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Please sort this out MoH

Written By: - Date published: 1:18 pm, April 12th, 2020 - 85 comments
Categories: covid-19, health, health and safety, workers' rights - Tags: ,

Newsroom are reporting on the denial of PPE to frontline workers providing care in the home to many New Zealanders, often the elderly and disabled people, work that includes close contact personal cares where a 2m physical distance isn’t possible.
 
At the end of March, Ashley Bloomfield promised home care workers masks, gloves and gowns to keep them and their clients safe from Covid-19. Almost two weeks later, why are so many still going to work unprotected?

It’s a somewhat complicated situation where we appear to have enough masks in NZ for home care workers, but there’s a disconnect between supply lines and the DHBs releasing kit to workers. The sticking point appears to be the Ministry of Health’s online advisory telling everyone that they only need a mask if their client has covid or has had close contact with someone with covid. Yet, the Ministry’s CE and NZ Director-General of Health Ashley Bloomfield is saying the opposite.

Support and care workers have been reported by Newsroom as the professional group with the highest rate of covid infection in New Zealand.

This seems like a straight forward thing to sort out. I’m tempted to say the problem is a consequence of a government department overstretched by the pandemic, but I think this is also chickens coming home to roost for a health ministry that has long been failing culturally and administratively in a number of areas related to disability. Needless to say it’s not the planners/managers that will end up wearing the shit.
 
I look forward to the MSM going all Tova on this in the daily briefings in the coming week. And no, don’t go after Clark’s head, ask the MoH, because that’s where the immediate fix is that will help protect workers and their vulnerable clients.
 
Update: in today’s briefing from Ashley Bloomfield (link and time stamp in comments), there were no questions specific to home care PPE. There were some general questions that Bloomfield answered as residential care issues.

For those that aren’t aware, there are many New Zealanders who require at least daily care that involves close contact. There are already reports of staff shortages because of workers becoming unwell or having had close contact with people with covid. But also people losing their support workers because the worker doesn’t have access to PPE. Some people are choosing to have care without adequate PPEs, or are forced to because there is no other choice.

The MoH yesterday published a PDF guide Keeping disabled people and their support workers safe,
 
The Ministry of Health is currently working with District Health Boards about supplying PPE to health and disability service providers including community and disability health workers. District Health Boards are now communicating with disability organisations to let them know how this will work. Contact your disability provider if you have any queries about PPE
 
However as Newsroom pointed out, the link to the MoH guidance Personal protective equipment (PPE) used by community care providers for prevention of COVID-19 still says that workers don’t need to be wearing masks even if doing physically close support work.

85 comments on “Please sort this out MoH ”

  1. Ad 1

    Ashley Bloomfield did extensive commentary on this on RNZ 20 minutes ago.

    [to clarify, the issue of home care workers, clients and PPE was not addressed at all in the briefing. There were some questions about issues in residential care, especially aged residential care – weka]

    • weka 1.1

      Oh good. Will catch up soon.

    • Carolyn_Nth 1.2

      I'm pretty sure Bloomfield didn't talk specifically about home care workers.

      He talked a lot about the instructions to DHBs about how to manage residential homes for the elderly.

      I thought he was talking about other frontline workers in institutions, when he said that frontline workers needed to be adequately trained in when and how to use PPEs, before using them. I think he also said it's not appropriate for all frontline workers to use PPEs on all occasions – maybe if they are not in close contact with individuals for more than 2 minutes?

      Partly, I think it is quite a lengthy procedure to put on and take off full PPEs ie done in a specific order, from feet up, and washing hands between putting on each bit of PPE. (saw an RNZ video showing this).

      When I had a face-to-face consultation with a GP on Monday, the GP had on full PPE gear. He had as little contact with me as possible – ie with implements like stethoscope, and a temperature & blood pressure check by putting this thing in my ear.

      The nurse who gave me a flu shot, had no PPE on, including no mask. She wasn't near me for more than a minute.

      I was wearing a mask that the GP gave me.

    • lprent 1.3

      Added this so that I could have a look at the video

      • weka 1.3.1

        First mention is just after 31 mins. It's a poorly worded question (talks about care workers, not home care workers). Bloomfield doesn't get it yet and just denies the problem. Subsequent question and his answer are focused on care facilities not home care.

        Listening to the rest but they appear to have moved one.

      • lprent 1.3.2

        He talked a lot about the instructions to DHBs about how to manage residential homes for the elderly.

        It sounds like that was the key point. Nothing in there about home care workers that I have heard so far up to 25m

        BTW: They updated the guidance to aged care yesterday. That would be worth looking for.

        • lprent 1.3.2.1

          Something at 30m. But about moving between areas with home care.

          • weka 1.3.2.1.1

            just finished listening, there was nothing in the whole briefing about home care issues.

        • weka 1.3.2.2

          I've updated the post with the links, but tbh, I just feel like I'm going round in circles. Afaik, the MoH and DHBs are still saying no masks are needed, care workers and disabled people are saying they need them.

          • lprent 1.3.2.2.1

            Sort of Kafkaesque. I often feel this way when dealing with most large organisations, public and private. There are almost always discontinuities between the policy and what actually happens in practice.

            Generally I find that just making sure that it gets expensive and/or embarrassing will eventually fix the problem. In this case, embarrassing is the correct response based on the health risks and time factors. It is also why I bumped this post to the top.

            • weka 1.3.2.2.1.1

              Hopefully there will be some movement this week, but I will look at doing another post in a few days.

            • Rosemary McDonald 1.3.2.2.1.2

              "…sort of Kafkaesque. "

              In early 2018 I made an OIA request to MOH for '…..details on work the Ministry had done with regards to this discussion document circulated in 1999.'

              The document in question discussed the issues surrounding a small but significant group of disabled people living in the community who's care needs required skills and expertise closer to a registered nurse or enrolled nurse. These care tasks were being performed by untrained carers from a largely unregulated industry. The term Advanced Personal Care was used. (This was part of an ongoing engagement with MOH:DSS described in various posts by myself and others over on Public Address in the Access section.)

              Long story short…there had been no work done on addressing the issues raised in discussion paper other than the Ministry Pontius Pilating their way out of the problem by simply refusing fund this level of care.

              Problem solved. 'If we don't fund it we're not responsible.'

              What we did get sent instead of discussion papers or policy work was a cache of emails between Wellington based MOH bureaucrats, NASCs, Contracted Care Providers and in one case one of the spinal rehabilitation units. This last one was relevant to our long running battle against MOH:DSS regarding funding for my C4/5 pre ACC tetraplegic partner. Nowhere had we ever seen a written admission from the Ministry or their agents that they did not fund one particular care procedure through the contracted providers. And there it was…the MOH numpty displaying phenomenal ignorance regarding care at this level and seemed not at all fazed when it was pointed out this was daily care for these people. The bureaucrat's solution was the patient could perform the care task himself, and when the professional explained why the patient couldn't, the bureaucrat said that his wife could do it.

              Hmm. Somewhat undermined one of the arguments used by the Ministry for nearly twenty years for not paying family carers as according to them there was always the option of having a contracted provider do the work.

              We were sent about 5 years worth of emails….you'd have to read them to fully appreciate how seriously fucked up and dysfunctional is the Ministry of Health. Huge concern this current government has given the Group Manager of MOH:DSS special access to Ministers.

              If you want the OIA stuff just for Lockdown shits and giggles….

              Thanks for giving this latest Ministry debacle some prominence.

              • weka

                the sinking feeling I have is that people just don't get what the issue is here, public and MSM. There is understandably a great emphasis on the elderly, but an almost complete absence of even acknowledgement of the home care issues affecting the elderly and disabled people. Not a single mention in the MoH briefing yesterday.

                Having read your stories over the years this doesn't surprise, nor the really messy communication coming from the MoH and Bloomfield on the PPE, especially masks situation. It's entirely typical of the going round in circles, drives you bonkers stuff I've experienced from the MoH too, and my dealings are pretty mild compared to yours.

                I'll put up another post in a day or so, so if you have anything you think should be highlighted about the current situation please let me know. Sometimes I can't keep up with the conversations, so am probably missing bits.

  2. Treetop 2

    When it comes to home care workers the more vulnerable would have less care workers as they would do more hours of care with the person they are caring for. I am assuming this. Restricting the amount of carers to each individual would create a carer bubble.

    Not sure if this would be more effective than wearing PPE. My view is that PPE is required as well as a carer bubble.

    • weka 2.1

      Probably the ideal, but there's already a shortage of workers because they can't work if they have an respiratory infection type symptoms. This too should be a primary focus of the MoH, because it's only going to get worse as we go into winter.

  3. lprent 3

    From coverage outside of Newsroom, it looks like more of being a specific DHB problem.

    What is the bet that there is some kink between what the DHB thinks is a reasonable stock with the home care workers vs what the homecare workers and clients think. Or for that matter with the MoH.

    If the home care are doing what I suspect that they are – moving between 'bubbles' then they really need to use PPE for most of the contact time. You simply don't know when people are shedding virus because they do it before they are symptomatic, and it increasingly looks like people may be completely asymptomatic.

    Anyway..

    https://www.rnz.co.nz/news/national/414042/dhbs-accused-of-rationing-ppe-say-they-re-working-to-distribute-it

    Earlier this week, the Ministry of Health (MOH) widened access to publicly-funded PPE to include all frontline health workers – including home-support workers – but unions say distribution problems continue.

    The Public Service Association, which represents 8000 caregivers and home-support workers, said it was fielding many calls from "very distressed people", who were unable to get PPE.

    It named Bay of Plenty, Southern and Canterbury district health boards as having the most serious "distribution problems".

    The chief medical officer at Southern District Health Board, Dr Nigel Millar, admitted the rapid turnover to multiple users was "a huge step up" for its supply team.

    "But they have taken it on and are working hard and long hours to make it work."

    However, it was important to keep stock on hand in case of "an urgent larger need somewhere in the system", he said.

    "It would be imprudent to have large stocks out with users because they could not be mobilised if needed elsewhere," Dr Millar said.

    "This may give the impression that there is rationing – this is not the case."

    The aim was to ensure the system was "flexible and responsive".

    "It is very disappointing when we do not meet need, or leave people concerned about when the next delivery is. We will continue to improve the system responding to issues by tightening up the system."

    Dr Millar said the priority to protect home care workers and those involved in supporting vulnerable people was "as important as for anyone else".

    "We are all working to the same aim – a safe and effective care system for people who are suspected of having of have Covid-19 which includes protecting staff as they work."

    Good to see the PSA union taking this up.

    • weka 3.1

      The DHBs are saying that they're just following MoH guidance, which according to the Newsroom piece still says the home care workers don't need PPE most of the time.

      So yeah, it could be the DHBs using that as an excuse, or it could be both the MoH and the DHBs thinking the PPEs aren't necessary.

      I'm guessing that the MoH position is based on all the information they have about spread and various strategies for preventing it i.e. they assume that most people in the community are safe. Still pretty risky.

      I know Newsroom quoted the stocks, but I'd like to see the calculation done on how many masks are needed per day by home care workers, and hospital/hospice/residential care facilities, to get a sense of how close to the bone we are and what would happen if we get a major outbreak in the next few months.

      • Nordy 3.1.1

        I would prefer not to guess, but to leave it to those who actually know, i.e the clinicians & those who advise the govt when preparing the guidelines for PPE use.

        There are time when opinion and commentary are useful/contribute to a greater understanding, and there are times when it doesn't.

        One of the problems with some of the the reporting and commentary we see in times like these is that it can distort and drown out the the important advice from people who actually know, the experts.

      • lprent 3.1.2

        …I’d like to see the calculation done on how many masks are needed per day by home care workers, and hospital/hospice/residential care facilities, to get a sense of how close to the bone we are…

        Yeah, and I suspect that when they actually talk to people at the front line of home care about what they think is actually needed for their specific job(s), there is a large discrepancy between the two (both up and down).

        If someone is in-house care then they are different from someone who is dealing with multiple people for a short time. But there will be considerable simplification going on to make the delivery logistics work. The is because the entire health system really isn’t used to doing targeted inventory systems and doesn’t know what many roles outside of the hospital systems should need.

        The same issues have been showing up with GPs who have similar supply/usage issues.

        In this case they’d be better to use a demand model and then document the demand by person. If the demand looks excessive or too light for the role then it should warrant someone checking why. But at present that level of fine control probably isn’t there.

        Holding out stocks to support hospitals in the event of an outbreak is less important than making sure there isn’t an outbreak in the first place.

  4. Corey Humm 4

    My mum is a home care worker and this terrifies me.

    Some of her clients have refused to stay in their bubble etc and there's not much she can do about it.

    The lack of damns the media gives about this will be remembered by me!

    • Shanreagh 4.1

      This is a case where the action is to inform the authorities of breaches of the bubble. The elderly person or person getting cares is putting others at risk, including the carers.

      The solution is to decline to go on providing cares to them until the breach has been looked at. Employers should be on top of this. Appreciate that many employers will not be and that the best idea is to involve the Union if a carer does not want to go to a client because that client has breached the bubble. If the bubble has been breached and the carer has been put in danger then all the masks in the world will not help. I also appreciate that some clients/carers have very close relationships, we had wonderful carers with my Mum several of whom we still are in contact with.

      In the first instance the carer could make a note in the cares book. perhaps to say client may have breached bubble by XXXXX. Then say something like ‘I am checking to see that my safety has not been compromised.’

      • Corey Humm 4.1.1

        Yep mum has informed her work and refused to care for these people at this time.

        It still scares me, I just called her and asked her what her PPE situation is and she said she's still waiting, she's brought her own gear online (which is dubious and she shouldn't be out of pocket for doing her job) this is not the govts fault but it is the fault of a ministry the govt controls. I really hope they sort this out. My mum deals with dozens of disabled and elderly people a week, my fear is that she catches it and inadvertently spreads it , I know ppe isn't the lifesaver people think it is but we should be giving our front line staff,all front line staff, the best gear we have and providing it free of charge.

        Thanks for having her back everyone

  5. barry 5

    and when we step down a level, then anybody whose job brings them in close contact with others should wear masks and maybe gloves. Not necessarily full PPE.

    I look forward to having a haircut, but want to make sure it is safe for me and the professional who supplies the service.

    We need to get a supply of surgical masks in the country and soon.

    • Carolyn_Nth 5.1

      Yes, I won't be going to the hairdresser or the dentist til I'm sure it's safe.

      We keep being told there are enough masks in the country….?

    • In Vino 5.2

      If you have a surgical mask on, are you sure the barber will have access to hair around your ears, etc?

  6. Shanreagh 6

    Newbie here.

    Both PM and DG of Health have said they are happy to look into specific cases and this to my mind is a far better process than to go and 'do a Tova'. She is heavily into 'gotcha' rather helping with problem solving. The thought that journalists are holding onto information that might point to lapses etc until they can ambush a public servant at a press conference once a day fills me with horror. Surely their first point of call as humans, is to alert the authorities in a timely fashion rather than being overly scoop conscious with people's lives.

    If DG Health (Bloomfield) or of Public Health (McElnay) are approached they can be working on this rather than having to respond at a press conference.

    Parent had a home cares for 10 years. Some of the odd responses to things that were troubling her carers that she discussed with them, were very much to do with the organisations who had the contracts to provide home cares ie the employers of the carers.

    If a home carer is not either being provided with PPE, where it is deemed appropriate, or the training on its use then going to their employer is the first thing they should do. If a refusal then either DHB or DG of Health. Involving the Union in either or both of these actions is a good idea.

    I am aware of differing views about masks in particular but also of Dr Bloomfield's view (expressed for hospital level workers) about being happy about the level of PPE required.

    I am in two minds about home care workers and masks. Are home care workers saying they are needed as the carers themselves are not sure of their own health status? So they may have a sniffle or cold or think they may be asymptomatic for Covid-19 and still want to go to elderly people in their homes? I would have thought that the employers should have been encouraging workers not to go. Or is the reason because the home carers feel that their elderly people may have Covid-19? The masks we have readily available do not prevent transmission but they do prevent/hinder passing on a mild respiratory illness from a carer that may be very dangerous to an elderly person.

    • Macro 6.1

      Welcome, and thank you for a very good comment. I agree will all the sentiments expressed here. The badgering by Tova is frankly sickening. The officials have been handed a huge hospital pass, and I think that they are doing an immense job in a situation no one would wish on anyone.

      As for the concern wrt to PPE equipment in home care I am also in two minds – Proper use of PPE is not something you just put on and then everything is AOK.

      Furthermore as we see in, so many sad cases of healthcare workers dying overseas, use of face masks, gowns, and gloves is not a 100% protection from infection.

      Fortunately for NZ our relatively small population and the continual testing and contact tracing means that we are getting a very good oversight of just where the hotspots of infection are now likely to be.

      • weka 6.1.1

        the problem there is that the individual disabled person needing close contact care is not necessarily going to be protected by public health measures designed to protect the population.

        "so many sad cases of healthcare workers dying overseas, use of face masks, gowns, and gloves is not a 100% protection from infection."

        Do we know how many of those were using appropriate PPE all the time vs the ones that were infected because of not using PPE? The issue as I see it is about limiting the chance of spread. That some PPE systems failed doesn't mean they are not useful.

        • Macro 6.1.1.1

          Two of my close family (my wife and a sister-in-law) both work, or have worked with people with needs and special needs. So yes I understand completely the nature of their work. One of our close friends is the supervisor for public health care in our region. I happened to talk with her just yesterday about another matter we are currently working on – the provision of adequate care for those who are homeless in our town – but I asked her about this very question. They follow the guidelines set out by the Ministry and they have sufficient PPE for those that require it.

          • weka 6.1.1.1.1

            Are they doing personal cares?

            They're lucky though. There are other workers and clients who don't have access to PPE. If a care worker goes into a house to provide essential support tonight and the client has a new undiagnosed respiratory infection, what is supposed to happen if the worker or client doesn't have masks already? Do they provide care and put themselves and other clients at risk? Or do they leave the client in the lurch?

            • Macro 6.1.1.1.1.1

              Are they doing personal cares?

              Yes.

              I wonder if those who are providing home care and are worried about the lack of PPE are in fact employed under the DHBs or by some private care company or NGO working under contract to the DHB. In which case the matter wrt to the provision of adequate PPE is initially the responsibility of the employing organisation.

              • weka

                Ways that people get home care in NZ:

                • private agencies that have contracts with the government (DHB, MoH, ACC)
                • DHBs
                • private agencies that don't have contracts with government
                • private contracting of care workers
                • conventional, private cleaners
                • family members

                If the DHB is controlling who gets PPEs and how many they get, and they are using the MoH guidelines that say caring for someone with covid needs a surgical mask not an N95 mask, and the carer is also someone who is at risk (eg has asthma), then there needs to be an explanation of why that worker only has one or three masks a day and why a surgical mask is appropriate.

                "In which case the matter wrt to the provision of adequate PPE is initially the responsibility of the employing organisation."

                Did you read the Newsroom piece? My understanding is that the DHB is limiting supply. Not sure how employers can make the DHB change that, and bearing in mind that some of the employers are the disabled person themselves. Some people aren't even employed eg family members.

    • weka 6.2

      The bit about going all Tova on it was a dig at the MSM who were defending Tova in various places on the basis that being able to ask repetitive questions is a sound tactic in getting information from organisations that are reticent about sharing. The rationale was reasonably sound, but let's see if they apply it to something more meaningful than getting Clark's head. My point was probably too subtle.

      "If DG Health (Bloomfield) or of Public Health (McElnay) are approached they can be working on this rather than having to respond at a press conference."

      Have a read of Rosemary McDonald's comments on TS. Her and others have long been pushing the MoH to sort their shit out around disabled people. These issues are not unknown. The MoH would have known about the Newsroom piece. Most people don't have access to Bloomfield or McElnay, so I think the MSM is probably the only way this is going to get the attention it needs.

      "Are home care workers saying they are needed as the carers themselves are not sure of their own health status? So they may have a sniffle or cold or think they may be asymptomatic for Covid-19 and still want to go to elderly people in their homes? I would have thought that the employers should have been encouraging workers not to go."

      There is already a shortage of staff in some places because they're not working due to illness. For people that are highly dependent eg need personal cares and close physical support several times a day it's not appropriate to just say the carer can stay away as if this solves the related logistical problems.

      "Or is the reason because the home carers feel that their elderly people may have Covid-19? The masks we have readily available do not prevent transmission but they do prevent/hinder passing on a mild respiratory illness from a carer that may be very dangerous to an elderly person."

      It's both. The carer or the client could have covid, so it's about protecting both specifically because of the close contact and inability to use physical distancing. There will be situations where both people should be wearing a mask, but obviously a carer who is seeing multiple clients in a day and is doing grocery shopping, maybe has someone in their own bubble who works in a higher risk situation should be taking more care.

      There is also the issue of care workers who are themselves at risk due to having asthma or similar.

      There are different grade masks and different levels of protection. We need to get past this idea that masks can't inhibit spread just because they're not 100% protective of individual transmission. There are also issues around how much virus is in each cough/sneeze/breath.

      One problem with the MoH is that much of what's just happened around this issue is poor communication. I wrote a post about it and it's only later today that I finally understood that where the MoH is saying there are plenty of masks, that's probably based on their current position that not many people need to wear them. That they didn't address the home carer issue today is a real concern. If they don't address it in the next few days, even more so. Because of the actual need, but also because that's just a really shitty way to relate with the disability community.

  7. bill 7

    Is there an assumption that NZ is somewhat alone in not having a severe shortage of purportedly appropriate masks?

    I noticed in a government announcement I read from last week that the provision of PPE was mentioned, but only insofar as gowns and gloves. There was no mention of masks.

    The US has had changes of 'piracy' leveled for offering inflated prices for consignments of masks sitting on the runway ready to be dispatched to countries other than the US. China has been shipping consignments of masks around the world – though that's apparently nefarious. And the US was exporting them even while sectors within the US were screaming for them.

    Sorry, but I'm not going to go hunting down all the links for the info above.

    Then there's this from Thursday's Herald – (that you can draw your own conclusions from in terms of distribution and availability)

    A total 500 tonnes of PPE sourced by health equipment supplier NXP will be brought to New Zealand on five chartered flights over 10 days. The first flight – an Air New Zealand Dreamliner – arrived at Auckland Airport yesterday and a second landed today.

    Millions of disposable masks, gloves, wipes, hundreds of thousands of coveralls, and face shields are in the shipments, according to Kiwi-owned company NXP.

    (….)

    It will be used for essential workers in the police, healthcare and defence force.

    It follows the arrival of a shipment of PPE on Sunday, paid for by New Zealand's Mowbray family, the owners of China-based toy company Zuru.

    Six planeloads of PPE – containing 50,000 sterilised gowns, 100,000 litres of hand sanitiser, 140,000 alcohol wipes and 30,000 face shields, gowns and masks – were set to arrive in New Zealand, Anna Mowbray told Newshub. The stock would be sold to the New Zealand Government at cost.

    At the time Prime Minister Jacinda Ardern welcomed the additional product, saying it would supplement the 400,000 N95 masks produced locally each week at a factory in Whanganui.

    • Grafton Gully 7.1

      No certainty that masks are beneficial.

      "This systematic review and meta-analysis supports the use of respiratory protection. However, the existing evidence is sparse and findings are inconsistent within and across studies."

      https://pubmed.ncbi.nlm.nih.gov/29140516/?from_term=mask+pubmed&from_pos=1

      • bill 7.1.1

        No certainty that masks are beneficial.

        That statement doesn't apply to all masks, but I get your point (reiterated by Carol nth too).

        More importantly (and just for the sake of argument, let's assume we're only talking about appropriate masks) all PPE is single use. And that means the volume/numbers of stuff is colossal.

        For exampleHill, a vascular surgeon […]- “When I’m operating I put on a hat, visor, proper ventilating mask, two pairs of gloves and a full-length surgical gown – six pieces of PPE. So does my assistant, two scrub nurses and two anaesthetists. That’s 36 pieces of PPE for just one operation.”

        A personal carer might get away with using fewer bits of PPE, or re-using some bits ( eg – gloves), but a carer moving around between homes or patients has to throw everything away after every use. And how many such carers are there?

        It's one thing to ask that the MoH sort shit out. But there needs to be shit that can be sorted out. I don't believe we're looking at simple distribution problems, but a dire shortage of appropriate kit. And if that's the case, then MoH (or whoever) needs to front up.

        edit – I should add, that in an environment of widespread testing, the need to assume infection recedes, and the need for a given volume of PPE diminishes – so I’d guess (justifiably or otherwise) that MoH is trying to wing the gap, aye?

        • Carolyn_Nth 7.1.1.1

          In his update on March 2, director-general of health Ashley Bloomfield said that 200,000 masks were being produced locally each day and that the Ministry of Health and DHB stores contained 1.9 million aprons and gowns, 2.7 million pairs of gloves, 60,000 sets of eye protection and 18 million masks.

          March 31st:

          Clark said there were adequate provisions of protective equipment, with 18 million face masks, as well as 5 million masks in national reserves, 2.4 million pairs of gloves and 60,000 eye and face protection items. More was being sought abroad. Hospitals were well prepared, he said, with DHBs confident they can provide 533 ventilated beds. But the system could come under “unprecedented pressure” unless the lockdown was successful.

          So, they are saying it may not be enough if the system gets overwhelmed with cases. Plus, I'm pretty sure Bloomfield has said at some point, that not everyone needs to wear masks, but that some people feel less anxious if they have one even if it isn't necessary.

          It may be that they are being cautious about supplying too many people with masks who don't really need them, because NZ may need them at a later date.

          • pat 7.1.1.1.1

            Im not sure masks are an issue…perhaps other PPE may be, but we have local production capacity that would appear to be sufficient…i.e over 150k per day

            https://www.nzherald.co.nz/bird-flu/news/article.cfm?c_id=560&objectid=12321143

          • bill 7.1.1.1.2

            It may be that they are being cautious about supplying too many people with masks who don't really need them, because NZ may need them at a later date

            That would be my guess. Plus the whole mask efficacy thing. Plus, upthread a wee bit there's a comment quoting the PSA as representing 8000 carers.

            A single carer in a home facility will churn through – how many? – contacts in a single shift – 20…30…40…more? Certainly more than a carer in the community who visits homes.

            Bloomfield says 200 000 masks are produced each day, while the PM states 400 000 M95 masks per week. So Bloomfield's including surgical masks that only deal with "splatter"?

            Anyway. How long for 8000 workers interacting with numerous people over short periods to get through 400 000 disposable M95 masks? And whatever that time scale is, shorten it, because the PSA only has partial coverage in the sector.

            • pat 7.1.1.1.2.1

              the latest that was related to me was no masks (not needed?) …gloves, less than 1/2 typical supply….gowns, zero…uniform (smock) one….makes life difficult when you are working daily

              • bill

                lol Your comments a wee bit too shorthand for me to know for sure that I'm understanding you right.

                But regardless. The bottom line is an absolute need to get widespread testing available – that way, the need for given volumes of PPE drops (assuming the virus has been contained)

                • pat

                  think regular testing of health workers has merit….but the PPE issue is real, even if only for peace of mind of those doing the work

                  • bill

                    the PPE issue is real

                    I've merely questioned whether it's just a distribution issue, or if it's an availability one. I agree it's a real issue on multiple levels, but however it's viewed, it diminishes with widespread testing.

                    • pat

                      i dont think that it does….theres the psychological aspect and testing can never be total…and then theres the time element, you tested negative 2 days ago, and since then theres been half a dozen contacts (real life situation for someone receiving home care)…are you still covid free?…therein lies the problem

      • weka 7.1.2

        That's research not really applicable here. The CDC recently changed its advisory on the public wearing masks,

        CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission.

        CDC also advises the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others. Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure.

        https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html

        In NZ we don't have widespread community transmission (and I assume this is part of the MoH's position), but, it does make sense that where people working with people vulnerable to covid, that extra precautions are taken. Both for protecting the vulnerable person, and keeping the workforce safe.

        The earlier advice about masks was that if not high tech and/or used properly they didn't stop infection. But the issue here is to *lessen transmission even where a mask is not ideal or not 100% effective. Obviously this needs to be done alongside other measures and proper training.

        • RedLogix 7.1.2.1

          We got three washable cloth masks a few weeks back and wear them when shopping. One each and a spare, we disinfect them and wash out in the sink after each trip out.

          All the guff about whether they work or not, I figure they're better than nothing.

          The most interesting thing is how most non-Asians are still not using them here … there seems to be a hell of a lot of resistance to stand out in the crowd.

        • Carolyn_Nth 7.1.2.2

          Yes. i was looking at that last night and was trying to put it in the US context and their regulations for Covid-19. I was not able to make a conclusive decision about their processes.

          Overall the CDC is big on recommending face coverings in a range of settings, and where standard medical masks aren't available, they recommend cloth coverings.

          They also recommend masks of a kind determined by an employer of a critical infrastructure worker who may have come into contact with a confirmed of probable Covid-19 positive person. This is to be worn for 14 days after contact. In NZ, wouldn't such a worker need to self isolate for 14 days after contact?

          The CDC guidelines for such cases include:

          • Pre-Screen: Employers should measure the employee’s temperature and assess symptoms prior to them starting work. Ideally, temperature checks should happen before the individual enters the facility.
          • Regular Monitoring: As long as the employee doesn’t have a temperature or symptoms, they should self-monitor under the supervision of their employer’s occupational health program.
          • Wear a Mask: The employee should wear a face mask at all times while in the workplace for 14 days after last exposure. Employers can issue facemasks or can approve employees’ supplied cloth face coverings in the event of shortages.
          • Social Distance: The employee should maintain 6 feet and practice social distancing as work duties permit in the workplace.
          • Disinfect and Clean work spaces: Clean and disinfect all areas such as offices, bathrooms, common areas, shared electronic equipment routinely.

          So, I'm not yet convinced that the CDC guidelines on masks is better than that of the NZ MOH or WHO.

          The CDC may be taking a pragmatic approach, like RedLogix, that a reusable cloth mask is better than nothing, when there are not enough medical quality masks available for all.

          Problem is, there's still a lot not been scientifically proved about how C-19 is spread.

          And I don't think this helps with provisions for home care workers. For them I would think a N95 or surgical mask, worn safely, plus gloves, etc, would be standard practice?

          • weka 7.1.2.2.1

            It's not standard practice, and the MoH is explicitly saying that home care workers don't need masks. The DHB is acting on that advisory and not giving out (enough) masks to home care workers or their clients. There is a defacto shortage.

            Personal protective equipment (PPE) used by community care providers for prevention of COVID-19*

            I'm still struggling to make sense of that. IMO it needs better explanation. But here is what I am guessing:

            They appear to be saying that if you are caring for someone with covid you don't need an N95 mask but should wear a surgical mask. Presumption being that a surgical mask will give adequate protection from cv spread by coughs and sneezes. This is not how I understood it, but they should clarify this. Or maybe it's about keeping N95 for hospitals in case of shortage.

            If the client has been exposed, the client should wear a mask, but they don't say what kind. In that situation the carer doesn't need a mask. Given the time lag between becoming infectious and testing positive (or getting a test at all), this seems problematic. Again, needs an explanation.

            They also don't differentiate between different kinds of care, and appear to be treating a range of situations as one.

            I get that they will have simplified down the advice to make it generic and accessible, but I think there are still communication issues here.

            I'm also concerned about what will happen if we end up with a lot of community transmission and whether they are prepared to change that advisory and give adequate training fast. I'm not confident of that for home care situations, and it's still unclear to me who is getting any kind of training at all.

            • Carolyn_Nth 7.1.2.2.1.1

              It comes down to the best masks being in short supply and being needed by those at the frontlines.

              This US web page explains the differences in use between N95, surgical masks, and home made cloth masks.

              Basically, it's saying N95 masks are best, but should be reserved for front line health workers and first responders because they are in short supply. They also need to be fitted to ensure there are no gaps. So just following hygiene in putting them on and removing them is not sufficient.

              Surgical masks don't have good protection, because there are gaps, but can be worn by Covid-19 positives to help stop spread of the virus. They should be only used by people caring for someone at home with Covid-19 who can't wear a mask.

              Cloth masks are pretty useless, but better than nothing for the general public. Summary is:

              The CDC recommends wearing cloth face coverings, such as homemade face masks, in public settings where it’s difficult to maintain a 6-foot distance from others.

              Cloth face masks should be worn while continuing to practice social distancing and proper hygiene. Reserve surgical masks and N95 respirators for hospitals and healthcare workers.

              N95 respirators can protect against infection with SARS-CoV-2 when used appropriately. People using N95 respirators need to be fit-tested to make sure the respirator seals effectively.

              A surgical mask won’t protect you from contracting SARS-CoV-2. However, it can help prevent you from spreading the virus to others.

              Only wear a surgical mask if you have COVID-19 and need to be around others, or if you’re caring for someone at home that can’t wear one. It’s very important that you only wear a surgical mask in the above situations.

              There’s currently a shortage of surgical masks and respirators, and healthcare workers and first responders urgently need them.

              If you have unused surgical face masks, you can donate them by contacting your local hospital or fire department or by checking with your state health department.

              • weka

                "It comes down to the best masks being in short supply and being needed by those at the frontlines."

                That may well be true for NZ as well, but if so then the MoH needs to stop saying we have plenty of masks.

                Someone caring for someone with covid at home IS a frontline worker.

                "Surgical masks don't have good protection, because there are gaps, but can be worn by Covid-19 positives to help stop spread of the virus."

                Yes, but see if you can find where the MoH is saying that and how they are making masks available. Because if I got covid today I have no idea how to source a mask quickly.

                In fact the MoH is saying that if the client has covid, the worker should wear the surgical mask, and not the client. Does that make sense to you?

                And again, the lag between being infectious and being tested positive.

                Really I think people need to listen to what disabled people are saying about this and their assessment of their own vulnerability.

                • Carolyn_Nth

                  Well, having just watched the PM and Bloomfield's press conference, the journalists present are not asking questions about this. They are focused on border restrictions, current clusters, nurse Jenny in the UK, etc,

                  Bloomfield is doing a Qu & A on facebook today, so maybe some facebook users need to go and ask him about home care workers. I'm not into facebook.
                  2.15pm, MOH facebook.
                  https://www.facebook.com/minhealthnz/

                  Bloomfield did reinforce that distribution of PPEs is from DHB's and who they usually work with, while MOH sets the guidelines. In future, MOH, MAY take over distributions in the future, if necessary.

                  • weka

                    Thanks. I've left a question but they've had 750 already so we will see.

                    That last bit contradicts what was reported over the weekend, which said that the MoH IS taking over national distribution.

          • weka 7.1.2.2.2

            The CDC had the same position on masks as the MoH for a long time, then it did an about face, presumably because they saw how out of control things were in the US. And that situation is quite different from ours. But, the idea that no mask was better has changed in terms of transmission.

            If masks aren't needed why are supermarkets using them?

            • Carolyn_Nth 7.1.2.2.2.1

              Good point. Well, I guess it's better safe than sorry. But it's still not clear what kind of masks should we be using.

              Anyway, I just tried hand washing the mask the GP gave me, and the anti-paint fume one I got from the hardware store. I use VERY hot soapy water, and hung them outside to dry. They didn't fall apart.

              If any mask, is better than no mask, I'll go with using one of them on the rare occasions I go out of self-isolation.

              But, still doesn't solve the home care worker situation, other than that some medically approved PPEs should be used…?

              • Poission

                If any mask, is better than no mask, I'll go with using one of them on the rare occasions I go out of self-isolation.

                Even a bad mask is better then none.

              • Stunned Mullet

                Hi Carolyn

                Are you feeling better ? I recall a few days back you feeling poorly and were off to the GP ?

    • Carolyn_Nth 7.2

      The mask issue seems to be confusing and/or complicated. So they need to be worn properly in certain circumstances. Not worn properly may make people feel over-confident in use of the mask. Plus, even with a mask worn properly, the eyes could be an entry-way for C-19.

      NZ MOH:

      For most people in the community, PPE such as face masks are not recommended. However, for people with symptoms of an acute respiratory infection, the World Health Organization recommends that there may be benefit in wearing a face mask to reduce the spread of infection to other people.

      Workplaces where people can maintain more than 1 metre contact distance from people with potential COVID-19 symptoms – facemasks and gloves are not recommended.

      These recommendations are a guide only and workplace settings should consider their ability to maintain the 1 metre rule. In general, surgical/medical masks prevent the dispersal of droplets by an infected patient and the inhalation of droplets if within 1 metre of a coughing individual.

      Hand hygiene and cough / sneeze etiquette (maintain distance, cover coughs and sneezes with disposable tissues and wash hands) will have a bigger impact.

      WHO guidance:

      • If you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection.
      • Wear a mask if you are coughing or sneezing.
      • Masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water.
      • If you wear a mask, then you must know how to use it and dispose of it properly.
      • Forget now 7.2.1

        This, to me, is the best reason to habitually wear a mask (or facsimile thereof):

        https://xkcd.com/2290/

      • weka 7.2.2

        see my link to the CDC advisory above.

        With training, masks can be effective at stopping spread, not because they're 100% effective, but because they lower droplet spread.

        I think the MoH quote is confusing. My understanding is that when working in the community, and with a lower tech mask, the mask is to protect other people, not the person wearing it. So someone receiving personal cares should be wearing a mask as well as the carer, to protect them both. This is where the carer is working with multiple clients and also having community contact eg the supermarket.

        "For most people in the community…"

        The people concerned at the moment aren't most people. They're people that can't maintain a 1m distance.

        • Poission 7.2.2.1

          The National academy of science has a problematic risk,it may spread from breathing alone.

          https://www.sciencemag.org/news/2020/04/you-may-be-able-spread-coronavirus-just-breathing-new-report-finds

          • pat 7.2.2.1.1

            peer reviewed?

            • Poission 7.2.2.1.1.1

              preprint,The NAS is observing standard risk management in a crisis.Identify risk early (where cost is low) rather them later treatment where costs are greater.

              • pat

                so not…then wait..theres all sorts being proposed at the moment and a lot of it will turn out to be bollocks…or half bollocks

                • Poission

                  Standard risk prevention for respiratory virus is masking of health personal.

                  https://jamanetwork.com/journals/jama/article-abstract/2749198

                  I would suggest few if any medical workers get CV from licking their patients FFS

                  • pat

                    lol…no i doubt many, or possibly any (you never know) medical staff lick their patients…that dosnt preclude other methods of transmission or poor practice…thats the point of peer review…not to mention flawed methodology

                • bill

                  Surely there have been peer reviewed studies done on the transmission of "common flu" and whether breathing is a vector, no?

                  I can't see why either the common flu or covid 19 couldn't spread by breathing. But that's just me…

                  • Poission

                    Its an obvious problem,which is why in shared spaces you do mask,and use PPE .

                    4) Wear masks in shared spaces: Coughs, sneezes, breathing out all spread the virus. Masks block transmission when people must be in the same space. Clean surfaces and use gloves or other ways to avoid touching them.

                    https://www.endcoronavirus.org/papers/how-to-win

                    Peters touched on the problem with close contact in elderly care when he stated to some unknown,"do you think we shower them with firehoses"

                  • pat

                    I dont either…but i dont have the expertise nor the inclination (or time for that matter) to read the study and determine whether the study has been competently carried out…thats what peer review is for
                    Its conclusions may be valid…equally they may not be

        • Shanreagh 7.2.2.2

          Weka, I have been thinking about this on and off today. From the 1.00pm press conference it seems that DG Health is well aware of blocks in the provision of PPE for home care workers, hence the comment made about direct provision from MOH stocks. I also feel that if the home care providers, the employers of many of the home helps/carers, are trying to work the word 'guidance' into either 'must have' or 'must not have' then some comprehension skills are lacking on their part.

          'Guidance' is well down the continuum of legal or moral persuasiveness, with regulation/law being at the other end. The big point at the moment is that when the DG of Health answered a question a week or so ago about mask wearing in a hospital setting he said that while not all hospital settings need mask wearing if it made for a less worried workforce he was happy that masks were available.

          What I see has happened is the the private providers who are the employers of the home care workers (often) have no such care for their workers and when you couple this with a misreading of the guidelines/guidance into a definite 'no need' they are denying workers who want to wear masks the opportunity.

          So Bloomfield's 'if it makes them feel more confident and assured in doing their job then they should have access to masks' would not be a usual way of thinking for these private employers.

          I definitely got the view from the presser today that MOH are looking at direct supply to these private providers, if the block is the DHB or direct to the workers from the DHB if the private providers/employers are the problem.

          The model we could/should perhaps be looking at is what is happening to District Nurses. Are they still visiting their clients? If they are what are they doing about masks etc. I bet if they are still visiting that they will be masking up for each client and disposing after each client. Most of the home care workers who visited my mother wore gloves as do the District Nurses. These are/were single use only.

          Hopefully if MOH do direct provide this coming week then the there will be access.

          Do you know what the situation with District Nurses is?

          • weka 7.2.2.2.1

            no idea about the District Nurses.

            I haven't listened to today's briefing but was told there was nothing in it about home care. Are you sure AB wasn't talking about residential care?

            "I also feel that if the home care providers, the employers of many of the home helps/carers, are trying to work the word 'guidance' into either 'must have' or 'must not have' then some comprehension skills are lacking on their part."

            Or the DHBs are. Who are also employers in some cases.

            "What I see has happened is the the private providers who are the employers of the home care workers (often) have no such care for their workers and when you couple this with a misreading of the guidelines/guidance into a definite 'no need' they are denying workers who want to wear masks the opportunity."

            Do you have any evidence of that? Employers of home care workers covers a lot of different situations. Some employers are good, others aren't.

            Here's a scenario: a client has covid and no-one knows. The care worker arrives to work and the clients is coughing. The care worker has no mask, and neither does the client. The client need personal cares. What should happen? If the worker does their job and then goes to the next client, what should happen? At what point is it possible that the care worker is now infectious?

            I'm guessing that these scenarios aren't being used in planning around mask use, because we have relatively little community transmission. Which from a public health pov makes sense. But it doesn't make sense from an individual pov (careworker or client). The difference here between the client and the general public is that the client may have far less agency in what happens to them. This is a disability issue. Having supermarket workers wear masks is about preventing spread, vulnerable individuals can be protected in other ways (ideally). Having careworkers/clients wear them is also about protecting individual vulnerable people.

            That's my thinking. I don't know how true all that is. I do feel pretty uncomfortable with the poor communication around this from various agencies including the DHBs and the MoH.

            • Shanreagh 7.2.2.2.1.1

              There was a comment started about community based home care access but it morphed into rest home/residential care per PM.

              No quotes or citations re my jaundiced view about private providers and use of the contracting model but worked in a RHA from go to whoa when they were around. As far as the contractual model was concerned it was no use having general 'good employer' clauses as was very common in the public sector at the time. Many just did not have a clue. We had to spell it out in words of one syllable and then of course the philosophical and wide ranging strength went out the window and our auditing on their treatment of their employees was very narrow based on these rigid and inflexible clauses employers had negotiated.

              Imparting rigidity onto to guidelines is part of this mindset too. They do not say you must but then neither do they say if you want to do well by your employees that you cannot source and issue adequate PPE etc.

              I saw great strengths in some of the work in the contracting model set up mainly around population identification & their needs and modelling, and innovative small contractors responding to innovative small packages of work.

              My mother had private based home help for personal cares and housework for 10 years. Great experience largely from carers who worked in their own ways sometimes despite the employer.

              I wish we knew about District Nurses as they would be the group quite close job-wise, physical closeness to clients-wise to home carers.

          • weka 7.2.2.2.2

            Have a read of this, it's pretty clear that it's the DHBs that are a core problem in some areas. I have all sorts of concerns about the contracting model (and the issues of using private companies), and I'm sure there are some agencies not getting it right this week, but I think the sticking point is the DHBs and MoH.

            https://www.tvnz.co.nz/one-news/new-zealand/were-not-getting-masks-gloves-because-ppe-confusion-say-disability-support-workers-v1

            • pat 7.2.2.2.2.1

              “This pandemic requires us to be positioned to supply PPE for the long term.”

              That statement suggests a shortage …and a lack of confidence in supply chain

            • Shanreagh 7.2.2.2.2.2

              Yes saw that. Hope things are resolved and soon.

  8. SPC 8

    An alternative to ventilators.

    Breathing machines that are relatively plentiful, such as those used to treat sleep apnea.

    https://www.wired.com/story/modified-sleep-apnea-machines-may-ease-the-ventilator-crunch/

    This technological fix is happening at the same time as a bubbling medical debate among physicians over whether too many coronavirus patients are being placed on traditional ventilators that some argue may do more harm than good. They added a filter to the exhaust valve so virus particles expelled from the patient’s lungs don’t endanger hospital workers and an alarm system to warn nurses when a patient might be in trouble.

    In social media and online discussions, some emergency medicine physicians suggest that existing Covid-19 protocols may need to change and that with some patients, ventilators may do more harm than good. They say that some patients have low blood oxygen levels that trigger the use of a ventilator according to existing medical protocols, even if the patients are not gasping for air or having heart problems. Kyle-Sidell and the Italian doctors both argue that it might be better to avoid putting Covid-19 patients on a ventilator for as long as possible, and use sleep apnea machines instead.

    Ventilators work by forcing air into the body under pressure. Over time, this pressure eventually damages tiny air sacs in the lungs, and can harm the patient just as much as the coronavirus that is attacking the entire respiratory system. In New York, city health officials reported this week that 80 percent of Covid-19 patients placed on a respirator have died, according to the Associated Press.

    Less-invasive machines, such as the BiPAP or anesthesia devices, may be a solution for patients whose lungs are not completely destroyed by Covid-19, but still need to maintain oxygen levels.

  9. adam 9

    Like the post weka and thanks for putting it up. But the bit the really sticks in the craw is the fact disability organisations and activists were arguing with MoH about this right up to the point of lock down. The usual put downs, and we know better puffery was fully on display.

    You did missed out one other biggie – the subjective cutting off of home help to many disabled and elderly people by the MoH via the DHB's. Many were informed via a letter when the country went into lvl 4 lock down. This caused massive stress, and I know some homes which are in a bad, bad way becasue of this. I've been informed that many disabled and elderly have just stayed in bed as a way to cope and not make a mess.

    There is no conspiracy here, its just the usual shit fuckery disabled have to face all the time. We are the last people to be thought of, the last people who are consulted, and the very last people to be listened to. Situation Normal, All Fucked Up.

    • weka 9.1

      thanks adam. I was aware of that but had lost track of what happened. Did they reinstate the care? Would appreciate any links you come across.

      Agreed that what is happening now is a consequence of a long history of the MoH and DHBs simply often being bad at disability support.

  10. Mark 10

    Meanwhile you see NZ police officers wearing 3M N95 masks at road blocks – but no eye protection even though they lost quite a few due to spitting attacks.

    the NYPD frontline cops wore N95's for two weeks – now they wear the surgical masks.

    the PPE we have in NZ gets distributed with little sense and the lack of instruction on how to wear it is staggering – the police handed out boxes to frontline workers containing hand sanitizer and one N95 mask – are they meant to wash those?

    and on the other extreme you see the Covid -19 testing station workers wearing the cheap surgical masks even though they take a higher risk.

    its not looking good.

  11. Carolyn_Nth 11

    OK. So, Kristin Hall at One News has an article about this tonight, specifically addressing "community" care workers of disabled people, going into people's homes.

    The Government could step in to provide health and community care workers directly with protective gear, as concerns remain over access to items like masks and gloves.

    We're not getting masks, gloves because of PPE confusion, say disability support workers

    Alison Riseborough has muscular dystrophy which means she's extra susceptible to Covid-19, and she needs close contact help with things like eating and dressing.

    But after the lockdown began, she became anxious about a stream of care workers coming into her home without masks.

    “I usually have eight or nine different support workers each week… pretty much no-one had any masks.

    "I need help with a lot of things during the day, showering, feeding, I need people to hold up my drinks, you can't do that from two metres away, you need to be in quite close contact.

    “I've had associates with muscular dystrophy who have died from influenza so it's not unheard of, this is a real fear,” she said.

    Kristin Hall has also tweeted about this article & video.

  12. R.P Mcmurphy 12

    bit of anal retentiveness in what remains of the public service eh wot.

    • Shanreagh 12.1

      I think more like a failure of the contracting model bearing in mind that most of the employers of home care workers are private companies.

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