A visitor to a hospital ward where Covid-19 patients were treated by nurses who became infected themselves says the lack of physical distancing between staff was surprising.
Nurses and doctors at Waitakere Hospital stood close to him when talking, the man said, and staff sat nearby one another in meeting rooms, at workstations and at while having lunch.
"It was noticeable to me that nobody was maintaining physical distancing at all."
The three infected nurses worked with patients transferred to Waitakere Hospital after an outbreak of Covid-19 at the St Margaret's aged care home in Te Atatu.
The nurses also worked shifts on other Covid-free wards - something clinical leaders from Auckland and Northland DHBs agreed was appropriate, as long as infection control safeguards including "meticulous" use of personal protective equipment (PPE) and physical distancing were observed within the workplace.
Waitematā DHB has now changed its policy so nurses caring for Covid-19 patients do not also work in other wards, something it says came after staff feedback and goes "above and beyond what is advised".
The source of the nurses' infection is being investigated, and 36 staff are in self-isolation as a precaution. Testing of staff has not returned further positive results.
A Waitematā DHB spokesman said staff were expected to observe the same physical distancing rules as the wider public when not using PPE.
"Correct and appropriate use of PPE at all other times is designed to mitigate risk of transmission while still allowing our staff to tend to the healthcare needs of our patients."
Nursing health and safety representatives raised concerns with management about staff moving between Covid and non-Covid wards after the transfer of St Margaret's residents on April 17.
The first nurse tested positive on the weekend of April 25/26, one was included in last Thursday's national tally of new Covid cases, and another the following day. A family member of one of the nurses is a probable case.
NZ Nurses Organisation kaiwhakahaere Kerri Nuku said hospital staff should keep a distance between themselves as much as possible, but there would be plenty of situations where that wasn't possible, such as when working in ED.
Nurses' organisation delegates were now in daily meetings with hospital management, and attention was turning to how big workplace "bubbles" should be.
DHBs are gearing up to clear a huge backlog of elective surgeries and procedures that were postponed during level 4, but the threat of Covid-19 means usual rostering can't always be used.
"When there are shortages of staffing - when staff call in sick - then staff are mobilised to different places," Nuku said.
"That was common pre-Covid, but because we are dealing with Covid-positive patients in one wing we can no longer do that sort of practice."
E tū has raised concerns about an official FAQ for DHB employees that advises no action is needed for those in close contact with someone who has recently been asked to self-isolate because of potential Covid-19 exposure, unless symptoms develop.
Asked today if the Waitakere Hospital situation was a wake-up call for DHBs, Director-General of Health Dr Ashley Bloomfield said it was a "learning experience". A DHB review with input from Waikato DHB's director of nursing was due on Friday, he said.
"I think all DHBs are interested - what did we learn? How do we strengthen our protocols and make sure that we are reducing the risk to our frontline health workers? And this will provide us with information for that."
Waitematā DHB says full PPE was worn by staff when treating the rest home residents. On April 17 ambulances transferred the first St Margaret's residents to Waitakere Hospital, with the DHB saying this "will ensure the residents receive the support they need while St Margaret's staff are cleared to return to work".
Three of those residents subsequently died. Another three residents with Covid-19 have now been moved from Waitakere to North Shore Hospital, which is also run by Waitematā DHB.
As of this afternoon, there were 43 cases linked to the St Margaret's cluster, with 18 recovered.
Five cases were added to the cluster in the past 24 hours, which were existing cases now linked to the grouping, and not new cases or patients at Waitakere Hospital. The origin of the outbreak is still listed as "unknown".