• Noted there was anxiety among the crew members about what would happened – a plan would have assisted with
this.
• Daily check-ins went well.
• MoH decided any positive cases in NZ would go to MIQ. When numbers of cases increased, we worked with the
shipping agent and captain and were advised there needed to be 14 crew onboard to run the ship. Seven out of 21
crew were cases and it was suspected there would be more. Discussions continued about whether to take the cases
off or not. It wasn’t possible to take all crew to MIQ. Guidance from the MoH was requested.
• This was a customs-led event which was different to what we have previously experienced. It was a maritime
decision about how many crew stayed on board, rather than a health decision.
• We had to provide cel phones – there was difficulty getting hold of people as phones didn’t work very wel in some
parts of the ship (sleeping quarters). We asked crew to come further up into the ship which worked. We were using
one of the crew (not medically trained) to assist with contacting patients and using the pulse oximeter (there was
only one of these).
• Realised we needed primary care support and asked WellSouth who tried to find GPs (no one was available to assist).
Southland ED agreed to provide primary and secondary care. The communicable disease nurses did the monitoring
calls and any issues were escalated to ED. There was a low threshold for accessing care.
• Two crew were assessed in ambulance then went back on board. Then we put telehealth in place.
• When unable to find primary care (for clinical assessment) this was raised with MoH IMT – they advised they were
a Public Health IMT not an all of health IMT and it was Southern’s responsibility to source this. There was difficulty
because the crew weren’t enrolled in a practice. WellSouth are working on a system for responding to patients who
aren’t enrolled.
• Virtual ward rounds were held daily.
and
were involved in these. Noted this was
discussion for decision making not clinical assessment - rather than a ward round. ED were happy to provide backup
but it was difficult given their normal workload, and this work was outside normal roles. This work significantly
impacted the running of ED but there wasn’t an alternative option at the time. Noted great communication with
Lou and Mandy. There was also on call work for other staff involved (not just clinicians) so this was very resource
intensive.
• Learning: Anthony providing continuity was real y valuable, but this isn’t sustainable – a 24-hour service is needed.
• Noted that when borders open this will be ‘normal’ BAU so planning is required for a system to manage this
(resurgence planning).
Transport for admission to
• There was no system for transport - St Johns was wil ing to do this, but it took an entire crew out for approx. 4 hours
Hospital
(so compromised the community). Work is needed on IPC and processes with St Johns.
• Had to rent a van for transport which wasn’t ideal. Processes need to be tightened. Sue Dil on had to clean the van
every time it was used.
• Learnings: we need to work with St Johns and transport providers so issues are addressed in advance. We need
transport solutions throughout the DHB.
Patient admission in ED
• St Johns took crew around to another entrance, in a lift and into a medical ward. This was very time consuming –
this involved all security in the hospital to block other entrances and hallways.
• Cleaning of the lift took up to 1 hour which took out one lift. It impacted a handover, so staff had to use another
entrance. It also impacted getting meals to wards.
• This work took a lot of different personnel from the hospital and impacted business as usual.
• Learning: There aren’t defined red and green streams in Invercargill hospital.
• Security support was also required for crew accommodated in Invercargill hospital cottages. Need to consider
inhouse security.
• There are significant environmental constraints in Invercargill Hospital re air flow/ventilation for IPC.
• Auckland uses 60 minutes after exposure in an enclosed environment.
• Staff were doing literatures searches about Delta as there weren’t clear national guidelines available at the time.
• Susan J thanked Southland Hospital for all their work.
Patients on Ward
• There was a lot of anxiety about the physical environment from staff e.g. were the negative pressure and ante-
rooms sufficient?
• Accessing PPE was fine and fit testing was organised.
• Staff exposure was limited as much as possible – staff were tested before, during and after exposure to patients.
• There was some unpleasantness from some staff/patients towards staff caring for crew.
• Vaccination of staff and their families was organised. Acknowledged the vaccination team who stood up hospital
clinics for staff.
• Nursing staff were fantastic – there were dedicated teams looking after the crew.
• Learning: need to work with staff to increase confidence with physical environments.
• Pilipino workforce provided the crew with excellent support.
• Issues with discharge of ARC patients – in-patients were vaccinated before they went back to ARC facilities.
• Staff surveillance testing went well once the process was in place but it required a lot of resource. This needs to be
included in resurgence plans.
• Learning: need to be able to test staff inhouse with quick turnarounds for results as delays in getting results affected
staff availability for rosters. Lack of inhouse diagnostic testing is an issue which has been raised for some time.
• James: Saliva testing was set up at short notice and worked well – need to investigate if this can be done
independently of Occ Health e.g. using an app.
• Tried to have daily meetings with the people involved which worked well as a form of communication, even if there
was nothing to discuss. This was very time consuming.
• Communication between IMT and staff on the ground: It worked well but it was difficult to attend meetings and
have time to do the work required. A DHB EOC would have worked more efficiently (and needed on the Southland
site).
• Learning: when we have cases, we need a DHB EOC for a health system response.
Discharge process
• Crew were moved to the cottages after leaving the hospital. This was done slowly and in a planned way. This transfer
took a lot of work, particularly with IPC.
• Decisions about discharge were made at virtual ward rounds. It was decided not to discharge over the weekend due
to logistics, but it wasn’t easy for the medical ward. This could have been resolved with primary care for one of the
crew members.
• Acknowledged the hard work of Pete Whalley and Owen Black for organising accommodation.
• There was an impact on finding accommodation for locums who would have normally used the Southland hospital
accommodation.
• The hospital residence was used as it was difficult to get crew moved to MIQ - eventual y some of the crew were
moved to MIQ. The captain stayed locally which was difficult to arrange (24/7 security was needed). Now the MoH
is planning for areas without an MIQ and there is acceptance that cases may be cared for in the community, but we
don’t yet know what that means for security and other systems as yet.
Transfer to MIQ
• Serology was done on negative cases – three had evidence of past infection but one crew member was required to
stay on the ship.
• There were many complex decisions that needed to be made. A DHB EOC set up at an early stage would have been
able to assist with a lot of logistics work.
• Without a MIQ in the district we aren’t connected to the RIQs that run them.
Monitoring of crew on the
• Once patients recovered, Mandy and Lou did daily phone cal s – with ED on standby.
ship
Welfare
• Southland hospital provided meals as this wasn’t organised by customs. The marae took over this and were able to
be more flexibility in meeting their requirements and could provide hot meals.
• There were low demands, but welfare requirements took a lot of time (e.g. picking up prescriptions).
• Learning: We could deal with welfare requests for a small-scale event only.
• A security firm pulled out at 6am one day, but we now have a backup.
• If an emergency isn’t declared the Council CDEMS don’t operate.
Other
• Overall it was a positive experience to be part of and there were a lot of new relationships established which will
stand us in good stead for the future.
• Received feedback from Maritime that SDHB were very good to deal with.
• The captain and crew very much appreciated the care that they received.
