Dear Member / owner,
With the lull in new Covid 19 cases, there has not been much to report.
Regarding financial support, we’re disappointed to report that the government has given a series of ‘not at this stage’ replies to AMCA’s requests.
Details of two government announcements are given below, and some information on the move to level two on Thursday.

Moving to level 2

New Zealand as a whole

The government’s advice on level 2 has softened in the latest update, in that the previous recommendation to at risk patients to stay home has been removed, and tightened in that the physical distancing recommendation has been increased from one metre to two.
Excerpt:
  • People can reconnect with friends and family, go shopping, or travel domestically, but should follow public health guidance.
  • Physical distancing of two metres from people you don’t know when out in public is recommended, with one metre physical distancing in controlled environments like workplaces unless other measures are in place.
  • No more than 100 people at indoor or outdoor gatherings.
  • Sport and recreation activities are allowed, subject to conditions on gatherings, contact tracing, and – where practical – physical distancing.
  • Public venues can open but must comply with public health measures.
  • Health and disability care services operate as normally as possible.
  • Businesses can open to the public, but must follow public health guidance including in relation to physical distancing and contact tracing. Alternative ways of working encouraged where possible, for example remote working, shift-based working, physical distancing, staggering meal breaks, flexible leave.
  • It is safe to send your children to schools, early learning services and tertiary education. There will be appropriate measures in place.
  • People at higher-risk of severe illness from COVID-19 (those with underlying medical conditions, especially if not well-controlled, and seniors) are encouraged to take additional precautions when leaving home. They may work, if they agree with their employer that they can do so safely.
The loosening of restrictions, with a much greater range of social and work practices permitted, and physical distancing reduced to 1 metre in workplaces, will significantly increase the risk of a fresh outbreak compared to level 3 and 4.

For urgent care

The principles of medical practice that applied in Level 3 will still largely apply in Level 2. Factors to bear in mind:
  • As of May 12th, there are still approximately 200 known active cases.
  • There may well be undetected asymptomatic cases.
  • Ongoing transmission of COVID-19, and a fresh outbreak, will remain a possibility in the medium term.
  • Medical practices and rest homes here and overseas have been a significant source of transmission.
  • A cautious approach has paid off in terms of Covid-19 morbidity and mortality
  • With the increase in social and economic activity, patient numbers and stress on infection control systems may increase.
Our recommendations for level 2 derive from the Ministry of Health ‘yellow alert’ guidelines for the healthcare system, which we circulated previously.
  • Continue to offer virtual consultations to patients where you judge that the benefit of avoiding a face-to-face consultation will outweigh the risk.
  • In-person visits should be preceded by virtual triage or assessment, when practicable.
  • Maintain physical distancing within the facility as much as practicable – empty waiting room, or space as widely as possible, and limit patient attendants as much as practicable.
  • Stream patients – those with symptoms compatible with Covid-19 should be asked to wear a mask and wash their hands, and kept away from facilities used by other patients where practical, and meticulous disinfection of the areas used by Covid-19-potential patients should continue after each consult.
  • Scrupulous hand hygiene still required.
  • Maintain the use of PPE per Ministry of Health guidelines, which include mask use at your discretion when you judge there is a safety issue.
  • Make preparations for a move to orange alert or red alert (see below)

Planning for a fresh outbreak

While we hope Covid-19 will soon be eliminated in New Zealand, it would be prudent to plan for a fresh outbreak, locally, regionally or nationally.
The Ministry of Health’s alert levels document outlines four levels of alert - green, yellow, orange and red.
Note that this is specifically for healthcare providers and is separate from the level 1-4 advice.
We appear to be on yellow alert.
Urgent care is a prominent part of Ministry planning at orange and red alert levels.
Some points of note for urgent care are highlighted below. In particular:
  • At red alert, there’s advice to stream Covid-suspect cases between facilities
  • Urgent care will be expected to take on more work that normally would have been done in hospital.
  • Increase hours as demand requires.
  • Support high needs patients whose hospital services have been postponed.
There may be opportunities and benefits in clinics within a region discussing amongst themselves and with their DHB(s) how they might collectively and cooperatively respond if there is a fresh outbreak.
We’d encourage you to read the alert levels document in full. Some other key points are excerpted below.

With best wishes,

David Gollogly, Jasmine Mackay, Richard Chen
Pandemic Response Committee
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Yellow alert
Presence of a COVID-19 probably or small outbreak: May be some staff absence and redeployment to support response
  • Move to delivery of care by virtual or non-contact means wherever possible whilst ensuring access for priority and vulnerable populations
  • Activate streaming of suspected COVID-19 positive and non-positive patients to separate areas
  • Activate plans for community-based testing clinic(s), by referral only and close to any known
    possible outbreaks and mobile assessment teams
  • Plan for extended acute demand service available to manage people including extended large-scale illness and palliative care to all community facilities.
  • Plan for all hospital activity that needs to continue to transfer to community options where able
  • Identify and support high risk patients, those awaiting elective services which are postponed and those with chronic conditions
Orange alert
Urgent care facilities and primary care capacity severely affected, significant staff absence, extensive staff redeployment
  • Urgent care facilities and primary care capacity severely affected, significant staff absence, extensive staff redeployment
  • Patients with COVID-like symptoms referred to Community Based Assessment Units
  • Move to even greater delivery of care by virtual or non-contact means wherever possible whilst ensuring access for priority and vulnerable populations
  • Activate the plan for extended acute demand service available to manage people including extended large-scale illness and palliative care to all community facilities.
  • Activate the plan for all hospital activity that transfers to community options.
Red alert
Urgent care facilities and primary care at capacity, all available staff redeployed to non-deferrable care
  • Urgent care facilities and primary care at capacity, all available staff redeployed to non-deferrable care
  • Activate additional plans as required at Community Red Alert
  • Streaming of suspected COVID-19 and non COVID-19 positive patients, either within or between facilities as agreed via local incident control
  • All patients with COVID-like symptoms referred to CBACs with assessment, testing, mobile medical
  • Activate the plan for extended acute demand service available to manage people including extended large-scale illness and palliative care to all community facilities.
  • Activate the plan for all hospital activity that transfers to community options.