It was the worst-case scenario that health officials were dreading – the deadly coronavirus entering a rest home. The eleven deaths at Christchurch rest home Rosewood now accounts for the deadliest cluster in New Zealand. How did it all happen? Kurt Bayer reports.
The ambulances were stacking up. Frail, elderly residents were slowly ushered into the car-park, 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 swiping 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 low resilience to a nasty largely-unknown bug.
It was just three days earlier, a Friday, that the first case of Covid-19 was confirmed at Rosewood Rest Home & 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 & 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 confirmed 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 of 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 Friday, April 3 to Sunday, April 5, the 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, and gerontology nurse specialist, as well as the Emergency Coordination Centre, including the incident controller.
Several Rosewood staff had to self-isolate 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 ill-advised 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 processes and aged residential care facility processes – and as part of that, CDHB is doing its own review into Rosewood but only once it is operating again as an independent facility.
The NZACA, which represents more than 600 members, accounting for 90 per cent of the 40,000 beds in the rest home sector, was told of the emerging Rosewood crisis on Sunday evening, April 5.
Rosewood, owned by the Tuckers who in 2012 also bought a Whanganui rest home, the former Aubert Home of Compassion, had been members for years.
"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," said Wallace.
"We were in contact with them almost immediately to offer support."
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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 were a total of 16 cases, with four residents as confirmed cases and another eight as probables, and one staff member as a confirmed case and three staff deemed probable 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 and 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. They were transporting the 20 dementia residents to Burwood Hospital, just 6.5kms 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. "I want to reassure all the families involved that everyone is working together to ensure this is the case."
Rosewood's facility manager was one of the several staff members forced into self-isolation. It meant that the CDHB had to appoint a temporary manager and try to cobble together replacement staff "at very short notice".
"Today the DHB is working to secure additional experienced staff to care for the 44 remaining residents at Rosewood Rest Home," said Meates on April 6. "If we are unable to source appropriate staff we may have to look at further relocations, although this is not the current plan."
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."
And the following day, Thursday, April 9 the cluster had its first death, a woman aged in her 90s. She was one of the 20 Rosewood rest home 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 who said she'd had underlying health conditions.
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, Dr 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 media enquiries were directed through Mike Kyne, who said he was acting as an advocate for the rest home operators.
"The CDHB have full authority and control over the Rosewood Residents and the Burwood facility," Kyne said when contacted by the Herald on Sunday this week.
"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."
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 Hospital.
Fellow boxing coach Phil Shatford, 63, paid tribute to his father-figure Pope. The last time he saw him was just before the nationwide lockdown.
"Bernie has been in a few homes," Shatford told the Herald. "Rosewood was the last one he was in obviously. I would go and see Bernie heaps of times. 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 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: "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 passed away, the CDHB announced they were moving another 20 of Rosewood's hospital-level residents to other aged care facilities in the city over the next week. The move came after they struggled to find staff to replace those forced into isolation. There were now 28 cases linked to the ever-growing cluster.
"Families have been contacted and are central to our decision-making about where residents are moved to," Meates said.
"Thankfully, there are a number of rest homes who have hospital-level rooms available. We know this is disruptive for both residents and their whānau, but under the present circumstances it is the safest option while we're unable to find appropriate staff to work at Rosewood to provide care to this group of vulnerable older people."
The next day, Meates confirmed that all 20 of the hospital-level residents moving from Rosewood into other facilities had tested negative for Covid-19 and were not showing any symptoms of infection. As precautionary measures, they would be cared for in isolation for the first 14 days after their move, with any staff wearing full Personal Protective Equipment (PPE).
One week after the Rosewood cluster was confirmed, on Monday, April 13 there was a third death – a man in his 80s.
But worse was to come. The following day, Tuesday, April 14, Rosewood's death toll jumped to six, with Director-General of Health Dr Ashley Bloomfield confirming three more residents had died, including two men in their 90s and a man in his 80s. All had underlying health conditions.
Prime Minister Jacinda Ardern told the country 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," she said.
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 that since many staff had to go into isolation so suddenly, it had led to shortcomings.
"In the demanding context of managing a cluster of frail elderly residents, a significant number of staff needed to be isolated because of exposure to Covid-19 and this contributed to a number of issues regarding safe practice, including the way PPE was used," a DHB spokesman confirmed to the Herald on April 14.
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," Dr 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 elderly patients were moved to Burwood Hospital, April 6, 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 over access to PPE and proper training. The NZACA also had concerns and was critical of the Canterbury DHB. Chief executive Simon 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".
Rosewood, Wallace said, was an "early mover" in implementing strict visitor protocols and infection prevention control measures, well ahead of New Zealand going into full lockdown mode on March 26.
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.
"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's medical officer of health Dr Cheryl Brunton said this week.
With the nation tuning in to the daily 1pm Covid-19 updates, the fatalities kept mounting. On April 16 a woman in her 80s with an underlying health condition transferred from Rosewood to Burwood Hospital on April 6 had died. She only had a Burwood staff member at her bedside when she passed away as lockdown restrictions meant her family couldn't be with her.
On Monday, April 20 – two weeks after the Rosewood cluster was confirmed, another woman in her 80s who had been considered a probable case died. Health officials said she had not been tested for the virus but was treated as a confirmed case based on her exposure history and clinical symptoms.
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, Prime Minister Ardern said it was "devastating" to see the impact of Covid-19 on vulnerable communities, such as Rosewood.
And the tenth victim came on April 24 – a man just in his 60s, who also passed away at Rosewood's hospital-level wing. Dr McElnay said he'd 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. As of Friday, 18 people had recovered.
With no new cases over the last week, Canterbury DHB officials wwre quietly hopeful that Rosewood is over the worst of it.
But this 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 today 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."
Incident controller Dr Nightingale said they will use what they have all learned from Covid-19 so far to try and 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".
• Covid19.govt.nz: The Government's official Covid-19 advisory website
"This Covid-19 pandemic is an unprecedented challenge for us all, especially for those working in aged residential care who are responsible for caring for the most vulnerable members of our society," she said.
"Dedicated managers and staff in these facilities have been working pro-actively with us to keep their facilities safe through restrictions on visitors and infection and prevention measures such as hand hygiene, environmental cleaning and disinfection and the use of PPE to reduce the risk of Covid-19 transmission.
"However, in the demanding context of managing a cluster of frail elderly residents, a significant number of staff needed to be isolated because of exposure and this highlighted a number of issues regarding safe practice, including the way PPE was used.
"Canterbury DHB is increasing support to the aged residential care sector in Canterbury with teams of experts in caring for the elderly and in infection prevention and control going out to give further support and guidance as we work together to protect the safety of residents and staff."