Covid-19

Surgical mask mess: A tale of two tables

More than a month after promising protective masks for home carers, the Ministry of Health has at last changed its guidelines so everyone might just get them.

One small tick makes all the difference, says NZ Spinal Trust national programme manager Andrew Hall. Or rather six small ticks, on a Ministry of Health chart buried on a webpage few think to look at. 

But it’s a chart that is crucial to the thousands of home-based carers and the tens of thousands of people they care for. It’s also a table that has been at the centre of a battle between community care workers, the people who employ them, the ministry and the district health boards about whether carers should be provided with surgical masks and other personal protective equipment to do their job safely.

On Tuesday those ticks weren't there. Official ministry guidelines, unchanged since March, said home carers performing up-close-and-personal tasks with elderly and disabled people in their homes didn’t need to wear masks. 

And that translated for some DHBs and care organisations into ‘We won’t be providing you with masks’, carers say.

BEFORE: THE OLD CHART

On Wednesday, finally, that chart changed. The crosses changed to ticks. The ministry told workers performing close-contact tasks they should wear disposable surgical masks.

AFTER: THE NEW CHART

NOTE: Newsroom has altered the format and layout of the new chart to make it easily comparable with the old one. Find the actual chart, including notes to the chart, here

The notes at the bottom of the chart on the ministry's website stress home carers should throw away their masks after each client, and change masks four-hourly “or when moist or soiled, whichever is sooner”.

As Newsroom has reported previously, some carers have been forced to re-use disposable masks because they have not been supplied with enough.

Andrew Hall is “thrilled” - and relieved - to see the new guidelines. That’s because despite director-general of health Ashley Bloomfield telling community care workers almost six weeks ago that there were plenty of masks for them, some DHBs, ACC and at least one of the big national agencies that supply care workers to elderly and disabled people, have refused to release masks to care workers.

These reluctant DHBs and care agencies have used the old ministry guidelines as a rationale for not providing enough masks. If the ministry says you don’t need them, why would we send them out? has been the attitude, carers say.

It’s been a frightening time.  

Canterbury DHB is seen as one of the worst offenders. Canterbury is also by far the most dangerous DHB. Twelve of the 21 people who have died of Covid-19 in New Zealand were in Canterbury. The mostly deadly cluster was at Burwood Hospital and Rosewood Rest Home, both in Christchurch.

Burwood Hospital is also where the NZ Spinal Trust is based.

Hall says the trust has so far distributed 6350 masks, but only 1400 of them came from the Ministry of Health via the Canterbury DHB. 

“Luckily we were donated 20,000 masks by [beef and lamb producer/exporter] ANZCO Foods. Otherwise by now we’d really be tearing our hair out!”

Even new table unclear

Not everything is clear, Hall says. In particular he’s not sure what a caveat to the ministry guidelines saying care workers “need to assess risk before putting on PPE” really means. 

The chart now has a big tick in the boxes where we wanted them.

“What risk are they talking about,” Hall asks “Is it of the care worker getting Covid-19? Is it of them giving it to the client? Is it of bodily fluid flying around? It’s not clear.”

But he’s not too worried. 

“Basically the chart now has a big tick in the boxes where we wanted them.”

Why has it taken so long?

Marsha Marshall, chief executive of disability support group Manawanui has been another person prepared to speak out about the lack of PPE for home and community workers. 

She’s pleased about the new guidelines, although “it’s a shame it has taken this long and that the messages have been so inconsistent and mixed.  

“It’s been, as you are aware, a long and arduous battle for providers, and our disabled customers, who I can say quite faithfully are thrilled to finally be receiving PPE,” she tells Newsroom.

Marshall believes the root of the confusion and the delay in releasing updated advice has been that two parts of the Ministry of Health - the epidemiology experts advising Ardern and Bloomfield, and the infection control people putting out the guidelines - don’t have the same message. 

This has been eight weeks of chaotic unaccountable process which has left thousands of vulnerable people scared and confused. 

“The clinical ‘infection control’ advice has been different to the public health ‘be safe and FEEL safe’ message.

“The Director-General said one thing (be safe and feel safe), but DHBs relied on the infection control guidelines. A complete disconnect existed there, and the DHBs were/are all doing things differently.”

Another carer industry leader went further, but didn’t want to be named.

“This has been eight weeks of chaotic unaccountable process which has left thousands of vulnerable people scared and confused. Ministry of Health and DHBs are chronically unable to be honest and to deliver with flexibility.”

Healthcare workers are getting sick

One frustration Newsroom has had is not getting regularly updated numbers on how many home, community and aged care workers have contracted Covid-19. The ministry's daily updates tend not to include medical and health care worker cases and even when they do, they often aren’t broken down.

And for some reason aged care staff are not included in the figures, despite the fact several important clusters are in aged care facilities. The ministry told Newsroom only that the figures are "not readily available".

However, in response to requests, the ministry on Friday provided Newsroom with a breakdown of medical and other health-related staff infected with Covid-19. In total, 169 have been infected, or 11.3 percent of the total. This is up from 10.4 percent the previous week, meaning medical and caring staff are being infected at a higher rate than the general population. 

Source: Ministry of Health

Of that 169 infections, 52 are nurses, 34 are carers, and 27 health care workers. One of four Waitakere Hospital nurses who have caught Covid in Waitakere Hospital over the last two weeks was seriously ill in hospital on Friday.

Source: Ministry of Health

Meanwhile, there is also some confusion about the Ministry of Health daily statistics of numbers of people hospitalised because of Covid.

Friday's figures show three people in hospital. However, Newsroom understands infected patients from St Margaret's rest home are in Waitakere Hospital, but are not being counted as part of the hospitalisation statistics.

In a similar case, Rosewood residents who were relocated to Burwood Hospital were not counted as being hospitalised because they were not considered to be receiving hospital-level care.

"The residents were moved to Burwood Hospital to assist with their management, but they’re not currently categorised as being in hospital," a Ministry of Health spokesperson told Newsroom.

The ministry says it is looking into the hospitalisation figures.

Additional reporting from Farah Hancock and Melanie Reid

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