Close to 20,000 Kiwis are missing out on dental care every day because of the lockdown and at least one person is in intensive care due to a life-threatening infection, says the head of the Dental Association.
Dr Katie Ayers, the president of the New Zealand Dental Association, is one of a string of health professionals due before the Epidemic Response Committee.
Ayres says she is now aware of at least one person currently in intensive care for the management of life-threatening dental infections.
She said the profession was in a "dire state" due to a lack of government planning, support and virtually no available PPE.
"The dental profession has been telling Government and the public for weeks about continued access issues around the mandatory requirements and quantities of PPE.
"However, the extreme uncertainty for us is a lack of ready guidelines setting out what dental treatment should look like at each Alert level. This means that planning is unable to begin. There is currently no indication when dental practices will be able to reopen and a workforce of over 10,000 is essentially sitting without work.
"Dentists are essential primary health care workers as they are frontline and there is a looming public health crisis, with one out of eight practices already having laid off staff and up to 45 percent currently being forced to consider doing the same.
The NZ Medical Association, the Aged Care Association, the Pharmacy Guild, the Disability Support Network are also appearing before the committee today.
Otago University Professor and epidemiologist Sir David Skegg will also appear.
It's likely the representatives will be asked about issues on the frontline and access to personal protective equipment (PPE).
The roll-out of the flu vaccine which saw doctors go without for up to 10 days without supply has been described as a "debacle" and "total disaster" by the NZ Medical Association.
And the block of second tranche of funding to GPs could see some practices and doctors without work by next week.
Kate Baddock, chair of the association, which represents doctors across all healthcare settings, is appearing before the Epidemic Response Committee.
She said the issues with the roll-out of flu vaccine meant her practice went without for 10 days while they had 4000 vulnerable people they needed to vaccinate.
"The flu vaccine was a complete debacle - there's absolutely no doubt about that," Baddock told the committee.
And the news Cabinet had stopped the second tranche of funding to keep GPs will have an immediate impact on practices.
The Herald yesterday revealed the second half of a $22 million funding package had been stopped by Cabinet but many GPs were depending on that money and had already spent it on overheads.
Baddock said they needed that decision reversed by the end of the week or practices and doctors would be out of work.
Baddock, a GP, also described the scramble to move almost all face-to-face appointments online as "hectic" and "frantic".
"It was an incredible feat that they've been able to achieve."
Chief executive of the New Zealand Aged Care Association, Simon Wallace, said it "seems crazy" that they can't test 700 people being admitted to rest homes each week when there's capacity to do so.
People being admitted might not have a sniffle or a sore throat, but they have many underlying health conditions and were at risk.
"If the likelihood is low but the severity is high like it is with Covid 19 why would you not test?," Wallace said.
"We just don't understand the rationale for not testing."
He said aged care facilities had to agitate DHBs to get PPE at the start of the crisis and while the situation had improved greatly, there were still pockets still struggling to get the supply they need.
Facilities shouldn't still have to quibble with health boards to get PPE, Wallace said
The chief executive of the Pharmacy Guild of NZ, Andrew Gaudin, wants the Government to scrap prescription fees.
Many people aren't able to afford the co-payment so pharmacies are being left $5 out of pocket each time they give prescriptions to people who need the medicine but can't pay for it.
The sector also had to battle to get adequate PPE for their frontline staff which see 1.5 million people each month, he said.
"That has now been resolved but it took too long."
Many pharmacies had to pay for it themslves, he said.
The sector also desperately needs funding because many community pharmacies may end up having to close without Government support.
Gaudin said the guild had tried to meet with Health Minister David Clark and Director General of Health Ashley Bloomfield but neither had made themselves available.
Pharmacies needed funding immediately, he said.
"This is delicate, pressing and urgent and it needs attention immediately … we're pulling our hair out."
If you can't stay open, you can't provide the service New Zealanders need, Gaudin said.
There was also the issue of pharmacists being able to access those who can't get to a pharmacy and a new delivery model was being worked on.
"But we don't have the answers yet."
There's a collective challenge about how they reach out to people at home so sick people "don't then hit the hospitals" when their conditions worsen because they aren't going to their GP or pharmacy.
"That would be appalling."
This isn't about making money, this is about staying afloat and providing the service New Zealanders want, Gaudin said.
"Community pharmacists have felt undervalued and under recognised. I take my hat off to them."
Chief executive of the Disability Support Network, Garth Bennie, said there'd been slow and contradictory decision making by the Ministry of Health.
For example, disability support workers originally weren't recognised as essential workers and had to fight to get their status changed.
There'd also been "considerable" confusion around guidance on PPE, Bennie said.
The sector also needs more secured funding to ensure ongoing service as many providers were already eyeing their next payroll payments with worry, he said.
Bennie said there'd been contradictions within the Ministry itself and significant delays to get advice approved.
Providers were still having to battle individual DHBs for PPE which had been unaware of the scope and scale of the disability sector. (edited)
The PPE situation was "definitely a work in progress" and while it had improved, there were still issues with supply, Bennie said.
Providers were having to ration PPE themselves because "they don't feel they have an adequate source", Bennie said.
One provider is yet to receive any PPE.
The single biggest cost for providers was staff, Bennie said.
Some lost 30 per cent of their workforce during the lockdown because the workers themselves were vulnerable and were told not to apply for the wage subsidy scheme as staff would be provided.
That hasn't yet happened and so providers had to employ workers at their own cost, Bennie said.
There had, however, been a flexibility under the Covid-19 crisis about how staff and resources were deployed which the sector had been asking for "for years", Bennie said.
He hoped that would continue after the pandemic.
Speaking to the Committee NZDA President Dr Katie Ayers said Australia was "well ahead" of New Zealand as dentists there had been able to work on their own guidelines.
Dentists were struggling to get PPE for urgent dental work.
The cost of full PPE required for an urgent procedure was $80 and Ayers said it was not fair to expect patients to pay for this - yet practices can't bear this cost either.
Some DHBs still hadn't sent any PPE to practices despite the public repeatedly being told it was available.
Because of the costs, some practices will be forced to fold, she said.
The industry hadn't been adequately considered throughout the crisis.
This was creating a looming dental health crisis, Ayers said. The industry needs clear guidelines, adequate PPE and more funding.
And the situation for dentists was still unclear under alert level 3, she said.
The team within the Ministry of Health was too small and not powerful enough leaving the dental industry feeling its voice wasn't being heard.
Ayers said the patient in ICU was seen by the dentist who tried to manage the patient with antibiotics and pain relief but that wasn't successful and was admitted to hospital for an infection which was spreading from his mouth down through his neck.
The man had to be airlifted to another hospital for emergency surgery and was now in intensive care.
Ayers said because they're not allowed to do procedures to preserve teeth - like root canals - would mean more extractions.
The overheards at Ayers practice while it was closed were about $60,000 a month.
She also urged the Government to get fluoridation across the line after Covid-19 as it was vital for prevention of dental issues.
Epidemiologist and University of Otago professor Sir David Skegg said there'd been good progress with suppressing Covid-19 with border issues resolved, widespread testing and issues starting to be addressed.
The Government's pivot to having a goal of elimination was ambitious but achievable, he said.
Nearly all of the issues many of the health sector raised would disappear if elimination was achieved.
Sir David said there was still a big risk with airline staff not having to self-isolate, as seen with the Bluff wedding cluster.
Australia was in a better position to contact trace because it hadn't run down its health system for decades like New Zealand had under both National and Labour governments.
Australia is now also looking to eliminate the virus which Sir David said he hoped they'd be able to achieve so we could have a "trans-Tasman bubble".
Countries like the States and the UK would not be able to ever achieve elimination and they'd have to wait for a virus.
"I fear that a lot of the world is going to look like a trainwreck in slow motion."
Sir Kegg said testing people with symptoms needed to be supplemented with active surveillance in at risk communities and contact-tracing needed to be scaled up urgently to ensure New Zealand reached its elimination goal.
But Sir Skegg said perhaps the most important factor of all was New Zealanders maintaining physical distancing under alert level 3.
He said comment pieces calling for the lockdown to be eased relied on data from overseas in countries which weren't hoping to achieve elimination.
Eliminating Covid-19 would be one of New Zealand's greatest achievements, Sir David said.
Chair of the committee, Opposition leader Simon Bridges, said about the representatives: "All of these organisations have faced difficulties during the lockdown, particularly when it comes to accessing to PPE."
Also on the committee is National party health spokesman Michael Woodhouse who has also been critical of the Government's handling of PPE and has said it was too slow to act.
The Auditor-General yesterday announced a review into the Ministry of Health's distribution of PPE after mounting frustrations from healthcare workers on the frontline despite reassurances from top level officials.
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The review will assess the controls over procurement, distribution to district health boards and other agencies and stock levels.
Director-General of Health Ashley Bloomfield said he welcomed the review and any recommendations it may have.
Skegg will be appearing before the committee as an independent witness.