Minutes: Technical Advisory Group (TAG) for COVID-19
Date:
Friday 21 August 2020
Time:
10.30am – 11:30am
Meeting URL:
2
Location:
Out of scope
Meeting ID: 948 2567 1811
Password: TAG
or Numeric Password: 498734
Chair:
Dr Andrew Simpson
ACT
Dr Anja Werno, Dr Bryan Betty, Dr Col in Tukuitonga Dr Erasmus Smit, Dr
Members:
Matire Harwood, Professor Michael Baker, Dr Nigel Raymond, Assoc Prof
Patricia Priest, Dr Sal y Roberts, Dr Shanika Perera, Dr Virginia Hope
Ministry of Health Attendees:
Andi Shirtcliffe, Asad Abdullahi, Louise Chamberlain, Dr Tomasz Kiedrzynski
Guests:
INFORMATION
Dr Ian Town, Dr Juliet Rumball-Smith, Dr Richard Jaine, Sarah Mitchell, Dr
Apologies:
Caroline McElnay, Dr Harriette Carr, Jeremy Tuohy, Margareth Broodkoorn, Dr
Niki Stefanogiannis
1.0
Welcome and Previous Minutes
Dr Andrew Simpson welcomed all Members and Attendees in his capacity as Acting Chair of the
Technical Advisory Group for COVID-19.
Minutes of the last meeting (07 August 2020) were accepted.
2.0
Update on open actions
Open Actions updated. Action 57 remains open.
3.0
Ministry of Health update on COVID-19 response
The Chair gave an update on current issues being worked on in the Ministry:
Case Update
•
The total number of active cases in New Zealand is 112, of which 87 are from the Auckland
cluster. Two cases are stil under investigation.
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Lab Testing Figures
•
Lab tests processed have peaked to 24,000 in a day. On 20 August 2020 over 15,000 tests
were processed, averaging over 20,000 tests per day over the last 7 days.
•
Acknowledgement and appreciation given to the phenomenal effort of Lab workers.
Contact Tracer App
•
Prior to 12 August 2020 the number of users of the NZ COVID Tracer app was 600,000; the
most recent figure has surpassed 1,2 million registered users.
Incident Management Team (IMT)
• The IMT has been stood up on 12 August 2020 as part of the National Health Coordination
Centre (NHCC) Response.
• Ongoing advice and decision making are happening on the Ministry and the Government
levels. Alert levels are being considered further today.
Science and Technical Advisory (STA)
• A piece of work is being developed around fomite transmission. Another work initiated by
STA coordinating pieces already underway through the Institute of Environmental Science
and Research Limited (ESR), Ministry for Primary Industries (MPI) as well some work done
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by the Auckland Regional Public Health Service (ARPHS).
• STA wil be connecting more formally the members of the Expert Advisory Network (EAN)
over the next couple of days.
• A formal request from some TAG members was received for an independent review of
border protection measures.
ACT
• Testing modalities and emerging technologies is an area of great interest form All of
Government (AoG).
4.0
Any other business
Emerging Technologies for Testing for COVID-19
• There is a lot of development on the saliva testing and it is being considered crucial to
increase patient acceptance of the COVID 19 test, potentially increasing voluntary
testing of those who need repeat testing.
INFORMATION
• It would be helpful to have direction from the Ministry of Health that newly diagnosed
COVID-19 patients would have a repeat nasopharyngeal swab (NPS), saliva samples
and blood for serology. This wil help ensure no false positives have occurred (good
laboratory and clinical practice) and provide evidence for the validation of saliva and
blood sampling.
• Saliva samples taken at the same time as an NPS wil be used for validation of the
testing method and satisfy the regulation body, International Accreditation New Zealand
(IANZ).
• Testing relies on actual saliva samples as it is difficult to develop artificial spike samples
of saliva to send to laboratories, as saliva contain RNases, an enzyme that degrades
RNA.
TAG Feedback
• While ideal, the proposed addition of saliva and serology samples may be difficult to
achieve with the current resources.
• Labs would prefer to ultimately switch to saliva as the easy obtainable sample and is
important for the lab workers to get experience dealing with saliva as a different
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specimen.
• Query to international experience with the testing method and how well its performance
has been assessed.
o International y the problem in the past with the saliva studies was the use of
different methods, but the meta-analysis of a couple of studies had shown that
saliva testing is not as sensitive as NPS (about 90%). A recent publication from
Yale, however, showed that if no buffers are added to stabilise the saliva
sample, the SalivaDirect protocol, the sensitivity is comparable to an NPS.
o New Zealand is different than other countries as being keen on test sensitivity
in a way not to miss any cases, even low-positive ones.
Activity Updates
Primary Care: The demand put on General Practices and frontline is concerning; Never seen
such a sense of fatigue. Other issues raised from the Sector are:
- Inter-regional travel with private community providers.
o Ministry has held discussions on the inter-regional travel for health workers with
Police and AoG.
- More clarity around the advice on mask use in GP waiting rooms in the different Alert
Levels.
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- Some Pacific GPs from South Auckland concerned about social providers at CBACs
providing support, such as food packages, not wearing PPE.
- Rural doctors and essential health care workers coming from overseas being required
to pay the $3000 quarantine fee.
- 80% of GPs across the country are COVID-swabbing on top of providing bas
ACT ic routine
care is a real challenge.
Epi: Recent meeting to discuss incubation and infectiousness periods and the relationship with
ideal quarantine times in support of a review being developed by the Science and Technical
Advisory.
Involvement with the Te Punaha Matatini (TPM) Modelling Group and their need for information
about the of proportion of people with symptoms currently being tested.
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In relation to the non-PCR testing and the potential benefit of the less sensitive but more
frequent tests is more relevant on places with high community transmission, but it is important to
think about them in anticipation of the need for them would be worth investment of time and
effort.
Clinical: The members of the former Clinical Subgroup are meeting informally and continue
working on medicine supply issues, bringing attention to the lack of structure in New Zealand for
critical medicine guidelines; the proposal of an independent review of border protection
measures.
Pacific Health: Three quarters of the current cases in the Auckland cluster are Pacific and show
the impressive response from the community.
Importance of continuing to provide as much information as possible and appealing to church
ministers to stop having church service during Alert Level 3.
Access to testing largely being resolved.
Infection Prevention and Control: The IPC team is working exceptional y hard to provide
evidence-based and principle-based guidance.
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Laboratory: The main issue is around workforce and how to get through the work. Lab workers
have done a stel ar effort across the country in getting through thousands upon thousands of
samples, but this testing volume is not sustainable. Not from a workforce point of view neither
from consumables supply point of view.
The request for a surveil ance program that ensures a deliberate and non-reactive approach is
been reiterated.
o A comment from an ADHB perspective has been made of how important it is to fully
comprehend that the Lab work is highly technical, and the amount of expertise required
to support this amount of testing.
o Comments from Primary Care and Māori Health perspectives have been made, echoing
the need for proactive surveil ance program and strategy.
o The Epi Subgroup had intermittent involvement with the development of the current
Surveil ance Strategy. The observation is that it was hard to identify who was
responsible for the work and who should the group be advising. Not enough feedback
on how the advice was being used was provided by the Ministry and that could be
improved.
- Commentary wil be fed back to the Ministry and the Executive Leadership 2
Team.
Public Health: Public Heath teams have been very involved in the outbreak response, not only
in terms of containment but also in terms of source ascertainment.
An issue raised is the shared processes between the National Investigation and Tracing Centre
ACT
(NITC) and other PHUs not been yet aligned and some testing protocols (i e. testing of close
contacts) not being finalised. Communications need to be streamlined and consistent across
multiple entities providing management.
Institute of Environmental Science and Research Limited: ESR aims to have referrals of
specimens for genomic analyses completed as rapidly as possible and appreciation was given
to those sending the referrals.
Epidemiological information assists with contextualizing the genomics but there were some
difficulty entering cases rapidly into EpiSurv.
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ESR is also collating information from different sources across at least four different databases
and it has been chal enging. ESR has been asked about environmental sampling information.
5.0
Agenda items for next meeting
• No items discussed
6.0
New Action Items raised during meeting
• No new actions raised on 21 August 2020 meeting
7.0
Summary of TAG Recommendations
Meeting closed at
11:34am
Next meeting
Friday 04 September 2020 - 10.30am – 12:00pm
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