A review of last year's winter health response recommended ventilation be improved in a range of settings as part of the 2023 plan, but the Government has ignored that advice, Marc Daalder reports
The Government's plan to keep hospitals running over winter has a concerning "omission", experts say.
The plan, which mostly deals with shifting demand for hospital services to primary care, lacks any mention of improving ventilation to reduce disease spread. That's despite an independent review into last year's winter health response advising the Government to make ventilation a bigger focus this year.
A rapid review of the 2022 winter response, which didn't arrive until early July, was supportive of the measures used but critical of the process and communications. While Covid-19 cases declined after the plan was introduced, independent consultants Allen + Clarke said that couldn't necessarily be attributed to the Government's actions. In the end, Covid-19 killed more than 1100 people between June and August.
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Many of the recommendations of the review, such as more timely development of a winter plan and the involvement of primary, secondary and community care, have been embraced by the Government. However, one on ventilation has been ignored.
The review recommended the 2023 plan "consider ventilation in a broad range of settings and how this can be incorporated into the health system response, as recommended by public health experts".
Newsroom sought comment from Health Minister Ayesha Verrall's office regarding the absence of ventilation from the 2023 plan and was referred to Te Whatu Ora/Health New Zealand. Te Whatu Ora referred Newsroom to the Ministry of Health, which pointed to the Ministry of Business, Innovation and Employment, which redirected the query back to the health ministry. It ultimately took two-and-a-half weeks for the Government to confirm ventilation won't feature in the response this year.
"Improving ventilation is a complex, systemic, long-term issue which requires a whole-of-government approach and considerable investment across the public, private and residential sectors. In the last half of 2022, government officials looked at possible ways to improve ventilation to have the greatest health benefit and ways to achieve this. Factors looked at included different environments where the state has a duty of care, as well as high risk indoor spaces and workplaces, and those where vulnerable people are present," a ministry spokesperson said.
"Much has also be learnt about the benefits of ventilation since the beginning of the pandemic and evidence continues to emerge. The Ministry of Health continues to monitor developments in this area. Ventilation will be an important part of future policy, population health and pandemic planning.
"Te Whatu Ora’s 2023 Winter Preparedness Plan is a comprehensive plan of 24 short and medium-term initiatives to help support community care and reduce hospital demand this winter. It also takes on board the lessons learnt from winter 2022, highlighted by Allen + Clarke, and those learnt from the pandemic since 2020, including the benefits of public health measures physical distancing, isolation, testing and hand hygiene. Vaccination remains one of the best ways we can protect ourselves and our vulnerable loved ones who are most at risk of severe illness from Covid-19."
Emily Harvey, lead researcher at Covid Modelling Aotearoa, told Newsroom being indoors "massively increases the risk of disease transmission".
"There's starting to be evidence that clearly shows that when you improve ventilation in these indoor settings, you can reduce the risk of Covid and other virus transmissions."
University of Otago epidemiologist Amanda Kvalsvig agreed.
"Indoor air quality is still a big gap in our defences and that's a great pity, because it's one of the most effective and cost-effective protections that we have. There is just no downside to breathing clean air. It's a fundamental health protection just like drinking clean water," she said.
"All New Zealanders should feel confident that they can access essential sites like healthcare, education, and work even if there are high levels of infection circulating in the community."
She said a short-term response could include improving ventilation on public transport and placing portable air filters in key indoor locations to remove viruses from the air.
Harvey said other countries were implementing ventilation measures that New Zealand could learn from, like requiring businesses and public facilities to prominently display air quality information.
If actually improving ventilation in most settings wasn't possible by the start of winter, she said she'd like to see two measures from the ministry.
"That businesses, classrooms, and healthcare settings should be assessing the indoor air quality and safety and communicating that to people in real time through the use of CO2 monitors and other signage about the performance of the ventilation/filtration that is in place [and] that people should be wearing a mask in indoor settings with poor ventilation," she said.
"Recommending the monitoring and communication of risk would hopefully incentivise businesses/classrooms/healthcare settings to make changes in real time like opening windows or increasing HVAC settings or adding portable air cleaners, and if that doesn't do enough, it gives justification for targeted requirements around mask wearing for those higher-risk environments."
She was also concerned to see the ministry had not emphasised mask-wearing in its statement to Newsroom about public health measures. The Allen + Clarke review also advised the ministry to issue communications encouraging mask-wearing this winter.
"It seemed an omission that when they were talking about public health measures that will decrease transmission, that both ventilation and also masking weren't mentioned," she said.
"If improving ventilation is not something that can be done (even in high-risk settings like healthcare facilities) in time for this winter, then there is evidence to support recommending or requiring masks to help reduce transmission in those settings in the short term."
Kvalsvig said New Zealand was lagging behind the rest of the world.
"People sometimes ask about Covid protections: 'Are we going to keep this up forever?' In the case of clean indoor air, the answer is yes. Healthy indoor environments should be a lasting legacy of the Covid-19 pandemic. Once we get used to going through winter without a stream of coughs and colds and overloaded hospitals, we'll never want to go back."
