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If a Second Covid Wave Hits HB …

HB Recovery

Bridget Freeman-Rock31 July 2020

It’s easy to feel that Hawke’s Bay is at a safe remove from the frontlines of Coronavirus – we’re a long way from an international airport (although we do have the port) and we don’t have quarantine hotels.

But as Melbourne brought close to home, it doesn’t take all that many human breaches for the virus to flare and send its viral sparks flying, and we should brace ourselves for a return at some point to the ‘stop it and stamp it out’ phase.

The government has a continency plan in place for a second wave, which will prioritise localised over nation-wide restrictions – locking down suburbs if necessary or metropolitan areas, or isolating affected regions. The PM warns that at any sign of an outbreak, action will be swift.

While details are still forthcoming about what regional restrictions would look like on the ground, recently BayBuzz met up with Dr Nick Jones, clinical leader of population health at Hawke’s Bay’s DHB, and Karyn Cardno, the Covid coordinator within the Public Health Unit (PHU), to discuss preparations at the local level.

While both are hoping, of course, that Alert Level 1 continues and there’s no community transmission in New Zealand, “it’s clear we need to be prepared for a cluster or outbreak here,” says Jones, “and we have been preparing for that.”

More testing and tracing

This includes increasing our testing, investigation and contact tracing capacity, a more sophisticated approach in monitoring outbreaks, and providing training opportunities and employing additional “dual-purpose” staff – nurses who have had specialist training to step into ICU roles if necessary, for instance, or growing the number of team members (from 50 to 70) who can be co-opted to the local Covid case investigation and tracing teams – these then contribute to the National Contact Tracking Service (NCTS).

The four extant CBACs (community-based assessment centres) in Napier, Hastings, Wairoa and Central Hawke’s Bay have been renamed ‘designated swabbing practices’, and in addition there are a number of other GP practices that now have dedicated capacity for swabbing and making Covid assessments.

During the first wave, Hawke’s Bay took some 16,000 swabs. Until recently these samples were processed in out-of-region laboratories, which did mean a lag time of 2-5 days. Hawke’s Bay has since purchased its own Covid lab-testing machine, with capacity to process up to 190 tests per day with “fairly fast turn-around”.  It’s vital, say Jones, to improve timeliness as this directly impacts hospital flow (any patient tested for Covid is treated as positive until test results prove otherwise).  Shorter turnaround times also means the PHU can identify and isolate contacts more quickly, reducing the risk of further spread.

There will be priority categories (urgent cases, essential and healthcare workers, etc), but with a national system now in place for targeted, needs-based distribution, Hawke’s Bay will also be able to send swabs away to any lab in the country for testing.

“If we get an outbreak here,” says Jones, “there will be a very large increase in testing.” As many as 8,000 tests a week! “There is likely to be more people to test and follow up than during Lockdown when we were all in isolation,” he explains. “Everything will be more complex, and we have to be ready for that complexity.”

A major advance, is that New Zealand now has the capacity to work across all 12 PHUs, with one national database under a delegation model, meaning contact tracing work can be picked up elsewhere in the country if the system locally is overwhelmed.

Hospital capacity

Based on government modelling, the DHB has planned for, and is confident it could manage, up to 12 new cases per day in Hawke’s Bay, with an estimated 20-30 contacts to follow up per case. To put this in perspective, our busiest week during the first wave had 17 new cases, whereas our upsurge capacity now can accommodate 80 new cases, and 4-5 potential hospitalisations, per week.

The Covid hospital within the hospital, which was set up during Lockdown with ‘hot’ and ‘cold’ areas to keep suspected Covid patients isolated at all times and now with an additional 11 ICU beds, is able to be quickly brought back into effect if and when needed.

As for a Hawke’s Bay-specific Covid plan, the global pandemic is such a fluid, mercurial situation, anything written down is soon out-of-date. Instead healthcare workers use the likes of the Āwhina app, which provides the latest government healthcare advice – “it’s what we are governed by,” says Karyn Cardno.

The government issued a Maritime Quarantine Order on 30 June with the purpose of restricting vessels coming into NZ (extending as well the ban on cruise ships), and to put in place strict isolation or quarantine requirements for those arriving at the maritime border. It’s a very different environment now to the one we saw back in early March when the Ruby Princess cruise ship came to town.

In brief, maritime crew will not be able to leave their vessel, unless they have been at least 29 days at sea since the last port and the crew have had no other contact with people since leaving port, or have completed 14 days of isolation which starts when the ship arrives in New Zealand waters, or have completed 14 days managed isolation in New Zealand.

The DHB says it’s working in collaboration with Napier Port on preventative work there, which is being coordinated by the Ministry of Health Border Protection team.

As to our individual actions, the basics still hold true, says Cardno: wash your hands, get tested, stay at home when ill. The DHB is pushing to promote the government’s QR codes and Covid Tracker app, so that contact tracing if required is quick and effective.

On the topic of masks (epidemiologists like Michael Baker say this should be mandated under Level 2, as has happened in Victoria), in the event of community transmission, Nick Jones would be supportive of masks being worn by the public and believes this will be considered by the government in future.

As an aside, in Victoria masks have become the new toilet paper: scarce and in demand. And there’s an anecdotal shortage of DIY essentials, such as elastic and even sewing machines. Wouldn’t hurt to make or source a few masks now for your civil defence kit!

More BayBuzz articles

Bridget Freeman-Rock31 July 2020

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