How rest homes hit by coronavirus responded will be reviewed after deaths at one facility reached six - with "safe practice issues" identified, including how protective equipment was used.
Director-General of Health Dr Ashley Bloomfield confirmed three more Rosewood Resthome and Hospital residents have died, including two men in their 90s and a man in his 80s. All had underlying health conditions.
The Christchurch facility is now linked to six deaths and 33 confirmed or probable Covid-19 cases, of which 18 are staff members.
Bloomfield also announced a review of how the six aged care facilities nationwide that have had coronavirus cases responded, and how other facilities have prepared.
He hoped that would be done with the Aged Care Association, and would show "what has worked well, and what could be improved".
Some of the six facilities had quickly managed to contain Covid-19 cases with no further transmissions, Bloomfield said, but "in others we have seen just how tricky this virus is, and that it can spread quite rapidly".
Bloomfield's comments were made after the Herald revealed the coronavirus outbreak at Rosewood spread so rapidly that there were subsequent shortcomings in a range of practices.
"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 [personal protective equipment] was used," a Canterbury DHB spokesman said.
Another Christchurch aged-care facility, George Manning Lifecare and Village, is dealing with its own Covid-19 outbreak. Canterbury DHB will review the response and preparedness of both rest homes "as soon as it is appropriate to do so", the spokesman said.
"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.
"Dedicated managers and staff in these facilities have been working proactively 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 transmission."
Bloomfield read messages from two families of Rosewood residents moved to Burwood Hospital, who praised the staff at the hospital. One family also commended the care at Rosewood.
The Director-General of Health said the six aged-care facilities with confirmed cases were a fraction of more than 650 homes across the country. He put that down partly to the preparation and restrictions put in place by the sector, including new arrivals being isolated for 14 days, no visitors and no shared meals.
"The fact that we have had relatively few of our facilities affected by this virus, in quite a strong contrast to other countries, I think is testament to the work they have been doing."
The NZ Aged Care Association, which represents aged-care facility owners and companies, has been critical of the difficulty in getting incoming residents tested. Bloomfield said there was a low threshold for testing of residents, and that he had talked to the association about what else could be done, and that extra funding would be announced soon.
Rosewood Resthome referred all comment to Canterbury DHB. The Aged Care Association has been approached for comment.
NZ Nurses Organisation (NZNO) kaiwhakahaere Kerri Nuku said the union was pleased a review had been announced and wanted to be involved. Systemic problems in the industry had been exposed by the Covid-19 crisis, she said, including in homes with no cases.
"In those environments we usually bring the residents out and they can socialise with other residents, and have shared dinner. That model of care needs to change, and deal with them more in an isolation-type approach. But that requires increasing staff at this time.
"We have had a burden of short-staffing before Covid. Now that we are in the midst of it, we need to see an increase in stafffing - not the same numbers retained."
The ministry's website listed the Rosewood cluster's origin as "unknown". The DHB has previously said it was highly likely a staff member took the virus into the unit, given strict visiting restrictions under the alert level 4 nationwide lockdown.
On Monday last week 20 residents from a dementia unit were moved to an isolated area of Burwood Hospital, to try to contain the spread of the virus. Six of that group have died.
Twenty of the residents remaining at Rosewood will be moved to other aged-care facilities providing hospital-level care over the course of this week. That will leave 24 residents at Rosewood, which is undergoing thorough cleaning.
The DHB has appointed an acting manager to Rosewood Resthome. The DHB spokesman said that was originally done "to give the facility manager a break but also because they were one of a number of Rosewood staff had to go into isolation due to being in contact with people later found to have Covid-19."