Residents at a rest home struck by a deadly Covid-19 outbreak were only all swabbed 11 days after a staffer tested positive - turning up undetected cases that health authorities say could have led to a "catastrophe".
Documents obtained by the Herald also reveal concerns that CHT St Margaret's aged-care home in Te Atatu lacked bins for safe disposal of personal protective equipment (PPE), after an outbreak began with the first positive result on April 4.
Only staff and residents with symptoms were tested, but on April 15 it was decided to swab everyone - and three more residents were found to have the highly-contagious disease, two of whom would die soon after being moved to hospital.
One of those residents had a cough in the week prior to her diagnosis, her son told the Herald. They were only officially told there was Covid in the facility the day before she was taken to Waitakere Hospital, where she died after a rapid deterioration in her health.
"If there were already cases at the rest home, and Mum had at least one symptom, it's surprising it was left that late before she was tested."
Waitematā DHB said its decision to swab all residents "averted a potentially catastrophic situation".
"If left undetected, these positive cases would likely have quickly spread within the facility, infecting large numbers of vulnerable residents," a spokesman said.
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DHB "situation reports" released under the Official Information Act provide a clear timeline of the outbreak for the first time.
A staff member first had Covid symptoms on March 28, and a total of five staff at the Te Atatu facility would fall sick before the first resident became unwell on April 7.
With facility staff sick or in isolation, the DHB sent in health care assistants from April 9, and registered nurses and cleaners from April 11.
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Only residents who had possible symptoms were tested, as per advice including from Auckland Regional Public Health Service (ARPHS).
This changed 11 days after the first case was confirmed and following a directive by Waitematā DHB's incident management team to swab all staff and residents, excluding those in the dementia unit.
By that point the lack of available staff was at a crisis point, and a rushed decision was made to send the six infected residents to Waitakere Hospital.
A situation report from that day - April 17 - shows DHB staff in the rest home had been worried about the PPE available, and on April 13 it was agreed they would wear fluid-resistant gowns instead of aprons "to manage staff anxiety".
There were "ongoing concerns with the safe doffing and disposal of PPE due to lack of rubbish bins". Staff were checked for symptoms at the start of shifts but temperature checks would begin only once infra-red thermometers arrived.
St Margaret's asked for other gear, including an urgent need for tympanic thermometers, stethoscopes, linen skips and bins. The volumes requested were based on a set of dedicated gear for each isolation room, with the request noted on April 8 and again on April 17.
"The facility is unsure about sharing medical equipment between residents in isolation and would value guidance on this. Currently sharing equipment and sanitising after each use," the situation reports state. "Bins and skips remain a priority."
St Margaret's is run by CHT Healthcare Trust, a charity with 16 aged-care facilities across the upper North Island.
CHT chief executive Max Robins declined to comment. He has previously said all its facilities had strictly adhered to ministry guidelines for PPE and infection control, and contact tracing immediately began after confirmation of the first case with ARPHS advising who to isolate.
The situation reports show frustration with communication: "Facility has noted that they are not getting clear clinical information about swabbing and classification of cases and noted that they have received differing advice," an April 8 document notes.
"Facility confirmed they do not have the capacity to swab large numbers of residents if this is agreed approach," a report from the next day noted. "Decision to treat symptomatic residents - facility to manage."
A Waitematā DHB spokesman said the decision to test all residents was made in consultation with the ministry and northern region health co-ordination centre, "even though the case definition at the time was that only symptomatic people should be swabbed".
"Given the emerging experience of significant rates of deaths in rest home overseas once Covid-19 entered these facilities, this was considered an appropriate precaution to take."
On the concerns over disposal of PPE, he said there were existing bins but larger rubbish bins were "considered helpful for managing the volume of material needing to be discarded".
Once groups of residents were sent to Waitakere and North Shore Hospitals the existing bins were sufficient. Extra equipment including thermometers was supplied, he said.
The St Margaret's "cluster" of linked cases number 51. A household contact of an earlier case announced last Friday was the country's latest confirmed case.
Director general of health Dr Ashley Bloomfield yesterday announced a former resident of St Margaret's, Eileen Hunter, 96, would be classified as a Covid-related death, bringing the nationwide number to 22.
Hunter was one of the six patients taken to Waitakere Hospital, and then to North Shore Hospital. She recovered and recorded two negative results, and was taken back to St Margaret's, where she died on Sunday.
Bloomfield made the announcement soon after the Herald reported on the case - saying her death would be included in the official tally "consistent with our inclusive approach to date".
Concerns related to PPE have now been raised at the two rest homes that have lost residents to Covid-19. The Herald previously revealed the coronavirus outbreak at Rosewood rest home in Christchurch spread so rapidly that there were "safe practice" issues, including the way PPE was used.
Six rest homes have had Covid-19 cases, and some successfully ended transmission quickly. Bloomfield noted the differing results when announcing a review into "what has worked well, and what could be improved". That report is set to be released in the next week.
The ministry has ordered all DHBs to audit aged-care facilities to make sure infection control and other processes are up to scratch.
Dr Debbie Holdsworth, director of funding for both Auckland and Waitematā DHBs, told a recent Auckland DHB board meeting that the auditing done after Covid-19 had "highlighted the standards need to be improved, and there have been lots of learnings that have come out of it".
"We will see a change to the standard which will lift the infection-control requirements that are set by the Ministry of Health."