Minutes:
Technical Advisory Group for COVID-19
Date:
Friday 5 June 2020
Time:
10.30am – 11.30am
Location:
Zoom Meeting
Chair:
Dr Ian Town
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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 Anja Werno, Dr Patricia Priest, Dr Erasmus Smit
Ministry of Health staff - Dr Caroline McElnay, Dr Harriette Carr, Dr Tomasz Kiedrzynski,
Dr Juliet Rumball-Smith, Dr Niki Stefanogiannis, Dr Richard Jaine, Andi Shirtcliffe, Asad
Abdul ahi, Margaret Broodkoorn, Fiona Gillam (Secretariat)
Guests
Mary Van Andel
INFORMATION
Apologies:
Dr Collin Tukuitonga, Louise Chamberlain
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.
Minutes of the last meeting (29 May 2020) were accepted.
2.0 Update on open actions
Open actions updated. Actions 42, 44 remain open. Actions 37, 38, 41, 43, 45, 46 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 include:
• Ministry has now finalised advice on the move to Level 1 for Monday 8 June Cabinet
meeting
• NZ remains close to achieving the initial milestone in the Elimination Strategy ie, being
confident chains of community transmission have been eliminated for at least 28 days
• Details of last community transmission cases are now all known
• Ministry conscious of the need to improve a number of systems and processes, including
data management and providing clear information; and wil be addressing this
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• ELT considering commissioning an external review of the Ministry response to date
• All of Government (AOG) Team considering:
• Border management
• Trans Tasman bubble - Trans Tasman Working Group have provided reports to AU
and NZ PMs on pathways to consider
• Possible scenarios in a Level 1 environment eg: outbreaks, lapses in quarantine
• Vaccine Strategy has been formally announced – MBIE lead task force and
establishing a science platform TAG discussion:
Border control:
• Acceptance that new cases linked to border are inevitable. Effectiveness of Public Health
measures, identification and management will be critical
• Al entry currently through Auckland; capacity has been reached with existing managed
isolation and quarantine facilities
• Pressure to stand up Christchurch quarantine and isolation facilities; option of taking
Auckland overflow has been raised
• Discussion underway on whether the present more formal quarantine approach is
sustainable, and how to have confidence in effective quarantine measures, given the larger
number of arrivals in the future, and whether some form of monitored self isolation
management can be implemented
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Serology testing:
• PCR testing at border for all those going into a managed quarantine facility is part of
current PH approach
• AU have been testing everyone coming into quarantine and isolation and are
planning on using PCR results to step down from managed facility into self isolation
for those testing negative and who are asymptomatic after 48 hours
TAG feedback:
INFORMATION
• Serology testing has now developed to enable specificity testing or confirmatory
testing. If PCR is negative and antibodies are positive there may be no need for
quarantine
o See item 6 0 Testing Strategy for further discussion on serology testing
Risk assessment:
• Work required to develop risk assessment framework and identify different levels of
risk during this phase of the pandemic; bringing together a range of policies and
procedures across agencies
• To be formalised in an overarching policy which Ministry of Health informs but does
not lead (MBIE, NZTA and Customs also involved in border management)
• Maori and Pacific equity will be addressed
• Framework wil be brought to TAG
o Noted queries are being received from general practitioners on risk
assessments for breaches and significant breaches of border controls,
particularly over the next 12 months
4.0 Review of suspect case definition
Appreciation given for TAG contribution to the review of suspect case definition and subsequent
input into operationalising.
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Since last TAG meeting update, date for proposed change coming into effect has changed to 15
June, to align with Testing Strategy implementation.
Communications and impacts to sector are being considered for 15 June change and in the event
the country moves to Level 1 before 15 June.
4.1 Managing respiratory il nesses over winter
TAG advice sought on whether current guidance should be changed
• Current guidance to stay at home for 48 hours after symptoms have resolved was
developed when country had lower testing capacity
• Testing capacity now al ows for anyone with respiratory symptoms to be tested. Should the
advice now be simplified to be to ‘stay home if you are sick’? or kept at the 48 hours?
TAG feedback:
• Remains important to have a 2 tier system – borders and identification of cases in the
community. Essential for adults with acute respiratory infection to be tested (surveillance
and the greater public good). Messaging needs to change as no longer a clinical indication,
but needs to be de-linked from infection control measures. Need to have a system for
respiratory illness in general rather than just COVID-19 specific
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• Traditional guidance has been to stay at home for 24 hours
• Simpler messaging to say ‘stay home if you are sick’ but there is a risk this guidance won’t
be followed
• Any guidance must have simple messaging
• Many people do not have sick leave, so will not be able to stay home, regardless of
messaging. Financial support should be provided if necessary, for people to stay home when
sick or while awaiting a test result
General y, Subgroups support the current guidance, but acknowledge peop
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will vary. Communications need to be clear
5.0
Publication of Elimination Strategy
Elimination Strategy has been published on Ministry website and wil continue to be updated as
required.
TAG feedback:
• Some countries communicate the last known date of community transmission. Adding this
date to the Ministry website would be useful to communicate how the country is tracking
towards the Elimination Strategy target
6.0 Testing Strategy
TAG was presented with the final working draft of the Testing Strategy which is one of the key pillars
of the Surveillance Strategy. Appreciation given for all who have contributed.
• A Cabinet paper will be developed over the coming week to introduce the Testing Strategy
and wider surveillance approach
• Testing Strategy is a strategic framework (for both diagnostic and surveil ance purposes);
contains high level approach and designed to be flexible; considers testing developments
that will occur
• Contains five surveillance components (as re
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August
• A new Surveillance Testing Working Group will be meeting weekly to develop operational
plans and activities
TAG feedback:
• Clinical input from clinical and primary care groups will be useful, particularly as
implementing testing in the community has a practical dimension
• Provide an explanation of why testing is being done at days 3 and 12 for new arrivals
• Consider obligations under Te Tiriti and to Pacific populations and strengthen that language
• Strengthen language around ‘taking the testing to communities’; particularly as many DHBs
have introduced mobile testing centres and are considering their ongoing use, and including
this in Strategy will benefit the cases of those DHBs seeking to keep mobile units in place
• Consider the use of serological testing in some populations eg: pilots, to assess levels of
exposure – useful to know how different barrier methods functioning
Serology testing:
• ESR has been evaluating serology tests, body of evidence is suggesting they are
successful especially if confirming positives. Estimate serology testing will be available in
NZ in a couple of weeks.
• Mindful that at early stages, about ⅓ of cases thought to not serologically convert
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Rapid review testing:
• ESR has been evaluating easy to perform (point of care) tests.
• The Public Health Subgroup are developing a clinical algorithm to support implementation
of the new approach to testing and implementation of the higher index of suspicion
classification. Consultation with other Subgroups on logic, content and operationalising
including PPE and notification requirements is underway
INFORMATION
Longer term Testing Strategy to be developed. Developments in serology and rapid review
testing are of particular importance.
Action: Seek involvement of Laboratory Subgroup in development of longer term Testing
Strategy, particularly in relation to serology and rapid review testing
Any further feedback on the Testing Strategy is welcomed
7.0 Maori perspectives
• Ensure any formal reviews of COVID-19 response have Maori and Pacific representation
• Hospitalisation issue - concern of inequities for Maori - data showing 66-70% drop in heart
failure admissions compared to same time last year. Currently seeing large number of
severely ill hospital admissions, many did not seek care during earlier alert levels. Working
with DHBs on diagnostics and seeing people early
9.0 Subgroup verbal updates
Primary Care
Feedback to IPC Subgroup
• Infected HCW return to work guidance – query as to why differentiation has occurred,
shouldn’t HCW and other workers be treated the same?
• Different DHBs have different requirements for the use of PPE – national guidance
required
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Public Health
• Developing clinical algorithms and wil be seeking advice from other Subgroups
Clinical
• Suggest begin planning a Strategy for COVID-19 treatment; although there are currently no
drugs which have had an effect so far, some drugs are showing weak effectiveness
