Inside NZ’s deadliest cluster
It was the worst-case scenario that health officials were dreading — the deadly coronavirus entering a rest home. The 11 deaths at Christchurch’s Rosewood now account for the deadliest cluster in New Zealand. How did it all happen? Kurt Bayer reports.
The ambulances were stacking up. One by one, frail, elderly residents were slowly ushered into the carpark, gently held at the elbow by face-masked, blue-gloved staff. Once safely inside, the next awaiting ambulance came forward.
Some family members watched from a low, red fence, waving goodbyes and wiping away tears. Visits had been banned, so it was as close as they could get.
They were worried. Information was scant. And their fears were not allayed from seeing private security guards patrolling the perimeter and the looks on the faces of staff and senior District Health Board figures who had turned up. This was the worst case scenario — the virus, already rampaging across the world, had slipped into a Christchurch rest home; and worse than that, it had invaded its dementia care unit — 20 mostly elderly residents, vulnerable, often with pre-existing health issues, and a low resilience to a nasty largely-unknown bug.
It was just three days earlier, a Friday, that the first case of Covid19 was confirmed at Rosewood Rest Home and Hospitals on Woodham Rd, Linwood, in the eastern suburbs of Christchurch. Things had moved quickly over the weekend.
New Zealand was already well into full national alert level 4 lockdown by Thursday, April 2. And Christchurch’s George Manning Lifecare and Village had had a few of its own cases confirmed.
A specimen taken from a resident at Rosewood arrived at a Canterbury DHB laboratory that afternoon. The results came through about 24 hours later — it was positive. Rosewood were called and advised by the DHB’s infection prevention and control team later that same day.
It was a shocking turn of events for Rosewood owners, husband and wife Malcolm and Lynda Tucker.
It was a “deeply distressing time” for them, New Zealand Aged Care Association (NZACA) chief executive Simon Wallace would later say.
Over that first weekend spanning
April 3-5, the DHB’s infection prevention and control team swept into action. Through phone and email, they were in contact with various key players — the Tuckers, a community and public health team, a gerontology nurse specialist, as well as the DHB’s Emergency Coordination Centre, including the incident controller.
A number of Rosewood staff had to selfisolate at home, as they were considered close contacts of a confirmed case. “This was appropriate,” Canterbury DHB incident controller Dr Sue Nightingale would reflect.
But it took two full days after confirmation of the disease at Rosewood before the CDHB had someone on site. On Sunday, April 5, infection prevention and control, plus the nursing director for older people visited the 64-bed facility to “assess the situation and advise in person”.
Whether that delay in getting people to the epicentre of what would become New Zealand’s deadliest Covid-19 cluster was illadvised or not will form part of a review that began last Thursday. Since the outbreak of coronavirus at five rest homes — two in Christchurch, two in Auckland and one in Hamilton — the Ministry of Health has ordered all DHBs to audit rest home and aged residential care facility processes. CDHB is also doing a separate review into Rosewood.
The NZACA, which represents more than 600 members including Rosewood, was told of the emerging crisis on April 5. “Notwithstanding the obvious concern for residents and families, our first reaction was to reach out to the owner and manager of Rosewood, knowing such news would have been difficult based on the impacts experienced by facilities overseas,” Wallace tells the Herald on Sunday. Within days, the situation worsened. By Monday, April 6, it was revealed publicly there was a cluster at Rosewood, involving staff and residents. By midday, there was a total of 16 cases. It was clear that the 20 residents in its hospital-level dementia facility were at a serious health risk. They needed moving into their own “bubble” to try to control the spread of the disease, and to give them space and room to be treated.
That’s when the stream of ambulances and paramedics vehicles turned up to transport the 20 dementia residents to Burwood Hospital, just 6.5km away.
“Our priority is to ensure that all residents of Rosewood Rest Home receive quality care in a safe environment,” said Canterbury DHB chief executive David Meates, who authorised the move.
Rosewood’s facility manager was one of several staff members forced into self-isolation.
It meant the CDHB had to appoint a temporary manager and try to cobble together replacement staff “at very short notice”.
At Burwood, where several gunshot victims from the March 15 mosque shooting had recovered a year earlier, the Rosewood evacuees were isolated as a group.
While the CDHB moved to reassure families that their loved ones were going to “receive quality care in a safe environment”, they were still struggling to get a clear picture of what was happening.
One family member, who had an
elderly relative at Rosewood, said they were phoned by the CDHB that Monday morning.
They left the conversation feeling confident in the care their loved one was getting — but said the situation was moving very quickly. Their family member would later succumb to the virus.
Over the next two days, staff began to fear the worst. By Wednesday, there were 20 coronavirus cases linked to the privately-owned dementia unit — 12 residents and eight staff. The numbers had jumped by five overnight.
Canterbury medical officer of health Dr Cheryl Brunton warned ominously: “These figures are likely to be subject to change.”
The following day, Thursday, April 9, the cluster had its first death, a woman aged in her 90s. She was one of the residents moved to Burwood Hospital. Her death — New Zealand’s second Covid-19 fatality — was announced by deputy director of public health Dr Caroline McElnay in an unscheduled press conference on Good Friday.
Lockdown restrictions meant her family weren’t able to visit her or be with her before she died in hospital. Hospital staff did all they could to provide her comfort before her death, McElnay said.
The Tuckers were not speaking publicly. They had enlisted the help of a former police officer who led one of the police anti-terrorist squads during the Aramoana massacre in 1990.
“All comments or discussion regarding those residents can only be made by the CDHB and not by the Rosewood operators. It is vital and necessary to ensure the privacy of the families is fully respected at this sad time,” Mike Kyne said when contacted by the Herald on Sunday this week.
The cluster’s second death came the following day — April 10. Legendary boxing coach Bernard ‘Bernie’ Pope, 78, had been a resident at Rosewood and was transferred to Burwood.
Fellow boxing coach Phil Shatford, 63, paid tribute to his father-figure Pope. The last time he saw him was just prior to the nationwide lockdown.
“I only went to Rosewood about three times because, oh, it was so sad seeing the guy in that sort of state.”
Like many families who have lost loved ones at Rosewood approached for comment for this article, Pope’s family say they don’t have any concerns with the level of care he received. His health had gone downhill in recent months and they have nothing but respect for his carers and the hospital staff.
Families were able to keep in contact through Skype and other video and voice calls. One family member who had an elderly relative succumb to the virus told the Herald on Sunday: “He couldn’t have been treated any better at Rosewood, and at Burwood when he was there. It’s just one of those unfortunate things that has happened.”
On the day Pope died, the CDHB announced they were moving another 20 of Rosewood’s hospital-level residents to other aged care facilities in the city after struggling to find staff to replace those forced into isolation. There were now 28 cases.
A week after the Rosewood cluster was confirmed, on April 13, there was a third death — a man in his 80s.
But worse was to come. The following day, Rosewood’s death toll jumped to six, with director general of health Dr Ashley Bloomfield confirming three more residents had died: two men in their 90s and a man in his 80s. All had underlying health conditions.
Prime Minister Jacinda Ardern told the country that the highest daily New Zealand death toll was a “sad and sobering reminder of the need to stay the course”.
“We always knew there would be more deaths, even at level 4, and especially in cases where the virus enters a vulnerable facility like an aged-care facility.”
How rest homes hit by coronavirus responded would be reviewed, Bloomfield announced, with “safe practice issues” identified, including how protective equipment was used.
For, by now, questions were being asked over just how the deadly virus outbreak was able to spread through the home so rapidly.
Canterbury DHB accepted on April 14 that since many staff had to go into isolation so suddenly, it had led to “a number of issues regarding safe practice, including the way PPE was used”.
And a week later, on April 22, Canterbury DHB incident controller Dr
Sue Nightingale told the
Herald technical experts had been looking into how three CDHB staff members became unwell after caring for the elderly patients. “Their collective view is that a PPE ‘breach’ is the most likely scenario,” Nightingale said.
“It is believed damp masks may be the source of the breach.
This factor is likely to have increased risk of exposure to Covid-19.”
Due to the demands on staff, it was not always easy to interrupt care of “very unwell dependent patients” to change PPE as frequently as recommended, she said.
This was particularly noted on the day the first group of elderly patients were moved to Burwood and the day after. “Some staff reported their PPE had become moist with the physical exertion that occurred over some hours that day. This factor is likely to have led to exposure to Covid-19.”
Nurses’ union NZNO welcomed the Ministry of Health review after members’ concerns were raised over access to PPE and proper training. The NZACA also had concerns and was critical of the Canterbury DHB.
Wallace said they had been advocating for better access to PPE for all aged residential care facilities from as early as late February. But his rest home members had been telling him that the CDHB had been “one of the slowest DHBs to provide our members with sufficient supplies of PPE”.
It led to questions being asked over just how coronavirus got into Rosewood in the first place. The Ministry of Health’s website continues to list the cluster’s origin as “unknown”.
Even now, it’s still under investigation, although most indications seem to suggest it came in with an unsuspecting staff member, given the first positive cases were confirmed during lockdown when family were unable to visit.
“How and when Covid-19 was introduced into Rosewood rest home is still the subject of investigation, including the possibility that the infection was introduced by a staff member who may have been asymptomatic at the time,” CDHB medical officer of health Dr Cheryl Brunton said last week.
With the nation tuning into the daily 1pm Covid-19 updates, the fatalities kept mounting. On April 16, a woman in her 80s with an underlying health condition died. She had only a Burwood staff member at her bedside.
On April 20, two weeks after the Rosewood cluster was confirmed, another woman in her 80s who had been considered a probable case died.
It kept coming. A man in his 70s died in Rosewood’s hospital unit on April 22. He’d initially tested negative for the disease but was a probable case.
The following day, Ardern said it was devastating to see the impact of Covid-19 on vulnerable communities such as Rosewood.
And the 10th victim came on April 24 — a man just in his 60s, who also passed away at Rosewood’s hospital-level wing. He also had underlying health conditions and was initially considered a probable case given his clinical history.
It was now the nation’s deadliest coronavirus cluster, accounting for 11 of the nation’s 20 deaths, and totalling 55 cases.
With no new cases in the past week, Canterbury DHB officials were quietly hopeful that Rosewood was over the worst of it.
But yesterday morning, another resident, George Hollings, aged in his 80s, died at Burwood.
His family asked the ministry to share his name and details about him in their 1pm update and said he had a lot of friends who the family don’t have contact details for.
“His family tell us that George will be remembered as a real Kiwi bloke, a rough diamond, who loved his deer stalking.”
The family praised the staff from the hospital.
“We can’t speak highly enough of the care Dad received. You’ve clearly chosen the best, most compassionate staff to work at Burwood.”
Nightingale said they will use what they have all learned from Covid-19 so far to try to keep the deadly pandemic out of all aged residential facilities — and where they can’t, to “manage it effectively and with the least possible harm to our elderly people”.