Ministry of Health ‘reviewing procedures’ for compassionate and exceptional quarantine rules

There was confusion between the Prime Minister and Ministry of Health yesterday after a court judgment was released that found the Ministry of Health should not have refused leave for a man to leave Covid quarantine to see his dying father – see Court rules man under Covid quarantine can visit dying father.

Both the PM and MoH gave assurances procedures would be reviewed after confusion between them over numbers of people granted compassionate of exceptional exemptions – 18 had applied but it turned out the be none had been granted.

RNZ: No exemptions from border rules given on compassionate grounds

None of the travellers returning to New Zealand to see a family member who is close to dying have been allowed out of managed isolation.

Figures provided to RNZ suggest 24 people have applied for an exemption to visit someone dying or close to dying and all have been turned down.

In some cases the traveller was still in isolation when their relative died.

About 50 other people who applied for an exemption from the mandatory 14-day isolation on other compassionate grounds were also rejected.

The Ministry of Health said the border rules could be “very distressing” but it was taking a precautionary approach.

It looks like it has been more than ‘precautionary’.

However, during a media briefing after her Cabinet meeting this afternoon, Prime Minister Jacinda Ardern told media 18 of 24 requests where a relative was dying had been accepted.

“Information that I’ve received from the Ministry of Health, though, sets out that there were 283 requests for an exemption to the conditions of isolation having been received by 30 April, and that 24 exemptions was sought in cases where relative was dying or close to dying, of which 18 were granted.

“That does suggest that there has been due consideration. That is advice I’ve received from the Ministry of Health, but I’m sure that they will be reflecting on this judgment.”

Questioned about the discrepancy, the Ministry said the Prime Minister’s figures were incorrect, and no exemptions had been granted for compassionate reasons.

“The layout of Ministry of Health figures supplied to the Prime Minister’s Office may have contributed to confusion over compassionate exemptions. The Ministry sincerely apologises for this.

“As of 30 April, the number of requests from a returned traveller, or travellers, for an exemption to the conditions of their isolation totalled 283. The number of those requests for exemptions granted was 18.

“To the same date, the number of ‘compassionate’ or similar requests for exemptions totalled 73. The number of these where this was to visit a relative dying or close to dying totalled 24. None of those 24 exemptions were granted.”

NZ Herald: Judge overrules lockdown, allows son to visit dying father

Speaking at her post-Cabinet press conference this afternoon, Prime Minister Jacinda Ardern said authorities needed to make sure “we learn” from the Christiansen and other rulings.

It appeared the response to his application was an automotive response, so it was her expectation the Ministry of Health would take the ruling into consideration.

‘Automotive response may be a typo, it doesn’t make sense. Does it mean automatic? That’s what was suggested in the judgment. That would be an awful way to deal with compassionate or exceptional circumstances. Or unemotive?

Stuff:  Jacinda Ardern asks for review of all cases where family members were denied permission to visit relatives

“The Prime Minister has spoken to the Minister of Health this evening and asked that each of these cases now be reviewed in light of the Court’s ruling.”

That will be too late in cases where people have already died.

The Ministry of Health would not comment on whether it had apologised to the Christiansen family.

Instead, the spokeswoman said each request for leave from isolation on compassionate grounds or exceptional reasons is considered on its individual merits.

“The fact that the Court decided to intervene in this case does not mean that it would take the same approach in respect of other decisions by the Ministry not to allow leave from isolation.”

She said the Ministry is reviewing its processes for considering requests for leave on compassionate grounds and exceptional reasons to prevent this issue arising again.

Dr Ashley Bloomfield is speaking about this on RNZ now and is explaining and defending the way the Ministry of Health has dealt with requests.

Ashley Bloomfield, the Director-General of Health, tells Morning Report that every case is considered individually, not automatically.

Dr Bloomfield says he spoke with the team who run the process and told them to carefully consider the man’s application.

Dr Bloomfield does not know how many people had now died in the 24 cases but assured a quick review of the cases.

The RNZ interview: https://www.rnz.co.nz/national/programmes/morningreport/audio/2018745167/coronavirus-ashley-bloomfield-on-isolation-exemptions


Update – RNZ report: Ashley Bloomfield defends staff after judge overturns quarantine decision

There were 283 requests for exemptions to 30 April, and of those 24 were on compassionate or similar grounds. None of those on compassionate grounds were granted, Bloomfield said.

But the High Court ruling didn’t mean the team had failed to apply the criteria, he said.

“What the staff do is they apply the criteria and look at all the information they have objectively and fairly … and with great empathy. They don’t just say this is a no, they have to – and they do – look through the information very carefully.

“What the judge was saying is that they didn’t feel from the information that was presented that it was obvious that that process had been followed.”

The decisions on mandatory isolation also had to be fair, and in line with the process for people applying to travel within the country.

“That has very strict criteria and many New Zealanders will know of people who during the lockdown in alert level 4 were unable to either attend funerals or visit dying relatives because we were on a really clear pathway to try and stop the transmission of Covid-19 in our communities to protect everybody.”

No new cases, no more people in hospital, no more deaths

This is just one day, but for the first time since the Covid-19 outbreak there have been no new cases (one probable case has switched to confirmed), no more deaths, and 3 less people in hospital (now 4 with none in ICU).

So another promising step but still a long way to go.

There is also a very low level of influenza in the country, not surprising given the lockdown situation. This will save hospital resources and probably lives, although the traditional ‘flu season’ is coming up with winter approaching.

Director-General of Health Dr Ashley Bloomfield:

“Clearly these are encouraging figures today, but it is just one moment in time. The real test is later this week when we factor in the incubation period for the virus and the time it takes for people to display symptoms which is generally five to six days after exposure.”

“That’s when we will have an indication if there are any new cases coming through that might be emerging in the community as a result of our shift from level four to level three.”

“We cannot afford to squander all the hard work and effort of the past weeks. We did see at the weekend that it can be easy to start slackening off and we need to maintain discipline and keep pushing on and sustain the advantage that we have fought so hard for.”

That’s going to be a battle with the health authorities and Government versus a growing complacency.


In her post-Cabinet press conference Jacinda Ardern said that Cabinet discussed what level 2 would be like. She said she would advise the public on Thursday.

“It will provide clarity and certainty and give people time to prepare. No decision has been made on moving out level 3 at this stage.”

She has said a decision will be made when Cabinet meets next Monday.

By delaying sharing this information and delaying the decision she may be hoping people will wait until they relax their isolation, but given behaviour over the weekend just past this week and particularly this weekend many people may end up choosing their own level, and may not be keen on being restricted more than that even on level 2.

RNZ:  Prime Minister Jacinda Ardern to join Australia Cabinet meeting to discuss trans-Tasman bubble

Prime Minister Jacinda Ardern will join Australia’s Cabinet meeting tomorrow via video link to discuss the possibility of a trans-Tasman bubble. Ardern briefed media at 4pm after her own government’s Cabinet meeting. Watch here: “The meeting will discuss a range of matters in relation to the covid response on both sides of the Tasman including the creation of a trans-Tasman travel bubble.”

Daily Covid update – 18 new cases, 49 more recovered

Director-General of Health Dr Ashley Bloomfield  back again today after a couple of days off media duties (he’s likely to have other stuff to do).

18 new cases (14 confirmed and 4 probable) for a total 1331

A total 471 recovered, up 49 so more recovered than new cases.

14 in hospital, 5 in ICU, one critical.

No more deaths so that total is still 4. Dr Bloomfield warns there could be more covid-19 deaths in the coming days.

The Wellington man who died on Friday was connected to the Bluff wedding cluster.

Testing yesterday was down due to Easter at 2421 for a total of 61,167

Rosewood residents were last week transferred to Burwood Hospital but aren’t count as hospital patients because they are getting the same level of care as they would have at the rest home with their GP.

As at 9am, 12 April 2020
Total to date New in last 24 hours
Number of confirmed cases in New Zealand 1,049 14
Number of probable cases 281 4
Number of confirmed and probable cases 1,330 18
Number of cases in hospital 14 -1
Number of recovered cases 471 49
Number of deaths 4 0

Note: The number of confirmed and probable cases reported in the last 24 hours includes cases which were entered on an earlier date as ‘under investigation’ or ‘suspected’ whose status has now been changed to confirmed or probable.


 

 

Daily Covid update Thursday – 29 new cases, 35 recovered

Dr Ashley Bloomfield:

29 new cases (23 confirmed and 6 probable) down again – total 1239.

14 in hospital with 4 in ICU.

317 recovered (+35) which again is more than new cases – a very promising sign.

3,990 tests processed yesterday.

Bloomfield says he expects case numbers to stay low, with a few bumps up and down.

Prime Minister Jacinda Ardern:

New modelling to be released this afternoon – current controls have enabled us to meet the most optimisitc modelling scenarios,

She acknowledges they risks to many businesses and makes assuring comments “doing what we can to cushion the blow but this is going to be a marathon”.

She repeats that the best thing we can do for the economy is to keep the virus out.

From midnight tonight every New Zealander returning to the country will go into quarantine (or managed isolation) in a Government approved facility for a minimum of 12 days. A network of 18 hotels will be used for this.

Ardern defends not doing this earlier saying nearly 40,000 New Zealanders  have returned home since we closed the border to foreign nationals and it couldn’t have been done – that’s more than our total hotel capacity.

Contact tracing is now critical and a top priority.

Signposts so we can have a plan.

They will give detailed level 3 rules “for when it comes time to eventually change” to level 3. This will be published on 20 April, 2 days before the 4 week lockdown period is over (so it is based on as much data as possible) to give businesses a couple of days  to plan.

We need to give similar more detailed guidance on what life at Level 3 looks like, and we will do that next week. That will give us a window to iron out questions and issues, and make sure we’re as prepared as we can be when it comes time to move.

It is then my intention that on the 20th of April, two days before the lockdown is due to finish, Cabinet will make a decision on our next steps. That’s because we need to use the most up to date data that we have to make that decision.

That means, if we are ready to move to Alert Level 3, business we will have two days to implement arrangements.

Preparing for coming down to level 3 (with revised rules) but not a guarantee it will happen after 4 weeks.

Message to businesses – prepare for all possibilities.

Asked if there is an endpoint Ardern says now, no end date at this stage, “this will be a marathon”.

As at 9am, 9 April 2020
Total to date New in last 24 hours
Number of confirmed cases in New Zealand 992 23
Number of probable cases 247 6
Number of confirmed and probable cases 1,239 29
Number of cases in hospital 14 2
Number of recovered cases 317 35
Number of deaths 1

Waikato DHB says two nurses have tested positive for COVID-19. They worked in the same ward at Waikato Hospital and  have been stood down immediately on developing symptoms.

 

Lockdown could be maintained ‘for a long while’

New Zealand has just started the second week of a four week lockdown, (which means isolation at home with exceptions for essential activities). But this always looked like an initial period, and there are more signs that it could extend for some time longer in some parts of the country at least as it has emerged that the plan here is to try to ‘stamp out’ the Covid-19 virus.

That could see lockdown maintained “for a long while”.

Stuff: Government says it has no plan B if lockdown fails to stamp out Covid-19

Health Director General Ashley Bloomfield told reporters on Thursday that the Government would keep the country or parts of it in lockdown for as long as possible to “stamp out” Covid-19.

“One of our key drivers on this has been to protect our healthcare system, protect our population – keep them well – and to not see the number of deaths modelling suggested would happen. We didn’t see that as tenable.”

Some  non-health people see the initial impact on the economy as untenable (with some justification), let alone the impact on businesses and jobs if there’s an extended lockdown.

Asked again if there was any backup plan, Bloomfield said the Government was “in the plan” and that could see lockdown maintained for a long while.

“Well we are in the plan. The plan is the plan, isn’t it. That’s why we’ve got alert level 4. If we need to we will keep the measures in place until we see that dropoff in cases. We will then maintain that long-term stamp-it-out phase.”

He referred back to the pandemic influenza plan which has acted as a blueprint for government action, but said the Government had essentially decided to stay away from the phase of that plan where the disease was “managed”.

“We decided we didn’t want to move to manage it. We wanted to stay in an extended keep it out, stamp it out phase. And the stamp it out we are trying to do at the moment is stamp it out altogether.”

But can we afford (economically and socially) to wait an extended time to see if our approach works?

University of Otago epidemiologist Nick Wilson, who has worked on the models for the Government, said on Tuesday that the Government needed clarity around a Plan A and a Plan B if it failed.

This might involve all older people staying in lockdown but other age groups restarting something closer to normal life.

Bloomfield said the Government was currently working out what exactly the conditions would need to be for either the whole country or parts of it to exit the level 4 lockdown.

He expected this work would be completed in the next few days.

So they don’t know yet. They have had to make big decisions based on limited information in a very short space of time, but we should be given a reasonable idea of what to expect over the next few months and for the rest of the year.

ODT: South may face Level 4 lockdown for longer

The Southern District Health Board amassed 10 new cases yesterday, and director-general of health Ashley Bloomfield advised the amount of cases due to community transmission was higher than previously stated.

They don’t even knoiw the amount of community transmission due to fairly narrow criteria for testing up until now.

Further, he said the Government was just now looking at how the spread of the coronavirus might indicate when lockdown restrictions could be eased.

“The goal is to get the number of cases right down again, and as soon as we can.

“We want to be able to release, or step down from, Alert Level 4 to Alert Level 3.

“It may well be that we are not able to do that in every part of the country at the same time, as one possible scenario,” Dr Bloomfield said.

The Southern district (Otago and Southland) has the highest number of cases in total and by far the highest number per population so we could be well down the de-lockdown list. Personally this doesn’t worry me, I can keep working from home if the rest of the country cranks up and there’s work to do. But the situation is a lot trickier for many people.

Australia has not taken as drastic action as here, but Prime Minister Scott Morrison has warned of ‘the long haul’: Scott Morrison scraps childcare fees while warning Australia to brace for six months of upheaval

Morrison declined to be specific when asked on Thursday when Australia’s international border might reopen or other strict restrictions on public gatherings might be lifted. But he took the opportunity to urge Australia to “stay together” and brace for the long haul, ahead of another meeting of the national cabinet on Friday.

“There is a new normal here in Australia and it’s one that we now need to get used to and settle into for that haul over the next six months,” Morrison said. “That is something that will go against the grain for so many, but we adapt. We can change the way we live, but it doesn’t change who we are.”

Morrison said he is the only leader in the world talking about a much longer timeframe.

I’ve just heard Morrison on RNZ in response to questions about opening borders to the US, UK and Europe: “It is likely to be at least six months, It could be longer.”

It’s time for Jacinda Ardern to be giving us in New Zealand a clear indication of her expectations of timeframes in lockdown and reduced to Level 3. If it’s doing to be ‘a long while’ we should know about it.

 

Daily Covid-19 update – fewer new cases but Sunday

From today’s briefing from Dr Ashley Bloomfield:

  • 48 new confirmed cases of covid-19 and 10 probable cases (so +58, down from +75 yesterday)
  • 74 people in total have recovered
  • 14 people currently in hospital, two in intensive care who are stable
  • 647 total of cases in New Zealand (up from 589)

That’s a smaller increase than over the last few days but Dr Bloomfield says he does not expect a drop overall – lower numbers may reflect a lower number of tests done on Sunday – fewer couriers on Sunday – holding up test results.

He still says he expects increases over the next 7 to 10 days (it’s been 7-10 for a few days now) and then hopes for a decline.

Summary

As at 9.00 am, 31 March 2020
Total to date New in last 24 hours
Number of confirmed cases in New Zealand 600 48
Number of probable cases 47 10
Number of confirmed and probable cases 647 58
Number of cases in hospital 14
Number of recovered cases 74 11
Number of deaths 1

More from RNZ Live:

A comment on modelling – a number of modelling reports have been published. These were updated during the last month to take into account newly emerging evidence. They paint a sobering picture of what the impact of Covid-19 in Aotearoa would be if we were not taking a strict approach, Bloomfield says.

We need to take this virus seriously, he says, and part of taking it seriously is getting the best possible outcome from the level four measures put in place.

Ventilators – we have 533 in NZ. There are also quite a number in the private sector that can be used and more have been ordered from overseas.

Training for medical staff to use ventilators is also underway.

Bloomfield says he cannot be 100% confident Covid-19 isn’t already transmitting through hospitals – but the death of the Greymouth woman triggered changes in the way respiratory illnesses are treated.

Sarah Stuart-Black:

A Covid-19 Local Government response unit has been formed. These measures will help people access medication and food and will help the elderly and disabled.

Wet wipes are a major problem for council’s sewers. Use has increased markedly. Disposing them down the toilet leads to blockage. Always put wet wipes in the rubbish, not the toilet she says.

54 people in temporary accommodation are being flown to Wellington and Christchurch to return home.

People have been congregating in groups at parks and beaches – please don’t gather where others are, don’t take your children to playgrounds or schools.

The Kiwi tradition of passing something over the fence to your neighbour is not encouraged.


The State of National Emergency to help stop the spread of COVID-19 has been extended for a further seven days, Minister of Civil Defence Peeni Henare said.

The initial declaration on March 25 lasted seven days and can be extended as many times as necessary.

“Since we went into isolation as a nation most New Zealanders have done the right thing and stayed at home to break the chain of transmission, which saves lives,” Peeni Henare said.

“Extending the State of National Emergency ensures we have all the resources, support and powers we need to prevent the spread of COVID-19 in our communities.

“This includes ensuring our civil defence emergency management workers can carry out critical work during this time including managing roads, traffic and public places, issuing first aid, and providing food, shelter and accommodation.

“But this global pandemic has also called on every New Zealander to make sacrifices in their daily lives and we thank them for that,” Peeni Henare said.

Each week, the Director of Civil Defence Emergency Management will provide the Minister with advice on whether the State of National Emergency should be extended again. This will include consideration of the current COVID-19 Alert Level, as Alert Levels decisions and State of Emergency decisions are complementary to each other, but one does not dictate the other.


COVID-19 hospitalisation and death rates estimated

A new study in The Lancet Infectious Diseases journal reveals the latest hospitalisation and death rates from COVID-19 in mainland China.

Nearly one in five people over the age of 80 who are infected with COVID-19 are likely to require hospitalisation, compared with around 1 percent of people under 30, according to an analysis of 3,665 cases.

The death rate from confirmed COVID-19 cases is estimated at 1.38 percent, while the overall death rate, which includes unconfirmed cases, is estimated at 0.66 percent.


A bob each way for Easter – Jacinda Ardern (RNZ Live):

Easter Trading – it has been agreed that supermarkets will be closed on Good Friday as usual , but can open on Easter Sunday.

Decision was made to avoid people rushing to the supermarket before it closes for two days.

Sounds sensible. Two days off so close together could have been a problem, one day should be manageable.

Case summary – 647 currently. 1391 tests found the 58 new cases overnight. There have been 21,384 tests have been conducted in total.

It’s too soon to draw conclusions on New Zealander’s position, but we do not have enough testing to tell us what we need to know. The more we test, the more it tells us how far our community transmission is and it tells us where it is.

It has been recommended that testing requirements be broadened. People who don’t have a history of travel or exposure to another case can be tested.

It may take a few days for these changes to take effect, but Ardern expects testing to grow – and it needs to grow.

More tests may mean more confirmed cases for a while.

The thing to watch will be whether hospitalisations increase, and also critical cases.

Some differences between wage subsidy schemes in Australia and NZ. Australia’s scheme is paying out in May, while immediacy was important to us.

There have been no decisions as to whether the scheme will be extended further than 12 weeks.

Covid-19 daily update (MOH and police) – 78 new cases, total 283

Today’s update as usual from MoH’s Director General Dr Ashley Bloomfield:

78 new cases (73 confirmed, 5 probable) – quite a jump to a total of 283.

Summary

As at 9.30 am, 26 March 2020
Total to date New in last 24 hours
Number of confirmed cases in New Zealand 262 73
Number of probable cases 21 5
Number of confirmed and probable cases 283 78
Number of cases in hospital 7 2
Number of recovered cases 27 5

Map of cases - tabular data to follow.

Details: https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-current-cases

Tests yesterday 2,417 and total tests 12,683 – average per day over the last week 1,400 which may partially explain the jump in number of cases.

Most cases are still linked to overseas travel, but there are also ‘clusters’ – a Wellington group were at a wedding. They are still dealing with cases related to the Ruby Princess cruise ship when it was in Napier.

From Pharmac – there has been some stockpiling so from tonight all funded prescriptions will be limited to one month’s supply (3 months for contraceptives). There is no shortage, they just need to control supply chains.

How many cases? “It may get into the thousands”.

And also Police Commissioner Mike Bush.

He first refers to the guilty plea of the Christchurch mosque murderer.

Day 1 about how the police go about responding to level 4. The majority of new Zealanders are complying.

Initially police will use their discretion and educate people when finding people way from their homes. Some will be essential workers, some will have legitimate health or food shopping reasons for travel. Some stopped by the police say they knew nothing about the lockdown.

He said that those returning to NZ from overseas today without a plan for isolation have been met by numerous officials (customs, police etc) and then triaged to locations for self isolation.

360 arrived at Auckland Airport this morning, 8 were deemed to have symptoms and a risk. 160 had no plans and also needed ‘facilitated’ with being put somewhere safe.


RNZ Live:

Marist College in Auckland says there are now 11 cases of Covid-19 at the school and more are expected tomorrow.

In a statement, the board chair Stephen Dallow, says seven teachers and four students have tested positive.

He says the principal, Raechelle Taulu, is among those who tested positive today.

The entire school of about 750 students, as well as staff, is classed as close contacts and Mr Dallow asked them to ensure strict isolation rules.

That shows how quickly and widely it can spread.