The Technical Advisory Group for 2019-nCOV teleconference meeting
29 January 2020
12:30Pm – 1:35pm
133 Molesworth
A Present 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 Caroline McElnay (Chair),
Ministry staff in attendance
Dr Harriette Carr, Dr Tomasz Kiedrzynski, Dr Juliet RumbalL-Smith, Dr
Niki Stefanoginnis, Dr Richard Jaine and Asad Abdullahi (MoH staff),
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B Apologies: Dr Sal y Roberts.
C. Welcome to new attendees - Caroline welcomed everyone and
acknowledged Dr David Murdoch as a new member.
She noted this is the second meeting for the group.
1.
Agreed and Actioned
1. TAG Structure combined with item 5
Rationale: The meeting noted the magnitude and seriousness the
2019-nCoV situation in China. It is clear this is a highly dynamic
INFORMATION
situation. There is a lot of requests for technical details and a single
TAG cannot adequately meet the demand. Caroline has been talking
to members of this group about creating sub-groups that report to
the existing TAG structure.
Recommendation one:
The setting up of the fol owing subgroups were agreed on:
•
Infection Prevention and Control Sub-group – Dr Sal y Robert
(Lead) – Dr Niki Stefanoginnis (MoH contact)
Recommendation one
•
Epidemiology Sub-group – Dr Michael Baker (Lead), Dr David
Create TAG subgroups to do
Hayman, Nick Wilson, Jodie McVernon (in Melbourne) and
work on -Infection prevention
potentially others, ESR representative, Dr Richard Jaine (MoH
and control, laboratory testing,
Contact).
public health and epidemiology
•
Laboratory Sub-group - Dr Anja Werno (Lead), New Zealand
Action (1):
Microbiology Network (NZMN) as the core of the group
S
ubgroups Leads and MoH
•
Public Health Sub-group - Dr Shanika Perera (Lead) – Dr
Contacts to discuss how the
Harriette Carr (MoH Contact).
subgroups can better be joined-
Action:
up.
Shanika and Harriette to discuss public health aspects
Harriette and Shanika – public
Richard and Michael to discuss Epidemiology aspects.
health
Additional comments:
Michael and Richard – Epi.
• Is a clinical management subgroup needed? .
• Is a primary care subgroup needed or any other subgroup?
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• Potential y could combine the public health and epi subgroups
• It was noted that primary care is not represented on the TAG
• Subgroups need to first focus on specific technical
guidance/advice and then discuss the system impacts for
example if the public health subgroup has a recommendation
then the implications of their recommendation on the work of
the Laboratory subgroup or any other subgroup should be
discussed at TAG.
•
The overal guidance and advice that TAG puts together has to be
joined up and some thinking has to go into translating the
technical advice into practical implementation and how that wil
affect different parts of the system.
2. Case Definition Option B (as per the Case definition
Recommendation two
paper circulated).
Option B as presented (refer to
agenda item 2 paper) was
Additional comments:
endorsed and adopted with the
•
MoH has reviewed and assessed al the feedback received from
addition of sore throat as a
TAG
symptom, along with cough and
•
CDC has a more sensitive case definition than CDNA.
shortness of breath).
•
Casting wider at this stage is better than narrow case definition
Action (2):
as there wil be a range in clinical presentation and also in risk of
Every term in the case definition
transmission
need to be defined ‘sudden’,
•
Option B is easier to understand
‘sustained outbreak’– MoH to
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•
Option A is quite complicated based on the epidemiology which
action.
does not seem manageable at practical level and option B is
consistent with Australia.
•
The suspect case definition needs clarification as we are
beginning to see testing happening where the case does not
meet the suspect case definition and there is risk of over-
testing.
•
Over-testing at the very early stages is a good idea as that’s
when containment of the disease might work
•
It’s difficult for GPs to distinguish between upper and lower
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respiratory viral infections based on the clinical symptoms.
•
Careful thinking must go into the resourcing implications of
option B as this may lead to higher number of cases identified,
more testing, what public monitoring wil look like, whether
they require hospitalisation, do al contacts need monitoring or
wait until they are confirmed.
•
If we adopt option B – we are not going to automatically adopt
the Australian contact management - this has to be adopted to
our context. Further work is needed on what it means for
public health fol ow up and primary care.
•
Every term in the definition need to be defined e.g. ‘sudden’,
‘sustained outbreak’ and actual clinical symptoms.
4. Infectivity and transmissibility
Recommendation three
A key factor that influences transmission is whether the virus can
There is currently not enough
spread in the absence of symptoms – either during the incubation
evidence to assume
period or in people who never get sick. Richard tabled a summary
asymptomatic person can
paper- infectious period for 2019-nCoV which was discussed.
transmit the virus and in the
Background: Media reports on the virus being infectious in those
absence of further data
asymptomatic seems to have stemmed from a single Lancet paper
evidence confirming that this is
that looked at a family cluster and one child in the infected family
the case – no policy or
had no symptoms, but a chest CT scan revealed he had pneumonia
procedures is going to change
and his test for the virus came back positive.
based on this single case.
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After Further information was
Additional comments:
received (via email) after the
Provide advice to the public and ask people to take particular care
meetin, a consensus was
about hand hygiene and social distancing
reached that a precautionary
Need to be aware of the risk setting such as child care/schools,
approach be adopted.
hostels, prisons, etc where transmission can occur.
TAG recommends that:
•
Returned travel ers from
Hubei province of China
should self-isolate for 14
days after leaving Hubei
province
•
contacts of confirmed case
should self-isolate at home
for 14 days fol owing
exposure
•
the individuals in these
categories should avoid
high risk settings for 14
days including child/care,
schools, age care and
healthcare facilities.
3. Risk Assessment –
Recommendation four
Niki summarised the risk assessment level as fol ows:
That the risk assessment be
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The likelihood of one or more imported cases of 2019-nCoV infection adapted as fol ows: The
in New Zealand is
moderate to high. This assessment considers that
likelihood of one or more
the reported numbers are rapidly increasing overseas, New Zealand
imported cases of 2019-nCoV
has close transport links to China, and Chinese New Year
infection in New Zealand is
celebrations are underway.
high
The likelihood of limited person-
The likelihood of limited person-to-person transmission is low to
to-person transmission is
moderate and
the likelihood of sustained transmission, and
moderate and
the likelihood of
widespread outbreaks, is low. This assessment considers the
sustained transmission, and
evidence to date which suggests limited human-to-human
widespread outbreaks, is low,
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transmission and assumes that symptomatic cases transmit the virus
notwithstanding, it may be high
and that the timely and robust management of both cases and their
in some settings (e.g. hostels,
contacts wil limit the spread of disease.
institutions, aged care facilities,
childcare and schools)
There was discussion based on the latest epidemiology and amended
the risk assessment as high likelihood of a case in New Zealand;
moderate likelihood of limited human to human transmission. There
is an low overal likelihood of a sustained outbreak but this likelihood
may be high in some settings (e.g. hostels, institutions, aged care
facilities, childcare and schools)
5. New Zealand Microbiology Network (NZMN) to lead technical
guidance item combined with Item 1 above.
6. Primary Health Guidance Document
MoH has received feedback on the current document. TAG to send
any further comments/feedback they may have to Dr Tomasz
Kiedrzynski,
7 No other business item discussed
8. Next meeting: Monday 3 February @3:00 – 4:30pm TBC
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Minutes: Technical Advisory Group (TAG) for COVID-19
Date:
Friday 04 September 2020
Time:
10.30am – 11:30am
Meeting URL:
Location:
9(2)(k)
Chair:
Dr Ian Town
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Members:
Dr Anja Werno, Dr Bryan Betty, Dr Erasmus Smit, Dr Matire Harwood, Professor
Michael Baker, Dr Nigel Raymond, Dr Shanika Perera
Andi Shirtcliffe, Asad Abdullahi, Louise Chamberlain, Dr Tomasz Kiedrzynski, Dr
Ministry of Health Attendees:
Juliet Rumbal -Smith, Dr Richard Jaine, Dr Caroline McElnay, Dr Harriette Carr,
Margareth Broodkoorn, Dr Niki Stefanogiannis
Guests:
INFORMATION
Apologies:
Assoc Prof Patricia Priest, Dr Collin Tukuitonga, Dr Virginia Hope, Dr Sally
Roberts, Sarah Mitchel , Jeremy Tuohy
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.
Minutes of the last meeting (21 August 2020) were accepted.
2.0
Update on open actions
Open Actions updated. Action 57 closed.
3.0
Ministry of Health update on COVID-19 response
• Smal number of cases indicates that the recent outbreak seems to be tailing off, but as per
New Zealand’s previous experience this can still last a long time.
• Genome sequencing has added an important dimension in understanding the connection
between cases.
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Resurgence Planning
• Lessons learned from the first wave have been put into practice providing a rapid and
proactive response to the first case.
• The National Contact Tracing Centre has been working to support Auckland with the
assistance of several Public Health Units across the country. Success is partly attributed to
the centralised database system.
• Formal adoption of the MOH Emergency Operations Centre has also contributed to better
communication and coordination within the Ministry and across the sector.
TAG feedback:
• Query to how effective is the removal of positive cases to quarantine facilities in preventing
secondary cases.
o This outbreak has involved a number of cases of family with children, who were sent
to MIQs with their parents.
• Clarification was asked on the use of N95 masks by Health Care Workers in contact with
Higher Index of Suspicion (HIS) patients in the community since the positive case of a health
care worker in Tokoroa.
o An adverse event review is being undertaken to determine the cause of the Tokoroa
HCW incident, before it can be considered due to the use of improper PPE and any
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other actions to be taken.
• Suggestion of the use of more nuanced Alert Level System (i.e AL1.5, AL 2.5) considering
minimal cost and disruption measures of risk management. Suggestion that an Alert Level
2.5 would include mandatory mass masking in indoor environments and seal of the borders
between city states with an outbreak in the community.
o A more nuanced approach is needed, and work has commenced at the Ministry to
refine the levels and control measures
INFORMATION
• A reminder that the term Community Transmission is being used liberally and it is important
to make the distinction between Community Clusters and Sustained Community
Transmission, the latter being of greater concern.
• Query to the importance of having serology testing on HIS patients’ whānau in the control of
the outbreak.
o Serological testing would be important in identifying outbreak dynamics before
symptomatic onset.
o The understanding is that it wil be used in particular sub clusters to identify how
they are linked to the outbreak.
4.0
COVID-19 Health System Response Directorate
• The COVID-19 Health System Response directorate has been established. The Science
and Technical Advisory (STA), which TAG is a part of, has been paired up with Intelligence
& Surveil ance Workstream, Epidemiology, and Behavioural Insights under the new Science
& Insights Group.
• The STA Work Programme has 250 line-items of research areas that are either being
commissioned, undertaken internally across the Ministry or being monitored by ESR and
HRC projects. There are also 110 active research projects active at the moment.
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• Key, amongst the new pieces of work is a review of testing and surveil ance done by the
COVID-19 Testing oversight group, co-chaired by Sir Brian Roche and Heather Simpson.
• STA is also developing an internal repository of latest evidence about the virus, treatments
and the prospect of the vaccines to assist the staff across the Ministry in their work.
• Discussions are being held on how to make this information available to members of TAG
and key advisors along with staff in other government agencies.
5.0
TAG Workstream Update
See above
6.0
Testing
• There is an intense political interest in the Surveil ance and Testing planning.
• An Expert Working group is reflecting on the Testing Strategy and analysing data from the
previous week. Its been suggested the use of a risk-based approach rather than a blanket
approach to the Testing Strategy.
• A strong statistical and modelling framework to the testing plan wil help the Ministry
understand the degree of certainty a testing plan can provide.
Implementation of the Saliva Testing
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• Many laboratories are experimenting with saliva testing, mainly spiked samples.
• Paired nasopharyngeal & saliva samples are starting to be gathered from Jet Park MIQ.
• LabPLUS wil run the samples through their normal system. ESR wil run the samples
through one of their automated extraction machines
• ESR is also using the saliva-direct method. INFORMATION
• Full validation of the method wil take some time as for the need of pairing saliva and swab
samples.
TAG Feedback:
• Question about testing data capture and if coding test requests have been implemented
o Reason for testing is now being captured in the Éclair electronic referral system.
Information on how data is being used analytically wil be gathered and brought
back to TAG.
7.0
Re-shaping of the Elimination Strategy
• The Elimination Strategy has not changed, but there is a strengthening of the pil ars of the
existing Elimination Strategy.
• The four pil ars are:
o Border controls
o Robust case detection and surveil ance
o Effective contact tracing and quarantine
o Strong community support of control measures
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• Some pil ars fall more of under the Ministry of Health and some more the All of Government
group, but all have been active looked at in ways they can be strengthened
• For the contact tracing and quarantine pil ar, one of the differences this time around is the
use of Managed Isolations and Quarantine facilities.
• The Ministry is also current working on and seeking further advice on contact tracing and
the concept of recursive contact tracing – proactively contacting contacts of contacts.
• The Ministry has identified the need to get a wider understanding of the behavioural drivers
that wil support the behaviour expected from the population and shake people out of the
complacency experienced on Alert Level 1.
• TAG will, as usual, be used to provide guidance and feedback.
TAG Feedback:
• Suggestion of information being developed for people before they arrive in New Zealand;
providing information on ways to minimize the risk of acquiring an infection a week before
they leave.
8.0
Māori Health Perspectives
• The Chair mentioned a publication of NZ Medical Journal about the risks of uncontrolled
spread within Māori communities given other access inequalities and acknowledged that due
to the work done by Māori Pandemic Coordination Group fortunately some of the dire
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predictions have not happened.
o A collective approach is required to keep Equity and Māori Health in mind.
Leadership has been shown and Māori communities have come together to keep all
safe.
• Māori communities stil struggle with lack of work, loss of employment and access to kai.
9.0
Pacific Health Perspectives
• No updates given.
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10.0
Any other business
• No items discussed.
11.0
Agenda items for next meeting
• Recursive contact tracing and digital tools to assist on identification of contacts.
New Action Items raised during meeting
• No actions raised.
Meeting closed at
11:40am
Next meeting
Friday 18 September 2020 – 10:30am – 12:00pm
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INFORMATION
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Minutes: Technical Advisory Group (TAG) for COVID-19
Date:
Friday 18 September 2020
Time:
10.30am – 11:30am
Meeting URL:
Location:
9(2)(k)
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Chair:
Dr Ian Town
Dr Anja Werno, Dr Bryan Betty, Dr Col in Tukuitonga, Dr Erasmus Smit, Dr
Members:
Matire Harwood, Professor Michael Baker, Assoc Prof Patricia Priest, Dr Sal y
Roberts, Dr Shanika Perera, Dr Virginia Hope
Ministry of Health Attendees:
Andi Shirtcliffe, Dr Caroline McElnay, Dr Juliet Rumbal -Smith, Margareth
Broodkoorn, Dr Niki Stefanogiannis Asad Abdullahi
INFORMATION
Guests:
Matthew Reid, Jeremy Tuohy Rebecca Drew, Catherine Marshall
Apologies:
Dr Nigel Raymond, Louise Chamberlain, George Whitworth
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.
Minutes of the last meeting (04 September 2020) were accepted.
Update on open actions
There are no open actions.
2.0
Ministry of Health update on COVID-19 response
• The Chair started by acknowledging the efforts of colleagues in Auckland for their
leadership across the system to bring the current outbreak under control.
• The Chair also commented on his observations around the speed and effectiveness of
contact tracing and testing plus the important role genomic sequencing has played in
disease and outbreak management.
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• One of the key agenda items for agencies is Strategic Planning (see below)
• Lack of public commentary by the Director General of Health may be due to the sensitive
time for officials as per requirements of the Electoral Commission/State Service
Commission.
• There is a large amount of work happening at the Ministry to identify a Strategic Planning
team which wil engage with the wider DPMC group.
TAG feedback:
• Query to how the COVID-19 Testing Oversight Group relates to AoG, the Ministry of Health
and DPMC group.
o The group was formed at the request of the Minister to provide an assurance review
of testing. They wil provide a report to the Minister including a range of
recommendations to further the implementation of the Testing Strategy.
3.0
Surveil ance Plan Refresh
An update about the Surveil ance Plan and Testing Strategy was provided by the group manager of
Science & Insights. The key points include:
• It’s time to refresh the original plan due to the resurgence in addition to a better
understanding of the disease since the plan’s original release.
• An initial scoping meeting has been held with members of the Ministry and ESR.
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• The goals are:
o To revise the Surveil ance Plan and Testing Strategy with focus on implementation.
o To review the questions from the original plan to assess if they are still the right
questions.
o To include more advice from Statistical Advisory Group.
• A risk framework has been developed with the help of ESR and Ministry’s Expert Working
Group. Once completed it wil be shared with TAG for peer-review. The 3 key aspects of
framework are: risk of exposure, risk of transmission and risk of adverse health outcomes.
• The approach taken is to work more closely with PHUs early in the design phase.
INFORMATION
• The timeframe for implementation is mid to late October/early November.
• Until the plan is ready for release, testing data by DHB, ethnicity and age group are being
reviewed fortnightly, overlaid with the syndromic surveil ance.
TAG Feedback:
• Include the rationale for the surveil ance plan and strategy and focus on clear
communications to those doing the testing in the front line for consistency across the system
(especial y primary care).
• Acknowledgment that the current 2-weekly cycle has increased the clarity of testing
guidance
• Query whether the plan refresh will concentrate on items that can be operationalised or will
the plan wil be kept strategically broad with focus on implementation.
o The current plan is comprehensive and permissive, but it lacked the operational
detail.
• Regarding the testing data, query if breaking down the reason for testing is part of the scope
of the plan refresh in order to guide the financial investment on testing.
o The electronic laboratory ordering system wil be able to provide more information
on reason for being tested.
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4.0
AoG Response Group Scenarios (sensitive not to be shared or discussed externally)
The Chair noted the early draft of the AoG Scenarios document created by DPMC.
• The Ministry of Health has not formally commented on this document as of yet.
• The subject of precision of health terminology in the document has been brought to DPMC
attention.
• Engament with wider society has been suggested.
• TAG comments and feedback wil be col ated and provided by the end of the day.
• Further iteration of the document wil be brought to TAG
TAG feedback:
• Lack of mentions of Equity, especially in sections A and C.
o The Chair offer to connect a member of wider Urutā group directly with DPMC.
• The importance of the use correct terminology and precision of health terms have been
reiterated.
• Query to the process going forward.
o The next step is for the Ministry to provide detailed feedback and engagement.
5.0
Nasopharyngeal Swab (NPS) alternatives for Surveil ance
Due to increasing consumer resistance to repeated nasopharyngeal swabbing, TAG has been
asked for a recommendation on alternatives for surveil ance, especially for those frequently tested.
A paper summarizing of the current alternatives has been prepared by the Science & Technical
Advisory and included in the agenda for discussion.
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• No single test will detect al individuals with SARS-CoV-2.
• At present the only non-NPS testing options are Oropharyngeal swab (OPS), Anterior Nares
swab (ANS) or combination OPS-ANS.
• Testing Saliva is not yet an option in NZ.
• Combination of OPS-ANS has a higher detection rate and is no more difficult than OPS or
ANS alone.
• Combined OPS-ANS testing has been adopted and considered acceptable by a wide range
of organisations.
INFORMATION
• Testing saliva is a useful alternative to NPS but requires validation.
TAG feedback:
• Different swab types needed for combined OPS-ANS may pose a logistical chal enge,
however the process of sending sample to laboratories is the same.
• Sensitivity only makes a difference if the individual is swabbed beyond 7 days post
symptom onset.
• Logistically, for labs to receive NPS and saliva samples, is anticipated as the biggest
difficulty.
• Training needed for workers in testing centres to ensure good specimens.
• If a there is an agreement to changing the recommendation for the type of swab used, a
rollover timeline is important from labs and high-volume processing perspective.
• Suggestion of offering both types of swabbing to the wider community, not only to border
workers.
• Serology testing in border workers highly recommended.
• Query about the role of rapid antigen testing, since it is an emerging topic in the literature.
o There is not enough data to consider rapid antigen testing to be used in isolation,
and more validation stil required.
o Sensitivity is the main issue in rapid antigen testing and other new molecular
quicker test options arising. Sensitivity of those is around 80% to 90%.
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o Another caveat is the need for frequent testing.
o Under the current scenario the antigen tests are not suitable for NZ.
Recommendation: TAG broadly accepts the recommendation for a combined OPS-ANS swab for
those being tested frequently. The Science & Technical Advisory Principal Advisor will work with the
Chief of Pathology and Laboratories, Canterbury Health Laboratories and ESR Clinical Virologist to
make the recommendation as precise as it can be.
6.0
Close contact of probable or confirmed case: Consistent approach to Testing and Release
from Isolation and Decision Tree Context: During the current outbreak in Auckland, some work has been delegated to be managed
by other PHUs, in order to speed the follow-up of symptomatic close contacts.
One potentially contentious area was the testing protocol to determine if a contact is becoming a
case and how to release them at the end of quarantine.
TAG was presented with a paper written by Medical Officers of Health with a suggested approach
and asked for feedback.
TAG Feedback:
• Clarification that the 3-test protocol is a national protocol to classify symptomatic close
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contacts who initially test negative.
• Clarification is needed on what is expected with asymptomatic testing.
• Consideration for keeping people in quarantine for 14 days with follow-up with a serological
test a week after release.
• Serology testing needs to be included in the diagram as PCR testing plus serology
increases sensitivity from 92% to 96%.
• Testing people 4 times seems excessive.
• The Office of the Director of Public Health is currently working on serology testing in order to
advise its use in Public Health.
INFORMATION
• Asymptomatic testing was implemented in this current outbreak and its value needs to be
assessed as an approach going forward.
Agreed that the Contact Tracing team would convene a small group to finalise the advice.
7.0
Māori Health Perspectives
The use of remote consultation for those with English as a second language was raised as an issue
by Urutā at an informal meeting of the former Primary Care subgroup.
8.0
Pacific Health Perspectives
No update given
9.0
Any other business
Other issues raised at informal meetings of the former Primary Care subgroup are:
• The general stress among GPs in South Auckland.
• The aerosol vs droplets spread issue in home visits for HIS patients.
10.0
Agenda items for next meeting
No specific agenda items discussed.
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New Action Items raised during meeting
No new action items raised.
Meeting closed at
11:45am
Next meeting
Friday 02 October 2020 – 10:30am – 12:00pm
Minutes: Technical Advisory Group (TAG) for COVID-19
Date:
Friday 02 October 2020
Time:
10.30 am – 12:00 pm
Meeting URL:
Location:
9(2)(k)
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Chair:
Dr Ian Town
Dr Bryan Betty, Dr Erasmus Smit, Dr Matire Harwood, Professor Michael Baker,
Members:
Dr Nigel Raymond, Assoc Prof Patricia Priest Dr Sal y Roberts, Dr Shanika
Perera, Dr Virginia Hope
Ministry of Health Attendees:
Andi Shirtcliffe, Dr Caroline McElnay, Margareth Broodkoorn,
INFORMATION
Guests:
Catherine Marshal , Aoife Kenny, Tara Swadi, Naomi Gough
Apologies:
Dr Anja Werno, Dr Col in Tukuitonga, Dr Juliet Rumbal -Smith, Louise
Chamberlain, Dr Niki Stefanogiannis
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.
Minutes of the last meeting (18 September 2020) were accepted subject to the following correction
being made to item 5.0 Nasopharyngeal Swab (NPS) alternatives for Surveil ance
• Sensitivity only makes a difference if the individual is swabbed beyond 7 days post symptom
onset.
• Since addressing screening asymptomatic people, sensitivity is adequate under the
circumstances.
Update on open actions
• There are no open actions.
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2.0
Ministry of Health update on COVID-19 response
• Work is focused on Ministry’s long-term strategy including the update to the Surveil ance
Plan, Testing Strategy, Alert levels and Resurgence Planning.
3.0
Advice for higher-risk international arrivals
TAG members were asked to provide advice on higher-risk international arrivals and high-risk
environments including MIF-MIQ.
TAG feedback included:
Pre-departure Testing
• Pre-departure testing can filter out a few cases, but would need to consider factors such as
timing, and accessibility/validity of tests in the countries of origin.
• To gain a true risk assessment about country of origin, knowledge of people’s entire travel
history for the previous 14 days is needed, not just the most recent departure country.
• Need to identify the range of policy options and make some assessment of their likely
effectiveness, cost-effectiveness, and sustainability.
• When going for elimination the price of failure/breaches is high in terms of public health and
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economic set-backs.
• Consider what the epidemiological data says about risk as a combination of the prevalence
in the source country and how many incoming travellers there are from that country.
• Importance of date of onset of symptoms and assessing when people were infected.
• Consider data about whether people are more likely to catch the virus during the week
before travel or while in transit.
• Suggestion to maintain day 3 and day 12 nasopharyngeal swab (NPS) tests, plus adding
one or two additional saliva tests to increase likelihood of recognising infection earlier and
INFORMATION
therefore reducing risk of transmission.
• Importance of collecting testing data on day 0 and day 7.
• Rapid antigen testing could be required by airlines, which may remove people who are
infectious.
• People in MIF/MIQ with acute infection could be re-tested after day 12.
• Note ‘long term excreters’ are possible, with people being PCR positive for weeks or months
after infection.
• Passenger and aircrew tiredness after a long journey and other human factors such as
close conversations while in MIF/MIQ may result in IPC practices not being observed
undermining any pre-departure testing.
Policy options will be drafted and circulated to TAG members for comment
Incubation Period
• Note background paper did not include information about the latent period vs the incubation
period, as well as asymptomatic vs pre-symptomatic infection.
• Some specific guidance in terms of home isolation and testing would be advisable after the
14-day period.
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• Incubation periods can be unhelpful and unhelpful metric as it is unsound from a virological
point of view ie respiratory viruses tend to have a short incubation period.
• The long-incubation cases in literature were from the beginning of the pandemic when
understanding the disease was limited and relied on people recal ing having initial
symptoms.
• PCR tests replaced the need to rely on clinical symptoms.
• Re-testing the particular case in question is most likely to the possibility of the infection being
acquired while in transit or while in MIF/MIQ, not long incubation periods.
• If MIF/MIQs are considered a high-risk environment, a review of post-release management
should be undertaken.
Fomite Transmission
• Fomites are really important in health care, but there is little evidence of significant fomite
transmission of SARS-CoV-2 in literature.
• Important to strengthen the message around hand hygiene practices.
• The danger around fomite transmission in MIF/MIQs environment can be reduced with
proper cleaning.
• Transmission via aerosolised particles should not be excluded
eg in a lift
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• Addressing transmission in planes. Air NZ is encouraging the use of facemasks on domestic
flights, however since returning to serve drinks and snacks in these flights, there was an
impact on the proper use of masks and challenges adherence to IPC practices.
• Science & Technical Advisory is undertaking work around airborne and fomite transmission.
Virulence of Different Strains of SARS-CoV-2
• There is currently a debate around the D614G mutation having greater inf
INFORMATION ectivity, possibly
due to a more stable interaction between the S1 and S2 sub-units and increased uptake.
• Apart from that there is no evidence that certain strains of SARS-CoV-2 are more virulent
than others.
Impact on Sensitivity
• Timing and technique of swabbing can make an impact on sensitivity in ‘long term excreters’
but would make no difference to acute cases.
4.0
Māori Health Perspectives
No update given
5.0
Pacific Health Perspectives
No update given.
6.0
Any other business
New Zealand definition of quarantine and isolation, changing and/or rectifying the terminology.
7.0
Agenda items for next meeting
RELEASED UNDER THE OFFICIAL
No specific agenda items discussed.
New Action Items raised during meeting
No new action items raised.
Meeting closed at
11:40am
Next meeting
Friday 16 October 2020 – 10:30am – 12:00pm
Minutes: Technical Advisory Group (TAG) for COVID-19
Date:
Friday 16 October 2020
Time:
10.30 am – 12:00 pm
Meeting URL:
Location:
9(2)(k)
ACT 1982
Chair:
Dr Ian Town
Dr Anja Werno, Dr Bryan Betty, Dr Erasmus Smit, Dr Matire Harwood, Professor
Members:
Michael Baker, Dr Nigel Raymond, Assoc Prof Patricia Priest, Dr Sally Roberts,
Dr Shanika Perera, Dr Virginia Hope
Ministry of Health Attendees:
Andi Shirtcliffe, Dr Juliet Rumball-Smith, Louise Chamberlain, Dr Richard Jaine
INFORMATION
Guests:
Prof Michael Bunce
Apologies:
Dr Caroline McElnay, Dr Collin Tukuitonga, Margareth Broodkoorn
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.
Minutes of the last meeting (02 October 2020) were accepted.
Update on open actions
There are no open actions.
2.0
Ministry of Health update on COVID-19 response
The Chair gave an update on current issues being worked on in the Ministry:
•
Work continues on stablishing the Strategic Planning Framework, led by the Director-
General advised by a steering group that includes several members of ELT.
•
Framework wil inform the incoming Government on the COVID-19 response and indicate
and proposed changes to the Elimination Str
RELEASED UNDER THE OFFICIAL ategy.
•
Work also includes the review and updates to the Surveil ance Plan, Testing Strategy and
Outbreak Response Management. Once the review is completed and finalised internally at
the Ministry, it wil be brought to TAG for advice and feedback.
•
An expert panel including members of TAG wil be established to discuss and provide
advice on establishing new policies related to testing technologies and techniques.
3.0
COVID-19 in Health Care and Support Workers Report
The Chair noted the COVID-19 in Health Care and Support Workers in Aotearoa New Zealand
report, taken as read, and TAG members were invited to comment.
TAG feedback:
•
Query to whether the PHUs have col ated their experience with clusters and the chain of
transmission.
•
More qualitative research around Health Care and Support workers’ experience and impact
in areas not covered in previous reviews.
•
Report lacked information around MIF and MIQ workers, but expectation is that
recommendations and actions derived from this report to also cover these settings.
ACT 1982
•
Standardisation of template to promote understanding across different reports.
4.0
Auckland August Outbreak (sensitive not to be shared or discussed externally)
The Chair acknowledged the openness of the Director-General in al owing a set of ELT documents
about the lessons learned from the Auckland August Outbreak to be shared with TAG.
TAG feedback:
•
Concern around dissemination of information to the point confirmed cases could potentially
be identified.
INFORMATION
•
Highlight the need for Māori and Pacific specific responses to address the diversity of the
communities and religious, language and other access barriers.
•
The Ministry needs to proactively build relationship with leaders of other communities.
•
Need to strengthen and clarify communications with the sector.
•
Clarification about the age distribution of cases reported in the second outbreak being
younger than the age distribution of cases reported in the first half of the year.
•
Query whether the report includes the Christchurch cluster and other sub-clusters.
o A second report about the Christchurch cluster is being prepared in conjunction with
MBIE.
Age distribution wil be extracted from the ESR report for clarification.
5.0
COVID-19 Resurgence Plan V.2
The Chair noted the second version of the COVID-19 Resurgence Plan and spoke about the ability
of using a wider framework in developing Regional plans and SOPs as well as the implementation of
new technologies for contact tracing.
RELEASED UNDER THE OFFICIAL
The response this time around has been reported as more robust and pushed staff to operate at
speed. The progress towards a more structured national public health network wil provide support
for smaller centres. Ongoing professional support and adequate time off are important
considerations.
The next planning priority is immunisation, with three or four vaccine types anticipated in the first half
of 2021.
s 9(2)(ba)(i)
6.0
7.0
Māori Health Perspectives
Update included on discussion of item 4.0
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8.0
Pacific Health Perspectives
No update given.
9.0
Any other business
The Chair noted the two Lancet Public Health articles include in the agenda for information.
10.0
Agenda items for next meeting
INFORMATION
No specific agenda items discussed.
New Action Items raised during meeting
No new action items raised.
Meeting closed at
11:40am
Next meeting
Friday 30 October 2020 – 10:30am – 12:00pm
RELEASED UNDER THE OFFICIAL
Minutes: Technical Advisory Group (TAG) for COVID-19
Date:
Friday 30 October 2020
Time:
10.30 am – 12:00 pm
Meeting URL:
Location:
9(2)(k)
ACT 1982
Chair:
Dr Ian Town
Members:
Dr Collin Tukuitonga, Dr Nigel Raymond, Assoc Prof Patricia Priest, Dr Sally
Roberts, Dr Virginia Hope
Ministry of Health Attendees:
Andi Shirtcliffe, Louise Chamberlain, Niki Stefanogiannis, Aoife Kenny, Anna
Cook, Bronwyn Croxson, Michael Bunce
Guests:
Samantha Fitch, Nic Blakeley, Philippa Yasbek, Bevan Lye, Simon Everitt
INFORMATION
Dr Anja Werno, Dr Bryan Betty, Dr Erasmus Smit, Dr Caroline McElnay,
Apologies:
Margareth Broodkoorn, Professor Michael Baker, Dr Shanika Perera, Dr Matire
Harwood, Dr Juliet Rumbal -Smith
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 (16 October 2020) were accepted.
Update on open actions
Therapeutics
• Feedback and questions from TAG members were collated and sent to the COVID-19
Innovation Acceleration Fund (CIAF) team.
• The Ministry is keeping a watching brief on therapeutics.
2.0
Ministry of Health update on COVID-19 response
RELEASED UNDER THE OFFICIAL
The Chair gave an update on current issues being worked on in the Ministry:
• Briefings have been prepared and are ready for the incoming Government.
• Resurgence planning work has been completed.
• The final Surveil ance Strategy will be back on the agenda for a future TAG meeting.
• COVID-19 card trial to start in Rotorua and final refinement plans contact tracing system and
the Ministry contact tracing app.
• The Ministry is working on improving its data and analytics function, with an imminent
upgrade to the website, with better and more organized data, along with sophisticated
access to real-time data viz dashboards.
• MBIE and MoH are running workshops on the research agenda for COVID-19 and future
requirements for wider and long-term research in preparedness and capacity building in
infectious diseases.
3.0
Reviewing the Elimination Strategy: Border Settings
As part of the first stage of the work underway to review New Zealand’s COVID-19 Elimination
Strategy, TAG members were asked to provide advice on changes that should or could be made to
border settings and MIF-MIQ based on the latest public health evidence.
TAG Feedback included:
ACT 1982
• While a review of the current the set of measures to ensure it is kept proportionate to risk
has been underway, there is a need to exercise caution of opening the borders.
• One area of concern is the fatigue amongst primary care, laboratory MIF-MIQ staff.
• Reducing the isolation time for people travel ing from low-risk countries could impact the risk
of people entering the health system.
• Importance of balancing the costs of maintenance M F-MIQ versus outbreaks of disease, in
order to know where to invest time and resources.
• From an IPC perspective MIF-MIQ are not really fit for purpose facilities.
INFORMATION
• Public perception and which measures the NZ public considers acceptable
• Slow progress has been made in col ecting and storing saliva samples due to the technical
difficulties as well as public adherence.
• Considering a person with a negative PCR on day 3, it will not be appropriate to support an
early release from isolation into ful households. That brings up the inequity issue of low to
middle income families, who wil not have an empty home to self-isolate.
• Early release of isolation could also present a problem in releasing some but not all
members of the same bubble.
• Importance of al owing Recognised Seasonal Employer (RSE) workers into the country with
an option of isolating at working facilities rather than MIF-MIQ.
• Experimenting with different isolation requirements for cohorts and monitor the level of
compliance and whether risk-factors for non-compliance might be.
• Acceptance that any loosening up could increase cases in the community.
• Trying out different testing modalities and testing frequencies.
• Clear communication that once vaccines become available and while it may be possible for
some to be vaccinated prior to departure, it will not indicate opening of the borders.
RELEASED UNDER THE OFFICIAL
• Have isolation facilities located away from major centres of economic activity.
• RSE workers from the Pacific will be from low-risk countries and traditional y NZ partners.
• Ensure the use of the best testing technology with high sensitivity tests prior to release.
• Reminder that isolating people from the rest of the population is different from isolating them
from each other and being careful to not allow transmission chains to set up within the
former.
4.0
Māori Health Perspectives
No update given.
5.0
Pacific Health Perspectives
Update included on discussion of item 3.0
6.0
Any other business
7.0
Agenda items for next meeting
No specific agenda items discussed.
ACT 1982
New Action Items raised during meeting
No new action items raised.
Meeting closed at
11:40 am
Next meeting
Friday 13 November 2020 – 10:30am – 12:00pm
INFORMATION
RELEASED UNDER THE OFFICIAL
Minutes: Technical Advisory Group (TAG) for COVID-19
Date:
Friday 13 November 2020
Time:
10.30 am – 12:00 pm
Meeting URL:
Location:
9(2)(k)
ACT 1982
Chair:
Michael Bunce (Acting)
Members:
Dr Erasmus Smit, Dr Nigel Raymond, Dr Sal y Roberts, Dr Shanika Perera
Ministry of Health Attendees:
Andi Shirtcliffe, Louise Chamberlain, Samantha Fitch, Aoife Kenny, Kate Rose,
Richard Jaine, Mary van Andel
Guests:
Nic Blakeley, Bevan Lye, Simon Everitt
INFORMATION
Dr Anja Werno, Dr Bryan Betty, Dr Col in Tukuitonga, Professor Michael Baker,
Apologies:
Dr Virginia Hope, Dr Caroline McElnay, Dr Ian Town, Dr Juliet Rumball-Smith, Dr
Matire Harwood, Margareth Broodkoorn, Assoc Prof Patricia Priest
1.0
Welcome and Previous Minutes
Michael Bunce welcomed al Members and Attendees in his capacity as Acting Chair of the
Technical Advisory Group for COVID-19.
Minutes of the last meeting (30 October 2020) were accepted subject to the following correction
being made to item 3.0 Reviewing the Elimination Strategy: Border Settings
• Reducing the isolation time for people travel ing from low risk countries could impact the
risk of people entering the health system.
• Reducing the isolation time for people travel ing from low-risk countries, to allow more
people from high-risk countries to occupy the vacated MIQ room-days, would result in
greater risk overal .
2.0
Ministry of Health update on COVID-19 response
The Acting Chair gave a brief update on some of the topical science that Ministry’s Science &
Technical Advisory (STA) team were watching and rev
RELEASED UNDER THE OFFICIAL iewing:
• The STA has launched the COVID-19 Pātaka Knowledge Hub
• Pfizer vaccine data has been reported 90% efficacy and protection in the vaccine group
relative to the control group. New Zealand has secured 750k double doses
• As part of the community surveil ance strategy ESR has been working on wastewater
testing – the Ministry is reviewing this together with swab-based environmental testing.
• The Ministry along with ESR and Universities across New Zealand have worked together
and wil soon publish a paper about COVID-19 transmission in airplanes
• Rapid testing technology stil constantly appearing in the news with mixed results around
efficacy and sensitivity
• Large paper in Lancet Psychiatry shows that among 60K people in the USA 1 in 5 show
symptoms of mental health problems
• A paper published in Nature on 11 November 2020 on mobile phone tracking data show
that fully occupied restaurants, gymnasiums and rubbish bins represent some of the major
points of transmission.
3.0
Advanced Review of the Surveil ance Strategy
TAG members were asked to provide feedback on the new Surveil ance Strategy which will shortly
replace the Surveil ance plan.
TAG feedback included:
• Include wastewater testing and environmental testing in the sentinel surveil ance
ACT 1982
• Environmental sampling in the absent of known community transmission could be used to
understand sensitivity for detecting infectious people and use it as a tool in a community
outbreak
• Importance of having data on the reasons tests have been taken
• Early detection of symptomatic people should stil be a priority
• Incorporate a note on how surveil ance might change if a vaccine is available. After borders
are opened, the focus on elimination could possibly transition to a flatten the curve strategy
INFORMATION
• Incorporate in the document reference to the parameters of vaccination and strategy of
post-vaccine time
• Clarify the use of ‘monitor’ in elation to IPC measures
• Include ‘community pharmacies’ when writing about other community settings in future
proofs of the document
Consider including Situation Reports in the material sent to TAG members.
The acting chair asked for any final comments to be sent to the Intelligence and Surveil ance team
asap for consideration prior to finalising the document.
4.0
Reviewing the Elimination Strategy: Findings of Keep it Out Pillar
• In the interest of time, comments and feedback about this document wil be submitted via
email to the policy team.
5.0
Reviewing the Elimination Strategy: Prepare for It and Stamp it Out
Continuing our work to review the Elimination Strategy for COVID-19, TAG members were asked to
provide feedback on the second pil ar ‘Prepare for It and Stamp it Out’, focusing on detection and
surveil ance, contact tracing, case management, and public health measures. Its was noted that
some of the conversations regarding the Surveil ance Strategy apply equal y to this discussion.
RELEASED UNDER THE OFFICIAL
TAG feedback included:
• Increasing test frequency (using faster or non-invasive tests) might help, but it would not
make-up for loss of sensitivity in New Zealand’s COVID-19 context
• In terms of Resurgence, increasing the frequency to review the Case Definition should not
be necessary, only if there are changes that would affect Probable or Confirmed case
definitions.
• Preference for remaining with PCR testing instead of opting to use lower sensitivity antigen
tests. Such tests may play a role in detecting people that are actively shedding virus.
• Additional public health measures could be considered in high-risk regions, such as regions
that have MIQ facilities, in order to make Alert Level 1 stronger
• Strengthening the public messaging to promote change in mindset for the realisation that
NZ wil have more cases coming through the border and trade-offs wil be required
regarding public health measures in the community
• Technology can be very helpful in identifying casual contacts, but it would not replace the
case investigation/interview process
• Some concerns were raised about the amount of information being shared on case details
and how much it can impact the trust in the system, discouraging people to disclose
symptoms.
ACT 1982
• Adjusting Alert Levels needs consideration on how dangerous the scenario is but
introducing some flexibility might be considered as long as the message remains clear and
concise. For example, closing regional borders could be introduced in Alert Level 2 and 3
settings.
• Full occupancy restaurants and gymnasiums were hot spots according to American data1,
so caution in proposed changes on Hospitality settings for Alert Levels is advised. Risk-
based frameworks are starting to provide empirical data on relative risks of transmission.
INFORMATION
6.0
Māori Health Perspectives
No update given.
7.0
Pacific Health Perspectives
No update given.
8.0
Any other business
The Acting Chair asked TAG if there were any items outside of the agenda that could be discussed.
9.0
Agenda items for next meeting
The Acting Chair asked for any item for the next meeting. No specific agenda items discussed –
TAG was asked the send any item to TAG Secretariat.
New Ac ion Items raised during meeting
No new action items raised.
Meeting closed at
11:55am
Next meeting
Friday 27 November 2020 – 10:30am – 12:00pm
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1 Mobility network models of COVID-19 explain inequities and inform reopening -
https://www.nature.com/articles/s41586-020-2923-3
Minutes: Technical Advisory Group (TAG) for COVID-19
Date:
Friday 27 November 2020
Time:
10.30 am – 12:00 pm
Meeting URL:
Location:
9(2)(k)
ACT 1982
Chair:
Dr Ian Town (til 11am) then Professor Michael Bunce (Acting)
Members:
Dr Anja Werno, Dr Bryan Betty, Professor Michael Baker, Dr Sal y Roberts, Dr
Virginia Hope
Ministry of Health Attendees:
Dr Caroline McElnay, Louise Chamberlain, Assoc Prof Patricia Priest
Guests:
Anna Cook, Nic Blakeley, Samantha Fitch, Tara Swadi
INFORMATION
Dr Collin Tukuitonga, Dr Erasmus Smit, Dr Matire Harwood, Dr Nigel Raymond,
Apologies:
Dr Shanika Perera, Andi Shirtcliffe, Dr Juliet Rumball-Smith, Margareth
Broodkoorn
1.0 Welcome and Previous Minutes
Dr Ian Town welcomed all Membe s and Attendees in his capacity as Chair of the Technical Advisory Group for
COVID-19.
Dr Town also informed the Members and Attendee that he would leave the meeting at 11am to provide a briefing
on the Vaccine Strategy to Ministers. Professor Michael Bunce wold then take on the duties as Acting Chair.
Minutes of the last meeting (13 November 2020) were accepted.
Update on open actions
There are no open actions.
2.0 Ministry of Health update on COVID-19 response
The Chair gave an update on current issues being worked on in the Ministry:
• The Prime Minister, Ministers and senior ministerial co
RELEASED UNDER THE OFFICIAL leagues have been actively engaged in discussions
on the future settings of the Elimination Strategy
• There are also important Resurgence Planning activities underway and a Risk Framework being
developed with DHBs anticipating any COVID-19 outbreaks that could occur across the holiday period.
The Acting Chair gave a brief update on some of the topical science that Ministry’s Science & Technical Advisory
(STA) team were watching and reviewing:
• Cochrane update on mask use was released
• CDC model ing paper on multi-layered testing exploring border options
• Pre-print study about a deadly virus strain posted online attracts criticism and may raise anxiety about viral
mutations
• Early trial data shows that the rheumatoid arthritis drugs tocilizumab appears to treat people who are
critically ill with Covid-19
• One month out from Christmas, Dr Anthony Fauci just confirmed Santa Claus is immune to SARS-CoV-2
3.0 Reviewing the Elimination Strategy
Continuing with the review of the Elimination Strategy for COVID-19, TAG members were asked to provide
feedback on refining and improving the strategy.
ACT 1982
TAG feedback included:
• Effort into reducing the number of infected people boarding planes coming to NZ from high-incidence
countries
• Evaluation of the impact of a COVID-19 vaccine becoming available in NZ on other strategy pil ars
• Support for maintaining a multi-barrier approach
• Incorporation of action research approach into the pandemic response – so that any changes to
procedures are careful y evaluated
INFORMATION
• Saliva testing might not be the solution as being suggested considering the difficulty of finding the right
collection device, the difficulty of properly assessing the sensitivity of the test and the additional upfront
work for labs in handling specimens
• Rapid antigen tests have a potential role for triaging but stil require a nasopharyngeal swab (NPS)
• Increased frequency of testing might counterbalance the need for high-sensitivity tests, considering the
compliance of those who need to be tested frequently
• Ensure standardised process for taking NPS - anecdotal experience was shared from a Marine Pilot who
had 10-20 NPS taken and commented that al have been very different
• Suggested wording around 2A pil ar ‘Careful integration of more rapid tests’
• Under 3B pil ar, to incorporate communication that address risk and hazard to communities as Alert Level
rises
4.0 Māori Health Perspectives
No update given.
5.0 Pacific Health Perspectives
No update given.
RELEASED UNDER THE OFFICIAL
6.0 Any other business
• Feedback from the Community Medical Sector was relayed to TAG of concerns in terms of PPE supplies
planning and advice in case of significant resurgence in the community.
• Disagreement with the latest released MIQF IPC guidance and request to feed back the concerns of
unintended consequences for the rest of the Health Sector.
• The Chair would explore options to distribute the Ministry’s COVID-19 Science Briefing (CSB) with the
TAG papers.
7.0 Agenda items for next meeting
No specific agenda items were discussed, and TAG members were asked the send any items to TAG Secretariat.
An announced was made that Louise Chamberlain is leaving the Science & Technical Advisory.
The Ministry of Health and TAG members would like to formally acknowledged and express gratitude for Louise’s
valuable contribution to the COVID-19 Pandemic Response, to wider Ministry and to Aotearoa NZ.
New Action Items raised during meeting
Action #
Agenda item
Actions
Action Owner
Coordinate with Dr Matire Harwood and invite members
ACT 1982
58
Māori and Pacific
Louise
Health Perspectives of the Te Rōpū Whakakaupapa Urutā for an update on
their work.
Chamberlain
Meeting closed at
11:50am
Next meeting
Friday 11 December 2020 – 10:30am – 12:00pm
INFORMATION
RELEASED UNDER THE OFFICIAL
Action #
Agenda item
Actions
Action Owner
Updates
Status
Coordinate with Dr Matire Harwood
58
Māori and Pacific Health
and invite members of the Te Rōpū
ACT 1982
Perspectives
Whakakaupapa Urutā for an update on Louise Chamberlain
27/11 - Action raised
Open
their work.
INFORMATION
RELEASED UNDER THE OFFICIAL
