Canterbury District Health Board’s infection prevention and control service, whose job it is to “minimise the occurrence and spread of infection”, phoned Rosewood with the result late on Friday. (In fact, DHB chief executive David Meates told Checkpoint three days later “a number” of patients tested positive on Friday night.)
It was a huge problem for Rosewood, the 64-bed rest home and hospital, situated just east of the central city, in Linwood. The cases were confirmed in the worst possible place – its specialist dementia wing.
The response from Rosewood was to isolate staff, as they were close contacts of the confirmed cases.
“That was appropriate,” the DHB says in an anonymised statement sent to Newsroom late last night. But, as you’ll read later, other procedures were not.
On April 3, public attention was on another Christchurch rest home, the 81-resident George Manning Lifecare & Village in Spreydon, which had its second confirmed case.
Over the weekend of April 4 and 5, the DHB was in contact with Rosewood via phone and email. “The infection prevention and control team liaised with Rosewood and the relevant community and public health team, the gerontology nurse specialist as well as the emergency coordination centre (including the incident controller),” the DHB’s statement said.
On Sunday afternoon, at the Beehive theatrette in Wellington, director-general of health Ashley Bloomfield announced a new significant cluster in Canterbury, but with no further information.
The Ministry of Health’s website later identified the cluster as being at a Christchurch rest home, with 10 cases. A DHB spokeswoman told the Christchurch Star that didn’t mean all cases were in the home itself. She wouldn’t name the home.
DHB representatives from its infection prevention and control service, and its “nursing director, older people”, visited Rosewood during the day on Sunday, “to assess the situation and advise in person”, the DHB says.
Things escalated quickly.
Temporary manager appointed, residents moved
DHB boss Meates phoned Bloomfield on Sunday night. A plan was hatched to move all 20 dementia unit patients to Burwood Hospital, where the nursing director, older people, is based.
At the Wellington media briefing on Monday, April 6, Bloomfield confirmed Rosewood as the cluster, with 15 confirmed and probable cases.
He said of the 20 people transferred to Burwood: “It’s not because they need hospital-level care; it’s because the assessment of the clinical staff was that was the most appropriate place where they could get appropriate daily supervision and care.”
Meates’ tone in a statement on Monday afternoon seemed relaxed and matter-of-fact.
It talked of a deep clean at Rosewood “before the residents move back, when the DHB knows that all residents are clear of infection”.
The DHB had only appointed a temporary manager because the facility manager had to self-isolate. Additional experienced staff were being sought for Rosewood and while further relocations of the remaining 44 residents were possible “this is not the current plan”. (That did happen.)
Meates told RNZ’s Checkpoint programme on Monday evening the confirmed and probable cases at Rosewood were 16 – four residents and one staff member confirmed, with eight residents and three staff members listed as probable.
On Good Friday, a week after the first cases were confirmed at Rosewood, the Ministry of Health called an unscheduled press conference to announce the second New Zealander had died from the virus. She was a woman in her 90s, originally from Rosewood rest home, being treated at Burwood Hospital.
‘Issues regarding safe practice’
Repeating similar comments made earlier this week by its chief medical officer, Sue Nightingale, the anonymised statement sent last night says the DHB will complete a review of Rosewood’s systems and processes “as soon as it’s appropriate to do so”.
But problems are already apparent.
Mirroring a statement sent to the NZ Herald on Tuesday, the DHB statement says: “In the demanding context of managing a cluster of frail elderly residents, a significant number or staff needed to be isolated because of exposure and this highlighted a number of issues regarding safe practice, including the way PPE was used.
“Canterbury DHB is increasing support to the aged residential care sector in Canterbury with teams of experts in caring for the elderly and in infection prevention and control going out to give further support and guidance as we work together to protect the safety of residents and staff.”
The reason for moving 20 “frail and elderly people” to Burwood was to ensure they were more effectively isolated, and they received the best and safest care while Rosewood staff were isolated, the statement says.
The DHB will use what it has learned from its “Covid-19 experience” to try and help residential aged care facilities keep the virus out. When it does get in, it’ll be managed effectively, the statement says.
It notes the pandemic is unprecedented. “Dedicated managers and staff in these facilities have been working pro-actively with us to keep their facilities safe through restrictions on visitors and infection and prevention measures such as hand hygiene, environmental cleaning and disinfection and the use of PPE to reduce the risk of transmission of Covid-19.”
Rosewood’s owners, Christchurch couple Malcolm and Lynda Tucker, say they’re under instructions from the Canterbury District Health Board not to say anything. But several sources have raised concerns about staff access to protective equipment (PPE), and associated training, leading up to the facility’s first confirmed case on April 3.
“It’s not appropriate to use testing as a routine screening tool for asymptomatic people.” – Josh Freeman
Josh Freeman, Canterbury DHB’s clinical director of microbiology, says in the statement sent late last night: “It’s not appropriate to use testing as a routine screening tool for asymptomatic people.”
He points to a consensus statement from the NZ Microbiology Network, which comprises consultant clinical microbiologists representing every diagnostic laboratory in the country.
The statement says: “Testing asymptomatic persons exposed to SARS-CoV-2 has a very limited role as it’s essentially only as good as the day it’s performed.
“To be assured that asymptomatic persons exposed to coronavirus remain free of infection, testing would be required daily for the 14 days since the last exposure.”
(Bloomfield said yesterday 46 of 107 healthcare workers infected by Tuesday had contracted Covid-19 while working.)
There are now significant clusters at six aged care facilities across the country.
An investigation into rest homes with confirmed Covid-19 cases was announced by Bloomfield on Tuesday. Mounting concerns over outbreaks at rest homes have prompted Chief Ombudsman Peter Boshier to bring forward planned inspections, sending an expert team to make them urgently.
With Canterbury DHB also conducting a review of Covid-19-affected facilities, it’s likely the public will have a while to wait before it gets a more definitive picture of what happened at Rosewood.