A case of COVID and a cup of tea: lessons for practices

Just by chance, last week all of Dee Street Medical’s staff in Mount Maunganui went into isolation after an asymptomatic staff member was given a PCR test and found she was positive for COVID-19.

What followed was a scenario that involved chaotic dealings with the Ministry of Health, an understanding that fate often has clear causes, and a very well-timed return home from the UK for nurse Emma Morton, who had started her new job at Dee Street two weeks earlier.

The team at Dee Street agreed to share their story with GP Pulse as a way to help other practices and there’s an offer to answer your questions at the end of this story.

Calling Emma Morton’s employment at Dee Street ‘well-timed’ would be a massive underestimation of the power of timing. She led the team’s response to their COVID-positive case and was informed by most recently having worked in the “nightmare” of COVID-19 nursing in Central London. Amongst other things, she worked in the Intensive Care Unit of Guy’s and St Thomas’ hospital; work she describes as “awful” but work that gave her the skills to lead Dee Street’s response.

She learnt on a Sunday evening that one of the practice’s staff had tested positive for COVID. She contacted the business’s directors, then organised for all staff to be tested, and consulted the Ministry of Health’s website for guidance. New Zealand is well behind the rest of the world’s outbreaks so Emma expected to find easy-to-use plans, policies, guidance, and possibly a checklist for what to do that had been informed by the situation around the world. She did not.

What Emma found was a matrix for what to do (dated 31 January 2022), which she dutifully followed only to be told later that she’d followed the ‘Phase Two’ matrix and the Ministry were currently working from ‘Phase One’. Start again.

Dee Street’s priority was naturally the safety of their patients and their staff. As Emma says, “I wanted people to hear from us first, instead of through a sensationalised media story.” They were also aware that there was a lot of anxiety circulating in the community about COVID-19 and that, particularly staff, had obligations to their families and that some would be isolating as single parents with kids.

They texted all their patients – wording that had to be signed off by the Ministry of Health and also shared messages on their website. They’ve shared the text message below for other practices to use if needed (to speed up your processes).

This is a message to inform you that a [practice name] staff member tested positive for COVID-19 on routine surveillance testing, while asymptomatic.

We are advising all patients that as a practice we are following strict Ministry of Health guidelines and carrying out diligent infection control practices at all times to ensure your ongoing safety.

If you have a face-to-face appointment within the practice in the next 7 days and would like to change this to a phone consult, please contact our reception team on [phone number] [hours] [days].

Please be assured that all staff are carrying out daily testing prior to seeing any patients and your safety is our main priority. Patients who have been identified as contacts are being managed by [insert organisation name] who are providing them with public health advice.

Working with the practice manager Camilla Wilkin, the two staff contact-traced staff and patients and ran an assessment around the building for weak points. Those two jobs took 12 hours. “Having better records about where staff were, and when, would have meant fewer people self-isolating because we would have been able to show contact points,” says Emma.

Now Dee Street ensure they maintain accurate documentation of where employees are working throughout the day incase there is a suspected COVID-19 infection within the workplace. Emma also wrote a ‘Prevention and Mitigation of COVID-19’ document for the practice, which documented many of the principles they were already running on (hygiene, communication, risk assessment etc) but made it absolute and ‘provable’ to the Ministry.

Emma encourages other practices to do this now, because the “watch and wait approach” that many people are currently operating is “not okay” once you get a positive case in the practice.

Because all the Dee Street staff were considered close contacts (and critical workers), the Ministry’s advice was to isolate at home with the exception being they were let out for work. They’d stay home (their house mates, partners and kids could come and go) and report each morning to the car park at work for a Rapid Antigen Test (RAT), which had to be negative before they could enter the building to work.

The practice had ordered RATs but they hadn’t yet arrived so ringing around other practices and the District Health Board (DHB) for RATs was something Emma had done on Monday (Waitangi Day) when she realised the PCR test results would come back too late to be able to keep the clinic open (a key objective for the team).

“Closing the practice was not an option for us because it would have put too much pressure on others in our community, so we needed to work out how to remain open safely,” says Emma.

“We have been very lucky to not record any more positive cases.”

The reason all of the team had to self-isolate was because they couldn’t be confident that nobody had come into contact with the positive person, who’d worked Tuesday and Wednesday, worked (and taken the survillance test) on Thursday, worked on Friday and got the results on Sunday.

“Our tea room was our biggest let down,” says Emma.

“It’s a small space of about four metres by five metres that sometimes had 10-20 people coming and going at a time. Masks are off for eating and drinking but we’d also got into the habit of taking them off just to socialise too so we couldn’t be confident to 90-100 percent that our positive case hadn’t been in that space with others.”

“We’ve since limited the number of people who can be in there, removed chairs, added signage about social distancing and been much more thorough about wiping down high-use areas like the fridge door handle and the coffee pot handle.”

“For us the breaking point was simple things like hygiene, things that we’re very strict about in clinical practice, but were a bit relaxed about when socialising.

“And because we couldn’t confidently show social distancing, or didn’t have a log of staff movements around the building during the day then we all had to self-isolate.”

While she understands the rationale, the model of self-isolation lacks a bit of common sense for Emma. “Every morning we proved we were negative but still couldn’t be in the community; no petrol or supermarket stops, for example, despite proving every single day that we were negative for COVID-19.”

• Confirm with the Ministry of Health which is the current guidance before you begin working through a process.
• Ensure you have documented practices and policies in place for managing COVID-19.
• Have a look at your practice today with fresh eyes and work out whether you’re doing the best you can on social distancing and mask adherence.
• Consider staggering break times and lunches.
• Use the message Dee Street wrote as a base for your own messages.

Dee Street is really keen that other practices learn from their experiences. If you’ve got a question for the team, please email it to communications@rnzcgp.org.nz, we’ll compile them (because we’re sure there will be common questions) and seek answers then share them back with everyone.