Ministry of Health DHB C19 Update - 09 Feb 2022

09 February 2022 Kia ora koutou, As we prepare for entering further phases of the Omicron response, we wanted to provide you with an update around Personal Protective Equipment (PPE), pulse oximeters and rapid antigen tests (RATs), including the plans and hot topics for different parts of the Health and Disability System. If you have any questions on this update, please email covid.healthsupplychain@health.govt.nz.

Table of Contents District Health Board update .................................................................................................................. 1 General update for sectors ..................................................................................................................... 3 General Practice and Urgent Care sector update ................................................................................... 4 Pharmacy sector update ......................................................................................................................... 6 Aged Residential Care sector update ...................................................................................................... 6 Home and Community Support Services & Disability Support Services sector update ......................... 7 Mental Health and Addiction services sector update............................................................................. 8 Community update ................................................................................................................................. 9

District Health Board update Personal Protective Equipment The Ministry of Health holds close to 15 weeks supply across all PPE categories at projected high pandemic usage, with the exception of face shields. An additional 320,000 face shields are arriving this week and next week, and a further 1.3 million will arrive in mid-late April.

The Ministry’s Central Supply of PPE currently holds approximately 25 million P2/N95 particulate respirators, 210 million procedure masks, 210 million nitrile gloves, 9.5 million isolation gowns, 14 million aprons, 1.3 million goggles/glasses and 800,000 face shields.

Fit testing to 1870+ and the transition away from 9320A+ As we’ve previously communicated, those needing to use a P2/N95 particulate respirator should transition to using an 1870+. We will only be receiving small volumes of the 9320A+ model that many of you will be familiar with and the 1860S and 1860 models will continue to be supplied to New Zealand in small volumes.

The shift to 1870+ and away from the 9320A+ models reflects business improvements and refinements from 3M to accommodate Global Health requirements. 3M have adjusted their manufacturing lines and prioritised manufacturing of the 1870+. The 1870+ fits a high portion of the workforce (80-90%+) and has a high level of fluid resistance (Level 3 160mmhg – surgical grade).

3M have advised that the 9320A+ and the 1870+ are a ‘paired fit’, and that a successful fit test outcome to one model can help predict a successful fit test outcome for the other. Decisions about re-fit testing prior to use reside with the employer and the employee. A decision not to re-fit test

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before use and to wait until an annual fit test should be made with informed consent and an understanding of the associated risks.

We know that some of our workforce successfully fit test to the 9320A+, but not to the 1870+ or other alternatives. It is therefore important that we carefully manage the supply of 9320A+ to ensure that these can be used where needed and that workers can continue to be protected in their workplaces. The 9320A+ will still be supplied to those that have fit tested to this model and don’t fit test to other models. We remain confident in the current supply situation, however note the essential work underway to get the vast majority of people utilising 1870+.

Currently, of the 25 million P2/N95 particulate respirators the Ministry’s Central Supply of PPE holds 3.6 million of the 9320A+ and 13.2 million of the 1870+. We have orders in place to receive a further 400,000 9320A+ and 5 million 1870+ between now and June 2022.

Pulse Oximeters The Ministry currently holds 17,000 pulse oximeters, with various other stocks held by DHBs and others for supporting people with COVID-19 through the Care in the Community model. We have orders in place for a further 20,000 pulse oximeters. We intend to increase the number of Pulse Oximeters we have to 50,000 to support COVID-19 Care in the Community.

Pulse oximeters are one of a number of measures used to ensure COVID-19 cases can safely isolate at home – it’s important to note that they shouldn’t be viewed as a definitive piece of equipment for monitoring health status. Cases isolating at home receive a health pack with all the information they need, along with any health equipment required to keep track of their recovery. This may include a pulse oximeter if a clinical assessment by a health professional determines they need one.

We’re continually reviewing clinical advice around the use of pulse oximeters. We’re in the fortunate position where we have been able to observe and learn from other countries as they respond to large outbreaks of COVID-19 and the Omicron variant. Based on this, we anticipate the proportion of cases in the medium/high categories for clinical need to be between 10-20%. However, currently we are observing pulse oximeters being distributed for most cases and request that distribution based on clinical assessment is reviewed as a priority.

DHBs and Care in the Community hubs are required to have mechanisms in place to support the return of pulse oximeters so they can be cleaned and re-used. We understand this process is not working as intended and want to work with you so this can be improved. This could include creating a dedicated template on the PPE Portal for DHBs to access Pulse Oximeter equipment, including batteries, detergent wipes and other products.

We have added pulse oximeters to the DHB PPE Portal template so that these can be accessed from the Ministry’s Central Supply. As the DHBs are the leads for Care in the Community across their geographical regions, we expect them to manage the supply and distribution of pulse oximeters from the Ministry to support their community requirements.

The Inhealth Ebos pulse oximeter (SKU 1172095) should be the product primarily being provided to patients where a clinical assessment supports it. For patients with darker skin pigmentation, and supported by a clinical assessment, please provide the Nonin Onyx pulse oximeter (SKU 1170482).

Rapid antigen tests The Ministry currently has 4 million RATs in its Central Supply. There are a further 1.8 million RATs that have been distributed so far to those involved in the public health response in preparation for 2

Phase Two of the Omicron Response. This includes DHBs, general practice, pharmacies and frontline critical health services.

Confirmed deliveries are in place for a further 20 million RATs by the end of February and we have recently placed orders that will mean more than 50 million RATs are delivered in March. In total the Ministry has 185 million RATs on order.

The Ministry is working with DHBs and others to finalise the distribution model to support the integration of RATs into our testing system at Phase Two of the Omicron Response alongside PCR tests.

The use and supply of RATs will continue to be prioritised to enable asymptomatic critical workers to return to work and to help us identify transmission of COVID-19 early and at scale to help protect New Zealanders, including those who are most vulnerable. Many of the RATs will be used to implement the Test to Return programme.

General update for sectors Rapid Antigen Tests The use and supply of RATs for Omicron Phase Two will continue to be prioritised to enable asymptomatic critical workers to return to work and to help us identify transmission of COVID-19 early and at scale to help protect New Zealanders, including those who are most vulnerable. Many of the RATs will be used to implement the Test to Return scheme. It is not intended that surveillance testing will take place except for those organisations required under the Required Testing Order. In the event of any changes to the position for surveillance testing, the Ministry would work with the applicable sectors on implementation.

We have received a large volume of orders for rapid antigen tests (RATs). Publicly funded healthcare organisations are able to order both supervised and unsupervised RATs. Please note that some orders have been reviewed and adjusted to ensure that initial volumes supplied reflect anticipated application and the proposed alternative distribution mechanisms for supporting communities in Omicron Response Phases Two and Three. We’ve provided information directly to sectors around how to order RATs in preparation for these next Phases. Please note that RATs should not be used yet except for in approved circumstances (DHB point of care testing and supervised pharmacy testing for eligible people).

Unsupervised (self-test) RATs can be ordered from the Ministry directly to selected (DHBs, general practice & urgent care, pharmacies, ARCs, community health providers and first responders) publicly funded healthcare organisations for their critical workers to hold and prepare to use as part of the Test to Return scheme in Omicron Phase Two. These organisations have been selected due to their role in supporting the overall COVID-19 response. MBIE has developed a self-assessment tool to help identify critical workers in other organisations. This notes that all workers within a workforce may not be critical.

Fit Testing for Primary and Community healthcare workers We are aware that access to fit testing services remains constrained as a result of the increased demand for fit testing with more parts of the sector and industry potentially using P2/N95 particulate respirators, alongside annual fit testing requirements. Realistically, it will not be feasible for every healthcare worker who may come into contact with a positive case to be fit tested and prioritisation of fit testing resources is required.

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The Ministry suggests that those District Health Boards and Primary Health Organisations in possession of portacount machines from the Ministry consider and prioritise fit testing programmes within communities based on the following guidance: 1. Healthcare workers operating in high risk environments such Emergency Departments, Urgent Care, COVID-19 BCP wards, Respiratory Wards, Intensive Care Units and COVID-19 Care in the Community alternative accommodation facilities 2. Healthcare workers providing in-person care to COVID-19 positive people isolating at home as part of COVID-19 Care in the Community 3. Identified staff in an aged residential care facility who will mobilise as part of the ARC BCP response and identified home care, disability support workers and mental health & addiction staff who will provide direct care for COVID-19 positive patients where care cannot be deferred during the isolation period 4. Healthcare workers who will undertaking COVID-19 swabbing with symptomatic people 5. Other healthcare workers and non healthcare workers providing in-person support as part of COVID-19 Care in the Community (e.g. MSD providers, Oranga Tamariki and others).

Please also note, healthcare workers should only be fit tested to a 9320A+ particulate respirator if they do not fit test to any other model of particulate respirator, noting that this would only occur in a small number of instances. The preferred model for fit testing is the 1870+ before trying other alternatives. The 1870+ is a ‘paired fit’ with the 9320A+ and the 1870+ has a superior level of fluid resistance.

Manufacturing of the 9320A+ has significantly reduced. As such, a transition to the 1870+ is advised and supplies are limited to those who have already fit tested to an 9320A+ and those who only fit test to the 9320A+. It is important that we ensure that those who only fit test to a 9320A+ can continue to be protected in the work that they do.

Models of P2/N95 particulate respirators for people who have not been fit-tested The Ministry will supply 1870+ particulate respirators for those people who require a P2/N95 particulate respirator and who have not been fit tested. This model of N95 fits 80-90%+ of the workforce. Workers should perform a fit check (also called a seal check) before engaging with confirmed COVID-19 positive cases, or people considered high-risk based on the IPC risk assessment.

If the mask does not fit properly, they should not engage with the patient and look at other options e.g. another staff member conducting the engagement.

The Ministry receives limited supplies of alternative models (e.g. smaller sizes) of P2/N95 particulate respirators. Supplies are prioritised for those who have been fit tested to these models and those working in settings where they are likely to require P2/N95 particulate respirators based on the IPC guidance. We are in continuous conversations with suppliers around accessing appropriate smaller sized models of P2/N95 particulate respirators.

The Ministry will consider case by case circumstances for supplying alternative models of P2/N95 particulate respirators for community settings, however in most instances we expect organisations to utilise the 1870+.

General Practice and Urgent Care sector update 4

N95s supplied for providing close care for a confirmed case of COVID-19 The Ministry has previously held the position that it will supply P2/N95 particulate respirators to those general practice and urgent care facilities that have confirmed staff have been fit tested. We continue to hold the view that fit testing is a prudent step and is a requirement under the AS/NZS 1715:2009 standard for the selection and use of respiratory equipment.

However, we note the constraints with fit testing capacity and the need to utilise a well fitted P2/N95 particulate respirator when providing close care for a confirmed case of COVID-19.

The Ministry will provide 1870+ N95 particulate respirators to general practice and urgent care without confirmation that fit testing has been completed until further notice. The 1870+ model of N95 fits 80-90%+ of the workforce based on fit testing data. The decision to utilise a particulate respirator without having conducted fit testing to confirm an appropriate level of protection is at the discretion of both the employee and the employer, and in all instances the employee should be informed of all associated risks under the Health and Safety at Work Act 2015.

Ministry IPC guidance and N95 use The Ministry’s current IPC guidance for PPE recommends that all primary and community health and disability care workers complete a risk assessment before interacting with a patient, client or resident to determine their likelihood of exposure to COVID-19. Requests for P2/N95 particulate respirators that fall outside this guidance will not generally be supplied by the Ministry because at the moment it is not deemed necessary.

That said, to provide workers with greater levels of comfort and reassurance of feeling prepared, we will be allowing general practice and urgent care to order reasonable volumes of N95s as contingency supplies to be used only as cases in the community and the consequent risk of exposure to COVID-19 increases. These supplies are not for use now, but for if and when N95s are required, adhering to national IPC guidance.

We have been made aware that P2/N95 particulate respirators are being utilised outside of the Ministry’s IPC guidance. As a reminder, the Ministry does not supply PPE for it to be used outside of the Ministry IPC guidance, and autonomous decisions for receptionists and those screening and seeing patients in low and moderate risk settings to utilise P2/N95 particulate respirators must be met by alternative supply lines. The inappropriate use of P2/N95 particulate respirators compromises New Zealand’s ability to successfully respond to COVID-19 and our ability to utilise this resource in the settings where they are most needed. Note there is scope within the existing IPC guidance for those operating ‘red streams’ with consideration of moderate to high-risk patients in circumstances of widespread cases – we are not yet at this stage.

Please also remember sessional use of PPE can be applied.

9210+ particulate respirators Recently we’ve worked with some fit testers who approached us regarding a small number of staff that did not fit any of the P2/N95 models available to general practice and urgent care facilities.

We’ve identified that the 9210+ model successfully fit tests for a portion of these people and have decided to make this available to all general practice and urgent care where the Ministry (via covid.healthsupplychain@health.govt.nz) have received a fit testing declaration to confirm fit testing to this model.

The 9210+ is similar in design to the 9320A+ and 1870+. We’ve confirmed with 3M that it meets level 2 fluid resistance testing and it is acceptable for use in general practice and urgent care 5

settings. The headloops have more tension than the headloops of the 9320A+ and 1870+ and should be pulled before donning. You can find further information about the 9210+ at: https://www.3m.com/3M/en_US/p/d/v101213340/.

Overall, we expect national usage of approximately 10,000-15,000 a month for general practice/urgent care. MIQF non healthcare workers also utilise this model of particulate respirator in returnee facing zones.

Pharmacy sector update IPC guidance and N95 use The Ministry’s current IPC guidance for PPE recommends that all primary and community health and disability care workers complete a risk assessment before interacting with a patient, client or resident to determine their likelihood of exposure to COVID-19. This guidance is reviewed weekly with consideration of the latest science, evidence and New Zealand’s COVID-19 outbreaks.

The Ministry has work underway to identify and clearly articulate the circumstances and interactions where it would be recommended for pharmacy staff to utilise P2/N95 particulate respirators during times of widespread cases. The Ministry has agreed to do a ‘push order’ of a small volume of P2/N95 particulate respirators for pharmacy to hold, to await this guidance around where P2/N95s are recommended and to only use in very high-risk situations.

At this stage we have not added P2/N95 particulate respirators to the PPE Portal for the Pharmacy sector. Requests for P2/N95 particulate respirators that fall outside the Ministry’s IPC guidance will not generally be supplied by the Ministry because at the moment it is not deemed necessary.

Aged Residential Care sector update Aged Residential Care response kits New Zealand is in the incredibly fortunate position of being able to learn from some of our international partners as COVID-19 has changed the way that we all go about our days. We have also been in a fortunate position in the way that the country has worked together to stamp out COVID-19 where possible and now suppress COVID-19 in our communities as we shift into this next stage.

We’ve worked closely with DHBs and ARC facilities as COVID-19 cases have been identified and responded to. We’ve learnt that in many instances it isn’t practical for ARC to hold large stocks of PPE in anticipation of a COVID-19 outbreak. However, we are keen to ensure that ARC facilities have confidence in the PPE supplies they hold and that they have the PPE they need, when they need it.

In preparation for this, we have prepared Aged Residential Care Outbreak Kits which include P2/N95 particulate respirators. Each DHB holds at least two of these kits in their supplies, ready to deliver to a facility as needed. As we move into this next Phase of our Omicron response, we are preparing at least 100 more of these kits and will increase the number that DHBs hold. These kits will be added to the PPE Portal template for each DHB to maintain a supply of and to support their community needs.

The Aged Residential Care Outbreak Kits can also be deployed and utilised for large disability and mental health and addiction residential services if required. A case by case assessment would be made each time, with consideration of the volume of PPE and whether multiple HCSS/DSS kits might best meet PPE requirements.

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P2/N95 particulate respirators We communicated with the sector on 22 December 2021 regarding the supply of P2/N95 particulate respirators. The decision to provide a ‘push order’ of a small volume of N95s to ARC facilities recognised the significant congestion in the freight/courier network over the busy holiday period, as well as the shift to the COVID-19 Protection Framework and the suppression strategy. It is intended that the volume of P2/N95 particulate respirators distributed is sufficient supply to support an ARC facility’s essential engagement, while an ARC Outbreak Kit is deployed. The Ministry will be engaging with sector representatives over the coming days to understand whether the volumes supplied before Christmas met this intent, or whether further supplies might be necessary in some instances/locations. A few aged residential care facilities have indicated they haven’t received the contingency supply of N95s sent in December which we will also address on an individual case by case basis.

We know just how devasting outbreaks in Aged Residential Care facilities can be and the ability to respond immediately is critical. We also know that one of the best strategies to prevent the spread of COVID-19 through facilities is to be incredibly vigilant in Infection Prevention and Control practices before COVID-19 is identified. The introduction of Rapid Antigen Testing supports the identification of COVID-19 before transmission becomes vast and it is one of the many measures, that when used properly and together with other measures, can help to keep our communities safe.

At this stage we have not added P2/N95 particulate respirators to the PPE Portal for Aged Residential Care facilities. The Ministry’s Infection Prevention and Control guidance for PPE selection remains that P2/N95 particulate respirators should be used in specific circumstances when engaging with a confirmed case of COVID-19, or with a person who is both a close contact of a confirmed case and symptomatic. A medical mask should be utilised in the majority of other scenarios. The Ministry continually reviews its Infection Prevention and Control guidance and in the event of changes, these will be communicated, including information around accessing appropriate PPE.

Home and Community Support Services & Disability Support Services sector update HCSS and DSS response kits The Ministry has prepared HCSS/DSS COVID-19 response kits which include P2/N95 particulate respirators. These have been rapidly deployed in recent instances where COVID-19 cases have been identified and where ongoing care and support for the client is necessary. As we move into this next Phase of our COVID-19 response, we are preparing a further 300 HCSS/DSS kits and adding them to the PPE Portal template for each DHB to maintain a supply of and to support their community needs.

We have engaged with representatives from the home care sector and intend to provide HCSS/DSS kits to the large home care providers with a view to them collaborating with other local providers, DHB portfolio managers and COVID-19 Care in the Community hubs to support caring for those with COVID-19.

The Ministry has already supplied HCSS/DSS COVID-19 response kits to Manawanui which supports Individualised Funding disability providers with PPE for employers. We will be increasing the number of response kits Manawanui holds and will be engaging directly with Disability sector representatives to enable access to response kits, as we are doing for the home care sector.

This plan to make kits available for rapid deployment directly to those providing care is intended to allow important care to continue and support the needs of clients and communities. The Ministry will be working over the coming days to confirm the details of where kits should be initially deployed 7

and held for quick access. We will also work through the controls and mechanisms for replenishing kit volumes as they’re accessed.

P2/N95 particulate respirators At this stage we have not added P2/N95 particulate respirators to the PPE Portal for HCSS and DSS organisations. The Ministry’s Infection Prevention and Control guidance for PPE selection remains that P2/N95 particulate respirators should be used in specific circumstances when engaging with a confirmed case of COVID-19, or with a person who is both a close contact of a confirmed case and symptomatic. A medical mask should be utilised in the majority of other scenarios. The Ministry continually reviews its Infection Prevention and Control guidance and in the event of changes, these will be communicated, including information around accessing appropriate PPE. Supply of PPE & BAU purposes The Ministry’s Central Supply of PPE for COVID-19 is intended to support what is an additional requirement as a result of COVID-19. We continue to receive requests for large volumes of PPE that would exceed our understanding of PPE requirements and which are not consistent with other organisations in the sector. We want to better understand some of this PPE use by the sector and will be working with organisations and the sector in the coming weeks.

While we work through this, you may note the Ministry reviews and adjusts some orders for PPE where orders requested are particularly high.

Mental Health and Addiction services sector update In preparing to enter further phases of the Omicron response, we anticipate that some Mental Health and Addiction services will review some of the direct to patient services being provided and deliver services remotely where it is practicable to do so. For others, it will be necessary for services (e.g. residential and respite) to be able to continue in person, with Infection Prevention and Control practices in place and appropriate PPE. This week we will be engaging with the Mental Health and Addiction services sector representatives to consider options for supporting important monitored and direct care for those impacted by COVID-19 and mechanisms for supplying PPE, including P2/N95 particulate respirators, directly to large organisations and residential facilities. We hope that through discussions, we can leverage similar arrangements with other parts of the health and disability system where large providers and DHBs are able to support smaller providers within their local communities with the PPE needed to provide care.

IPC guidance and P2/N95 particulate respirators The Ministry’s IPC guidance recommends that all primary and community health and disability care workers complete a risk assessment before interacting with a patient, client or resident to determine their likelihood of exposure to COVID-19. PPE is selected for each interaction based on the risk assessment. Requests for P2/N95 particulate respirators that fall outside this guidance will not generally be supplied by the Ministry as it is not deemed a necessary requirement for fulfilling duties.

PPE supplies for Caring for COVID-19 positive cases Well-fitted P2/N95 particulate respirators are recommended when providing close care for a confirmed case of COVID-19. To enable appropriate supplies of PPE for caring for positive cases of COVID-19, the Ministry has prepared COVID-19 outbreak and response kits which include P2/N95 8

particulate respirators and isolation gowns. These kits could be utilised for Mental Health and Addiction services to provide monitored care and support for the client/resident where appropriate.

The outbreak kits may be suitable for larger residential services and response kits suitable for providing direct care to a person who is COVID-19 positive.

We have made these kits available for DHBs to order from the PPE Portal and DHBs will maintain a supply to support their community’s needs. The deployment of kits will be based on the case-bycase assessment conducted by the DHB/PHU when there is a confirmed case of COVID-19 in residence.

The COVID-19 Care in the Community supports DHBs and primary care providers at a regional level as they undertake the clinical component requirements to support COVID-19 positive patients and their immediate close contacts. The Ministry’s COVID-19 team is working with the COVID-19 Care in the Community team to ensure that those providing wrap around support services can do so safely with appropriate levels of PPE. If you have any questions about accessing supplies, please contact covid.healthsupplychain@health.govt.nz.

Community update The Ministry has made procedure/medical masks available to agencies so that they are able to support their networks, with a view to ensuring communities are protected and that workers can adhere to the mask mandate. Note that the Ministry of Health’s Central Supply is responsible for servicing the requirements of the Health and Disability system for COVID-19 and that agencies are supporting their own networks where they can.

The Ministry has provided the following: • 4.3 million masks to Ministry of Education • 5 million masks to the Ministry for Social Development distributed via the Food Network other avenues • 500,000 to Ministry for Pacific Peoples to distribute throughout church networks • We’ve offered 500,000 masks to Ethnic Communities and are awaiting a response • We have made available approximately 750,000 masks to community health providers who are servicing wide regional networks as one-off shipments • In late 2021 we made over 1 million masks available to Te Arawhiti to iwi providers. We are considering another request from Te Arawhiti for 850,000 masks Note it is not the Ministry’s role to service the general public on an ongoing basis and intend to have broader discussions with government agencies regarding their plans in the medium term.

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