Minutes
The Technical Advisory Group for COVID-
19 Teleconference
Date:
13 February 2020
Time:
9:00 am- 10:00 am
Location:
National Health Coordination Centre (NHCC), 133 Molesworth St Wellington
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Chair:
Dr Caroline McElnay
Attendees:
Dr Sally Roberts
Professor Michael Baker
Professor Stephen Chambers
Dr Nigel Raymond
Dr Virginia Hope
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Dr Shanika Perera
Dr David Murdoch
Dr Bryan Bet y
Ministry of Health staff:
Dr Caroline McElnay
Dr Harriette Carr
Dr Tom Kiedrzynski
Dr Geoffrey Roche
Dr Juliet Rumball-Smith
Dr Richard Jaine
Dr Niki Stefanogiannis
Andi Shirtcliffe
Asad Abdullahi
Apologies:
Dr Anja Werno and Dr Erasmus Smit
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Documents tabled:
• Minutes of the last meeting (5 February 2020)
• Interim guidance for health staff implementing home care of people not requiring
hospitalisation for COVID-19 infection, 11 February 2020
• Case definition of COVID-19 infection
• Caring for yourself and others who have, or may have COVID-19 infection
• The Technical Advisory Group for COVID-19 teleconference meeting agenda 13 February
2020
Item Notes
0
Preliminaries
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• Correction for the minutes of the last meeting: David was not at that meeting. The
Minutes were otherwise confirmed to be correct.
• Follow-up on the actions in the last meeting.
Under “Query on testing of the Wuhan repatriated passengers” at Whangaparoa. “It
was asked whether the repatriated passengers were having daily nasal pharyngeal
samples being taken. Niki would follow up.”
It was asked what sampling was being taken, and what sampling shoul
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before discharge. It was noted that sampling was not daily; samples had been
taken upon arrival and all results were negative. A thorough examination had been
taken out by physicians.
Current advice is to do both nasopharyngeal oropharyngeal swabs.
There was agreement that samples would be taken based on clinical symptoms
and there is no intention to do regular screening of returnees. There would be no
asymptomatic screening of guests before they are discharged from Whangaparoa,
which is scheduled for Wednesday 19th February.
1
Situation Update
A teleconference with public health chiefs from the United States of America, the United
Kingdom, Australia and Canada at was held at midnight New Zealand time, 12-13
February. Border restrictions were discussed.
Australia
Following the
Lancet (Wu et. al.) modelling paper that
predicts spread within mainland China; self-isolation
facilities provided.
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United States of America
Active screening at borders with different layers of
management (primary, secondary, tertiary); formal
questionnaires and tertiary screening for symptomatic
cases. Applies to all of mainland China.
Canada
Alignment with WHO guidelines; reviewing epidemiological
data; focus on Hubei Province as main risk area; handouts
provided at airports; recommendation that anyone who has
been to Hubei Province self-isolate for 14 days; those who
have been to mainland China are provided with a
telephone number to call if they have symptoms. No travel
restrictions.
United Kingdom
No border restrictions. 14 days self-isolation for travellers
returning from Hubei Province. Other countries besides
mainland China have been added to the case definition,
including Hong Kong, Japan, Macau, Malaysia, Republic of
Korea, Singapore, Taiwan or Thailand.
To date none of those individuals that had been repatriated from Wuhan to Canada, the
UK and USA have been positive for COVID-19.
Pre-symptomatic transmission
UK public health representatives do not think that Presymptomatic transmission occurs; the
United States believe it is unlikely but are concerned. Australia and New Zealand are
taking a cautionary approach.
Discussion
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There was discussion on whether self-isolation for those returning from mainland China
was overly cautious.
It following were noted:
• The economic costs of maintaining isolation measures
• The disruptions for universities and students
• Flow on effects for students self-isolating in halls of residence (it was added that at
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least Otago University in Dunedin had been planning to manage this, by setting
aside a residence for foreign students for this purpose)
• much of the decision depended on whether asymptomatic transmission was
possible.
It was
agreed that the Ministry would continue the current precautionary measures and
advise 14 days self-isolation for those returning from mainland China.
Risk Assessment: Update
ESR prepared an update risk assessment on this day; the only part changed was ‘risk of
transmission which has changed from low to potentially very high. Asad wil distribute this
text to the TAG.
Action: Asad to distribute ESR updated risk assessment.
2
Updates from the subgroups
2a
Lab (Anja, Virginia)
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Continuing from last minutes.
2b
IPC (Niki and Sal y)
Progress on reading documents and developing consistent wording for IPC hand cleaning
campaigns, to be released to the public soon. The WHO has a good FAQ text for IPC that
can be used.
There are challenges to get good IPC advice to health facilities. It was noted that many
queries to the Ministry on nCoV concern IPC.
2c
Public health (Harriette and Shanika)
Work on providing resources for PHUs and developing a resource repository on SIPHAN.
There was discussion on the WHO’s protocol for
the The First Few X (FFX) Cases1 and
Contact investigation protocol for COVID-19 and how regional partners would facilitate this.
3
Review of Suspected Case Definition
Key decisions to make:
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• whether we would continue to update our case definition to align with that of
Australia (who have changed theirs three times in the last ten days)
• whether the epidemiological criteria specify “casual contact” rather than just “close
contact”
• whether we remove “sore throat”
• whether “fever” be given a specific temperature
The utility of making the case definition to be more sensitive, and the flow-on effects of any
such changes (particularly lab workload), were considered.
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It was
agreed that there be no changes to the case definition for the time being, and that it
is fit for purpose. Change would be actively considered in the future; the case definition
would be updated in the event that significant changes were warranted (as opposed to
frequent changes made over a short period of time).
It was suggested that any changes to guidelines be notified as a cohort, for efficiency.
4
Interim guidance for homecare management of COVID-19 cases not requiring
hospitalisation- two sets of guidance for:
•
Healthcare staff
•
Cases and their households.
There was discussion on whether patients be hospitalised or managed at home. Key
issues were:
• Cases who may be managed at home and who may deteriorate
• Risk of nosocomial infection
• Public perceptions, and need to protect the Chinese community
• Management of cases where there may be immunocompromised individuals or
pregnant women in the home, or a lack of c
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available in the home
• Whether strict mandates or rigid rules were required on this point.
It was noted that the Interim guidance document tabled accounted for these issues (the
box at the top of page 1).
1 https://www.who.int/publications-detail/the-first-few-x-(ffx)-cases-and-contact-investigation-protocol-for-2019-
novel-coronavirus-(2019-ncov)-infection
“The health team (DHB, PHU and primary care provider) should determine roles and
responsibilities for community management of patients with 2019-nCoV. These may vary
from region to region.
The aims of community management of patients with 2019-nCoV are:
• Ensure that the patient has adequate support (health, PPE and social/personal
support)
• Establish a clear pathway should the patient deteriorate and/or require reassessment
• Minimise number of close contacts
• Ensure close contacts are monitored
• Limit risk to the community.”
It was
agreed that assessment and support were required for those confirmed cases that
were managed at their homes, and that decisions would be made on case by case basis.
The Interim Guidance wil be published today (13 Feb); attendees were invited to email
through any amendments.
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5
Next meeting: 21 February 2020
Summary of recommendations.
It was
agreed that:
1. samples from repatriated guests would be taken only if the case was symptomatic.
There would be no asymptomatic screening of guests before they are discharged
from Whangaparoa, which is scheduled for Wednesday 19th February.
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2. The Ministry would continue to advise self-isolation for those returning from China.
3. there be no changes to the case definition for the time being, and that it is fit for
purpose. Change would be actively considered in the future; the case definition
would be updated in the event that significant changes were warranted (as opposed
to frequent changes made over a short period of time).
4. assessment and support were required for those confirmed cases that were
managed at their homes, and that decisions would be made case by case.
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