Covid-19

Carers forced to wash and reuse masks

At the end of March, Ashley Bloomfield promised home care workers masks, gloves and gowns to keep them and their clients safe from Covid-19. Almost two weeks later, why are so many still going to work unprotected?

When Katie* gets home from her shift as a home care worker, she takes the handful of flimsy, disposable, surgical masks she’s been wearing that day and hangs them on the washing line. 

When she goes to work the next day, she reuses them.

She knows it’s crazy; she’s pretty sure it’s useless. It might even be harmful - who knows? 

But that’s what Katie has been told by her bosses to do. And for her it’s the better of two unpalatable choices: reuse her disposable masks, or not wear a mask at all when she’s caring for her elderly and vulnerable clients. 

One of her colleagues puts her small supply of disposable masks in a hot wash before hanging them on the line and then ironing them.

Why are carers like Katie facing this decision? Because many district health boards - the guardians of personal protective equipment (PPE) for front line workers - are still refusing to give community support workers the masks, gloves, gowns and other gear they were promised by the Government more than 10 days ago.

The DHBs justify that decision by saying that under Ministry of Health guidelines, community support workers aren’t eligible for face masks and other personal protective equipment (PPE), unless the person they are caring for actually has, or probably has, Covid-19.

Under the guidelines, they aren’t eligible for face masks or PPE even if someone is self-isolating because of possible contact with Covid-19.

Source: Ministry of Health

Katie is one of thousands of community support workers, the vast majority of them women, who every day go into the homes of elderly, sick and disabled people to give them personal care. Up-close-and-personal care like washing, toileting, feeding or giving medication, where you can be a few centimetres away from your client's face, not a few metres.

When Katie asked for masks, she was given... three. Not three per client, not three per day. Just three. When she asked again a week later she was given three more. 

Her best mask haul, last week, was 15 masks, and she was told she was lucky. Most of her colleagues are still getting only 3-5 masks.

Katie has up to six visits each day, five days a week.

Thirty visits, 15 masks if you are lucky, three if you aren’t.

Just to be clear, the latest advice from the World Health Organisation is unequivocal

“Do not re-use single-use masks. Replace masks as soon as they become damp with a new clean, dry mask. Discard single-use masks after each use and dispose of them immediately upon removal.”

Not everyone is re-using masks, but Katie’s experience of not having the protective gear she and her clients want her to be wearing is far from unique. Over the past 48 hours Newsroom has talked to care workers and their clients, the companies that employ the care workers, the unions that represent them, and MPs in constituencies where they work. 

The message is the same: masks and other PPE are not getting through to frontline community staff.

Ministry of Health guidelines still focus on hand washing and cough hygiene, despite Ashley Bloomfield saying PPE is available. Photo: Lynn Grieveson.

You shouldn’t just be safe; you should feel safe

On March 31, Director-General of Health Ashley Bloomfield made the announcement community support workers had been lobbying for for weeks.

“We are releasing a large number of masks from our national stocks out to our district health boards  and they will be distributing in their regions masks to frontline health workers... including our home and community support workers [and] disability support workers,” he said.

“Our frontline healthcare workers not only need to be safe, they need to feel safe.”

Katie does not feel safe. She says she and her co-workers are frightened, and their clients are frightened. Some elderly and disabled people are trying to cope on their own or with help from their families, rather than have people come into their bubble without a mask; others plead with them to wear masks they don’t have.

Some community support workers have resigned or taken leave rather than go to work unprotected.

Some mornings I wake up and I just cry. I don’t know if I am bringing something home. I don’t know if I am taking something into my clients’ homes.

“We just don’t know what to do. It is scary because of the unknown and how vulnerable we feel," Katie says.

“Some mornings I wake up and I just cry. I don’t know if I am bringing something home. I don’t know if I am taking something into my clients’ homes.”

It may be coincidence, but community support workers have the highest incidence of Covid-19 infection of all healthcare workers. Twenty had the virus, according to the most Ministry of Health recent figures, from Wednesday last week. 

By now there could be more.

Home carers wonder why supermarket and bank workers are provided with masks and gloves when they have none.

But mostly they wonder why two weeks after being promised PPE, so little has changed.

“Many support workers are still waiting for masks and other PPE,” says Kirsty McCully, a director of the E tū union, which represents many home care workers. “It is very disturbing.”

Same message from Andrew Hall, national programme manager at the New Zealand Spinal Trust, which represents people with spinal injuries, many of whom need daily or even round-the-clock care.

“We’ve spent the last days frantically trying to understand the process whereby this PPE will actually be distributed, but with little success.” 

And from the head of a community support provider, who didn’t want to be named for fear of jeopardising any stocks they might get: “As I understand it, no home care provider has yet received PPE consistent with the public announcements, and some DHBs are refusing requests altogether. 

“[When we ask the DHB why not], people tell us ‘there isn’t enough’. Junior officials are unsure why promises have been made which can’t be kept.”

“There is no shortage”

One of the strangest things about the whole situation is the Government insists there is no shortage of PPE in New Zealand. 

Director of Public Health Caroline McElnay reiterated it at her press conference on Friday. “There is no shortage of PPE,” she said. “PPE is not being rationed. The country does have sufficient stocks.”

Caroline McElnay says PPE is not being rationed. Photo from press conference video.

Meanwhile a Ministry of Health spokesperson gave Newsroom details of what seems like a lot of masks.  

- There are 8.8 million of the high-grade, filtered N95 masks and 4.8 million surgical masks in the national stockpile;

- Almost 14 million N95 masks and 8.2 million surgical masks are on order from overseas. Some are already arriving. For example, last week 150,000 masks, 106 face shields and 50,000 pairs of goggles arrived from international suppliers 

- Whanganui company QSI Safety produced 520,000 masks last week, a mixture of N95 and general surgical masks. Machinery arriving “over the next weeks and months” should allow the company to double production. 

And these masks aren’t languishing in centralised warehouses: they are being sent out to DHBs, the spokesperson said.

“It is not practical to list movements through the supply chain of so many items of PPE but a huge effort is underway to both procure and distribute supplies throughout the country. 

For example, in the week beginning March 30, 1.8 million masks were sent to DHBs, the ministry says. 

PPE is available and is not being rationed.

And on Tuesday this week, 1.2 million masks will be delivered to DHBs, specifically for distribution to community-based health and disability providers, a ministry spokesperson told Newsroom yesterday. That's separate from  another 600,000 for DHB use.

“PPE is available and is not being rationed.”

So why are these ample PPE stocks that are winging their way to the DHBs not getting to the home care workers Bloomfield promised to supply on March 31?

Andrew Hall, at the NZ Spinal Trust believes it’s the ministry’s own guidelines that are causing the problem, because they appear to completely contradict what Bloomfield told the industry.

Out-of-date guidelines

Hall says many DHBs are using the ministry guidelines as justification for not giving community support provider companies the PPE they need.

For example, Hall received the following message from the Canterbury DHB late last week: “Canterbury DHB can only provide PPE for residential care facilities and home-based support services if you have a suspected (by general practitioner) or confirmed Covid-19 case.”

There was a similar message from the Southern DHB: “As a starting point for what PPE can be provided, the MoH guidance on the type of PPE to be used for community care workers is on the MoH website here.” And Southern DHB provided a link to the Ministry of Health tables.

Hall can’t understand why the ministry hasn’t updated its guidance, given many DHBs are relying on it to make decisions on how much vital protective equipment to supply to home care workers.

“I’m not saying all DHBs are doing this, but the continued existence of the out-of-date MoH advice on the website seems to be confusing many parties involved in this process.”

Mixed messages

Confusion at the top of the health chain is feeding confusion lower down. June* is a home care worker who also does six visits a day. She says not only is the lack of PPE a problem, but also the lack of information about what the situation is.

We were told masks are not necessary, even though they had just finished telling us the virus was spread by droplets.

She says her company provided just one infection control session, just before lockdown started.

She still has the notes she took.

“We were told masks are not necessary,” she tells Newsroom, “even though they had just finished telling us the virus was spread by droplets. 

“We were told there were masks in stock and more coming in, but that if we were to get them it would deplete the stocks too quickly.

“They said many clients were worried about Covid-19 and their safety, but we were not to use masks to ease the stress of our clients.

“And then they argued masks were not used frequently by support workers before Covid-19. But that makes no sense because this is a brand new situation and now we do want masks.”

Asking for help

With the long weekend looming and thousands of home carers heading into work as usual, the PSA union decided on some coordinated action. 

On Thursday, home care workers emailed every MP in the country, telling them of the situation they were in, and asking for support. 

The response from many MPs was incredulity, one home carer told Newsroom.

“As far as the MPs were aware, community support workers have been provided what they need - gowns, masks, booties and hand sanitiser,” 

“They had no idea for the vast majority of people, none of this has been supplied.”

The consensus across the industry is that home care workers need one mask, one pair of gloves and hand sanitiser for every visit. If there are bodily fluids involved, they should have aprons or gowns and might need additional gloves or a spare mask.

The latest health information from the US Centers for Disease Control and Prevention suggests Covid-19 has been found present in faecal matter. Until there is more information available about whether it can be spread that way, carers involved in toileting, manual bowel operations and cleaning incontinent people need additional protection, some carer organisations say.

In addition, carers say they should have N95 masks, booties and protective eye goggles available in their cars, in case they arrive at a house and are particularly worried.

June, who was given three surgical masks, says one day last week she was sent to the house of a client she had never cared for before.

“There were three cars parked at front, one at back. With what PPE gear I had, I knocked on the door, but I was pretty scared. 

“Aside from the client, the house was full of people. I didn’t know anything about these people - whether they’d come from overseas, whether they’ve been in contact with someone with Covid, what they’d touched in the house. I just didn’t know and I didn’t want to catch anything off them.” 

The good, the bad and the ugly

One of the MPs who received that email from the PSA union members is the National Party’s health spokesperson Michael Woodhouse. He’s been checking with community support providers since Bloomfield made his announcement on March 31 and he says the lack of PPE belies belief.

“When you’ve got someone going into five to eight clients in a day, and you don’t know where the virus is, the issue of cross-contamination remains a live one. We know how fast Covid-19 can spread. 

“Despite a soothing response from the Director-General, these thousands of carers who do a fantastic job are not being given the support they need.”

Woodhouse says the picture varies between DHBs - a few are giving home care providers what they are asking for, some are supplying limited PPE, a third group have sent almost nothing.

On the good side are the three Auckland DHBs (Auckland, Waitemata and Counties Manukau), the Wellington region’s Capital and Coast, and Hawkes Bay, he says. 

The middle group includes Bay of Plenty, Tairawhiti (Gisborne and East Cape), MidCentral (Palmerston North), Nelson, Whanganui and Nelson.

The worst DHBs include Canterbury, South Canterbury, West Coast, and Waikato, he says.

Woodhouse says despite the Government saying there is plenty of PPE, some DHBs are still worried about running out.

“I think a fair bit of the problem is them thinking if they filled their orders fully they wouldn't have enough going forward and they don’t have confidence in future supplies.

“And that’s exacerbated by the feeling PPE is not really necessary for community support workers anyway.”

The Ministry responds

The Ministry of Health spokesperson who sent a response to Newsroom's questions on PPE reiterated Bloomfield’s statement about PPE for community support workers.

“Health care workers are doing an amazing job on the front line and it’s important they feel safe. We have provided guidelines on our website about the highest risk situations and which PPE should be worn to reduce risk, but we are certainly not rationing PPE outside of that. Supplies have increased so we should be able to support this.”

She pointed Newsroom to updated guidelines on the use  of PPE by community support workers, yet links on the updated page led invariably to the same tables which the DHBs are using to deny PPE to home support workers.

Moreover, Ministry of Health advice on physical distancing will be of no comfort to home carers.

“The evidence suggests Covid-19 is spread via respiratory droplets from contact transmission. Respiratory droplets tend to only travel for 1 metre during sneezing and coughing. Avoiding being face to face with someone for at least 15 minutes will reduce this mode of transmission. We are asking people to keep at least 2 metres distance from others as a precautionary approach.

“If you can’t maintain physical distancing because you need close contact to provide care then you should apply standard precautions [good hand washing and sneeze and cough etiquette]. Refer to our guidance to identify your PPE needs.” 

Back to square one.        

Moving to national distribution

Still there is one change that may give hope to home carers struggling with DHB suppliers: from this week the Ministry will move to national, rather than regional (read DHB) distribution of PPE.

“From 14 April, the sourcing and distribution of PPE will be managed at the national level to ensure ongoing supplies are adequate. This will initially involve the distribution of masks and later be expanded to include other PPE. While the PPE distribution situation is significantly improved, we are aware there have been some issues with distribution, we have been working with DHBs to make sure that distribution is moving smoothly.”

Until then, if community support workers want masks or other PPE and aren’t getting it, “they should speak to their employer or union”. 

The downside to that strategy of course being that those same employers and unions are tearing their hair out about DHBs refusing to release PPE.

Newsroom understands unions representatives met ministry officials just before the weekend and came away without an agreement.

One delegate told Newsroom: “We have no confidence this will be resolved quickly.”

E tū’s Kirsty McCully is frustrated at the delay. “We have new guidance but it is linked to old tables. There are new tables being developed, in consultation with unions, but they are taking some time to be put on the website and in the meantime providers continue to base their actions on the old guidance.”

Even in my own bubble, my family doesn't come close to me, including my son. Because we just don’t know.

Meanwhile, Katie says she and her family are so worried about the risks her job puts her in, they’ve decided she has to be isolated at home. 

“Me and my husband have chosen to sleep in different rooms. Even in my own bubble, my family doesn't come close to me, including my son. Because we just don’t know.”

*Not her real name.

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