Message from the Director General of Health, Ashley Bloomfield 23 April

23 Apr 2020

Kia ora koutou

On Monday, the Government announced that we will step down to Alert Level 3 at 11.59pm on Monday, 27 April for two weeks. A key part of New Zealand being ready to move down the response levels is the dedication and hard work from people working across our health and disability sector nationwide under Level 4 restrictions.

Health and disability sector at Alert Level 3
New Zealand is still at Alert Level 4, and we must still follow the guidelines that are in place. Health and disability services are balancing the need to protect people from COVID-19 with the need to continue to provide services to people who need healthcare.
At Alert Level 3, there will be some differences in how we access health and disability services. These are summarised on our website, and we have worked closely with sector representatives to develop this guidance. Some of the key points to note are:
·        Services will open and operate normally where possible, while managing public health risks.  
·        Strict hygiene measures and physical distancing measures will remain in place. Personal protective equipment (PPE) will be used when required.
·        Testing for COVID-19 will continue at community-based assessment centres (CBACs), designated practices, and some general practices.

Hospitals remain open for emergency care, whether or not that care relates to COVID-19.
Some planned care, including elective surgery and radiology, will be provided, and some non-urgent services or treatment may be deferred. Outpatient appointments will continue but will be mainly online or over the phone.
Visitors, from a person’s extended bubble and with no suspicion of COVID-19, will be allowed one-at-a-time, once a day. Discretion may be applied on a case by case basis.
Women in labour in a maternity facility will be allowed two support people from her extended bubble for the duration of the labour and birth.

General practices
General practices will be open, but appointments will still be conducted online or by phone where possible. People will be able to see their doctor or nurse face-to-face if required.
GPs and nurses will continue to provide care for urgent issues, management of long-term conditions, mental health consultations, prescriptions of medication and the treatment of common illness. Patients will be referred to specialists and for other treatment if needed.
It is important that people still contact their health professional or Healthline (0800 611 116) as you normally would. They can access all the treatments, vaccinations and medicines needed to stay well, whether or not the care needed relates to COVID-19.

Community health services
Community pharmacies remain open but medicine management services will be provided over the phone where possible. Medicines may continue to be delivered to some people.
Community midwives will provide services in a variety of ways, including face-to-face and on-line appointments. Antenatal and new-born screening programmes will continue.
Community dental services may provide face-to-face appointments for urgent or emergency care. Routine care (non-essential and elective dentistry) will not be provided.  Updates are provided on the Dental Council website.
Appointments for allied health services such as physiotherapy, podiatry, optometry and Well Child Tamariki Ora services will continue to be mainly online or over the phone. Some face-to-face physiotherapy, podiatry, optometry appointments may be provided for urgent appointments only, as long as professionals can take appropriate measures to manage public health risks.

Disability residential care
Residents can have an extended ‘bubble’. Residents, their family and whanau, and the disability provider will decide who is in the extended bubble. This will be managed by the provider so that extended bubbles do not get too big and do not mix with others.
In aged residential care, only family visits for palliative care residents will be considered on a case-by-case basis.
Planned respite services will remain suspended, but urgent respite care may be provided.
Essential personal care services, such as toileting, washing and feeding, will be provided as usual. Some home help, such as house cleaning, may be available.

Mental health and addiction services
Inpatient and residential mental health and addiction services will operate as usual, although there may be fewer beds available to reduce the possibility of infection.
Community mental health service appointments will be online or by phone where possible. There may be some face-to-face appointments. Urgent and crisis community mental health services will continue as usual.
There is a range of welfare, mental health and wellbeing programmes underway to provide support to New Zealanders.

Boost to contact tracing
On Monday, the Government announced an additional $55 million for contact tracing to support the move to Alert Level 3 next week. This will help us to achieve our aspiration of a gold standard contact tracing service to support our sustained “keep it out, stamp it out” approach.
Over the past two months, we’ve significantly boosted our contact tracing and are transforming it from what was essentially a manual local system by Public Health Units to a national automated system. This has been a first for New Zealand and is the result of a lot of hard work by many people.
Earlier this month, I asked Ayesha Verrall, of Otago University, to undertake an independent review of our strengthened contact tracing approach to ensure we’re heading in the right direction. It’s important that we ensure we’ve got the right systems in place as we move down alert levels.
On Tuesday, we published her report, Rapid Audit of Contact Tracing for Covid-19 in New Zealand, which includes constructive feedback and guidance to help us further build our contact tracing capability and capacity.

Extra funding for PPE
The Ministry has been working hard to ensure our supply and distribution of Personal Protective Equipment (PPE) protects our health and disability workforce from COVID-19.
Last Friday, the Government announced a further $200 million investment to further support PPE supplies. This is in addition to our current stock of about 20 million masks, 9.4 million pairs of gloves, 1.2 million aprons and other items of PPE.
So far, the extra funding has enabled us to place $140 million worth of orders. As part of that, we expect 75 million items of PPE to be delivered into New Zealand in the next eight weeks, including 17 million masks, more than 2 million gowns and coveralls, and 13.8 million gloves.
You will have seen the announcement that the Auditor-General will undertake a review of our PPE supply chain and stock management, which I’ve welcomed. This independent review will provide assurance to those working in the health and disability sector, as well as to all New Zealanders. We’re very open to feedback and suggestions of ways to improve our PPE supply and distribution.

Update to case definition
On 16 April, we updated our COVID-19 case definition to reflect that testing is available to people with respiratory symptoms suggestive of COVID-19 infection (including the acute onset of cough with or without fever), regardless of travel history or known contact with a confirmed or probable case of COVID-19.
Regularly updating our case definition is an important part in our response to COVID-19 and I know these changes impact on you. Thank you for your flexibility in accommodating these rapid changes and for your continued hard work and support as we progress together towards eliminating COVID-19 in New Zealand.

Ngâ mihi nui
Dr Ashley Bloomfield
Director-General of Health