A new review of Covid testing failures earlier in the year paints a picture of a health ministry failing to learn from overseas experiences and unable to keep track of its own modelling. Can the ministry learn from its mistakes? Sam Sachdeva reports
Asked about the country’s Covid testing capacity on February 21, as the Omicron outbreak took hold, Prime Minister Jacinda Ardern projected an air of calm.
“You’ll see, we have, overall, enough PCR capacity - the issue is we have a lot of tests being taken in one region,” Ardern said of news that some tests were taking more than five days to be processed.
Behind the scenes at the Ministry of Health, officials were less sanguine.
The day before Ardern’s soothing remarks, a briefing and communications plan on the backlog delivered to Director-General of Health Dr Ashley Bloomfield painted a different picture.
“The national laboratory testing network (the network) is now at capacity given pooling samples is no longer viable given positivity rates and Covid-19 cases in the community continue to grow. The increasing testing demand far exceeds the network’s testing capacity, as anticipated in the Covid-19 Omicron Response Plan.”
As staff were scrambling to put together the document for Bloomfield on the morning of February 20, Bridget White – the ministry’s deputy chief executive for the Covid-19 health system response - made clear its importance.
“Its urgent and will be noisy – with media, with Ministers etc. We need to get ahead of the issue or it will be very unpleasant for us all.”
That noise came soon enough: on March 1, Bloomfield stood before television cameras and admitted his ministry had overestimated the number of PCR tests which could be handled by Kiwi labs.
A backlog of 32,000 tests had been allowed to build up, with 9000 needing to go across the ditch to Australia.
Further unpleasantness for Bloomfield and his ministry has arrived this week, with the release of an independent review into the fiasco carried out by Allen and Clarke along with internal documents and email correspondence showing how officials handled testing capacity.
Worse still, the positivity rates used in modelling were consistently too low, understating the number of Kiwis returning positive tests by at least 20 to 40 percent.
The report does not pull punches, citing failures in data collection, communication, modelling and personnel management.
“The backlog in PCR testing that emerged in February 2022 should have been and was to some degree predictable,” the authors conclude in one of the more damning findings.
Indeed, the ministry’s own modelling in the weeks leading up to the capacity crash showed the system was reaching breaking point.
“Whether it is intentional or not, the model is forecasting a sample backlog of more than 80,000 samples in a single day with PCR baseline capacity exceeded each day for more than a fortnight from 31 January 2022,” the review says of January 30 figures.
“The backlog is not referred to or explained in any notes or commentary in the report.”
Worse still, the positivity rates used in modelling were consistently too low, understating the number of Kiwis returning positive tests by at least 20 to 40 percent.
Even a new testing model, developed on March 4 in the wake of Bloomfield’s mea culpa and using real data from the six weeks prior, somehow showed demand remaining below capacity despite the backlog.
In an interview with Newsroom, Bloomfield insists the ministry was watching the modelling closely on a daily basis.
“From where I sat, and this is where I started to ask questions, I was seeking advice for the team on why there was this gap between the number of tests and our capacity.”
Among the problems identified in the report is a rudimentary one: the issue of exactly how to define capacity.
The ministry and labs used “baseline capacity” interchangeably to describe pooled capacity (when batches of samples are tested together, and retested individually in the result of an initial positive) and unpooled capacity (when each sample is checked one by one).
Yet there is a world of difference between the two, with New Zealand’s ostensible pooled capacity in March being 58,000 and its unpooled capacity just 31,000.
That fuzziness did not escape the attention of Associate Health Minister Ayesha Verrall, who in a late December briefing circled ‘No’ when asked to indicate whether she was happy with the ministry’s capacity forecasts and scrawled a note of her own.
“My main concern is that [the] most recent briefing stated pooling was part of baseline capacity. My understanding is that we cannot rely on pooling as during periods of high prevalence it is not efficient.
“I am concerned that after Cab paper + months of focus definitions are not adhered to. Definitions need to be agreed with ministers/MoH/labs.”
That message was received, with the pooled and unpooled numbers reported separately, but problems remained.
In a January 24 email to several staff, Bloomfield questioned the figures he was being provided with, saying: “I have heard three different versions in the last 24 hours of what our extant capacity is.”
Bloomfield concedes it “might have been” helpful to use lower, unpooled figures to mark baseline capacity from the start, but offers a plea in mitigation.
“The point here is Omicron was completely uncharted territory for us, because even though we'd had a reasonable sized Delta outbreak in Auckland in particular…we had never had to use unpooled testing before…
“I think it was reasonable for us to continue to build our pooled capacity and to report that, remembering that our aim was to use that for as long as possible until the positivity rate got too high.”
But such a scenario was not uncharted worldwide, as the review points out.
“We had really good people doing good work, and there are few people that were working as hard as these folk around the country at that time, working under enormous pressure, so I don’t blame individuals.” – Dr Ashley Bloomfield
“As is now well known, PCR testing capacity was overrun in Queensland, New South Wales and Victoria during their respective Omicron outbreaks. These outbreaks all commenced in early December 2021 and PCR testing capacity with pooling had been rendered inefficient by the beginning of January 2022.”
While the ministry did incorporate analysis of the Omicron experiences in both Australia and Singapore, the review says it did not properly appreciate just how significant positivity rates had been to the functioning of the testing system.
Bloomfield says officials had been keeping a close eye on Australia, New South Wales in particular, and were aware of the impact of the positivity rate.
“I guess it's just, we hadn't been down that road before. It was a new road for us… the point at which you recognise that you've even been out by a day or two, or in our case maybe three days or something, that is what made the difference here.”
Despite the myriad shortcomings, Bloomfield says he has not asked for any resignations within his team nor believes that appropriate.
“We had really good people doing good work, and there are few people that were working as hard as these folk around the country at that time, working under enormous pressure, so I don’t blame individuals.”
And, Bloomfield adds, he is the one ultimately responsible for ministry failures.
“Part of what my job is to do – and my senior leaders – is to make sure our teams have got the resources they need, and so we need to put our hands up when things don't go to plan.”
Yet the director-general took his time to front up when the backlog developed.
'Always on the back foot', or adaptable?
Despite officials prompting Bloomfield and his team to share the February 20 briefing with ministers as “key stakeholders”, it appears he did not do so.
In a February 22 email to colleagues about questions raised by Ardern’s office regarding test processing, White said: “Basically this is all in the day 5 test memo and comms plan that went to Ashley on Sunday and he decided not to share with Ministers yet. We need to check whether DG [Bloomfield] is okay with providing the content from the memo and comms plan.”
Bloomfield does not recall exactly why he decided to hold off, but says he was generally keen to understand the reasons for the capacity shortfall and how the backlog could be dealt with.
In a statement subsequently provided to Newsroom, a ministry spokesman said Bloomfield did not agree with the recommendations made in the February 20 memo around destroying samples more than five days old and sought further advice, while there had been regular contact in the days following the preparation of that document.
"The Director-General is constantly aware of the need to balance informing ministers as soon as practicable with ensuring the ministry is providing an accurate and complete picture on an issue, including steps being taken to address the issue," the spokesman said.
In a statement provided to Newsroom, Ardern said she accepted Bloomfield was trying to better understand the capacity problems before updating ministers.
Some, including the National Party, see the testing failures as emblematic of a wider inflexibility within the ministry.
"Without [strategic planning], the ministry has always been on the back foot in responding to events.” - Independent review
The email chains "make depressing reading", National's Covid response spokesman Chris Bishop says, with testing numbers "thrown around like confetti at a boozy wedding".
"The most frustrating thing is that New Zealand was one of the last to get Omicron, so it's not like lessons from Australia couldn't have been learned."
That view may be buttressed by the review’s findings on a lack of strategic planning and planning capability across its Covid-19 directorate.
“There would have been benefit in having dedicated capability across the groups but centrally coordinated to develop forward looking strategic plans and ‘playbooks’ for future outbreaks and phases in management of the pandemic. Without this, the ministry has always been on the back foot in responding to events.”
The accusation of an inability to change with the pandemic is one Bloomfield rejects.
“I would say that our ability to adapt and flex and make decisions quickly and adjust over the last two years has been far and away - it's been a highlight of my career.”
He and the ministry have nonetheless begun work on all nine of the review’s recommendations, including the level of standing PCR testing infrastructure needed for future variants or pathogens.
It likely won’t be Bloomfield in the hot seat when that next threat comes – but whoever succeeds him will hope to avoid the “noise” of a similar failure in future.
* This article has been updated to include additional comment from the Ministry of Health, the Prime Minister, and the National Party.
