National Public Health Plan for Phase 3 Peak 11 March 2022

National Public Health Plan for the Phase 3 Peak

t of Snapsho the plan

TWO KEY STRANDS

AIMS

PHU ACTION

This plan is intended to be used for the peak of the outbreak, and as the country comes out the other side.

1. Support service continuity of critical services and infrastructure to mitigate societal impacts

AIM: To support critical service functioning (including lifeline services and infrastructure) and minimise the direct and indirect impacts of the Omicron outbreak.

AIM: Support outbreak management in settings where public health advice will make a difference to slowing the spread of disease and prevent severe illness in priority populations, and therefore achieve equitable outcomes.

Support critical services:

• Guide local response activities • Conduct local outbreak surveillance • Establish partnerships with local providers and communities to prepare, protect and support the most vulnerable populations • Identify key contacts and sharing contact details of PHU single points of contact (SPOC) for the settings above (if these have been identified) • Provide support for outbreak management • Maintain connections with DHB COVID operations centres and local coordination hubs to provide public health advice on relevant issues as they arise, and to continue to understand how the outbreak is progressing in their area.

• in the appropriate use of contact management guidelines eg, close contacts can stay at work and monitor for symptoms • to maintain services wherever possible, and prevent them from taking an overly cautious approach • to make appropriate use of exemptions schemes to enable workers to safely return to work during isolation periods.

PRINCIPLES OF OUR MAHI

2. Slow spread of the disease where practical, and support priority communities to manage and reduce its impacts

Te Tiriti o Waitangi

Equity

A national approach, with localised implementation

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National Public Health Plan for the Phase 3 Peak

Purpose of this plan

This plan is intended to be used for the peak of the outbreak, and as the country comes out the other side. This is a currently unknown time period, though cases are expected to peak in the latter part of March, and the length of the peak will be different for different regions of Aotearoa. The approach outlined in this plan will be reviewed regularly, and work on a post-Phase 3 strategy that is underway will include more emphasis on returning to BAU activities and see the sector through to 1 July 2022.

Over the past two years of the COVID-19 pandemic, New Zealand has implemented a range of public health strategies which have played a direct role in keeping morbidity and mortality from the disease low compared to other parts of the world. The elimination and suppression strategies not only contributed to a decrease in overall mortality and an increase in life expectancy; it also provided an important opportunity for New Zealand to prepare for the current Omicron wave of disease.

Introduction

Now that Omicron is widespread in the community, Phase 3 of the national Omicron response signals a significant shift from stamping out the disease towards managing the impacts of disease within communities and business sectors, and protect those most at risk. This is both a practical and philosophical reset back to public health approaches which focus on equity and population health, rather than on individual health, and on enabling and empowering communities to develop their own responses to health and wellbeing challenges.

The spread of Omicron throughout New Zealand presents an opportunity for Public Health Units (PHUs) to build on the success of the last two years, and strategically engage and strengthen relationships with communities and critical services and to help them build their resilience to not only manage the risks associated with COVID-19, but also for future public health emergencies.

Following on from discussions with PHUs and based on the directions for public health from the ‘Public Health Operational changes to respond to Omicron’ the focus for PHUs for Phase 3 has two key strands

Focus for PHUs during the Phase 3 peak

1. Slow spread of the disease where practical, and support priority communities to manage and reduce its impacts 2. Slow spread, where practical, and support priority communities to manage the disease and reduce its impacts

Within these strands, eliminating inequitable outcomes should be an over-arching priority.

The Phase 3 shift means that PHUs can focus on supporting communities and settings, rather than individual COVID-19 cases and exposure events, and reassurance and preventing panic are key parts of how PHUs can provide support.

Provision of COVID-19 support should be targeted based on: • Service continuity for critical services/industries • Priority populations, and ability to reduce inequitable impacts • High-risk settings.

These will need to be balanced against available capacity constraints.

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National Public Health Plan for the Phase 3 Peak

Te Tiriti o Waitangi Embedding the principles of Te Tiriti o Waitangi into our work is a key part of being responsive to, and providing an appropriate response for, Māori.

Meeting our obligations under Te Tiriti is necessary if we are to realise the overall aims of He Korowai Oranga: Māori Health Strategy and achieve outcomes for the health and disability system as a whole. This includes a desire to see all New Zealanders living longer, healthier and more independent lives. These Tiriti obligations underpin Whakamaua: Māori Health Action Plan 2020–2025 which sets the government’s direction for Māori health advancement over the next five years.

The principles of Te Tiriti o Waitangi provide the framework for how we will meet our obligations under Te Tiriti in our day-to-day work. These are: • • • • •

Tino rangatiratanga Equity Active protection Options Partnership

For more on the principles, and the Ministry’s position on Te Tiriti o Waitangi, and Whakamaua, see the Ministry’s website.

Principles of our mahi

Equity An equitable approach to public health and outbreak management includes more than a focus on vulnerable populations. It is also about empathy and understanding the barriers vulnerable groups face, enabling public health participation and promoting health and wellbeing through the determinants of health. Community engagement should also strengthen relationships and build health literacy for the long term.

As part of obligations under Te Tiriti o Waitangi, equity for Māori must be prioritised, and eliminating inequitable health outcomes should also be prioritised for other communities, including Pacific peoples, people with disabilities, rural and isolated populations, and communities who experience barriers to engaging with the health and disability system, among others.

A national approach, with localised implementation This plan sets the national public health direction for Phase 3 and helps PHUs work towards a nationally consistent approach to the outbreak at this point. However, as different parts of the motu will be at different stages of the outbreak at different times, and capacity also varies, it is expected that PHUs will localise their response within this national guidance.

National policies, processes and resources that have been developed to support the outbreak to date remain key reference documents for PHUs.

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National Public Health Plan for the Phase 3 Peak AIM

Support critical service functioning (including lifeline services and infrastructure) and minimise the direct and indirect impacts of the Omicron outbreak.

PHUs should support critical services: • in the appropriate use of contact management guidelines eg, close contacts can stay at work and monitor for symptoms • to maintain services wherever possible, and prevent them from taking an overly cautious approach • to make appropriate use of exemptions schemes to enable workers to safely return to work during isolation periods.

KEY ACTIONS FOR PHUS

• • • •

Strand 1 Support service continuity of critical services and infrastructure to mitigate societal impacts

There are several avenues for PHUs to find out when critical services are affected: Information available in the NCTS and surveillance reports Pre-existing local networks for sharing information Connecting with the Care in the Community hubs for situational awareness Connecting with other local government agencies (eg, MBIE, MPI or local government) so they are advised when outbreaks in critical services occur.

Different to previous phases of the COVID-19 response, the Phase 3 response prioritises continuity of critical services through ensuring, where possible, that people can continue to work to maintain services.

This is particularly important as case numbers rise, to avoid the indirect impacts of the Omicron outbreak on critical service continuity potentially being worse than the direct impacts of the disease. Continuing to invest efforts in flattening the curve will also help to maintain health and disability system and critical workforce capacity thereby preventing additional adverse impacts of health service reduction or loss of critical services.

WHY ARE WE FOCUSSING ON CRITICAL SERVICES

Widespread Omicron transmission has the potential to cause significant societal disruption, and this can cause poor health and wellbeing outcomes, both through widespread illness and due to isolation requirements. Such impacts include: • • • • •

Reduced healthcare capacity due to staff isolating – reduced access to care and delays to planned and acute care Supply chain disruptions – reduced access to food and other essentials Emergency services (fire, ambulance, police, civil defence) not able to respond due to staff shortages Missed time in education for children Economic loss leading to job losses with flow on health impacts from reduced incomes

All of the above impacts are highly inequitable. Their effects will be greater for people on lower incomes and those already structurally disadvantaged. Public health should work to prevent or minimise these, by giving expert and practical advice that balances the potential harms from Omicron to these services and their staff, with the potential population harms of these services reducing their capacity.

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National Public Health Plan for the Phase 3 Peak AIM

Support outbreak management in settings where public health advice will make a difference to slowing the spread of disease and prevent severe illness in priority populations, and therefore achieve equitable outcomes.

• Guide local response activities • Conduct local outbreak surveillance • Establish partnerships with local providers and communities to prepare, protect and support the most vulnerable populations

Strand 2 Slow spread of the disease where practical, and support priority communities to manage and reduce its impacts

• Identify key contacts and sharing contact details of PHU single points of contact (SPOC) for the settings below (if these have been identified) • Provide support for outbreak management: KEY ACTIONS FOR PHUs

• Provide advice and support on effective social distancing, isolation requirements, mask usage and other PPE • Minimise activities that are likely to cause others to become infected, eg, aerosol generating activities • Link communities to primary care, including connecting Māori and Pacific communities with Māori and Pacific health providers to provide culturally appropriate primary healthcare services • Continue to engage in local partnerships, and stakeholder engagement and management • Support communities to know how to detect cases early and how to escalate concerning symptoms early, and appropriately • Provide reassurance to communities on risks and how to safely manage the disease.

• Maintaining connections with DHB COVID operations centres and local coordination hubs to provide public health advice on relevant issues as they arise, and for PHUs to continue to understand how the outbreak is progressing in their area.*

PHUs and the National Case Investigation Service (NCIS) are prioritising exposure events in these settings: PRIORITISATION OF SETTINGS

• Residential housing (including transitional, emergency, social and community housing, boarding houses, youth justice, soup kitchens, homeless shelters, hospices, residential disability services, mental health services) • Faith based places of worship • Aged residential care • Marae and Tangihanga *Remaining involved with local response groups will also assist PHUs to be more integrated into the health and disability system as a whole.

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National Public Health Plan for the Phase 3 Peak Community engagement with a focus on equity The practical and philosophical reset back to public health approaches which focus on equity and population health, mentioned in the introduction, is about PHUs working enabling and empowering communities to develop their own responses to health and wellbeing challenges.

PHUs should engage, re-engage or strengthen engagement with their communities, particularly with Māori and Pacific peoples and providers, people with disabilities, rural and isolated populations and other communities who experience barriers to engaging with the health and disability system. To eliminate long-term inequities and indirect impacts of widespread outbreaks, there is benefit now in diverting resources to proactively supporting community engagement.

Strand 2 (cont.)

Slow spread where practical and support priority communities to manage the disease and reduce its impacts

WHY ARE WE FOCUSSING ON SUPPORTING COMMUNITIES

Where PHUs are working with specific vulnerable populations (eg, unvaccinated, immunocompromised, people living with disabilities, people in residential/transitional housing situations), they should aim to provide support to control outbreaks and to identify and enable communities to seek appropriate health and welfare support. This involves familiar outbreak management tools: • Building relationships, establishing trust and encouraging vaccination and other preparedness measures before outbreaks occur • Case finding with RATs and rapid isolation of cases • Isolation of Household Contacts • Infection prevention and control measures including masks and other PPE • Shielding the most vulnerable people • Identifying pathways to engage primary care services or locality welfare hubs who can monitor unwell people and get them appropriate care • Being mindful of language used to describe clusters to avoid stigmatisation of particular population groups and communities.

Specific communities will require targeted assistance and approaches. Some examples include: • Where people do not have adequate housing for isolation, assistance with connecting to services that can provide isolation facilities will be needed • Communities that experience access barriers to digital technology or are not as digitally capable and able to engage with digital technology will require more support • Communications and messaging for different population groups should be culturally appropriate and worded for people to understand, and for example, should be translated into the different Pacific languages.

PHUs should establish and utilise local providers to identify and address equity issues and solutions in the first instance. If escalation is required, PHUs should get in touch with the Public Health Operations Groups of the Ministry of Health.

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National Public Health Plan for the Phase 3 Peak

STAFFING AND RESOURCING

• The Ministry’s expectation is that PHUs maintain 7 day per week staffing and resourcing for now. This will be reviewed regularly and PHUs will be updated as the expectation changes.

• Weekends however can be at reduced capacity • PHUs should maintain an appropriate level of cover on weekends to respond to escalations and be able to activate a response as outlined in this plan. For different services across the country, this may look quite different.

As the drive to investigate individual cases and contact trace has reduced, PHUs can reorient services both within the COVID-19 response, as above, and start transitioning to some BAU activities. The Ministry understands that this may be possible for some PHUs, while there will be others where capacity only allows for focus on the COVID-19 response.

Additional considerations for Public Health Units

RETURNING TO BAU ACTIVITIES

Returning to BAU activities should focus on equity, community wellbeing and engagement, and reigniting non-COVID-19 priorities. This work must build on the community relationships which have been built and strengthened during the COVID-19 response. Activities could include: • Sharing information, exploring collaboration opportunities, and reconnecting with partner agencies and communities to establish post-Omicron priorities • Engaging with programme teams to reorient and reset priorities • Understanding and responding to new issues – information, protection, promotion, Health in all Policies • Reviewing, agreeing, and implementing programme plan priorities for 2022 • Continuing to have an important role in reducing the inequitable impacts for priority populations, including Māori and Pacific peoples, recognising that inequities have been exacerbated in some areas by COVID-19 • Providing more strategic public health advisory capacities at both a local and a national level.

The Ministry’s Public Health Capability Team will actively work with PHUs around prioritisation to support the transition to BAU and will commence this with the March PHU Service Managers meeting.

NEXT STEPS

The Ministry understands that PHUs require some clear and explicit focus once the Omicron peak starts to wane. The Public Health Operations Group, along with others in the Ministry, are working on next steps:

Short-term (within the next month) • Development of strategy for post-peak approach • Work on preparation for the risks associated with the border opening on other communicable diseases • PHU funding and priorities for 2022/2023

Medium-term (within the next 3 months) • Review and capture learnings from the PHU response over the course of the pandemic to recommend future system improvements.

• keep developing virtual networks and public health IT solutions • adapt tools developed for the COVID response to be repurposed for other public health threat, such as measles, eg, the Communicable Disease Case and Contact Management System • Prepare for the transition to and alignment with a National Public Health Service

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National Public Health Plan for the Phase 3 Peak

The table below describes the rationale for high priority exposures that PHUs and the NCIS are working to.

These priority settings were consulted on with public health units and have been previously signed off.

Residential housing • including transitional, emergency, social and community housing, boarding houses, youth justice, soup kitchens, homeless shelters, hospices, residential disability services, mental health services

These residential settings are considered the highest priority as they largely consist of vulnerable people in vulnerable settings where the disease is likely to spread rapidly.

Note that the types of residential housing is not an exclusive list of what can be escalated to PHUs.

Appendix One Faith based places of worship

Some of these settings are considered high-risk due to the interplay between the types of activities occurring (singing, close proximity), and the vulnerability of the populations attending. A risk assessment will be required to understand these factors and respond appropriately.

Aged residential care

ARCs are considered high-risk settings due to the population involved. However, most ARCs have good policies and procedures so may not require additional support.

Marae and Tangihanga

These setting are considered high-risk due to interplay between the types of activities occurring (singing close proximity and potential noho), and the vulnerability of the populations attending.

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