Article published in Sep/Oct Baybuzz magazine. While our protection levels are relaxing, much has been done behind the scenes in HB to be better prepared for any community outbreak.
In July, as coronavirus took off again in Melbourne and the prime minister began speaking of plans for a Covid resurgence, 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.
It was clear to both, long before the Auckland August outbreak, that Hawke’s Bay needed to be prepared for a cluster or outbreak here. “And we have been preparing for that,” said Jones at the time.
This included increasing our testing, investigation and contact tracing capacity, taking 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 Close Contact Service (NCCS).
More testing and tracing
During the first wave, Hawke’s Bay took some 16,000 swabs, which were processed in out-of-region laboratories, resulting in a lag time of 2-5 days. The game-changer has been that Hawke’s Bay has since purchased its own Covid lab-testing machines, with capacity to process over 600 tests per day, it turns out (the DHB’s initial figures were more modest). Results can be returned within 24-48 hours, while a rapid tester machine for clinically important cases can process a swab within the hour.
Improved timeliness is vital as it directly impacts hospital flow (any patient tested for Covid is treated as positive until test results prove otherwise), while shorter turnaround times also means the PHU can identify and isolate contacts more quickly, reducing the risk of further spread.
In the first week of our step back to Alert Level 2 in August, over 3,000 swabs were sent in from the region’s community testing centres (zero positive). There’s capacity to ramp this up further, and with a national system now in place for targeted, needs-based distribution, Hawke’s Bay can always send swabs away to any lab in the country for testing should it need to.
In the event of an actual outbreak here, “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,” explained Jones. “Everything will be more complex.”
We’ve seen this, first hand, in Auckland.
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.
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 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.
Our borders (no surprise) are the weakest link, and while Hawke’s Bay is a long way from an international airport and quarantine hotels, we do have the Port.
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 cannot leave their vessel unless they have been at least 29 days at sea since the last port and have had no other contact with people since leaving port, or have completed 14 days of isolation either on board (from the point the ship arrives in New Zealand waters) or in 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. Between 16-18 August, more than 250 port workers underwent surveillance testing for Covid – none of whom returned a positive result.
Where to go if you have symptoms of flu
You can call one of the community testing stations below (no walk-ins) or your own GP to book a Covid test, which is free:
• Napier: 06 650 4000 open 9am-5pm Mon-Sun
• Hastings: 06 281 2644 open 8am-8pm Mon-Sun
• Wairoa: 06 838 8333 open 8.30am-5pm Mon-Fri
• Central Hawke’s Bay: residents need to be referred from their doctor or Healthline: 0800 358 5453