Early in the country’s Level 4 lockdown, questions are being asked about PPE supplies. David Williams reports
The Health Ministry assures New Zealanders it has at least eight weeks’ supply of personal protection equipment (PPE) based on high pandemic usage. But already questions are being asked about the ministry’s opaque language and numbers, and PPE supplies being “drip-fed”.
Darryl Carpenter, the ministry’s group manager of Covid-19 immunisation, testing and supply, says it’s confident it has good PPE stocks to respond to the current outbreak – which on Friday grew to 31 cases, and moved to Wellington – and hospitalisation scenarios.
The ministry’s “national PPE supply chain” currently holds close to 18 million N95/P2 particulate respirators, 285 million medical masks, 18 million isolation gowns, 1.6 million face shields, 280 million nitrile gloves. It also has “good” volumes of hand sanitiser, disinfectant wipes and other items of PPE used across the health and disability sector, Carpenter says.
That’s at least eight weeks of stock “based on forecast usage at high pandemic volumes”, Carpenter says.
But as the country discovered last year, when the Covid-19 outbreak took hold, there can be a difference between stocks in reserve and what’s being doled out on the ground.
On Friday, NZ Nurses Organisation said it was concerned about primary care nursing staff – those in medical centres, emergency clinics, and testing stations. “We are already hearing alarming reports that PPE supplies in primary care, such as masks, are running low or being drip-fed; and mask fit-testing, which is essential to proper protection, is not occurring,” said NZNO kaiwhakahaere Kerri Nuku in a statement.
Nuku tells Newsroom: “We are wanting to ensure availability and supply of N95/P2 masks, and that testing has been done to ensure frontline teams are protected, and that PPE will be mobilised and made available and distributed in a timely fashion across the health sector (not just DHBs, as the current focus is largely in the primary health frontline testing and vaccination programmes, as well as emergency care).”
She adds: “We are hearing that in some place/practices access to swabs to meet community demand has created some problems.”
Last year, the Aged Care Association called out the worst DHBs for not distributing PPE to its members, including Canterbury’s DHB – home to the country’s most deadly cluster. Association chief executive Simon Wallace tells Newsroom: “At this stage there are no issues with PPE.”
Pandemic researcher Wendy McGuinness, head of Wellington think tank the McGuinness Institute, picks up on Carpenter’s phrase “national PPE supply chain”, as opposed to her go-to for PPE information, the national reserve supply.
Newsroom asked the ministry to clarify how much equipment was actually in the national reserve but it didn’t respond.
Carpenter says community care providers can access a centralised portal, established last year, to order PPE directly. “The ministry has established a twice a day ordering and distribution process across the health and disability sector.”
On August 6, the ministry asked health and disability providers to review their PPE contingency stock, Carpenter says. “Health and disability providers were invited to place orders for additional PPE, via the ministry portal, so that they have 1-2 weeks of PPE supplies.”
“NZ must have received a significant order in the last four weeks to get to 18 million today. This is very good news.” – Wendy McGuinness
Pessimism about public messages on PPE supplies could possibly be forgiven. Last year exposed difficulties in our devolved health system.
In last year’s national lockdown, district health boards were refusing to give PPE equipment to community support workers, despite promises from the Government.
The ministry was slow to change its guidelines – which would have encouraged DHBs to open their cupboard doors more quickly.
While DHBs held PPE in the national reserve, according to a report from Auditor-General John Ryan DHBs hadn’t had to report stock levels to the Health Ministry since 2016.
In March of this year, the ministry said it had “responded appropriately” to many of the recommendations in Ryan’s report – although not the one about regular public reporting of the national reserve.
McGuinness notes the national reserve webpage had 11 million P2/N95 masks on July 19. (The page was updated on August 13.) “NZ must have received a significant order in the last four weeks to get to 18 million today. This is very good news.”
Eighteen million is, in McGuinness’s view, a minimum baseline. “I also suggest better quality masks (above P2/N95) are essential for those working in hospitals dealing with Covid patients.”
The number of face shields (1.6 million) and nitrile gloves (280 million) “may be on the too-low side”.
“Regarding the move to a centralised system for the national reserve supply; we were and continue to be a strong advocate for the centralised system MOH put in place last year.” The Auditor-General reports have been instrumental in improving logistics, she says.
NZNO represents more than 51,000 nurses and health workers. Fifteen percent of its members were surveyed in April and May this year about PPE use and supply.
Based on those findings, the McGuinness Institute put forward myriad recommendations. They included: monthly updates of the national reserve, including separating out ministry-held and DHB-held pandemic stock; including minimum stock levels and expired stock; and including all equipment, such as infusion pumps, ventilators, and consumables.
Other recommendations included listing a detailed product description of each item, as quality may vary, and the size and fit of equipment like masks, gloves, and gowns. The Government should also explore and support domestic manufacturing options.
“Delta is different,” McGuinness says, “and it will be hard work to get on top of this emerging situation. My view is it can be managed but it will take a long lockdown.”
In mid-August, the Covid situation in this country was so settled – despite a pause in the trans-Tasman bubble because of the Covid outbreak in many Australian states – the Government announced a risk-based, border-opening plan, to be rolled out from early next year, with a small trial of self-isolation, instead of two weeks of managed isolation, for some returnees.
Now, the country has once again moved hard and early to beat Covid-19. Some of the big questions are, what have the Health Ministry and DHBs learned, about PPE in particular, from the last country-wide Level 4 lockdown, and are we actually better prepared this time than last? The answers will soon become apparent.