A damning new report has found a number of failures in the Ministry of Health's testing plans, Sam Sachdeva reports
A backlog in Covid-19 PCR testing which led to the country’s systems falling over should have been predicted and prevented by health officials, an independent review has concluded.
Poor communication, data limitations and a failure to learn from international experiences instead led to complacency and meant the country’s laboratories buckled under the strain of requests.
In March, Director-General of Health Dr Ashley Bloomfield admitted the ministry had overestimated the number of Covid-19 PCR tests the country’s laboratories could process as the virus took off in the community.
The revelation came as Kiwis waited upwards of a week for test results and health experts warned of laboratories reaching a crisis point, while months earlier one of the Government’s own groups had raised red flags.
An independent review commissioned by the Ministry of Health and carried out by consultancy Allen and Clarke has now been released, laying bare the failures which led to the crash.
While regular reporting had indicated labs were on track to reaching a national target of 60,000 tests per day, “inconsistency in the definition of capacity, together with insufficient caution in how capacity was reported to decision makers, created a risk of overstating estimated capacity”.
The numbers shared with Bloomfield and ministers relied on pooled sampling, and failed to flag a point at which the demand for testing would exceed unpooled test capacity - despite the modelling predicting as much.
“By the time clarity on single test capacity was provided to ministers, the backlog had already accumulated.”
The reporting of capacity as a national figure also failed to account for IT interconnectivity and other logistical issues which meant samples could not be shifted between labs after being collected, and as a result overestimated “useable” capacity.
“A high risk of missed opportunities and insufficient management and reporting capacity...ultimately led to a disconnect in understanding of the situation with decision makers." - Allen and Clarke report
While a three-phase response plan for the Omicron variant had been designed on the assumption PCR capacity would be reduced, the significance of rising positivity rates “was either not fully appreciated by the ministry or was not effectively communicated to decision makers”.
As a result, the second phase of the response was twice as long as it should have been to maintain PCR capacity, with the ministry’s testing group failing to convey the significance of positivity rates in calculations.
“While modelling was initiated in late January 2022, it appears that positivity rates were used to forecast demand only and were not used to forecast capacity or the point when pooling of samples is no longer viable,” the report says.
“Even then, the positivity rates used in the modelling are significantly understated and do not reflect the messaging from laboratories.”
With other countries having similarly faced difficulties with PCR testing in the face of Omicron, opportunities to learn from international experience were “substantial”.
“It is not apparent how these insights were incorporated into testing modelling, planning, or reporting.”
With no forecast date for when PCR capacity would be exceeded, there was no deadline for the rollout of RATs as an alternative. The lack of confidence in the system’s readiness meant the PCR backlog kept growing, despite labs calling for an earlier shift to the final phase of the response.
Among other issues raised in the report are limitations in the data available to the ministry, the strain on its experts due to the struggle to grow the lab testing team, and “a high risk of missed opportunities and insufficient management and reporting capacity that ultimately led to a disconnect in understanding of the situation with decision makers”.
“The backlog in PCR testing that emerged in February 2022 should have been and was to some degree predictable. The ministry’s testing modelling did forecast single test capacity being exceeded and modelled scenarios that forecast PCR testing capacity with pooling, would also be exceeded,” the report concludes.
However, deficiencies in the design and operation of the Covid testing system meant risks to the national strategy were not properly managed or communicated.
Among the report’s recommendations are addressing capacity deficits in the testing team, developing a clear testing plan on the role of PCR and other tests, and determining the level of PCR infrastructure needed for future variants or viruses.
Bloomfield: 'We could - and should - have done better'
In a media statement responding to the report’s findings, Bloomfield said the ministry was committed to learning from the experience and work was “well underway” to implement the report’s recommendations.
“These issues arose at a time that the health system was responding rapidly on many fronts to the highly transmissible Omicron variant and the emerging evidence about how it impacted our capacity and resources, including our labs.”
New Zealand had done comparatively well in responding to Omicron, but the review made it clear that “we could - and should - have done better on measuring and communicating lab capacity at that time”.
New Zealand Institute of Medical Laboratory Science president Terry Taylor said the report highlighted the woes of the country’s labs.
“For the dedicated and hardworking but always understrength frontline of dedicated medical laboratory scientists and technicians the testing capacity situation in February was always going to happen.
“This group of consistently under-resourced and respected health professions bore the brunt of being caught in between political expectation and real time system failures.”
The opinions of experts had been swept under the carpet for too long and that needed to change, Taylor said.
“Two years into the pandemic, Ministers should stop blaming officials for basic errors and start taking responsibility. The buck stops with them.” - National MP Chris Bishop
National Party Covid-19 response spokesman Chris Bishop said the ministry had been found wanting at critical times during the pandemic, with repeated recommendations from advisory groups related to improving its functionality and testing capacity.
Ministers had also failed to act, instead relying on assurances about testing capacity, and had rejected the advice of independent experts.
“Two years into the pandemic, ministers should stop blaming officials for basic errors and start taking responsibility. The buck stops with them.”
Green Party Covid-19 response spokesman Teanau Tuiono said the review's findings were "a strong signal that our public health system needs to be properly public", with most of the testing services run privately.
"It's clear we need to invest in allied healthcare, including pay equity, and long-term investment in the pandemic workforce because COVID-19 is still here, and it won't be the last pandemic we face," Tuiono said.
