Middlemore Hospital staff made the decision to leave a man - who later tested positive to Covid - alongside other patients while waiting for his test results to come back, the Health Minister has revealed.
There are now fears the man may have spread the virus at the hospital as 29 doctors, nurses and staff considered his close contacts have been put into isolation.
He was admitted to Middlemore Hospital on Saturday after arriving complaining of abdominal pain, Health Minister Andrew Little said.
Staff screened him and asked Covid-related questions, but it was not made known that he had been at a location of interest until the next day, Little told TVNZ's Breakfast Show.
When the man came down with a fever a Covid swab was taken.
But hospital staff made the call to "leave him where he was" - in a ward with other patients - as they waited for a test result, Little said.
The man subsequently tested positive, leading to 29 staff at Middlemore Hospital now being considered close contacts and being stood down for 14 days.
Eleven of the 29 staff are doctors, 13 are registered nurses, two are healthcare assistants, and the others are a phlebotomist, cleaner and ward clerk.
Kerri Nuku, kaiwhakahaere of the New Zealand Nurses Organisation, said the Covid scare placed huge pressure on remaining staff as losing so many people from any workforce would always create significant strain and stress.
A lot of support is needed to ensure Middlemore kept operating as business as usual, she told Newshub's AM Show.
If there are staffing shortages then some wards needed to be shut and the workforce consolidated, she said.
The Ministry of Health was now investigating how Middlemore staff handled the man's case and whether it could have been done differently, Little told the AM Show.
He said there was some distance between the man and other patients and curtains separated them. Staff were all wearing PPE gear.
"The advice to everybody if they have been tested for Covid because they are symptomatic is to isolate straight away. That means being away from other people," Little said.
"The clinicians at this point made a different judgment and this is the consequence we've now got."
Little wasn't sure about the availability of isolation rooms as he recalled one wasn't available for the Covid patient but some were found for the other three patients who were in the original room.
Little wasn't aware of any other positive Covid tests including of staff linked to the Middlemore patient.
He said throughout the lockdown cancer procedures and treatment had continued to be carried out.
Little later told Mike Hosking on Newstalk ZB it was a "significant" issue having 29 staff stood down at Middlemore Hospital.
He said health teams needed to know how and why the call was made to keep the Covid patient alongside others for several hours despite having a fever.
"In the meantime the right steps have been taken but that's going to cause more disruption," Little said.
He said it was not until Sunday morning that the patient started displaying Covid symptoms.
The Ministry of Health earlier said four wards are now closed to new admissions and all patients are being managed under strict infection and prevention control measures, including the full use of PPE, and treated as Covid-19 exposed.
It said the patient went to the Middlemore Ed at 5pm on Saturday with abdominal pains.
He denied having contact with Covid-19 or having been in a location of interest, the ministry said.
The patient later developed a fever, was confirmed with Covid-19 and shifted to a dedicated Covid-19 ward (see timeline below).
Three patients who initially shared a room with the case are now in single isolation rooms.
One patient has been sent to a managed isolation facility - the other two will remain in hospital for treatment for their conditions plus swabs as appropriate.
Potentially exposed patients on the wards are being checked daily for symptoms and tested on days 3, 5 and 12.
On discharge, they are being managed according to ARPHS guidance.
All patients have received further information.
The emergency department, the radiology room where the patient had his scan and room where he stayed have been cleaned.
The ministry said a "national process" was under way across all DHBs to identify and send staff to Auckland to support the Covid-19 response.
"Middlemore Hospital are actively reviewing staffing daily and, like other DHBs in the region, are experiencing significant shortages of registered nurses and health care assistants."
The ministry was working with metro-Auckland DHBs to match available staff to needs and would continue to deploy staff as required to ensure they had the necessary resources.
"Metro-Auckland DHBs are working closely together to manage the Covid-19 positive cases needing hospital level care. The hospitals have been constantly updating their planning for surge capacity, which includes preparations for staffing and resourcing additional beds in dedicated Covid-19 wards."
But Nuku believed this will have a knock-on effect, creating staffing shortages elsewhere in the country.
"It's important we don't deplete regions from having access from their own staff," she said.
"A month ago our members were prepared to take strike action because of the chronic understaffing and there is no difference.
"All that we've got is a tense situation under incredible pressure and we've still got this chronic staffing."
Yesterday, the Herald reported all patients and staff working in two affected Middlemore Hospital wards were being regarded as close contacts of a patient with Covid-19.
The hospital was taking a "precautionary approach" to potential patient exposure.
"All patients and staff who were potentially exposed between 0635hrs and 1630hrs are classed as contacts.
"Middlemore Hospital is following the advice of ARPHS for isolation and testing."
Middlemore has investigated the ventilation systems in the affected area.
"The outcome of the investigation suggests that the likelihood of virus being spread to other wards is extremely low. IPC and ARPHS are reviewing these findings and will advise accordingly."
CMH was seeking advice about reviewing screening questions at the front door to include abdominal pain as an indicator of Covid-19 risk.
Auckland Regional Public Health Service (ARPHS) said yesterday it was undertaking a case investigation to identify and isolate close contacts.
"All patients and staff working in the two affected wards between 6.30am and 4.30pm on Sunday 5 September are being classed as close contacts until we have done further investigations," Counties Manukau Health added.
A ministry spokesman said he understood Counties Manukau DHB would undertake a debrief and internal review of what occurred, including their processes, which was normal procedure.
"The ministry also understands Counties Manukau Health has already updated its Clinical Assessment Tool, which clinical staff should refer to when assessing all patients, to increase the range of symptoms that warrant Covid-19 testing."
Speaking with members, Nuku said nurses are scared as they may possibly infect their families and friends with Covid-19.
"They are really scared of taking something home and being responsible for spreading this," she said.
Timeline of events
• 1700hrs a patient presented in ED with abdominal pain. When asked screening questions, patient denied having contact with Covid-19 or having been in a location of interest
• He was triaged into main ED assessment where staff are in full PPE (N95s and goggles). He stayed in an open curtained room and seen by ED staff
• 2039hrs he was moved to Adult Short Stay into a four-bed room, where he awaited test results
• 2242hrs he had a CT scan and returned to Adult Short Stay.
• 0305hrs he was seen by the surgical registrar
• 0700hrs was admitted to ward 34N. At this stage no symptoms gave teams reason to consider he may be Covid-19 positive. He was admitted into a four-bed room at the front of ward 34N. Ward staff were wearing appropriate PPE for a surgical ward (ie surgical masks).
• He developed a fever during this time. Still no cause was identified for the abdominal pain.
• 0955 the consultant surgeon ordered swabs observing fever symptoms; clinical documentation records no cough, no loss of taste or smell, and patient had not been to any locations of interest
• Patient remained in the room post-swab because there were no isolation spaces on the ward. On advice from IPC the patient wore a surgical mask and curtains remained closed
• 1500 test result received with a low CT value
• 1620 patient moved to Ward 7 for Covid-19. Full PPE was observed.