Testing gaps at rest home risked ‘catastrophe'

Residents at a rest home struck by a deadly Covid-19 outbreak were only all swabbed 11 days after a worker tested positive — turning up undetected cases that health authorities say could have led to a “catastrophe”.

Documents reveal concerns that CHT St Margaret’s aged-care home in Te Atatu lacked bins for the safe disposal of personal protective equipment (PPE), after an outbreak began with the first positive result on April 4.

Only staff and residents with symptoms were tested, but on April 15 it was decided to swab everyone. Three more residents were found to have the highly contagious disease, two of whom died soon after being moved to hospital.

One of those residents had a cough in the week prior to her diagnosis, her son said. They were only officially told the disease was in the rest home the day before she was taken to Waitakere Hospital, where she died after her health failed quickly.

“If there were already cases at the rest home, and Mum had at least one symptom, it’s surprising it was left that late before she was tested.”

Waitemata¯ DHB said its decision to swab all residents “averted a potentially catastrophic situation”.

“If left undetected, these positive cases would likely have quickly spread within the facility, infecting large numbers of vulnerable residents,” a spokesman said.

DHB “situation reports” released under the Official Information Act provide a timeline of the outbreak.

A staff member first had Covid symptoms on March 28, and a total of five staff at the Te Atatu facility were ill before the first resident became unwell on April 7.

With facility staff sick or in isolation, the DHB sent in health care assistants from April 9, and registered nurses and cleaners from April 11.

Only residents who had possible symptoms were tested, as per advice including from Auckland Regional Public Health Service ( ARPHS).

This changed 11 days after the first case was confirmed and following a directive by Waitemata¯ DHB’s incident management team to swab all staff and residents, excluding those in the dementia unit.

By that point the lack of available staff was at a crisis point, and a rushed decision was made to send the six infected residents to Waitakere Hospital.

A situation report from that day — April 17 — shows DHB staff in the rest home had been worried about the PPE available, and on April 13 it was agreed they would wear fluidresistant gowns instead of aprons “to manage staff anxiety”.

There were “ongoing concerns with the safe doffing and disposal of PPE due to lack of rubbish bins”. Staff were checked for symptoms at the start of shifts but temperature checks would begin only once infra-red thermometers arrived. St Margaret’s asked for other gear, including an urgent need for tympanic thermometers, stethoscopes, linen skips and bins. The volumes requested were based on a set of dedicated gear for each isolation room, with the request noted on April 8 and again on April 17.

“The facility is unsure about sharing medical equipment between residents in isolation and would value guidance on this. Currently sharing equipment and sanitising after each use,” the situation reports state. “Bins and skips remain a priority.”

St Margaret’s is run by CHT Healthcare Trust, a charity with 16 aged-care facilities across the upper North Island.

CHT chief executive Max Robins declined to comment. He has previously said all its facilities had strictly adhered to ministry guidelines for PPE and infection control, and contact tracing immediately began after confirmation of the first case with ARPHS advising who to isolate.

The situation reports show frustration with communication: “Facility has noted that they are not getting clear clinical information about swabbing and classification of cases and noted that they have received differing advice,” an April 8 document notes.

“Facility confirmed they do not have the capacity to swab large numbers of residents if this is agreed approach,” a report from the next day noted. “Decision to treat symptomatic residents — facility to manage.”

A Waitemata¯ DHB spokesman said the decision to test all residents was made in consultation with the ministry and northern region health coordination centre, “even though the case definition at the time was that only symptomatic people should be swabbed”.

“Given the emerging experience of significant rates of deaths in rest homes overseas once Covid-19 entered these facilities, this was considered an appropriate precaution to take.”

The St Margaret’s “cluster” of linked cases number 51. A household contact of an earlier case announced last Friday was the country’s latest confirmed case.

If there were already cases at the rest home, and Mum had at least one symptom, it’s surprising it was left that late before she was tested.

Son of deceased resident