New Zealand's strong public health response must now give way to a larger emphasis on primary care and hospitals, the Director-General of Health says, while explaining why his ministry got testing numbers so wrong
A false sense of security about the spread of New Zealand’s Omicron outbreak may have contributed to health officials’ failure to accurately assess the country’s Covid testing capacity, Dr Ashley Bloomfield has conceded.
However, in an interview with Newsroom Bloomfield also expressed confidence that his ministry was ready for the next phase of the outbreak as pressure moved from testing and tracing to GPs and hospitals.
On Tuesday, the Ministry of Health chief admitted the organisation had overestimated the number of Covid-19 PCR tests the country’s laboratories could process as the virus took off. A backlog of 32,000 test samples was still waiting to be processed, with just over 9000 of those sent to Australia to ease the burden on labs in New Zealand.
Speaking to Newsroom, Bloomfield said the ministry had for some time been holding thrice-weekly meetings with the country’s entire lab network (including both public and private providers) to collect information on the current testing capacity and projected growth, while it also received near-daily updates on any staff shortages or equipment problems.
“It wasn’t just us forecasting what we thought might be there.”
He had also taken heed of warnings from his Australian counterpart Brendan Murphy about how the country’s Omicron outbreak had strained its testing resources and workforce.
“If a relatively low proportion of that workforce are off because they've got Omicron or are contacts or they're looking after cases or contacts, then that has an impact, and we started to see that reasonably early.”
"We did see – and I don't know if any of us had a false sense of security – but the case numbers were at what looked like quite manageable levels, we hadn't even got above the peak of the Delta outbreak, but when things took off, gosh, they took off really quickly." – Dr Ashley Bloomfield
Asked why the ministry had still overestimated its capacity given that intelligence gathering and forewarning from overseas, Bloomfield said “the way things play out when the surge is upon you is always a bit different from what the planning and the estimates might show.
“It's a bit like the modelling work: we've got good information and that information is, you know, ‘On a good day when we're fully staffed and here’s the equipment we're expecting and this is where we're planning to be, are expecting to be’.
“But then a combination of things like staff vacancies, staff being off unwell, delays and just getting a couple of those analysers and a few reagent delays that might take a machine out for a day or two, the cumulative impact of that, of course, is what I think made the difference.”
The pace at which Omicron had spread through the community had also been a surprise after what was initially a slow start, he said.
“Not just on the testing side, but elsewhere in terms of the case numbers, we did see – and I don't know if any of us had a false sense of security – but the case numbers were at what looked like quite manageable levels, we hadn't even got above the peak of the Delta outbreak, but when things took off, gosh, they took off really quickly.
“Yes, we could look at other countries and say that might be what would happen but suddenly, you know, the whole system's having to respond to that across testing, contact tracing, and so on.”
If the ministry had identified the surge a day or two earlier than it managed, it would have been able to spread PCR test samples – a large proportion of which were in Auckland – throughout the country to make laboratories’ workloads more manageable.
A further complication had come from the fact most GPs did not have access to an electronic ordering system used to record tests and instead relied on manual inputs, which meant once they had entered the lab system in Auckland they couldn’t easily be taken out.
'Live life forwards, understand it looking backwards'
Bloomfield demurred when asked whether he would have advised the Government to move from PCRs to rapid antigen tests (RATs) more swiftly had the ministry understood the true testing capacity, saying: “We live life forwards and we understand it looking backwards.”
However, RATs had already been rolled out sooner than anticipated and were now being used to identify the vast majority of new cases.
The wider health system was shifting from what had been a “very strong public health response” to one that was more focused on healthcare settings, such as primary care and hospitals.
“We're setting up in here and we've talked about… actually, we need our people to be in very close touch with all our DHBs because it will differ by DHB region: you know, Auckland's very different at the moment from South Canterbury, and getting a good understanding every day [of] what impact it’s having on the ground in primary care, in the emergency departments, in hospitalisations, and also on the workforce in those different parts of the system.
“We're building this intelligence picture on a daily basis that nuances DHB by DHB.”
While some experts have questioned the wisdom of processing the backlogged PCR tests given the effect of delays on their sensitivity, Bloomfield said he felt “a little bit of a duty of care” to see them through.
Those people who had been affected by the backlog were being told that the probability of a false negative was higher as a result of the delayed processing, he said.
