A critical review from the Government’s real-time advisory group says the Ministry of Health should not have abandoned its goal of being able to contact trace 1000 new cases a day, Marc Daalder reports
ANALYSIS: A large outbreak of Covid-19 could see contact tracers quickly overwhelmed, according to a review of the February Auckland cluster by a top government advisor.
The Covid-19 Independent Continuous Review, Improvement and Advice Group (IAG) was set up by Covid-19 Response Minister Chris Hipkins in March. He tasked it with reviewing the Government’s response to the February outbreak at first, but it will now provide real-time advice on the response and how New Zealand might open up to the world.
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That first report from the IAG, which is chaired by Sir Brian Roche, was released by the Government on Thursday. It is complimentary about some aspects of the response but said other long-standing issues have yet to be addressed. Roche was also the author of a number of other reviews of the Covid-19 response commissioned by the Government last year and he said the recommendations of some of these reviews are still outstanding.
“Several recommendations from previous reports remain to be acted upon and others have not been completed. Some decisions about what is important and not important have been made by the Ministry, against previous recommendations, with limited external peer review and accountability,” the IAG report found.
Contact tracing could collapse
However, the most important findings of the review related to the system readiness for future outbreaks.
The review warned that the Ministry of Health was wrong to have abandoned plans to be able to trace the contacts of up to 1000 new cases a day.
“Despite the previous recommendations about the Covid-19 Response System’s capacity in multiple reports, the ministry appears to have been developing advice based on the assumption that the need for capacity to surge to be able to trace the contacts of 1000 cases per day is now obsolete,” the report found.
Given that places with similar populations, like Melbourne and Singapore, had experienced outbreaks with nearly 1000 cases a day, New Zealand must be prepared to deal with the same.
“None of these outbreaks appear to have been due to new variants, which now complicate the picture further. Even if a lockdown back-up is actioned, Public Health Units (PHUs) will still have to do contact tracing around all cases of an outbreak,” the review stated.
“The risk of a large outbreak in New Zealand is real. If an outbreak is advanced already when it is detected, or an early aggressive approach fails, the ‘back-up’ surge capacity should continue to be substantial. In our view, if one uses 10-30 close contacts per case as a guide, we agree with the previous report of September 28, 2020, which suggested that New Zealand would struggle to maintain high system performance of contact tracing for a prolonged period with 100-200 cases per day.
“It is not clear at all how long New Zealand could sustain the early aggressive approach. We do not agree with the ministry’s assertion stated to us that it is not necessary to increase the standing or surge capacity in New Zealand or the assertion that this is not possible because there is a lack of an available workforce.”
In fact, it is likely that future cases might have even more contacts. Nearly 6000 contacts were involved in the February outbreak, for just 15 cases. And the Sydney man who visited Wellington while infected with Covid-19 in June produced more than 2600 contacts on his own. At that rate, even an outbreak of just a few dozen new cases a day would quickly stretch contact tracers to their limits.
Associate Health Minister Ayesha Verrall, who first made the recommendation that officials be able to trace the contacts of 1000 new daily cases in an independent review before she became an MP, declined to speak about the issue on Thursday.
Other issues also raised
Another major finding of the report was that independent experts should be consulted more readily.
“The ministry has disbanded Technical Advisory Groups (TAGs), other than the one for vaccines, and now will seek advice from experts at their discretion and is not necessarily accountable with respect to how it responds to this advice.”
At least two “major incorrect decisions” had been made which could have been avoided if outside experts had been involved.
Workforce fatigue was also understandable but could imperil a future response, the review said.
“We identified evidence of tiredness and burnout across he response, at all levels. Many individuals volunteered that they were tired and burnt out, others stated on questioning that they were tired, and others manifested clear signs without necessarily recognising it themselves or attributing them to tiredness and burnout,” the review found.
“Staff were clearly placed, or placed themselves, under unreasonable time pressure even between outbreaks. We noticed reduced capacity, compared to previously, within the ministry in particular to consider that an approach might not be the right one, to weigh up alternative approaches, or to be self-critical in depth. The default position was defensive and not reflective.”
Other significant recommendations included advice that the Government improve internal lines of accountability (a familiar theme from Roche’s past reviews), clarify communications with the public and do more to plan for large outbreaks. Past advice that the system be stress-tested had been ignored, with the Ministry of Health evidently deciding that its responses to real outbreaks were sufficient.
“There is confusion about the label ‘stress-testing’. A real outbreak should not be seen as a formal ‘stress-test,’” the review stated.
The Government appears to have taken some of the advice on board more readily than it had in the past. A blueprint produced by the Department of the Prime Minister and Cabinet shows a schedule for when new, specific scenario plans will be completed over the coming months. By December, eight plans detailing specific responses to different scenarios (like an outbreak involving a school or an apartment block) will have been written up.
The NZ COVID Tracer app was also found to be of limited utility due to low usage rates. Just five of the 15 cases in the February cluster had used the app and just two contacts were traced via the Bluetooth proximity function. One of these contacts, exposed on a beach, was considered to be low-risk and shouldn’t have been counted as a contact, the review said.