Minutes
Technical Advisory Group for COVID-19 Teleconference (final)
Date:
5 March 2020
Time:
9:00 am - 10:30 am
1982
Location:
National Health Coordination Centre (NHCC), 133 Molesworth St Wellington
ACT
Chair:
Dr Caroline McElnay
Attendees:
Dr Anja Werno
Dr Bryan Bet y
Dr David Murdoch
Dr Erasmus Smit
Prof. Michael Baker
INFORMATION
Dr Sally Roberts
Dr Shanika Perera
Prof. Stephen Chambers
Dr Virginia Hope
Ministry of Health staff: OFFICIAL
Dr Caroline McElnay
Dr Tom Kiedrzynski
THE
Dr Juliet Rumball-Smith
Dr Richard Jaine
Dr Niki Stefanogiannis
UNDER
Andi Shirtcliffe
Dr Geoffrey Roche
Dr Harriette Carr
Asad Abdullahi
RELEASED
Apologies:
Dr Nigel Raymond
1
Documents tabled:
• Minutes of the last meeting (27 February 2020) – approved with no changes.
• TAG Proposed Agenda Thursday 5 March 2020.
• Richard Jaine. COVID-19 Risk Assessment 03 March 2020.
• Preliminary modelling paper. Dr Lucy Telfar Barnard, Prof Nick Wilson, Dr Amanda Kvalsvig,
Prof Michael Baker.
Modelled Estimates for the Spread and Health Impact of Covid-19 in New
Zealand: Revised Preliminary Report for the NZ Ministry of Health. 27 February 2020. (Draft).
Item Notes
0
Preliminaries
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• The Minutes of the last meeting were accepted.
1
Situation Update
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a) Notification of third case.
A third case was notified last night. Al three cases were notified in Auckland. Two
originated in Iran. Case number 2 had travel history in Lombardy, northern Italy. Results
from the second case’s husband would be available later today.
b) Self-Isolation guidelines.
INFORMATION
Uncertainty was reported anecdotally regarding self-isolation. It was noted that easy,
intelligible guidance was being distributed to DHBs and was published on the Ministry
website.
It was noted that the retrospective application of travel and quarantine advice (i.e. self-
isolation for those who had been in northern Italy) was creating issues.
OFFICIAL
c) Testing loads
There was discussion on the variance in testing demand, community versus hospital
THE
settings. Auckland reported a 50/50 split between community versus hospital, Christchurch
reported that there were few, if any, hospital inquiries.
d) Border restrictions
Since the last TAG meeting
UNDER of Friday, 13 March 2020, the situation has moved very quickly
and the Government decided to add Iran to Category 1, which has led to a split in Category
1 into Category 1a (Category 1a countries have travel restrictions and foreign nationals
travelling from or transiting through Category 1a countries wil be prevented entering New
Zealand), and Category 1b (category 1b wil include countries with no border restrictions
but people who have been in category 1b countries are requested to register with
Healthline and self-isolate for 14 days starting from the date of departure from a Category
1b country or
RELEASED territory).
The Ministry of Health needs TAG to advise on criteria for which countries should be in
Category 1 and 2 and how a country moves between these categories.
There was a question if New Zealand now using the term ‘pandemic’ in the context the
COVID-19.
2
It was explained that NZ is waiting for WHO to use the term ‘pandemic’ but we are certainly
planning for the possibility for a pandemic as this situation is highly dynamic and has a
potential for the situation becoming a pandemic.
An enquiry was made if we are developing a specific COVID-19 emergency planning on
the experience from Australia and China.
It was confirmed that the COVID-19 emergency planning document is being developed by
NHCC. The draft response plan is informed by Australian and the UK response plans as
well as the WHO-China Joint Mission on COVID-19 Report. The Ministry wil appreciate
TAG’s comments and feedback on the draft response plan before it is being finalised. We
wil circulate the draft response plan for consultation shortly.
Action 1: Asad to send the WHO-China Joint Mission on COVID-19 Report - actioned.
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Action 2: Asad to send out the COVID-19 Emergency Response Plan draft - when
ready
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2
Revisiting Case Definition
An urgent TAG meeting was held on 4 March 2020 to review the epidemiological criteria of
the case definition. The meeting was attended by 5 TAG members.
It was agreed on to;
• Retain both criteria (epidemiological and clinical) of the current case definition.
INFORMATION
• Daily monitoring and review the list of high-risk countries at a set time
• Communicate the updated list of high-risk countries to all stakeholders including
the primary health care and public health units
• Daily update the Ministry of Health website
• Ensure testing for COVDI-19 is included for all SARI admissions
• Ensure testing of respiratory samples from ICU admissions includes COVID-19
OFFICIAL
• Initiate a community-based sentinel surveil ance system and testing for COVID -
19 included. THE
Action 3: Asad to send out the minutes of the meeting. Actioned.
The following comments were made about this meeting:
• Sensitivity and due c
UNDER onsiderations should be exercised in relation to testing of
respiratory samples from ICU admissions includes COVID-19. There was discussion
on whom samples should be taken from and it was agreed that COVID-19 testing
should only be undertaken on those with a respiratory infection in ICU (not for those
admitted for other reasons – eg post-operative patients).
Action 4: Caroline to fol ow up concerns regarding the implementation of the new
criteria with
RELEASED
the ICU subgroup (Andrew Simpson) and report back to the group.
Further discussion on the case definition:
• To review and update the list of high-risk countries we need to develop some –
options or criteria to use for identifying what countries to add to the high-risk list
countries and when as this is a rapidly changing situation. Factors to consider
are:
• Epidemiological criteria
3
• Phase of response plan (we are stil in containment phase)
• Local transmission (as defined in WHO sitreps) does not equate to
community transmission.
• Information dissemination issues if too many countries are being added
continuously to the list of high-risk countries.
• The purpose of the case definition (identifying who to test and diagnose
rather than border advisory)
• Workforce implications – increase in primary care presentations, lab
testing, border resources etc
• It was noted that primary care needs to be supported more on decision around
case definition – the current advice is ‘call medical officer of health’. The primary
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care may not have capacity to do this – potentially setting up a phone number
for primary care to ring for advice may be useful
• As the situation is rapidly changing globally, it is challenging to keep the c
ACT ase
definition up to date.
• Other considerations include
• Do we need to think how to manage people at home, e.g. Healthline can
facilitate triaging and manage people with mild symptoms at home.
• If you have people with mild symptoms staying home – you are moving
away from testing to verify COVID-19 infections. We want to test these
people to pick up infections and stop community transmission.
• Setting up a campaign that ‘if you have mild or moderate symptoms you
INFORMATION
stay at home and call Healthline’.
3
Updates from the subgroups
3a
Lab (Anja, Virginia)
• Three labs have the capacity to do COVID-19 tes
OFFICIAL ting ESR, LabPlus and Canterbury.
• In NZ and overseas, there are some issues with assays producing negative with single
gene targets where multiple gene targets are positive. There is a need to be up to
speed with what gene targets a
THE re reported and whether methods are sufficiently
sensitive. There is a need to look at alternative assays for backup.
• Canterbury Lab is looking at how to ramp up capacity and what other assays are
coming online for testing; what options are there for rapid point of case testing –
options for rapid flu and rapid COVID-19 testing.
UNDER
3b
IPC (Niki and Sal y)
• A number of documents have been produced and uploaded onto website.
• Primary care guidance has been uploaded.
3c
Public health
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(Harriette and Shanika)
• There was discussion when clearance of patients can occur and debate on when this
would occur. More work needs to be done in this area
• Contact tracing on plane discussed and the risk of people sit ing in the outer part of the
second row in front or behind the case. The TAG discussed that the risk was lower for
those more than 1 metre away and this should be considered in the contact tracing
advice for those on aircrafts.
4
3d
Epidemiology (Michael and Richard)
• Epidemiology case definition issues discussed above
• Michael discussed his modelling paper and it was clarified that more work needed to be
done in relation to modelling different phases of the response.
• Michael has updated the modelling paper and wil send out to group today.
3e
Primary Health Care (Juliet and Andi)
• Primary Health care subgroup, met on Monday and discussed the following:
•
advice on immunocompromised staff ie diabetes.
•
Capacity of primary care
•
financial impact on practices
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• A formal request was made for a document outlining the rationale of PPEACT
recommendations in primary care.
Action 5: IPC subgroup to produce specific advice on the use of face masks
in primary care – Actioned and document on Ministry website
5.
Other
• It was noted that a shared site where all TAG could sit would be useful.
Action – has been actioned with NHCC operations
INFORMATION
• Face to face meeting of TAG would be good
Asad wil look at dates and times for this in 3 weeks.
6.
Summary of recommendations OFFICIAL
7.
Date and time of next meeting: Friday 13 March, 9am
THE
UNDER
RELEASED
5
Minutes
Technical Advisory Group for COVID-19 Teleconference (Final)
Date:
12 March 2020
Time:
9:00 am - 10:40 am
1982
Location:
Room GC2, 133 Molesworth St Wellington
ACT
Chair:
Dr Niki Stefanogiannis
Attendees:
Dr Anja Werno
Dr Bryan Bet y
Dr David Murdoch
Dr Erasmus Smit
Prof. Michael Baker
INFORMATION
Dr Sally Roberts
Dr Shanika Perera
Prof. Stephen Chambers
Dr Virginia Hope
Ministry of Health staff: OFFICIAL
Shari Mason (Guest)
James Greenwell (Gues
THE t)
Dr Juliet Rumball-Smith
Dr Ian Town
Dr Richard Jaine
UNDER
Dr Niki Stefanogiannis
Dr Geoffrey Roche
Dr Harriette Carr
Asad Abdullahi
RELEASED
Apologies:
Dr Caroline McElnay, Dr Tomasz Kiedrzynski and Andi Shirtclif e.
1
Documents tabled:
• Minutes of the last meeting (5 March 2012)
• TAG proposed agenda 12 March 2020
• Proposed_COVID19_dashboard_indicators.xlsx
Item Notes
0
Preliminaries
• The Minutes of the last meeting were accepted.
1
Situation Update
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• The Director General of the WHO has just declared COVID19 a pandemic
(Wednesday 11 March). Planning in New Zealand is proceeding as planned;
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the Action Plan wil be revisited.
• Currently there are 5 confirmed cases and 2 probable. There are no changes in
the count since Saturday. Case 1 was discharged yesterday 11 March 2020.
The other cases are being managed at home. Of the two probable cases, one
was the father of the confirmed case who had been to Iran; the other had been
aboard the cruise ship Grand Princess in California.
• The National Crisis Management Centre is being stood up and wil manage the
whole-of-government response. The National Health Coordination Centre
(NHCC) wil manage the health response.
INFORMATION
Discussion
It was suggested that NAAT serology testing should be considered on the probable case
who had been onboard the Grand Princess.
OFFICIAL
The other probable case was the household member of two confirmed cases (who had no
travel history), who had returned from Iran and had mild symptoms for 48 days but had a
negative test.
THE
2
Dashboard
Shari Mason and James Greenwell (Health and Disability Intelligence, Analytical
Projects) presented work on an al -of-government dashboard system currently being
UNDER
developed to relay key information on the COVID 19 response. The Ministry was
approached by the Department of the Prime Minister and Cabinet (DPMC) to contribute
to the dashboard, which wil present health, welfare and economic data. The dashboard
is being built by MSD.
There wil be two ‘products’; a publicly accessible online dashboard, and a separate A3
sheet for the Ministers. Content wil be updated daily or weekly, depending on the
specific content.
RELEASED
A phased approach wil be taken to publishing information, beginning with high-level
statistics (e.g. total number of confirmed cases). Other suggested indicators are laid out
in the Excel sheet tabled at the meeting. Information from DHBs wil be collated, and the
State Services Commission has requested that other indicators be added.
Demographic breakdowns wil be provided but confidentiality wil need to be considered.
The developers are working with Health Legal and the data governance groups on
details.
2
They wil also be liaising with DHBs to determine what data is available and with MSD
on the final look of the dashboard. Indicators wil also be discussed with the NHCC to
ensure that they are correct for their needs. Advice from clinical leads was needed on
where the data would come from. Also requiring agreement are standard definitions
used in reporting. Ashley would be asked for final signoff.
Discussion
The distinction between the public and Minister’s dashboards was discussed. The
Minister’s dashboard is to provide a broad overview of the health system, in particular
system capacity and management of ‘business as usual’ (BAU).
TAG provided the following feedback:
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• The production of a dashboard was good idea
• The purpose of the dashboard – for both public and the Minister should be
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considered as well as the audience
• It was important to include primary care and laboratory indicators
• Interpretation of indicators was important to inform policy decisions
• separation of indicators into themes would be useful e.g. burden of disease,
service pressures
Other indicators could also be included:
• the workload on frontline GPs, and how they were managing with demand.
INFORMATION
There was concern that secondary care could be overloaded, and the data was
needed to inform overall management of the response.
• epidemiological data; ILI surveil ance; FluTracker
• elective surgeries in DHBs, and cancellations;
• COVID 19 hospital admissions, broken down into COVID 19 admissions to
OFFICIAL
ICUs, hospitals, and occupancy.
• Laboratory data, capacity, reagents used, number of tests performed, what the
results are. This was par
THE ticularly important given the need to understand the
impact on lab work anticipated that other strategic decisions wil make.
• data that wil identify clustering of cases and linked to high deprivation and low
socioeconomic areas.
• Data on number
UNDER of close contacts and number of self-isolations.
• Supply chain data on availability of PPE and swabs
• Relevant pharmaceuticals
• other indicators could be included such as rates of isolation and quarantine; the
median time from symptom onset to isolation of contacts; proportion of contacts
identified; number of people quarantined; median time from exposure to
quar
RELEASED antine.
It was noted that the one-pager A3 sheet for the Minister would include a glossary that
provided context for interpretation. Individual cells of the public dashboard could also be
provided with a plain English definition and interpretation that was updated weekly.
3
Decisions
TAG
endorsed the approach of the proposal.
Actions
Shari and James wil continue to develop the dashboard taking into account TAG
advice as above.
3
Case definition - epidemiological criteria (Richard)
Update following the last 48 hours:
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48 hours ago the Epidemiology Subgroup discussed the categorisation of other countries;
it was decided to put Europe into Category 2, Italy into category 1B, and not put the USA in
a risk category. In the last 24 hours there has been an increase in cases in the USA,
ACT
around 200 cases a day.
Feedback from NHCC (Border Operations) is that the frequent of small changes are not
feasible as this is confusing for traveller/tourists coming into the country and this should be
considered in any updates of the epidemiological criteria.
Discussion
TAG considered the current epidemiology of COVID-19 and noted the increasing numbers
across Europe as well as in the United States. Specifying cities or regions within a country
was considered too confusing. TAG also noted any widening of the epidemiol
INFORMATION ogical criteria
would have an impact on both primary care and laboratory capacity – due to increased
presentations and testing. As a result, systems needed to be in place to support any
broadening of the criteria. Taking into account these considerations the TAG
recommended staggering the changes in the epidemiological criteria.
The following classifications are recommended to be in place on Monday, 16 March
OFFICIAL
2020.
Classification
THE
areas
Category 1A
Mainland China, Iran
Category 1B
Republic of Korea
Italy
Category 2
Europe1 (excluding Italy) and the UK but
UNDER
excluding Italy.
Al of the United States of America.
• On Wednesday or a later date Category 2 should be expanded to include all
international travellers
• On 17 March, the Epidemiology subgroup wil consider whether the mainland China
and the Republic of Korea should be re-categorised into Category 1b or Category
2.
RELEASED
• The advice would be prospective, not retrospective.
In addition,
• There was support for a more straightforward approach, i.e. applying the same
principle to all international travel and adding all of USA is better for clear
communication and understanding in the sector.
1 The European Schengen visa countries
4
• It was suggested to have an ongoing watch on some other European countries
(e.g. Germany, France, Spain, Switzerland) for potential consideration into
Category 1b if appropriate.
• There was discussion regarding placing Seattle into Category 1b. This was not
recommended, due to being too granular, and would have implementation /
communication issues, as well as complicating future decisions by requiring the
need to consider epidemiology and make decisions at city levels.
• Flow- on effects of any changes to the travel history classification would include the
load on Healthline (given the number of people registering their self- isolation).
• It was noted that ARPHS has already scaled down some activities due to the load
on their workforce; they are not gate-keeping for lab testing and are not providing
1982
negative results to those who have been tested. Alternatives were being considered
to support GPs.
• Burden on Pacific community needed to be considered, were a restriction to be
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placed on all countries.
4
Case definition - clinical criteria (Harriette)
The TAG was asked to comment on whether the case definition should be revised from
“fever and respiratory il ness”
To
INFORMATION
“fever or respiratory il ness”
The TAG noted that in broadening the case definition, there needs to be a consideration
between balancing the need to avoid missing cases
OFFICIAL ; and the need to avoid overloading the
testing system.
In particular, it was noted that lab testing capacity and availability of PPE were issues and
THE
that rationing would be required.
The TAG
recommended revising itbut acknowledged that regional services need
to be prepared. It needed to be introduced in tandem with streamlining testing
processes UNDER
TAG
recommended separating out criteria 3 from the other two criteria as criteria
3 was primarily for surveil ance purposes.
Action:
Harriette to edit the case definition; separating out testing for surveil ance purposes into a
separate table
5.
RELEASED
Other issues discussed
1. There is a move to testing of COVID not needing approval by Medical Of icer of Health
as this would reduce time delays for primary care waiting for approval before testing
However that this would result in an increased workload for primary care and/or
laboratories, in terms of reporting back results. Because this approach is likely to be
implemented quickly it was agreed that a working group was needed, comprising
representatives from the laboratory, public health and primary care subgroups to:
5
• Identify the issues and solutions associated with the anticipated increase in
workload, and the decision that a Medical Officer of Health wil no longer be
necessary to approve of a COVID-19 lab test.
• An algorithm for processing a positive result
• An algorithm for processing a negative result
The group wil meet tomorrow, 13 March 2020 and wil report back to the TAG on the
outcome.
It was noted that, whilst some PHUs may prefer to take their own approach, others would
be expecting guidance.
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It was also noted that, given the increasing load on the system, a more nationally guided
and consistent approach was required that did not warrant regional variation.
In addition, the critical importance of rapid testing and rapid turnaround, and the emphas
ACT is
on diagnosis and containment, was noted, given the experience in the Republic of Korea
and Singapore. This suggested that the response be led centrally by the Ministry rather
than by individual DHBs and laboratories.
2. The TAG gave feedback to the draft COVID 19 strategy document out of session. Some
members of the TAG would like more engagement with the work around the broader
strategy. There wil be more opportunity for the TAG to input into the strategic plan at the
face to face meeting.
INFORMATION
3. The TAG requested that documents are provided with sufficient time to review.
4. Ian Town reported that university Vice Chancellors have been asked to report back on
their state of readiness if China’s borders were to open.
5. Bryan raised concerns by local GP that an upcoming event at Whangamata (Beach Hop
music festival, 25th-29th March 2020) was going ahead.
OFFICIAL This wil be followed up out of session
by Niki
6
Public Health (Harriette) THE
The Public Health subgroup has recommended that the close contact criteria be changed;
they recommend that close contact is now defined as being within 2 meters for more than
15 minutes.
UNDER
7
Review of current recommendations on clearance
The document on clearance was discussed. More consideration is needed – probably by
clinical subgroup of the TAG.
8 RELEASED
Mass Events:
Niki asked for feedback on paper sent out on social isolation that had been produced by
AHPPC.
9
Face to face meeting – Friday 20 March, 1 to 5pm
2. TAG members requested to send suggested agenda items to Asad
3. Niki confirmed that travel arrangements would be made by the Ministry.
10
Summary of Action Points
6
Agenda item
Actions
Dashboard
TAG
endorsed the approach of the
proposal.
Shari and James wil continue to develop
the dashboard taking into account TAG
advice as above.
Case definition – epidemiological criteria
• The following changes are
recommended:
Classification
areas
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Category 1A
Mainland China,
Iran
Category 1B
Republic of Korea
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Italy
Category 2
Europe (excluding
Italy) and the UK.
United States of
America.
• Category 2 expansion to all
INFORMATION
international travellers
• The Epidemiology subgroup wil
consider whether mainland China
and the Republic of Korea should
be re- categorised.
OFFICIAL
Case definition - clinical criteria
• Broaden clinical criteria in line with
THE
changes to access to testing.
• Clarify surveil ance in hospital
setting
UNDER
11
Next meeting: Friday 20 March 1 - 5pm
Face to face, 133 Molesworth St.
RELEASED
7
Minutes
Technical Advisory Group for COVID-19 Teleconference
Date:
20 March 2020
Time:
1.00pm – 5.00pm
1982
Location:
Room 1S.5, 133 Molesworth St Wellington
ACT
Chair:
Dr Ian Town
Members:
Dr Sally Roberts
Prof Michael Baker
Prof Stephen Chambers
Dr Anja Werno
Dr Erasmus Smit
INFORMATION
Dr Nigel Raymond
Dr Virginia Hope
Dr Shanika Perera
Dr David Murdoch
Dr Bryan Bet y
OFFICIAL
Ministry of Health Attendees:
Dr Caroline McElnay
THE
Dr Harriette Carr
Dr Tomasz Kiedrzynski
Dr Juliet Rumball-Smith
UNDER
Dr Richard Jaine
Dr Niki Stefanogiannis
Andi Shirtcliffe
Asad Abdullahi
Shona Meyrick
RELEASED Andrew Forsyth
Bronwyn Rendle
Doug Lush
Guests:
Prof Nick Wilson, Dr Hernando Acosta, Louise Chamberlain, Steve Brazier
(ESR),
Apologies:
Dr Geoffrey Roche
1
Item Notes
1
Governance
Dr Ian Town welcomed al Members, Attendees and Guests to the meeting in his capacity as
Technical Advisory Group for COVID-19 Chair.
Minutes of the last meeting (12 March 2020) were accepted.
2
Surveil ance
Dr Hernando Acosta, Principal Advisor, Communicable Diseases Team, Ministry of Health presented
an update on New Zealand’s ILI surveillance programmes to inform COVID-19 surveillance and
response.
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• A rapid assessment of New Zealand’s current ILI surveil ance systems has determined that,
with minor modifications, the earlier-than-normal start (i.e. as soon as possible and before
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the flu season) of the following programmes could provide valuable information for
prioritising COVID-19 surveil ance and help detect community transmission and that
monitoring and analysing the following (syndromic) data sources over this coming period
would be a cost-effective approach to evaluate their value as complementary information
for prioritising COVID-19 surveillance and investigations across the country.
INFORMATION
OFFICIAL
THE
Implementation Plan
UNDER
• Surveillance proposal was approved by the Ministry on 16 March and implementation
rollout began the same day. All surveillance programmes and an integrated online
reporting dashboard are expected to be up and running by the first week of April.
RELEASED
2
• FluTracking began 2 March and will run the whole flu season. Becoming popular as a
community-based programme (used in Australia and Europe). Complementary to this,
data can assist with determining if the usual increase of ILI across are related to ILI or to
something else.
• Clarification required on whether Healthline data is only ILI surveillance. Healthline
programme runs throughout the year and provides daily reports during the flu season.
• Healthstat expected to expand to 380 practices by first week of April. Invitation letters are
being distributed today.
• Event-based surveillance is ready.
• Laboratory testing currently conducted is mainly diagnostic not surveillance.
• Hospital cases include blood tests and other samples.
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• Healthline and Healthstat data ready to be sent to MoH today.
• School absenteeism and OTC pharmacy data feed has been established.
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Laboratory Testing (SARS-COV-2):
• Testing will still be mainly for diagnostic not surveillance purposes.
• ILI surveillance will be used to prioritise further surveillance testing.
• The virological sentinel surveillance’s flu swabs (270 tests per week from 90 GP practices)
will not be tested for SARS-COV-2, as it is not sensitive enough for cluster control.
• Testing for surveillance, and diagnosis, will eventually be determined.
• ICU SARI cases are currently being tested across the country (for surveillance purposes as
INFORMATION
part of the current case definition).
• Testing for non-ICU SARI will be highly dependent on available resources and lab capacity.
• Testing for COVID-19 wil be determined by the availability of resources at any particular
time eg: there is currently a worldwide shortage of swabs
OFFICIAL
First report as at Friday 20 March was presented.
THE
ILI_Surv_COVID-19_
TAG_200320.pptx
Discussion:
• Questions have been a
UNDER djusted for people answering the survey, following Australian
feedback, so now if patients answer yes for both fever or cough, they are now prompted
with additional questions.
• Potential equity issues are of concern as certain populations may not be able to engage
with an online questionnaire. Careful consideration is being given to where sampling occurs
to assist with these populations engaging with the surveillance if they are not in touch with
their G
RELEASED P. Healthstat is currently well represented at a national level.
• Green Cross Health are larger pharmacies and may not pick up vulnerable populations.
3
Testing Criteria, Testing Logistics, PPE Capacity and Supply
Testing Criteria
• Questions are still being raised about the criteria for testing.
• Current advice on MOH website is still coupling symptoms and travelling. Considering
trajectory of community transmission and supply issues, TAG was asked to consider
3
whether the current advice should be balanced between symptoms and travelling and
provide guidance on appropriate advice.
Discussion
• We may now be seeing cases of community transmission – currently 2 developing cases
with no history of travel.
• Almost at testing capacity, will have to test those with highest risk.
• Consider case definition against volumes – there is a current increase in testing as people
are returning home with new travel restrictions but this group will drop off.
• A lot of data is not being entered into Episurve due to resourcing.
• TAG considered that anyone with clinical symptoms should be tested.
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• Testing criteria already covers people presenting with symptoms that have not travelled –
the clinical judgement criterion.
• Precautionary advice required, considering best way to deploy staff and PPE. ACT
Testing Logistics
• MOH is currently working with all suppliers and centralising discussion on supply chains
and considering testing logistics and centralised procurement.
• Three main streams are being considered – diplomatic, procurement, university
capacity.
• There has been a positive response from universities on an arrangement to apply their
scientific resources.
INFORMATION
• A high risk around quality is recognised for unvalidated suppliers offering new rapid
testing kits.
• All available testing kit sources are being investigated.
• A backup plan may be required to send testing offshore.
OFFICIAL
TAG recommendations:
• No change to current test case definition.
• Use PPE as currently word
THE ed for patients with significant respiratory symptoms. Work
to rationalise messaging on PPE.
Action: PPE Issues to be addressed by Caroline McElnay in discussion with Juliet
Rumbal -Smith
UNDER
4
Providing guidance to healthcare workers with respiratory systems
TAG was asked to consider the fol owing scenario and to provide guidance and confirm the advice
given on the ability to work, and testing:
Scenario:
Healthcare workers with symptoms (i.e. respiratory, influenza-like etc) who are not suspected
cases or close contacts with suspected cases,
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Questions put to TAG:
1. Do we test healthcare workers if they have mild symptoms but are not a close or casual
contact of a confirmed case, and do not have a travel history?
o TAG response to Q1:
YES, we do test
2. Do we request healthcare workers to stand down from work if they have mild
respiratory symptoms but do not meet the case definition for a suspected case?
4
o TAG response to Q2:
YES, we do request stand down from work
Based on assumptions that there has been limited contact; can return
to work if negative and asymptomatic for 24 hours
Providing guidance to healthcare workers who have an underlying condition or who are
pregnant Question put to TAG:
3. What is the recommendation to health care workers with comorbidities regarding
involvement in care of COVID-19 suspected or confirmed cases?
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Discussion:
o Consider 3 high risk groups – those with conditions such as diabetes, tho
ACT se over
65, those who are pregnant.
o Current evidence does not support pregnancy as being an especially high risk
situation.
o Help line is currently being set up for community health workers and GPs for
general COVID-19 enquiries. If not a straight forward case, specialist clinical
advice will be sought.
TAG Recommendations:
INFORMATION
o These workers should be deployed to work ‘virtually’ or in an area with non-
patient contact.
o Provide guidance and principles to organisations on reducing face to face
exposure to ensure workers are kept safe.
o Ensure workers are well informed on the risk and enabled to voice concerns.
OFFICIAL
o Provide clarity and clinical guidance on patients who are being taken off
immunosuppressants.
Action: IPC subgro
THE up
5
Modelling
Professor Nick Wilson, University of Otago, presented his modelling reports:
1. 13 March 2020 repor
UNDER t- models the potential health impact of the COVID-19 pandemic
spreading in NZ and the extent to which this impact could be mitigated with control
measures;
2. 16 March 2020 report – models the potential age-specific health outcomes from the
uncontrol ed spread of COVID-19.
• Model ing is being conducted using NZ demographic data and relevant parameters from
RELEASED
international literature, with a wide range of scenarios being explored. .
• Planning to produce a new report using most up to date information, on scenarios to
reduce hospitalisation and fatality rates.
• Key message – if reproduction number (R0) can be reduced to near 1.0, the epidemic peak
could be pushed into 2021 when a vaccine is available. High isolation rates will be required
to push peak into 2021
• Seasonal factors are also being modelled.
• Currently modelling a 6-month control period
5
• Effectiveness of quarantine is dependent on social practices.
• A revised modelling paper bringing the 2 earlier reports together will be available 21
March.
Additional Papers Tabled
• Paper on links between cases of confirmed and probable COVID-19 cases was tabled.
Current data suggests NZ is on the cusp of community outbreak. This data is currently
being used in discussion with Ministers.
• Work on current progression rates is underway. This will be compared to other countries
rates and used to map NZ control measures.
Decisions
• 13 March and 16 March modelling reports are currently undergoing signoff. The 21 March
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report wil then be uploaded onto the MoH website on 23 March.
The Chair acknowledged the modelling has been and will continue to be critical to decision making.
ACT
7
New Zealand COVID-19 Alert Levels and COVID-19 Strategic Response Plan
Shona Meyrick presented New Zealand COVID-19 Alert Levels
and the Draft COVID-19 Strategic
Response Plan for TAG information and feedback.
NZ COVID-19 Alert Levels
• These alert levels are part of a framework for setting the scene for national construct
and signal ing to other agencies what they need to be doing. The Chair advised we have
INFORMATION
now eased into Level 2 – Disease is contained, but risks of community transmission are
growing.
• NZ’s COVID-19 strategy focuses on keeping it out, stamping it out and slowing it down.
• The 4 alert levels specify the public health measures to be taken and the impacts on daily
life.
OFFICIAL
• The alert levels may be applied at the town/city, TLA, regional or national levels. Different
parts of the country may be at different alert levels
• In general, the alert levels are cumulative.
THE
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6
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ACT
TAG feedback on Alert Levels:
INFORMATION
• Current diagram reads as if measures are sequential. Should they be shown in parallel?
COVID-19 Strategic Response Plan
• The Response Plan establishes a framework for operational planning. It is aimed at the
health sector but includes some components relevant to other agencies and sectors.
OFFICIAL
The Plan will be finalised on the 23 March and published by end of March. It wil be a
‘living document’ which wil continue to be updated.
• Detailed operational plans will not be published as ‘living documents’. There will be up
THE
to 10 operational plans.
TAG feedback on the overal Plan:
• Phasing terminology needs to be aligned with alert levels and other documentation
UNDER
• Include an up-front statement giving an ethical and community lens is needed along
with a purpose statement.
Section 1 - Key Aspects of the Plan
• Currently reflects the broader pandemic phases, but this will narrow to the current
phase of the COVID-19 pandemic.
RELEASED
Section 2 – Strategic Response Action Plan
• Response Plan identifies 8-10 areas of planning activities. They are not intended to be
siloed; there are activities that impact across all areas.
Public Health
• Confirmed high level action of ‘increased contact tracing capacity to 50 cases per day’ is
50 cases nationally, not per public health area.
7
Action: Dr Shanika Perera will check this relates to cases in the community and provide
feedback.
• A contact tracing platform based at the Ministry has been launched this week.
• A separate Psychosocial Plan is being developed.
• A workstream is currently investigating options for providing accommodation during
self-isolation eg, campervans and hotels. Current expectation is for individuals to pay
for this themselves.
Hospitals
• All District Health Boards (DHBs) are required to have Action Plans for Communicable
diseases – this work is well underway.
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• DHBs have been advised to activate their Business Continuity Plans.
• “Hospital at home” arrangements are not widely understood. There is evidence that
mild pneumonia can be safely managed at home, although this could be an issue
ACT in high
deprivation areas and is dependent on nurse availability. There is a possibility this could
be rol ed out in certain areas eg: Kapiti Coast which has existing infrastructure that
could be used.
Action: Dr Bryan Betty will enquire amongst colleagues if there are areas with current
infrastructure that could support this.
• ICU capacity is being worked on eg: ventilator sourcing.
• There are conversations underway with private hospitals eg: routine care of non-
COVID-19 patients. Acknowledged there is a constraint with many staff c
INFORMATION urrently
working across both public and private hospitals.
TAG feedback:
• Replace ‘field hospital’ terminology with ‘non-health settings’. DHBs may need to think
about additional planning for this.
OFFICIAL
• Include Personal Protective Equipment (PPE) lessons learnt eg: a group of GPs in the
Wairarapa have developed a process to sterilise and re-use masks but we are not sure if
this is safe and effective
THE
Care in the Community
• Health Pathways system wil be extended nationally and will be complementary to with
regional pathways as an enabling technology to support decisioning.
UNDER
TAG feedback:
• The role of primary care is not properly described. Plan does give a sense of the
differential spread of high needs.
• BAU should be included eg: underling care in the community.
• Include the at-risk populations such as migrant and refugee communities
RELEASED
Infection prevention and control (IPC)
• Operational plans are focused on standards and best practice.
• All communications channels are being planned and activated in parallel.
TAG feedback:
• Clarity which health care workers require masks.
• Guidance on domestic cleaning has been requested and published.
8
• There is a lot of IPC information on the CDC website which should be incorporated for
PIMS messaging. This is an opportunity to streamline messaging around the greatest
transmission place being the home. Discussion links with PIM flow from IPC group.
• IPC and Public Health areas need to be linked.
Action: PIM needs to lead the focus on home messaging.
• Require public facing messaging for extra precautions for patients leaving hospital to
avoid them infecting others.
Action: IPC subgroup consider.
Health and disability supply chain
• Pharmac and Medicines NZ are being urged to align their objectives as part of managing
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medicines supply chain issues.
TAG feedback:
ACT
•
Action: Andi Shirtcliffe will assist with wording for Order in Council.
• Consider the role for local manufacture for products such as masks and hand sanitisers
for use in the home.
At risk population
• Discussions progressing with Maori Leaders. There is urgency to discuss and deliver marae
based intervention and support.
• Chronic disease has been considered in this area of the plan.
INFORMATION
• Active and focused conversations are underway with local councils which cover higher risk
population areas.
TAG feedback:
• Plan needs to include how to consider providing directed support for high needs
patients to manage equity provisions. All at risk individuals including disability clients
OFFICIAL
should have a plan now. This process needs to begin now to increase realisation of
benefits.
• Pacific island nations are a
THE t risk for several reasons. ESR has offered testing services for
samples sent in from the Pacific.
• Change ‘at risk’ to priority populations.
Workforce UNDER
• Legislation/regulatory work in progress to make other resources available.
TAG feedback
• Require specific instructions for occupational health services.
• Can requirement for health staff not being able to work for 14 days be relaxed? ?
Action: Dr Sally Roberts will connect on the 14 days with Health and Safety Group in
Northern Region.
RELEASED
• Assistance required with gaining traction with NZ Medication Council on recruitment eg:
SMOs.
Action: Chair will discuss registration and training with NZ Medical Council (lead is Dr
Andrew Simpson CMO).
TAG invited to share any further feedback on the Strategic Response Plan with Shona Meyrick as
soon as possible for incorporation into the document on Monday: [email address]
9
8 Any Other Business
• The Chair requested the meeting consider mechanisms for providing more frequent advice
between TAG formal meetings. Suggest establishing ‘on duty subgroup representative’ who
could provide fast-turnaround information to Policy and escalate to the wider subgroup at a
later point.
o Meeting agreed:
Action: Louise Chamberlain will work with Subgroup Chairs to develop clear
processes and identify senior key individuals for this role.
• A Clinical Subgroup will be established across key disciplines. Membership should include a
Clinical Pharmacologist.
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9
New Action Items raised during meeting:
Agenda item
Actions
ACT
PPE Capacity and Supply
PPE Issues to be addressed by Caroline
McElnay in discussion with Juliet Rumbal -
Smith
Providing guidance to healthcare workers
IPC subgroup to provide guidance and
who have an underlying condition or who are principles for health care workers with
pregnant
comorbidities regarding involvement in care of
COVID-19 suspected or confirmed cases.
INFORMATION
Strategic Response Plan
Dr Bryan Betty will enquire amongst
Hospitals
colleagues if there are areas with current
infrastructure that could support ‘hospital at
home’ arrangements.
Strategic Response Plan
PIM to lead the focus on home messaging.
Infection prevention and control (IPC)
OFFICIAL
Strategic Response Plan
IPC subgroup consider public facing messaging
Infection prevention and control (IPC) for extra precautions for patients leaving
THE
hospital to avoid them infecting others.
Strategic Response Plan
Andi Shirtcliffe will assist with wording for
Health and disability supply chain
Order in Council.
Strategic Response Plan
Dr Sally Roberts will connect with Health and
UNDER
Workforce
Safety Group in Northern Region on the 14 day
requirement for health staff not being able to
work.
Strategic Response Plan
Chair will discuss registration and training with
Workforce
NZ Medical Council (lead is Dr Andrew
Simpson CMO).
Strategic Response Plan
Dr Shanika Perera will check contact tracing
RELEASED
Public Health
capacity relates to cases in the community and
provide feedback.
Providing mechanism for more frequent Louise Chamberlain will work with Subgroup
advice
Chairs to develop clear processes and identify
senior key individuals for an ‘on duty subgroup
representative’ who could provide fast-
turnaround information to Policy and escalate
to the wider subgroup at a later point.
10
10 Next meeting: Tuesday 24 March
Teleconference
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INFORMATION
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11
Minutes:
Technical Advisory Group COVID-19
Date:
Tuesday 24 March 2020
Time:
3.00pm – 4.30pm
Location:
NHCC meeting room – basement 133 Molesworth St
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Teleconference: see calendar invitation for details
Chair:
Dr Ian Town
ACT
Attendees:
Dr Sally Roberts, Prof Michael Baker, Prof Stephen Chambers
Dr Anja Werno, Dr Erasmus Smit, Dr Nigel Raymond, Dr Virginia Hope,
Dr Shanika Perera, Dr David Murdoch, Dr Bryan Betty
Ministry of Health staff– Dr Caroline McElnay, Dr Harriette Carr, Dr Tomasz Kiedrzynski,
Dr Juliet Rumball-Smith, Dr Richard Jaine, Andi Shirtcliffe, Asad Abdul ahi, Shona
Meyrick, Fiona Gil am (Secretariat)
Guests
Louise Chamberlain (PwC)
INFORMATION
Apologies:
N/A
Item Governance
1
Dr Ian Town welcomed all Members, Attendees and Guests to the meeting in his capacity as
OFFICIAL
Technical Advisory Group for COVID-19 Chair.
Minutes of the last meeting (20 March 2020) were accepted.
THE
2
Subgroup verbal updates
Epidemiology
• Considering criteria for progressive step-down from Alert Level 4. A considerable
amount of information is required to determine step-down criteria and will test
UNDER
utility of information available through considering two scenarios – testing
limitations or not.
• Discussed how to streamline information on surveillance and extending ESR
dashboard surveillance.
Laboratory
• Have national linkages on increasing capacity and improving supply chain. Also
RELEASED considering private suppliers. This is being led by the MOH procurement team.
Primary Health Care
• Have requested issues with telehealth resourcing and virtual consultation (phone
lines falling over) to be raised at national level.
• Data and Digital and Logistics are linking in with telehealth and feeding into
legislation on state of emergency.
Infection Prevention and Control
• DHB IPC guide – now focusing on aged residential care and hospice guidance and
supporting guidance on transport eg: air ambulance.
Public Health
• Have been discussing physical distancing conditions. Next meeting wil focus on
case definition, travel history implications, EPI criteria and its impact on testing
regimes. Considering how to prioritise testing if criteria is broadened. Do not want
case definition defined by testing ability.
Clinical
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• Discussions underway on set up of a specialist clinical subgroup. Requirement to
have access to specialists at short notice - 10-12 specialities focusing on key areas,
and potentially providing advice by email.
ACT
3
Definition of Recovered
Dr Harriette Carr presented a Review of possible NZ criteria for release from isolation.
Australia recently updated their definition. There has been a consensus from Laboratory
network using 2 negative tests as a criterion is not supported.
TAG Feedback:
• Wish to see science behind decision making.
• It is known that younger patients, although younger and seemingly he
INFORMATION alth, have the
highest viral load.
• PCR could be positive for weeks
• Singapore Chief Medical Officer has implemented to policy of requiring 2 negative
tests prior to release from self-isolation.
• Consider discharge planning – persistence of post viral cough can be issue for
OFFICIAL
release from isolation in absence of pre-existing illnesses.
• Consider monitoring of cases post release.
• Consider the official release process and it implications for families
THE
• Discussions underway with Operations on appointing Episerve Officer in every
Public Health unit and agreeing process eg: updated by certain time daily to
incorporate into reporting
Action: Provide any further feedback to Fiona Gillam urgently.
UNDER
TAG Recommendation:
• TAG recommended we adopt the Australian criteria (minus the double testing
requirement)
4
COVID-19 Health and Disability Response Plan
The Chair thanked TAG for their previous feedback and contributions to the plan. Any
RELEASED
further feedback needs to be received by Shona Meyrick by COB 24 March prior to being
published. The plan will include operational plans which wil be continual y updated as
required. Plan likely to be updated within 2-4 weeks – ie, will be living a document
TAG Feedback:
Primary Care
• Clarity required on levels 3 and 4 requirements in the health system (different alert
levels apply)
• Current wording of no face to face consultations in primary care has caused
significant issues. Propose rewording to ‘minimise face to face’.
• Most DHBs will have prepared their plans as pandemic. DHB Team is currently
working to resolve confusion on how levels operate. Communications Plan is in
draft, currently receiving sector feedback.
• NHCC Intelligence is working on strategic view and planning on measuring
effectiveness at level 4 and movement between levels 3 and 4. Societal approach
does not mean the same for health sector.
Action: EPI subgroup to consider criteria of cases going up or down, numbers of1982
community transmission and total cases on the alert levels
Health and Disability
ACT
• Do not have capacity in Auckland for all residential care support. Can carer roles be
more flexible?
5
Formation of Te Rōpū Whakakaupapa Urutā/ Māori Pandemic Coordination Group
Dr Bryan Betty presented briefing paper - Te Rōpū Whakakaupapa Urutā/ Māori Pandemic
Coordination Group to Technical Advisory Group and Senior Science Advisors
• TAG noted the formation of the Te Rōpū Whakakaupapa Urutā/ Māori Pandemic
INFORMATION
Coordination Group on 13 March, made up of key leaders in Māori health, including
Primary Care Specialists, Public Health experts, Public Health Physicians, Māori
physicians, Māori Nurses and iwi leaders. The group has established a
communication platform, has strong active links with a large number of Māori
organisations and has an active media presence.
OFFICIAL
• Primary Care subgroup has endorsed the recommendation to appoint a member of
Te Rōpū Whakakaupapa Urutā/ Māori Pandemic Coordination Group to the
Technical Advisory Group.
THE
TAG Recommendation:
• A member of
Te Rōpū Whakakaupapa Urutā/ Māori Pandemic Coordination Group
should be appointed to the Technical Advisory Group.
Action: Dr Ian T
UNDER own will action this appointment through the Maori Directorate.
Juliet to consider if NHCC requires Maori support.
TAG discussion:
• Discussions underway for Pacific Island representative to join TAG.
6
Operation of subgroups
RELEASED
Louise Chamberlain presented proposal on operation of subgroups for centralising and
managing urgent requests:
• There is expected to be an increase in information requests.
• Nominate an ‘on duty’ subgroup member to drive quick turnaround of technical
and scientific advice on urgent information requests
• A TAG inbox is being created as a single point of contact for information requests
• Proof of concept will be released over new few days.
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INFORMATION
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Minutes:
Technical Advisory Group COVID-19
Date:
Friday 27 March 2020
Time:
10.00am – 11.00am
Location:
Video conference; Room 3N.3 133 Molesworth St
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Chair:
Dr Ian Town
ACT
Attendees:
Prof Stephen Chambers, Dr Erasmus Smit, Dr Nigel Raymond, Dr Virginia Hope,
Dr Shanika Perera, Dr David Murdoch, Dr Colin Tukuitonga, Louise Chamberlain
Ministry of Health staff - Dr Harriette Carr, Dr Tomasz Kiedrzynski, Dr Juliet Rumball-
Smith, Dr Richard Jaine, Andi Shirtcliffe, Fiona Gillam (Secretariat)
Guests
N/A
Apologies:
No apologies were received prior to the meeting, however technical difficulties with
telephony prevented ful attendance. Al meetings wil now be conducted via Zoom.
INFORMATION
Item Governance
1
Dr Ian Town welcomed all Members and Attendees to the meeting in his capacity as
Technical Advisory Group for COVID-19 Chair.
Minutes of the last meeting (24 March 2020) were accepted.
OFFICIAL
2
Subgroup verbal updates
Epidemiology
THE
• Discussions in progress to increase membership to include a wider group of
specialists with practical and academic knowledge, to assist with management of
high workload. Richard Jain will update members by email.
Laboratory
UNDER
• Evidence has found a lot of new tests have not being validated. Ministry
Procurement Team is working through a formal process of assessment.
• Universities are stepping up efforts in university laboratories to conduct testing, but
this could be 3-4 weeks away.
Primary Health Care
RELEASED
PPE • Healthcare logistics and comms are working on getting clarity on current
supply chain
• Need to provide guidance to essential industry groups – healthcare workers are
the priority.
• Teleconferences being held today with DHBs and Health Staff Unions.
Public Health
• Advice for health professionals on criteria for release from isolation for probable and
confirmed cases has been updated to be released to clinical community.
updated-advice-for COVID-19 release
-health-professiona from isolation criteri
• Decoupling case definition and test criteria
Action: Dr Harriette Carr will provide proposal for discussion today on decoupling
case definition and test criteria with an eye to supply issues.
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Clarity on 1 / 2 mt social distancing rule
ACT
• There appears to be a need to provide additional clarity to the public and to
health care workers on social distancing rules although current advice is
readily available on website (at least 1mt, preferably 2mt for general
physical distancing and 2mt for contact tracing of close contacts). Any
change to current advice needs to be led by Clinical but come back through
Public Health
Action: Dr Harriette Carr to progress with Clinical Desk
Clinical
• Discussions underway on set up of a specialist clinical subgroup. Requ
INFORMATION irement to
have access to specialists at short notice - 10-12 specialities focusing on key areas,
and potentially providing advice by email.
3
Point of Care Testing
Louise Chamberlain presented a request for advice:
OFFICIAL
TAG was requested to provide advice to the Laboratory Testing workstream on whether
point of care testing is to be a component of their Testing Strategy, considering:
• If point of care testing is
THE to be implemented as part of the testing strategy;
• If so, what are parameters to implement to - where would point of care testing be
placed? – (all CBACs; only large ones; hospitals etc)
Noted by Advice Requestor:
UNDER
From a practical perspective, the benefits are that this will increase our national test
capacity and take some load off central labs.
TAG Feedback:
• Would be an advantage from a strategic and logistics point of view
• POC test ned to be valid and have good sensitivity and specificity
RELEASED
TAG Recommendation:
• Do not deploy point of care testing until we are confident that the exercise wil be
effective and not harmful.
• POC testing will be evaluated continuously by ESR and Michael Bunce
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INFORMATION
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Minutes:
Technical Advisory Group COVID-19
Date:
Tuesday 31 March 2020
Time:
10.00am – 11.00am
Location:
Zoom; Room 3S.5 133 Molesworth St
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Chair:
Dr Ian Town
ACT
Attendees:
Dr Sally Roberts, Prof Michael Baker, Prof Stephen Chambers, Dr Anja Werno,
Dr Erasmus Smit, Dr Nigel Raymond, Dr Virginia Hope, Dr Shanika Perera, Dr David
Murdoch, Dr Bryan Betty, Dr Colin Tukuitonga, Dr Matire Harwood
Ministry of Health staff - Dr Caroline McElnay, Dr Harriette Carr, Dr Tomasz Kiedrzynski,
Dr Juliet Rumball-Smith, Dr Richard Jaine, Dr Niki Stefanogiannis, Andi Shirtcliffe,
Asad Abdul ahi, Margaret Broodkoorn, Louise Chamberlain, Fiona Gillam (Secretariat)
Guests
N/A
INFORMATION
Apologies:
N/A
Item Governance
1.0
Dr Ian Town welcomed all Members and Attendees, particularly new Members Dr Matire
Harwood from Te Rōpū Whakakaupapa Urutā/ Māori Pandemic Coordination Group and Dr
Collin Tukuitonga from Pacific COVID-19 Response Tea
OFFICIAL m.
Minutes of the last meeting (27 March 2020) were accepted, noting an amendment has been
made to refence case definition and test criteria to be considered at today’s meeting.
THE
2.0
Update on open actions
Actions 03, 04, 08, 10 were closed. Actions 02, 06, 09 remain open.
3.0
Case Definition and Test Criteria
The Chair advised the D
UNDER irector General of Health requires a recommendation today on Case
Definition and Test Criteria for COVID-19.
• DG would like the criteria decoupled from travel and traveller
Dr Harriette Carr presented options:
Memo Re options
RELEASED
for case definition a
TAG Discussion:
• Current strategy is elimination.
• Test criteria must be simple, quantified, reflect elimination strategy and be easy to
interpret. Supplementary guidance wil be required for people who do not meet
case definition.
• Data is required to understand success of elimination strategy and to inform future
escalation or de-escalation decisions.
• Option 2a (Remove epidemiological criteria from Suspect Case definition and refine
clinical criteria) is simplest option - some criteria are based on most common
symptoms and would be most useful for people running CBACs in areas difficult to
self-isolate without a positive test result.
• Decouple case definition from travel.
• Many people are being tested that do not fit current test definition and criteria.
• Managing suspect cases without testing for long period of time may be an issue
outside of lockdown period.
• Respiratory illness hospital admissions should be treated as COVID-19 until proven
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otherwise.
• Lab capacity will be increasing over next 2-3 weeks.
• Clear comms is required, not only to health sector but also to public. ACT
TAG Decision:
• Agreed we are pursuing an elimination strategy.
• Approved in principle that a version of Option 2a be adopted.
Action: Dr Harriette Carr to draft and provide version of Option 2a for submission
to the Director General.
4.0
Clinical Subgroup
INFORMATION
Louise Chamberlain provided an update on the establishment of the Clinical Subgroup:
• Developing a core group of experts for advice and rapid response to clinical
questions.
• Working with representatives from Health Pathways and Hospital Pathways, on
improving information delivery.
OFFICIAL
• National Telephone Service is piloting an advice line for Health Professionals (not
just GPs).
• Invite feedback on Clinical Subgroup Terms of Reference
THE
Action: Louise Chamberlain distribute TOR to TAG for feedback
5.0
Supply of Essential Medicines
Andi Shirtcliffe provided an update on the supply of essential medicines:
• Putting together advice on stocks levels across sector.
UNDER
• No projected out of stock situation; any issues to date have been related to
communications between wholesalers and suppliers, and some stockpiling.
• PHARMAC and Medsafe are in regular contact with suppliers.
• MFAT working with air freight operators to circumvent potential supply issue in 4-6
weeks.
• Need information on current and likely future use of antivirals, likely range of
antibiotics, which oral medicines are being used to treat moderate COVID-19.
RELEASED
Acton: Dr Nigel Raymond investigate and report back
6.0
Evidence Base and Thematic Analysis
Dr Ian Town provided information on clinical trials:
• Library and information management staff developing reporting which will be
forwarded to TAG regularly.
7.0
Laboratory Testing
Dr Ian Town provided information on laboratory testing:
• Circulated paper has been prepared by Michael Bunce, Chief Science Advisor at EPA,
and has been provided to Ministry and other agencies, including MOH supply chain
team.
• Research on potentially useful test kits is being tracked with support from ESR.
• Information or feedback on any test kits welcomed.
TAG feedback:
• Need to connect with clinical community and laboratory specialists
• A Diagnostic Laboratory Expert needs to be involved in future assessments (E Smit)
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• Likely NZ will be slow producing data to validate tests as we have low case numbers
• Concerned some organisations have the right to bring test kits into NZ.ACT
• University laboratories should not be developing their own assays.
• Limited test capacity in Pacific Island communities. WHO is involved in supporting
testing capacity uplift.
• Rise in IgG not being detectable until 2nd week at earliest and this means that
serology testing is not very useful for acute diagnosis.
8.0
Subgroup verbal updates
Epidemiology
INFORMATION
• Subgroup has been strengthened and wil consider forward planning strategy which
wil then be used by officials for scenario planning.
Primary Health Care
• Ongoing discussions on PPE supply and deployment.
• Advice for health care workers – no difference with patients presenting with
respiratory conditions in hospitals or privat
OFFICIAL e practice.
• Not enough flu vaccine in vulnerable communities – the MOH is working with
PHARMAC on this.
THE
• Adjusting practice to treat respiratory symptoms then sending to CBACs (an
example in South Auckland)
Infection Prevention and Control
• Revised self-isolation criteria and advice published 30 March.
UNDER
• Important that advice is specific - release from isolation must be a conversation
between the patient and their practitioner.
Other:
• Supporting work on overcrowded housing and options to relieve; information flows
and GPs providing support for Pacific Island communities.
RELEASED
9.0
Any other business
•
No other business discussed
10.00 Agenda items for next meeting
• No future agenda items raised
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Minutes:
Technical Advisory Group for COVID-19
Date:
Friday 3 April 2020
Time:
10.30am – 11.30am
Location:
Zoom; Room 3S.1 133 Molesworth St
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Chair:
Dr Ian Town
ACT
Attendees:
Dr Sally Roberts, Prof Michael Baker, Prof Stephen Chambers, Dr Anja Werno,
Dr Erasmus Smit, Dr Nigel Raymond, Dr Virginia Hope, Dr Shanika Perera, Dr David
Murdoch, Dr Bryan Betty, Dr Colin Tukuitonga, Dr Matire Harwood
Ministry of Health staff - Dr Caroline McElnay, Dr Harriette Carr, Dr Tomasz Kiedrzynski,
Dr Juliet Rumball-Smith, Dr Niki Stefanogiannis, Andi Shirtcliffe
Asad Abdul ahi, Margaret Broodkoorn, Louise Chamberlain, Fiona Gillam (Secretariat)
Guests
N/A
INFORMATION
Apologies:
Dr Richard Jaine
Item Governance
1.0
Dr Ian Town welcomed all Members and Attendees, in his capacity as Chair of the Technical
Advisory Group for COVID-19. OFFICIAL
Minutes of the last meeting (31 March 2020) were accepted.
2.0
Update on open actions
Actions 9, 11, 12 were closed. Ac
THE tions 2, 6, 13 remain open.
3.0
Clinical Criteria of Case Definition
The Chair advised that feedback received on the Case Definition and Test Criteria (updated
on 2 April) indicates further fine-tuning is required. TAG was requested to advise and
provide decision on cha
UNDER nges required.
• Range of feedback received – too broad; too onerous; too narrow – potentially
missing cases; particularly how to operationalise in hospital setting – isolation issue
• Have received update on current presentation of cases and update from Intel on
presentation of combination of symptoms
• Requesting close contact analysis data from ESR
RELEASED
• Multiple procurement systems in place to increase testing capacity
TAG Feedback:
• Must be simple and clear message
• Sensitive clinical criteria important
• Public messaging must align and provide clarity as issues have arisen with current
public messaging and is impacting front line staff
• Difficult to capture all clinical judgement in a clinical definition. Clinical judgment
critical eg: if there is another clear source of fever
• Issue with drawing on other country’s experience as they have not been operating
under an Elimination Strategy
• Anosmia is an important symptom to consider
• Unlikely to get data for those who test negative – Public Health have not been
recording patient details
TAG Decision:
Clinical Criteria of Case Definition
• Make criteria as sensitive as possible
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• Fever is no longer a requirement. Replace case definition with ‘a range of
common respiratory symptoms’
ACT
• There is still an overarching clinical judgement criterion
Action: Clinical Criteria of Case Definition to be redrafted by early
afternoon today and will be posted on Ministry of Health website 3 April.
4.0
Clearance Criteria
Dr Harriette Carr advised the Director General of Health has requested TAG clarify the
difference between the Australian and New Zealand Clearance Criteria.
Current criteria:
INFORMATION
• 48 hours symptom free
TAG feedback:
• Queries being received from health professionals and the community that we are
not aligned with other countries
OFFICIAL
• Not enough data exists to base decision on. Must balance any change with sensible
practicalities.
TAG Decision:
THE
• No evidence to support a change to the 48 hour criteria
5.0
Influenza Vaccine Availability
Dr Niki Stefanogiannis provided an update from the Immunisation Team:
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• 1,000,000 vaccines arrived 2 days ago, 200,000 are in transit.
• The max order of 60 doses applies, but providers do have the ability to request
more.
• Reviewing orders daily and coordinating to ensure supplying where most needed.
• Practices eligible for funding are receiving.
• Coordinators working to move local stockpiles around.
• More stock arriving through to mid-May.
RELEASED
• Pharmac have ordered 1.6mill doses.
TAG feedback:
• Supply chain issues have not been resolved.
• Must be able to order more than 60 vaccines per practice at a time.
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INFORMATION
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• There is an overarching clinical judgement criterion
Clearance Criteria:
• No evidence to support a change to the 48 hour criteria
13.0 Meeting closed at 11.30am
Next meeting Tuesday 7 April 10.30am – 11.30am
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Minutes:
Technical Advisory Group for COVID-19
Date:
Friday 17 April 2020
Time:
10.30am – 11.30am
Location:
Teleconference
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Chair:
Dr Ian Town
ACT
Attendees:
Dr Sally Roberts, Prof Michael Baker, Prof Stephen Chambers, Dr Anja Werno,
Dr Nigel Raymond, Dr Virginia Hope, Dr Shanika Perera, Prof David Murdoch, Dr Bryan
Betty, Dr Matire Harwood, Dr Patricia Priest, Dr Colin Tukuitonga, Dr Erasmus Smit
Ministry of Health staff - Dr Caroline McElnay, Dr Harriette Carr, Dr Tomasz Kiedrzynski,
Dr Juliet Rumball-Smith, Dr Richard Jaine, Dr Niki Stefanogiannis, Andi Shirtcliffe, Asad
Abdul ahi, Margaret Broodkoorn, Louise Chamberlain, Fiona Gillam (Secretariat)
Guests
N/A
INFORMATION
Apologies:
N/A
1.0 Welcome and Previous Minutes
Dr Ian Town welcomed all Members and Attendees in his capacity as Chair of the Technical Advisory
Group for COVID-19.
OFFICIAL
Minutes of the last meeting (9 April 2020) were accepted.
2.0 Update on open actions THE
Action 19 remains open with a revised emphasis on a possible rapid review testing strategy and
performance
3.0
Ministry of Health update on COVID-19 response
The Chair gave an update on current issues being worked on in Ministry of Health including the
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development advice on moving out of Level 4 lockdown along with the monitoring and surveillance
tools for the next phase of the pandemic response.
Data analysis continues, with the Ministry acknowledging the need for improved processes and
infrastructure in this area. Further work on a strategic approach will commence on April 20th.
TAG noted that Epidemiology Subgroup has not been providing independent reviews of data (as has
been publicly stated).
RELEASED
4.0
Peak Surge Capacity required to support contact tracing
TAG considered Dr Ayesha Verrall’s report and subsequent request for advice on peak surge
capacity required to support contact tracing, received from the National Contact Tracing Service.
TAG noted this request for advice has been considered by the Public Health Subgroup.
TAG feedback:
• Agree with the principal of surge capacity, but this needs to be considered against
measures to ensure quality of contact tracing
• Contact tracing is not a linear process. Complex cases are an additional consideration, as
are operational implications
• Ensure feasible indicators and parameters based on circumstances are used.
• The number of 1000 is reflecting rapid spread/surge in certain circumstances. Modelling
group should be engaged, as they move to more of a network modelling framework which
takes into accounts people movements.
• The figure of 1000 was not evidence based
• An increase of cases in high density poverty areas should be considered in contact tracing
scenario planning.
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Action: Laboratory, Epidemiology and Public Health Subgroups to consider process and
elements further, as input into scenario and surveillance planning work.
ACT
TAG recommendation:
• Yes, surge capacity is required in all regions to respond to outbreaks
• Further work is required to understand the process, elements and strategic overview and
should be considered more as ‘the capacity to respond’ rather than a ‘number’
Action: Communicate recommendation
5.0 Serology Testing
TAG noted Serology testing for COVID-19 paper by Dr Erasmus Smit, Clinical Virologist ESR and
activities underway in the area
INFORMATION
TAG feedback:
• Point of care and rapid serology testing is not yet at a state to deploy in NZ now, but would
be useful in the future to monitor prevalence of antibodies in the community.
• Main issue currently is specificity and accuracy of any such with the current low prevalence
levels.
OFFICIAL
• Even if specificity isn’t as high as we would like, analysis can consider the known specificity
with good statistics to identify levels of prevalence.
• Epidemiologists should be leading the discussion with a systematic and targeted approach,
THE
not just convalescent samples from people suspected of having COVID but tested negative
from PCR
Action: Provide feedback to be incorporated into Surveillance Plan
6.0
Data
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Asymptotic Contact Data
• Current guidance is to only test symptomatic patients. More comprehensive testing is
required on asymptomatic contacts in and around clusters
• Chair advised data is being gathered in Queenstown and Waikato on clusters in response to
Prime Minister’s request and will form part of Surveillance Plan
Aged Care Facility Data
RELEASED
• Chair advised that more detailed information is being gathered on aged care facility
outbreaks
Healthcare Workers
• Data on how healthcare workers were infected would be useful to guide healthcare worker
safety and conditions
7.0 TAG Terms of Reference and Documentation
TAG noted work is progressing on TAG and Subgroup ways of working framework, including refining
the Terms of Reference, the definition and completion of ‘advice’ and fees framework.
The Chair noted a recent announcement by the Director General of Health on a change to
leadership structure at the Ministry. Keriana Brooking has been appointed as Deputy Chief
Executive responsible for the COVID-19 response
8.0 Pacific COVID-19 Response Team
TAG noted the Draft Operational Plan - Pacific COVID-19 Response has been provided and is aligned
to national plans.
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TAG is invited to provide any feedback on the plan to the Pacific COVID-19 Response Team,
ACT
Pacific action plan
contact
v1.6.docx
s 9(2)(a)
• Availability of accurate Pacific data continues to be an issue
• Mobile testing for Maori and Pacific communities is being scaled up in Auckland
9.0 Te Rōpū Whakakaupapa Urutā/ Māori Pandemic Coordination Group
• Greater numbers of Maori and Pacific people are presenting to their GPs in designated
clinics
• Availability of accurate Maori data continues to be an issue. Testing sho
INFORMATION uld be monitored
by ethnicity. Wider issues of contact tracing and quarantining exist for those already living
in crowded homes.
• Ensure Maori involvement in data sovereignty
Action: Seek guidance on data sovereignty from Professor Tahu Kukutai, University of
Waikato
OFFICIAL
10.0 Technical Advisory Groups operating in other regions
The Chair noted a teleconference is to be held next week with the Chairs of Technical Advisory
Groups operating in other regions
THE , to offer support and ensure alignment.
11.0 Aged Residential Care – Testing Requirement
TAG noted the Ministry does not support the requirement for a negative test fol owed by a 14-day
quarantine period before new residents are admitted to an aged residential care facility.
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• An independent view has now been sought on whether TAG supports the Ministry’s view.
• Public Health Subgroup are progressing, considering that of all rest home cases to date,
only 1 case has been brought in by a resident, with al other cases being brought in by
healthcare workers.
Action: Laboratory Subgroup will consider this urgently and provide advice back to the
Public Health Subgroup.
12.0 Subgroup v
RELEASED
erbal updates
Epidemiology
• Have been advocating strongly for equity to be as key consideration for data to be collected.
Not yet seeing that coming through in data.
Public Health
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INFORMATION
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25 Aged Residential
Laboratory Subgroup consider urgently and
Dr Anya Werno
Care – Testing
provide advice back to the Public Health
Requirement
Subgroup.
26 Intensive case and
Summarise options and next steps and
Dr Harriette Carr
contact management
provide to Clinical and Primary Care
to support
Subgroups for their consideration
elimination strategy
27 Public statement on
Follow-up on public statement being
Dr Ian Town
the development of
provided
new contact tracing
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tools
16.0 Summary of TAG Recommendations
ACT
Peak Surge Capacity required to support contact tracing
• Yes, surge capacity is required in all regions to respond to outbreaks
• Further work is required to understand the process, elements and strategic overview and
should be considered more as ‘the capacity to respond’ rather than a ‘number’
17.0 Meeting closed at 11.30am
Next meeting Tuesday 21 April 10.30am – 11.30am
INFORMATION
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Minutes:
Technical Advisory Group for COVID-19
Date:
Tuesday 21 April 2020
Time:
10.30am – 11.30am
Location:
Zoom Meeting
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Chair:
Dr Ian Town
ACT
Attendees:
Dr Sally Roberts, Prof Michael Baker, Prof Stephen Chambers, Dr Anja Werno,
Dr Nigel Raymond, Dr Virginia Hope, Dr Shanika Perera, Prof David Murdoch, Dr Bryan
Betty, Dr Matire Harwood, Dr Patricia Priest, Dr Erasmus Smit
Ministry of Health staff - Dr Caroline McElnay, Dr Harriette Carr, Dr Tomasz Kiedrzynski,
Dr Juliet Rumball-Smith, Dr Richard Jaine, Dr Niki Stefanogiannis, Andi Shirtcliffe, Asad
Abdul ahi, Margaret Broodkoorn, Louise Chamberlain, Fiona Gillam (Secretariat)
Guests
N/A
INFORMATION
Apologies:
Dr Colin Tukuitonga
1.0 Welcome and Previous Minutes
Dr Ian Town welcomed all Members and Attendees in his capacity as Chair of the Technical Advisory
Group for COVID-19.
OFFICIAL
Minutes of the last meeting (17 April 2020) were accepted.
• TAG noted the Epidemiology Subgroup has not provided any specific figures related to the
THE
1000 new cases per day target (item 4 - Peak Surge Capacity required to support contact
tracing) as has been publicly stated).
2.0 Update on open actions
Actions 19 and 24 remain open. Actions 21, 22, 23, 25, 26 were closed.
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3.0
Ministry of Health update on COVID-19 response
The Chair gave an update on current issues being worked on in Ministry of Health particularly the
preparation and delivery of advice to the Government on movement down from Alert Level 4. The
Ministry will continue to provide ongoing monitoring and advice on any movement from Alert Level
3 to Alert Level 2 in the coming week.
The Chair thanked TAG and Subgroups for all work related to this.
RELEASED
4.0
Surveil ance Plan
TAG discussed Surveil ance Plan v3.0, which has been updated with some of the feedback from the
Epidemiology Subgroup, with some of their feedback requiring further consideration. A critical part
of the Plan is surveillance testing, and this area needs further detailed work. The Plan will continue
to be developed rapidly to support the provision of information and advice to inform the next
phase of the response.
TAG feedback:
• Clarification required on the level of input sought and roles and responsibilities eg:
Epidemiology and Laboratory Subgroups, ESR, other experts
Action: Clarify roles, tasks and timing and advise
Community Testing:
- The Ministry of Health is developing this aspect of the Surveillance Plan which will
include serological testing in the future
- Testing must be systematic/population based to enable meaningful conclusions
- ESR have offered to develop a serum bank
- NZ is in a different situation than the rest of the world and consideration needs to
1982 be
given to NZ having a different need for serological testing, as we are assuming only a
small proportion of the population is infected.
ACT
5.0 Data and Data Analysis
The Chair noted that he was convening data and analytics workshops.
Current methodology is linear and manual and contributing to delays.
Options being considered for better tools for public health staff in the field.
• Epidemiology and Public Health intelligence needs to be linked
• Results of workshops will be shared at the next TAG meeting
6.0
Healthcare Workers with COVID-19
INFORMATION
TAG discussed analysis on healthcare workers with COVID-19. The Intelligence Team is conducting
further analysis.
TAG feedback:
• Critical to understand, particularly with the emergence of clusters in healthcare facilities
• Important to know how healthcare workers
OFFICIAL have become infected, but patients also need
to know they are in a safe environment
• Clinical Subgroup would like to be more involved and work with Public Health and analytics
THE
• Needs a combination of occupational health, public health and infection prevention and
control
• How has exposure occurred? Eg: household vs workplace; absence of PPE / PPE breach
• Need to provide clear guidance to healthcare workers and their employers
7.0 Rapid review of laborato
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ry testing
TAG discussed the recommendation for a rapid review of laboratory testing.
TAG feedback:
• Ensure linkage of current parallel activities, complex relationships and the possible future
state would all be helpful
• Include laboratory capacity and pathways in rural and regional areas
RELEASED
• Consider operational side of service workload and issue of re-agent supply
TAG recommendation:
• Support given for a rapid review of laboratory testing
Action: Finalise review proposal and submit for consideration and approval
Further TAG feedback:
• Consider a rapid review of Epidemiology and Surveillance. How are decisions being made
and who is having input?
8.0 Subgroup verbal updates
Epidemiology
• Received Surveillance Report V2.0 and have provided some initial feedback. Will also expect
to discuss further in the coming days.
• Have been meeting more frequently as necessary for incoming requests
Primary Care
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• Providing both positive and negative cases test results back to GPs is considered very
important. Current gap in this provision is resulting in a split focus with CBACs and regular
ACT
Clinical care.
• Access to data continues to be an issue
• Primary Care subgroup particularly interested in methodology for evaluating Point of Care
Testing now and in future.
The Chair advised that Section 37 Notice - Point of Care Testing will be issued on 22nd April
preventing the importation of POC test kits that have not been assessed for validity.
Laboratory
• Working on defining best utilisation for GenExpert, a rapid molecular test
INFORMATION
IPC
• Have received additional requests for random testing of asymptomatic people, which infers
PPE standards and prevention control is not good enough.
Clinical
OFFICIAL
• Sore throat swabbing in children (Group A strep & Rheumatic Fever)
- Recommendations for primary care management: aiming to finalize RFA by next
TAG meeting
THE
- Considering whether to recommend CBACs should do throat swabbing in high risk
groups – for TAG member comments
• Vulnerable healthcare workers (with comorbidities) – linking Occupational Medicine
specialist resource with HealthPathways
•
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Clozapine advice finalised: being implemented by MedSafe; sector communication pending
9.0 Intensive case and contact management to support elimination strategy
Discussion resulting from action 26:
TAG feedback:
• How are probable cases managed in terms of isolation and then quarantine requirements
eg: would contacts be isolated for probable cases?
RELEASED
• Epidemiological and clinical factors to be considered
• Consider Maori and Pacific isolation and quarantine restrictions in overcrowded homes
• Maori health service providers should be involved in contact tracing
10.0 Any other business
• No other business discussed
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INFORMATION
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INFORMATION
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THE
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Minutes:
Technical Advisory Group for COVID-19
Date:
Friday 1 May 2020
Time:
10.30am – 11.30am
Location:
Zoom Meeting
1982
Chair:
Dr Ian Town
ACT
Members:
Dr Sally Roberts, Prof Michael Baker, Dr Anja Werno, Dr Nigel Raymond, Dr Virginia
Hope, Dr Shanika Perera, Prof David Murdoch, Dr Bryan Betty, Dr Patricia Priest, Dr
Erasmus Smit, Prof Stephen Chambers
Ministry of Health staff - Dr Harriette Carr, Dr Tomasz Kiedrzynski, Dr Juliet Rumbal -
Smith, Dr Richard Jaine, Dr Niki Stefanogiannis, Andi Shirtcliffe, Asad Abdul ahi,
Margaret Broodkoorn, Louise Chamberlain, Fiona Gillam (Secretariat)
Guests
N/A
INFORMATION
Apologies:
Dr Col in Tukuitonga, Dr Caroline McElnay, Dr Matire Harwood
1.0 Welcome and Previous Minutes
Dr Ian Town welcomed all Members and Attendees in his capacity as Chair of the Technical Advisory
Group for COVID-19.
OFFICIAL
Minutes of the last meeting (24 April 2020) were accepted.
2.0 Update on open actions THE
Actions 28, 30, 32, 33 remain open. Actions 24 and 31 were closed.
3.0
Ministry of Health update on COVID-19 response
The Chair gave an update on current issues being worked on in Ministry of Health, which includes:
• Preparation of C
UNDER abinet advice on further movement down to Alert Level 2. Considering
against the original seven criteria; downwards overall trend in new cases, low numbers
with no obvious source, community transmission, new clusters, assurance of active
surveillance, case finding and gold standard contact tracing and adequate health system
capacity
• Particular focus on minimum period of 28 days for downward trend and if this interval is
long enough
• Re
RELEASED gular discussions are occurring with overseas colleagues, considering international
experience, especially in Australia
• 4 May Cabinet paper introduces the approach to a gradual step down through alert levels.
Cabinet decision due 11 May
• Healthline for Primary Health Clinicians has been contracted to a national telehealth service
and launched 30 April
• Web enabled addition to contact tracing system soft launch 1 May
• Integrated data query platform has been produced by Data and Analytics team
4.0
Terms of Reference
The Chair noted the final draft Terms of Reference (TOR), thanked those who have given feedback
and provided opportunity for final feedback before TOR are approved.
• TAG agreed no further changes are required to the TOR
• TOR and Fees Framework will now go through approval process with Keriana Brooking
(DDG)
• Appointment letters wil be distributed
• Concerns remain over capacity in some subgroups. An increase in membership may be
required
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• COVID-19 response portfolio is being realigned across the Ministry.
• Two Senior Advisor positions have been created to support TAG Subgroups
ACT
5.0 Testing Strategy
TAG noted the discussion document (taken as read) which will be developed into a Testing Strategy
under the umbrel a of the Surveillance Plan and will consider DHB approach and plans, targeting
asymptomatic patients in higher risk settings. Statistical advice has been provided about sampling
frames.
TAG feedback:
• Any directive to test contacts to ascertain source of infection needs to be considered against
laboratory capacity
INFORMATION
o Will be reassessed and scaled back if required
• Sensitivity and prevalence along with positive predictive values will need to be considered
• Communicating purpose of testing to the public is important
• Advice to DHBs on targeted asymptomatic testing will include protocols for quality checks
• Suspect case definition may be changed for Alert Level 2, as prevalence becomes lower
OFFICIAL
6.0
Request for brief update on COVID-19 vaccine framework
The Chair noted the development of a Cabinet Paper on Vaccination Strategy.
THE
• Requests for advice and input to the paper have been received from Ministers Woods and
Clark
• Considerations for any Vaccination Strategy include: development of a safe vaccine, vaccine
supply, immunisation program, international relationships, trade and supply chain
• Ministerial annou
UNDER ncement on the Strategy and process expected on May 11
7.0 Rapid Review of Laboratory Testing
The Chair noted the request for a rapid review of laboratory testing has been declined by the
Director-General and wil not proceed, s 9(2)(g)(i)
8.0 Subgroup verbal updates
RELEASED
Epidemiology
• Input to surveil ance testing and statistics
• Require assurance advice provided is being considered
• Request subgroup is advised of wider Ministry epidemiologist to support the intel igence
group
Primary Care
• Data being shared between PHOs and DHBs
• Swab notification – clarification received that these are being sent to practice inbox
• Testing strategy and planning for CBAC operations through winter
• Confidentiality issue with some employers asking for test results for level 3 work certificates
• National directive from NZMA and GPNZ will advise to continue operating red and green
zones throughout winter
Public Health
• Probable Case definition is being written up and progressing to sign-out stage; thanks given
1982
for NZMN position and confirmation
o Updated advice in how PHUs classify probable cases will reduce the number of
classified probable cases
ACT
• Providing advice on national guidance for the management of ARC clusters, including
clearance and recovery planning of an ARC facility that has had cluster, 28-day period to
clear cluster and implement step down approach, visitor policy, clinical requirements
Laboratory
• Focussed discussions held by NZMN on serological studies and serum banking. Laboratories
require clear processes
• Supply Chain Portfolio being linked to laboratories under new aligned structure is a positive
development
INFORMATION
• Supply chain continues to be fragile
Infection Prevention and Control
• Healthcare worker data required to enable focused advice and decision making
• Tuesday 5 May is world hand hygiene day
OFFICIAL
Clinical
• Sore throat management i
THE n children – advice has been finalised and circulated
• IPC Subgroup will link in with Clinical Subgroup on requests for advice on sore throat
management and rheumatic fever and a press release on the high risk of sore throats
• Clear public health messaging required giving reassurances it is safe to visit health practices,
as normal health services resume
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10.0 Any other business
• No other business discussed
11.0 Agenda items for next meeting
• No specific agenda items discussed
13.0 New Action Items raised during meeting
RELEASED
• No new action items raised
14.0 Summary of TAG Recommendations
• No further changes are required to the final draft Terms of Reference
15.0 Meeting closed at 11.30am
Next meeting Tuesday 5 May 10.30am – 11.30am
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Minutes:
Technical Advisory Group for COVID-19
Date:
Friday 8 May 2020
Time:
10.30am – 11.30am
Location:
Zoom Meeting
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Chair:
Dr Ian Town
ACT
Members:
Dr Sally Roberts, Prof Michael Baker, Dr Anja Werno, Dr Nigel Raymond, Dr Virginia
Hope, Dr Shanika Perera, Prof David Murdoch, Dr Bryan Betty, Dr Patricia Priest, Dr
Erasmus Smit, Prof Stephen Chambers, Dr Collin Tukuitonga, Dr Matire Harwood
Ministry of Health staff - Dr Harriette Carr, Dr Caroline McElnay, Dr Tomasz Kiedrzynski,
Dr Juliet Rumball-Smith, Dr Richard Jaine, Dr Niki Stefanogiannis, Andi Shirtcliffe, Asad
Abdul ahi, Margaret Broodkoorn, Louise Chamberlain, Fiona Gillam (Secretariat)
Guests
Dr Natasha White
INFORMATION
Apologies:
-
1.0 Welcome and Previous Minutes
Dr Ian Town welcomed all Members and Attendees in his capacity as Chair of the Technical Advisory
Group for COVID-19.
OFFICIAL
Minutes of the last meeting (1 May 2020) were accepted.
2.0 Update on open actions THE
Actions 30, 32, 33 remain open. Action 28 closed.
3.0
Ministry of Health update on COVID-19 response
The Chair gave an update on current issues being worked on in Ministry of Health, which includes
finalising staged approach options, advice and guidance on alert level step down criteria across
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health sector, schools, public transport and workplaces to inform the Cabinet decision 11 May.
4.0 Surveil ance Plan
The Chair acknowledged the amount of work that has occurred to produce Surveillance Plan v4,
particularly by the Public Health Directorate, Surveillance Team, Tom Love and Sarah Jeffries.
TAG Members are invited to provide any feedback on the plan by early next week. The Plan wil be
brought ba
RELEASED ck to next TAG meeting for endorsement.
• The Plan is a living document and wil continue to be reviewed as new surveillance
opportunities occur
• There is a commitment within the Ministry to provide accurate data to enable tracking the
pandemic progression and produce data sets for research
• V4 will be used within the Ministry as a working draft, prior to endorsement
• V4 can be distributed to Subgroups
Action: Review Surveillance Plan v4 and provide feedback
5.0
System Strategy Level 2 and beyond
TAG noted the framework for public health approach required over the coming weeks and months
as the country moves down through alert levels is being developed, considering Elimination
Strategy pillars and epidemiology criteria. Framework will inform all new directorate work across
the COVID-19 response and support the success of the Elimination Strategy over the coming months
until a vaccine is available.
Draft framework currently with Director General of Health for review and will be circulated to TAG.
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• Considering what moving through alerts will mean for existing protocols, guidelines and
systems.
• Framework being considered against the four pillars of the Elimination Strategy
ACT
1. Border controls – how and when these can be relaxed when it is safe to do so;
trans-Tasman bubble opportunities
2. Robust case definition and surveillance
- Ability to identify and act quickly
- What testing needs to be in place to inform surveillance
- Case definition influences test strategy
3. Effective contact testing and isolation
- Case management and isolation management going forward eg: managed
isolation facilities
INFORMATION
- Close contact testing and management
- Assurances of isolation or quarantine compliance
- Equity issues
4. Community support
- Require continued community compliance with physical distancing,
hygiene, appropriate PPE use, staying at home when sick
OFFICIAL
TAG Feedback:
• Voluntary isolation and quarantine should be considered – facilities may be required on a
THE
case by case basis
• Border controls
o Success of Elimination Strategy will become increasingly difficult as border controls
are relaxed
• Vaccine
UNDER
o Success of Elimination Strategy is based on assumption of vaccine development
within 24 months
o NZ’s participation in vaccine research in Australasia and the Pacific is to be part of
an all of Government Cabinet discussion on 18 May
• Physical distancing
o Basic precautions are at the heart of public health response and must continue
o Adherence is breaking down at Level 3
RELEASED o Biggest risk is people in mass gatherings who are not already part of an existing
group. Model ing commissioned by Epidemiology Subgroup suggests the number of
cases not detected is similar to the number of confirmed cases (eg 5-10 cases not
reported). Recommending not jumping straight to allowing large gatherings but
make decisions based on a balance between statistical risk and surveillance.
o Requirements need to be evidence based, particularly if low prevalence continues
• Communications
o Initiatives need to be part of strategy and woven into all of government
communications
o To date communications have been reactive, particularly in front line health sector.
Must have strong leadership, be clear and related back to Elimination Strategy
6.0 Wearing of masks in public
The Ministry is developing a more formal policy on the wearing of masks in public.
TAG noted the Review of Science and Policy around Face Masks and COVID-19 provided for
discussion.
• Considering range of international policies
1982
• Need to reflect on core IPC principles in a range of settings - community, health, non-health
• Current WHO advice is there is no evidence of benefit for use of masks by healthy people in
community
ACT
• Continue to receive feedback on current literature review on website.
• Chair will respond directly to feedback and ensure documents are kept up to date
IPC feedback:
• Two purposes of wearing masks in healthcare settings is source control and prevention of
inhalation during provision of care in internal spaces – used within a range of hierarchical
infection prevention controls
• Healthcare masks are of an accepted quality standard
INFORMATION
• Release of masks for general public that meet healthcare masks standards will result in a
supply issue
• Issue if general public wear non standard masks that do not meet filter efficiencies
• A number of countries are using masks in public settings, particularly with mass public
transport and dense housing, which NZ does not have
• Of limited benefit in social interaction settin
OFFICIAL gs
• General public not understanding the hierarchy of controls is of major concern
• Aligned with Netherland’s view - mass mask wearing in public won’t have significant impact
THE
TAG feedback:
• Practice caution in invoking policy in the absence of evidence
• More risks in mass public masking that outweigh any benefits
• The success of mass public masking international y needs to be considered against those
UNDER
country’s infection rates – benefits are not necessarily evident
• Any policy must be accompanied by clear messaging on effective use and infection control
• The option of recommending the use of masks on public transport was noted
Summary:
• There is not currently a good evidence base for mass public masking
RELEASED
• Policy continues to be developed, with IPC Subgroup input
7.0 Changes to case definition
TAG noted changes to case definition and testing prioritisation are being considered. Three options
being considered:
1. Retain current suspect case definition for as long as we can or for a certain number of
weeks; phase any change; becomes part of surveillance in terms of picking up possible cases
2. Revise and narrow suspect case definition and test al those that meet suspect case
definition eg: base on most common symptoms
3. Introduce epidemiology criteria eg: close contact of a case; recently travelled; age cutoff
a. Considered using data to date, although this may not be relevant, considering a
large number of early cases were imported cases, and this data won’t necessarily
reflect where cases will be going forward
TAG feedback:
• Analysis of impacts is required – there wil be unintended consequences of changing
definition
• Any change to definition must be timely, planned strategically and communicated widely
1982
across health sector
• Confirming case definition is now urgent for primary care, particularly as we head into
winter
ACT
• Can case definition and testing strategy be decoupled?
• Link Subgroup Chairs and ESR to consider changes
• Any changes need to form part of overall Testing and Surveillance Strategies
Action: Write up options paper for consideration by Subgroup Chairs and ESR
8.0 Frequency of meetings
TAG noted TAG meetings will now occur once weekly - Friday 10.30.
INFORMATION
The Chair thanked and acknowledged Subgroups for al additional meetings and the high level of
commitment that has occurred to date.
9.0 Maori perspectives
• Wil be involved in changes to case definition decisions
• Updated guidance on the swabbing of children with a sore throat has been distributed
OFFICIAL
10.0 Subgroup verbal updates
Primary Care
THE
• Throat swabbing as above
• Need to communicate testing strategy clearly
Public Health
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• Current subgroup meeting minutes being finalised
• No further updates in addition to case definition and testing prioritisation as were discussed
earlier in the meeting
Laboratory
• Laboratories now have received kits for rapid molecular diagnosis using the GeneXpert. Low
nu
RELEASED mbers of kits will be available to laboratories every week
Infection Prevention and Control
• Healthcare worker testing to be discussed offline with Laboratory Subgroup Chair
Clinical
• Working with PHARMAC on Propofyl supply
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Minutes:
Technical Advisory Group for COVID-19
Date:
Friday 15 May 2020
Time:
10.30am – 11.30am
Location:
Zoom Meeting
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Chair:
Dr Andrew Simpson
ACT
Members:
Dr Sally Roberts, Prof Michael Baker, Dr Anja Werno, Dr Nigel Raymond, Dr Virginia
Hope, Dr Shanika Perera, Prof David Murdoch, Dr Bryan Betty, Dr Patricia Priest, Dr
Erasmus Smit, Prof Stephen Chambers, Dr Matire Harwood
Ministry of Health staff - Dr Harriette Carr, Dr Caroline McElnay, Dr Tomasz Kiedrzynski,
Dr Juliet Rumball-Smith, Dr Richard Jaine, Dr Niki Stefanogiannis, Andi Shirtcliffe, Asad
Abdul ahi, Margaret Broodkoorn, Louise Chamberlain, Fiona Gillam (Secretariat)
Guests
Dr Natasha White
INFORMATION
Apologies:
Dr Ian Town, Dr Caroline McElnay, Dr Col in Tukuitonga
1.0 Welcome and Previous Minutes
Dr Andrew Simpson welcomed all Members and Attendees in his capacity as Chair (in Dr Ian Town’s
absence).
OFFICIAL
Minutes of the last meeting (11 May 2020) were accepted.
2.0 Update on open actions THE
Actions 30, 32, 33 remain open. Action 35 closed.
4.0 Surveil ance Plan
TAG noted Surveillance Plan v4.0
• Previous TAG fee
UNDER dback has been incorporated
• Testing Strategy – currently working through next phase of testing approach; scaling back
on asymptomatic testing and scaling up systematic testing
• DHB testing rates are available
• Future versions wil be brought back to TAG
TAG feedback:
• As
RELEASED this is a living document, in future, it would be helpful if changes between versions could
be highlighted
• Section 4 – Public Health Strategy, Case and Contact Management – should explicitly state
surveillance testing through ARC testing
• Testing Strategy impacts Laboratory capacity
5.0
Healthcare workers with COVID-19
TAG noted the COVID-19 cases in health workers report, taken as read and were invited to
comment on the report and any further analysis requirements
• Report data has been pul ed from EpiSurv data
• Currently purely quantitative data. Over time there are opportunities to provide improved
qualitative data eg: source additional data through public health as they have had links with
patients
TAG feedback:
1982
• Provide further breakdown of ‘Allied health workers’ as this covers a wide range of
professions.
• Confirmation on whether the 4 Community Doctors are GPs. Want to provide fe
ACT edback to
the sector
• Improve on how healthcare worker title and role and healthcare setting data is captured
• Important to link incident reviews back to public health messaging, particulary as Waitakere
report has highlighted IPC issues (IPC Subgroup currently progressing)
• Further analysis required on source of infection eg: 53% locally acquired cases,
epidemiologically linked – transmitted via other healthcare workers or a community
cluster?
• Helpful to know both directions of transmission for household contacts and potential risks
from healthcare workers eg: separate households
INFORMATION
• Infections from patients – helpful to know if this was due to failure of ppe / no ppe – as
could possibly address through policy
• A lot of information is not collected in any one surveillance system. Is there an opportunity
to conduct as a case series/comparison as a group rather than public health units?
• How does NZ healthcare workers infected by a patient data compare to international data?
OFFICIAL
Intel Team wil continue to seek data from other sources and provide further analysis and
detail
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6.0 Revision of suspect case definition and testing criteria for COVID-19
TAG discussed suspect case definition and testing criteria options. Subgroups requested to consider
options and feedback to Public Health Subgroup
• ESR input has been sought. Additional data is being provided
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• Consider any other data needed or other organisations to be involved to support a decision
• To be brought back to next TAG meeting to agree position
TAG Feedback:
• Discuss children impact with paediatric
• Borders - consider EPI criteria for return travellers; possible leakage from people who are
associated with people in quarantine; consider extra border teting
RELEASED
• Clarify relationship/intent between laboratory testing definition and case definition; would
change in different phases of pandemic – at moment they are linked, should they be
disassociated? If delink changing in lab testing criteria would be a variation of option
• Consider case definitions of other countries in similar position eg Taiwan, Singaport
• A lot of sector feedback on difficulty in making testing work eg: disestablishing CBACs,
school services starting up. Testing will be moving away from community and back to
primary care. More refined clinical criteria required– can mix and match approaches.
• Need clinical oversight particularly as moving into winter eg: sector capacity and workload
Action: Add comms to website – case definition under review
Action: Al Subgroups to consider options and feed back to Public Health Subgroup
7.0 Aged Residential Care IPC Outpatients
Related to current policy of a 14-day quarantine requirement for residents who have attended
outpatients and leaving premises for a short period of time
• IPC Subgroup developing advice on whether 14-day quarantine is required
• Communications to ARC sector be considered following development of advice 1982
8.0 Release from isolation
TAG discussed a request for advice on release from isolation for people who have had persistent
ongoing respiratory symptoms and PCR positivity after recovery. Clinical Subgroup devel
ACT oping
advice.
Isolation policy could be updated with AU guidelines but will only apply to a handful of people
• Evidence base for infectivity is required
• Have given advice DHBs should decide local y but a person should not be sent back into a
high risk work area until more recovered.
• DHBs are asking for national advice (there are a few people who have been in isolation for
almost 2 months)
• An interim position is required, to be used as case by case assessment, as well as a longer
INFORMATION
term plan
• IPC Subgroup developing paper for NZRM on recommendations for healthcare workers
returning to work – will advise looking at evidence for infectivity. Will bring back to TAG for
feedback
• Interim messages and longer term plan can be shared with Regional DHB TAGs at meeting
next week
OFFICIAL
TAG feedback:
• Evidence has shown a low r
THE ate of observed cases in those who are exposed late. Ability to
culture virus relates to viral load and PCR test cutoff is a rough estimate of viral load.
Difficult to say people are completely non infectious.
• For many diseases, people are RNA positive for weeks after recovery but there is no
evidence they can still infect.
• There is circumst
UNDER antial evidence in NZ that prolonged shedding only picked up that had
symptoms that reappeared. No cases came out of re-isolated people
• AU keep using PCR, not necessarily what they recommending as guidelines, but if PCR in
guidelines, it will be used
• Virus cannot be cultured after 7-8 days
• Most labs won’t attempt to culture with low PCR. Cannot culture with viral load less than
100,000.
RELEASED
• After a week secrete IGA and own antibiodies kick in and so very unlikely people are
infectious.
9.0 Membership – conflicts of interest
• Not discussed due to time constraints (information will be emailed)
10.0 Maori perspectives
• Involvement in review of case definition
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Minutes:
Technical Advisory Group for COVID-19
Date:
Friday 22 May 2020
Time:
10.30am – 11.30am
Location:
Zoom Meeting
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Chair:
Dr Ian Town
ACT
Members:
Dr Sally Roberts, Prof Michael Baker, Dr Nigel Raymond, Dr Virginia Hope, Dr Shanika
Perera, Prof David Murdoch, Dr Bryan Betty, Dr Patricia Priest, Dr Erasmus Smit, Prof
Stephen Chambers, Dr Matire Harwood, Dr Collin Tukuitonga
Ministry of Health staff - Dr Caroline McElnay, Dr Harriette Carr, Dr Caroline McElnay,
Dr Tomasz Kiedrzynski, Dr Juliet Rumball-Smith, Dr Richard Jaine, Dr Niki Stefanogiannis,
Andi Shirtcliffe, Asad Abdul ahi, Margaret Broodkoorn, Louise Chamberlain, Fiona
Gillam (Secretariat)
Guests
Jil Sherwood (ESR), Dr Natasha White, Sarah Mitchell, Chris Hedlund
INFORMATION
Apologies:
Dr Anja Werno
1.0 Welcome and Previous Minutes
Dr Ian Town welcomed all Members, Attendees and Guests in his capacity as Chair of the Technical
OFFICIAL
Advisory Group for COVID-19.
Minutes of the last meeting (15 May 2020) were accepted.
THE
2.0 Update on open actions
Actions 30, 33 remain open. Action 32, 36 closed.
3.0
Ministry of Health update on COVID-19 response
The Chair gave an update on current issues being worked on in Ministry of Health, which included:
UNDER
• Continuing to provide advice to Cabinet on stepping down through alert levels
• Advice to continue in Level 2 for at least 4 weeks, considering potential impacts of increased
activity in Level 2
• An integrated research file of de-identified data is being developed, to be made available for
universities and other research organisations.
• Vaccine Strategy will be announced by joint Ministers next week on May 25th
RELEASED
4.0 Suspect case definition and testing criteria for COVID-19
TAG discussed options for changes to the suspect case definition and testing criteria for COVID-19.
Subgroups have considered the options and Chairs provided feedback. Homecare Medical feedback
has also been sought.
Homecare Medical:
• Recommended continue with status quo for 28 days
• Broad clinical criteria paired with epidemiology criteria
• Operationalising advice and public communications
• Consider equity
Clinical Subgroup:
• Border:
o Returned travellers and their contacts are the greatest risk, so detecting all of these
is the best protection for the community. So should maintain the current sensitive
SCD and consider epi criteria which would detect any ‘leakage’ from travellers as
well as airport or isolation/quarantine workers, house-hold contacts if home
isolation, quarantine exceptions.
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• Children:
o Feedback from paediatric ID specialists (Auckland, Chch) would support children
only being included in the SCD if there is an exposure (travel-related, clu
ACT ster) or
being acutely admitted to hospital with an ARI. Discretion but not requirement to
test in other circumstances
• Adults with no exposure:
o A difficult challenge. On the one hand, aiming to detect most cases early to prevent
transmission and a large cluster; testing for a needle in a hay-stack for a community
benefit. On the other hand, testing mild or non-specific illness when there is almost
no community transmission is causing practical chal enges and unintended patient
harm. Labelling someone a suspect case has led to requirements to swab and
isolate, which is now often directed care away from patients’ ac
INFORMATION tual needs. This is
partly due to inclusion of people with symptoms unlikely to be Covid/ARI and partly
healthcare staff feeling obliged to institute testing and then isolation. For acute
hospital admissions, testing only those with a clear picture of an ARI, and not those
with atypical pictures unless after thoughtful review. Most members of the clinical
subgroup favoured a narrower clinical SCD in some form.
OFFICIAL
Epidemiology Subgroup:
• Support remaining with status quo for 2 to 4 weeks
• Have a number of epidem
THE iological criteria mainly around groups at risk because of contact
with a new case; groups that might be considered at risk given the case’s characteristics
(e.g. if the case is a member of a particular occupational group, then others in that group
might be appropriately tested)
• Should be a low threshold for testing healthcare workers and ARC residents and workers
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• Apply equity considerations as part of decision to test
Infection Prevention and Control Subgroup:
• Maintain the current case definition for a further 2-4 weeks (4 weeks, or 2 incubation
periods), since the step from Alert Level 3 to Alert Level 2 would allow for monitoring of the
impact of increased mobility including return to school and to work environments
• The diagnostic laboratory sector has capacity to undertake the current volume of testing
RELEASED o Consideration should be given to testing for influenza in parallel
• If it was delinked to the requirement to wear PPE (appropriate for both contact and droplet
precautions) in the hospital setting, then this would reduce unnecessary use of PPE whilst
providing care for patients meeting the case definition but who have a very low risk of
having COVID-19 infection
• Prioritisation of testing, as suggested by Option three, may complicate the screening
process and reduce testing across all groups in the community. It may also make the
management of patients with suspected but not test positive COVID-19 infection difficult if
people chose not to comply with public health expectations
• Do not agree with excluding children under the age of 15 from testing as suggested by
Option two. There is evidence from the Auckland region that children have been under-
sampled
• There are also reports from overseas of a very small number of children presenting with an
atypical immune response (atypical Kawasaki’s disease) syndromes. Testing in children is
required to support early recognition of this syndrome.
Primary Care Subgroup:
1982
•
Winter illness and ILI potentially increasing need to review the case definition, especially in
context of winter demand in community care, role of CBAC's, workload, and patient flow
•
Sense of urgency from the sector to have a clear change on definition ACT
•
Communication important
•
Under 15 year old need specific consideration
•
Suggest clinical definition plus epidemiological criteria plus prioritization
•
Need clinical judgement applied and oversight as to who gets tested
Laboratory Subgroup:
• Focus on what we’re trying to achieve, remain with current case definition but need to
move to epidemiology criteria
• Decouple PPE / isolation from testing to minimise barriers to testing
INFORMATION
• Look at modelling, including possibility of mild flu winter, to help with decision-making.
• RhF issues to be addressed
Public Health Subgroup:
OFFICIAL
• Universal support for continuing Option 1 (i.e. status quo in the short term)
• When suspect case definition is changed, proposal to remove suspect case definition. This
is based on the current suspect case definition has no surveil ance purpose (there is no
THE
reporting of suspect cases). Instead, clinical algorithm and pathway could be used to
communicate changes in testing, management, PPE use and notification process. In
addition, this proposal will still align with the surveillance plan and testing strategy in order
to ensure all testing is considered as part of surveillance.
• One approach is to have two tiers of clinical criteria that result in testing: (i) broad clinical
UNDER
criteria with epi/other criteria and (ii) narrow clinical criteria with no epi/other criteria. An
alternative approach to retain the broad clinical criteria with epi/other criteria and have
sentinel surveil ance that covers other groups that are not tested.
Action: Public Health Subgroup prepare recommendation for next meeting
5.0 Use of masks in public
RELEASED
Guidance on the use of masks in public about to be published on the Ministry website was
presented:
• Evidence is inconclusive for a requirement of widespread public use of masks in NZ at this
time
• Risks include equity, unsafe use, decreased adherence to other infection control measures
• Prioritise masks for healthcare and border management
• Website will reflect rationale for current position and what would need to occur for this
guidance to change
• Guidance on how people with COVID-19 needing to access primary care, without access to
public transport can access, and guidance on the correct use of masks.
TAG feedback:
• There is more evidence for masks as a barrier for source control than there is for the
effectiveness of mass masking.
• Messaging should reflect that PPE is different from mass masking amongst the general
public
• Masks are part of a multi-barrier approach, we should be using al the cheap and simple
1982
barriers we can. Masking on public transport should be used as a part of source controls
• Care required with messaging that there is low or no risk – impact now in primary care eg:
people are beginning to refuse testing
ACT
Action: Dr White and Chief Nurse to review the website material and submit to Dr Ashley
Bloomfield for his review and approval
6.0 Review of literature around SARS-COV-2, COVID-19, and nebuliser use
TAG noted the Review of literature around SARS-COV-2, COVID-19, and nebuliser use which has
been updated with IPC feedback. IPC Subgroup continuing to ensure scientific evidence is used as a
basis for any decision to change advice. No immediate change proposed.
7.0 COVID-19 response hub structure
INFORMATION
TAG noted the structure of the new COVID-19 Response HUB which was established 18 May
TAG feedback:
• Seeking clarity on how Maori and Equity teams and workstreams link in and out of TAG
Action: Seek changes to org structure diagrams to include Maori and Equity pathways
8.0 Science and Technical Advisory Update
OFFICIAL
• TAG feedback into Terms of Reference has been appreciated
• Feedback on Treaty and equity obligations is being discussed with Equity Team and wil be
THE
incorporated into the TOR and ways of working
• Developing processes to provide additional Subgroup support
9.0 Maori perspectives
• Equity issue with cervical cancer self-swabbing
UNDER
• Issue with medicine supply as whanau are released from quarantine following
international travel
• CHF admission rates in Auckland over lockdown compared with same period last year
were 66% lower for Maori. Now facing large amount of very ill people seeking health
care
•
Action: Supply information on these issues for triaging to correct Ministry areas to
address
RELEASED
10.0 Any other business
• Summary of events during NZ COVID-19 pandemic to be shared
11.0 Agenda items for next meeting
• Recommendation on changes to suspect case definition and testing criteria for COVID-19
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Minutes:
Technical Advisory Group for COVID-19
Date:
Friday 29 May 2020
Time:
10.30am – 11.30am
Location:
Zoom Meeting
1982
Chair:
Dr Ian Town
ACT
Members:
Dr Sally Roberts, Prof Michael Baker, Dr Nigel Raymond, Dr Virginia Hope, Dr Shanika
Perera, Prof David Murdoch, Dr Bryan Betty, Prof Stephen Chambers, Dr Matire
Harwood, Dr Collin Tukuitonga, Dr Anja Werno
Ministry of Health staff - Dr Caroline McElnay, Dr Harriette Carr, Dr Tomasz Kiedrzynski,
Dr Juliet Rumball-Smith, Dr Niki Stefanogiannis, Andi Shirtcliffe, Asad Abdul ahi,
Margaret Broodkoorn, Louise Chamberlain, Fiona Gillam (Secretariat)
Guests
Prof Nigel French (Delegate for EPI Chair) INFORMATION
Apologies:
Dr Patricia Priest, Dr Erasmus Smit, Dr Richard Jaine
1.0 Welcome and Previous Minutes
Dr Ian Town welcomed all Members, Attendees and Guests in his capacity as Chair of the Technical
Advisory Group for COVID-19. OFFICIAL
Minutes of the last meeting (22 May 2020) were accepted.
2.0 Update on open actions THE
Actions 37, 38 remain open. Action 30, 33, 39, 40 closed.
3.0
Ministry of Health update on COVID-19 response
The Chair gave an update on current issues being worked on in Ministry of Health, which includes:
UNDER
• With the continuation of another day with no further new cases, NZ is moving towards the
28 days confidence level. There is an opportunity to reframe NZ risk profile if the situation
of no new cases continues. 8 June Cabinet meeting wil be the next planned review.
• Research data set for will be available from next week and will provide an opportunity for
researchers to use the data for their own research. In the future the availability of this data
set is likely to be extended, particularly in light of NZ’s current pandemic experience
RELEASED
4.0 Suspect case definition and testing criteria for COVID-19
Feedback from TAG and Subgroups on options to change suspect case definition and testing criteria
for COVID-19 has been appreciated.
TAG was presented with a proposed change to the approach, for which approval is currently being
sought.
The proposed approach is a combination of the three options.
• Retain status quo up to and including Wednesday 10 June (28 days or 2 incubations periods
since start of Alert Level 2).
• On Thursday 11 June, introduce the fol owing:
o COVID-19 symptoms remain the same: Any acute respiratory infection with at least one
of the following symptoms: cough, sore throat, shortness of breath, coryza e.g. runny
nose, sneezing, post-nasal drip., anosmia – loss of sense of smell. with or without fever.
o Remove suspect case definition / no longer refer to anyone with symptoms consistent
with COVID-19 as a suspect case.
O Align higher exposure risk or ‘under investigation’ category to those being tested where
there is a higher degree of likelihood of COVID-19 – i.e. symptoms of COVID-19
and
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relevant epidemiological criteria. Further consideration should be given to what this
category is called for primary/clinical care and public use as ‘under investigation’ is
more for public health or EpiSurv use only.
ACT
• Proposed epidemiological criteria:
o close contacts of probable or confirmed cases
o people meeting the clinical criteria who have travelled overseas in the last 14
days, or have had contact, in the last 14 days, with someone else who has
recently travelled overseas (includes border, quarantine and isolation facility
staff, air crew, travellers and their households)
• Probable and Confirmed case definitions – remain the same.
INFORMATION
TAG discussion:
• Focusing on identifying those who are a case, or at high likelihood of being a case
• Uncoupling PPE and self-isolation requirements for general public with acute respiratory
symptoms, but maintaining for high risks groups
• This proposed change is separate to Testing
OFFICIAL Strategy and Surveillance Plan
• Testing Strategy is a framework which does not contain operational plans. All testing is part
of surveillance and feeds into the Testing Strategy. Communication to the sector is part of
how Strategy is operation
THE alised
• Public Health Subgroup are developing a clinical algorithm to support testing, PPE,
notification requirements. This will be useful to assist with central guidance as changes to
case definition are implemented
• If proposed change is approved, there is a need for clear communications for the public and
UNDER
within all primary care and clinical settings
o Clinical Subgroup suggest messaging could change from COVID-19 isolation to more
general isolation for acute respiratory infections, or good IPC approaches for acute
respiratory infection and testing more as surveillance activity is more than ‘clinical
likelihood’
Action: Subgroups are requested to consider the fol owing and provide feedback to Public
Health Subgroup:
RELEASED o IPC – what are the implications of proposed changes for IPC? eg: presenting to
primary care with respiratory illness and advice for higher risk group – within a
health care setting
o PC – how would advice be operationalised in a primary care setting?
o Clinical – how would advice be operationalised in a hospital setting?
o PH – are casual contacts of a confirmed case with symptoms considered high risk or
not?
5.0 IPC controls in community health and medical practices
There is a need for clear national guidance on IPC controls in community health and medical
practices, particularly over winter.
IPC Subgroup have been developing national IPC guidelines and wil share this with PC Subgroup as
an input to community health practice guidance
Action: Provide published national IPC guidelines to PC Subgroup Chair
6.0
Healthcare Workers return to work guidance
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TAG was presented with proposed returning to work guidance for infected healthcare workers or
who are close contacts with an infected person. This guidance is being developed by the IPC
Subgroup. Consistent national guidance is required.
ACT
TAG feedback:
• Time taken to recovery is longer than earlier thought. National guidance required so
workforce is not stood down for long period unnecessarily
• The Australian PHLN (Public Health Laboratory Network) is leading a project to establish a
quantitative viral load assay for SARS-CoV-2 which will assist in making the Ct values
reported by all the different assays used comparable. In future, this may lead to defining a
Ct value cut-off (for each assay) that aligns with non-infectivity
• Additionally, subgenomic messenger RNA assays may also guide the ass
INFORMATION essment of patient
infectivity – this is currently research and development
• Also impacts on occupational health practice
Actions:
• Subgroups consider and provide feedback to IPC Subgroup
• Clinical Subgroup seek feedback from NZ AS
OFFICIAL ID and Occupational Health Network
7.0 Maori perspectives
• Appreciation for quick res
THE olution by Ministry staff of Urutā issues raised at previous
meeting
8.0 Pacific perspectives
• Exploring NZ and Pacific bubble ahead of Trans-Tasman bubble
• Considering Pacific
UNDER responsibilities related to Vaccine Strategy (1st meeting of vaccine
taskforce scheduled for next week)
9.0
Subgroup verbal updates
Epidemiology
• Providing advice and response on Testing Strategy
• Discussing assessment model based on approach to specificity and sensitivity
RELEASED • Considering network modeling to look for potential hotspots at different phases of the
response; currently considering border
Primary Care
• Infection control and community medical centres
• Changes to case definition
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higher risk group – within a health
care setting
o PC – how would advice be
operationalised in a primary care
setting?
o Clinical – how would advice be
operationalised in a hospital setting?
o PH – are casual contacts of a
confirmed case with symptoms
considered high risk or not?
42 National IPC guidelines
Provide published national IPC guidelines Dr Sally Roberts
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to PC Subgroup Chair
43 Healthcare Workers
Consider guidance and provide feedback
Subgroup Chairs
ACT
return to work guidance
to IPC Subgroup
44 Healthcare Workers
Seek feedback from NZ ASID and
Dr Nigel Raymond
return to work guidance
Occupational Health Network
/ Prof Stephen
Chambers
45 Aerosol generating
Share rural hospital feedback/issues with Dr Juliet Rumball-
procedures
IPC Subgroup
Smith
46 Ministry lead work on
Discuss requirements and Clinical
Dr Caroline
HCW infection data and
Subgroup involvement for this piece of
INFORMATION McElnay / Dr
analysis
work
Nigel Raymond
13.0 Summary of TAG Recommendations
• N/A
14.0 Meeting closed at 11.30am
OFFICIAL
Next meeting Friday 5 June 10.30am – 11.30am
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