Contact tracing audit exposes significant shortcomings in health system

A high-level audit of the Ministry of Health's (MoH) COVID-19 contact tracing programme has found it risks being overwhelmed by a large-scale outbreak and has an "urgent need" for expansion.

Infectious diseases expert Dr Ayesha Verrall was commissioned by the MoH to do a rapid report on the health sector's approach to contact tracing.

Contact tracing involves tracking down and isolating people who may have been exposed to the virus before they can spread it to even more people.

But Dr Verrall's report has found the MoH's system is understaffed and lacking cohesion.

Before the outbreak, New Zealand relied on 12 Public Health Units (PHUs) to track and manage cases of communicable diseases such as mumps and measles.

These "highly devolved" units used different systems, from "basic excel templates" through to "purpose-built clinical systems". 

Appearing on Magic Talk on Monday afternoon directly after her report's release, Dr Verrall said this wasn't up to scratch.

"We have terrible data systems in the health system," she told host Ryan Bridge.

"We have 12 different Public Health Units. 12 different data systems."

As case numbers rose in March it became apparent that the workload would exceed the PHUs' capacity.

In response, a hub called the 'National Close Contact Service' (NCCS) was established in the MoH to coordinate the tracing and it was given its own technology solution (NCTS).

"Initially, the timeliness of the process was poor. For example between April 2 and 8 the average time from referral to instructing a contact to isolate was 2.3 days," Dr Verrall wrote in her report.

"Only 60 percent of contacts could be easily reached by phone, either because of incorrect contact details or because people choose not to answer calls from an unidentified number."

PHU staff were also cautious about diverting contact tracing to the NCCS as they couldn't see the outcome.

Dr Verral says the health system's response has "improved a lot", but we "still need to do more" to expand the number of cases that can be traced and the speed at which this can be done.

"There's been some expansion of the system since then but it needs to be expanded further," she told Bridge.

"The MoH has recently built a really good technology system for the central hubs for contact tracing and access to that needs to be extended to the Public Health Units."

Speaking at his press conference on Monday, Director-General of Health Dr Ashley Bloomfield said contact tracing in New Zealand has now become a nationwide automated system.

"Contact tracing was one of the first things that we started to scale up including creating a national service with more than 200 staff who have had the sole focus of tracking down close contacts of confirmed and probable cases," Dr Bloomfield said.

"Essentially what we are doing here is transforming what was a very local, manual process into a national automated system with scale."

But  Dr Verral's audit of the current system found "even these temporary increases are insufficient for likely future workload".

She told Newshub: "We definitely need more staff on the ground in public health units and we can't get away from that. These outbreaks are really complex. You can't manage a rest home outbreak, for example, from a call centre. You have to be there on the ground."

In a statement on Monday, Health Minister David Clark said the Government would invest another $55m into contact tracing. 

"Currently the NCCS has capacity to make 5000 calls per day, and the MoH is confident that can be scaled up to 10,000 if required. PHUs can also trace up to185 cases per day between them," he said.

"This funding will mean PHUs can be expanded as required, with additional surge capacity of up to 300 full-time equivalent staff. The NCCS will also get extra resources to manage complex investigations, such as detailed analysis of clusters."

Dr Verrall says that's acceptable for this stage in the crisis when the country remains locked down but says we must do better.

"I think we need to be able to surge up to tracing up to 1000 cases, and their contacts and remember when we go to level 2, each case will have many contacts because we're moving about more freely," she told Newshub.