Appendix 3.pdf

MINUTES: Technical Advisory Group COVID-19
Date:
Friday 20 August 2021
Time:
10.30 am – 12:00 pm
Meeting URL:
s 9(2)(k)
Location:
Meeting ID: 838 4804 8739
Passcode: Covid19TAG or Numeric Passcode: 6481015800
Chair:
Ian Town
Bryan Betty, Erasmus Smit, Matire Harwood, Michael Baker, Nigel French, Nigel
Members:
Raymond, Sally Roberts, Shanika Perera, Virginia Hope  ACT 1982
Ministry of Health Attendees:
Andi Shirtcliffe, Daniel Bernal, Jeremy Tuohy, Anne Buckley, Christian Marchello
Guests:
Stephen Harris, Susan Morpeth
Apologies:
Anja Werno, Caroline McElnay, Collin Tukuitonga, Emma Hickson
INFORMATION
Welcome and Previous Minutes
1.0
Dr Ian Town welcomed all members, attendees, and guests in his capacity as Chair of the COVID-
19 Technical Advisory Group.
Minutes of the last meeting (23 July 2021) were approved.
The meeting was shortened to one hour due to urgent matters requiring the attention of the Chair.
Ministry of Health Update on COVID-19 Response
2.0
The Chair provided an update on the Ministry of Health COVID-19 Response.
•
The Chair outlined the current situation, with community cases identified in Auckland and
Wellington and the expectation that this number will increase. At the time of the meeting a
decision had not been made regarding the duration of the level four lockdown, but it was
acknowledged that with the identification of cases outside Auckland that the current
situation should be considered a nationwide outbreak and a continuation of a nationwide
lockdown was likely.
•
The potential issues with health staffing particularly in the Auckland region were noted with
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many hospital staff being off duty due to contact with a case.
•
Testing staff and contact tracing staff may also be affected.
•
Testing capacity – looking to stand up additional capacity and consideration of the
increased use of saliva testing
•
Working on clear messaging about who is priority for testing and to contact Healthline – to
manage capacity
•
Vaccinations will continue, and pivot towards vaccinating as many individuals as possible
with their first dose to ensure some protection to as many people as quickly as possible.

Comments from the group included:
•  Concerns that there was not yet a consistent national pathway for management of COVID-
19 in the community, for example the ability to deploy pulse oximetry widely to ensure
cases with worsening disease are identified promptly
ACTION: Guidance on community management needed (particularly use of pulse oximetry). Follow
up with Justine Lancaster.
•  Concerns that supply of necessary items such as swabs was a potential problem and
would require close monitoring.
•  A wide raging discussion was held on the availability of therapeutics. The topics included
which medicines are useful in managing COVID-19, are these medicines available in New
Zealand, what regulatory requirements are needed to ensure these medicines are
available and are the clinical guidelines for the use of the medicines (developed at
Middlemore Hospital) both available and tailored to the New Zealand system.
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ACTION: a therapeutics advisory group will be established with an initial point of contact in the
Science and Technical Advisory Team
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•  It was suggested that testing and vaccination for essential workers is prioritised where
possible.
•  Need for isolation policy for vaccinated and unvaccinated essential workers raised. Chair
advised Andrew Connolly preparing this advice (S70 notice).
•  Comments were also made in relation to mask wearing and the necessity to engage with
the younger and most mobile members of the community to ensure they understand the
requirement to strictly adhere to the lockdown.
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Science Updates
3.0
Three COVID Science Updates (CSUs) were included with the agenda for information.
•  CSU 43 – Increased transmission of Delta variant: higher viral load and shorter incubation
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period and Mask-wearing and HEPA (High Efficiency Particulate Air) filters reduce
exposure to aerosols able to carry SARS-CoV-2
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•  CSU 44 – Variants of Concern key info summary and Guillan Barré Syndrome after
COVID-19 Vaccination
•  CSU 45 – COVID-19_Mortality_in_Children.
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Infectious Period/Release from Isolation Criteria
4.0
A document outlining the available evidence for any change in the diagnosis of the infectious
period and release from isolation had been circulated.
An outline of the rationale for this review was presented. In brief this was due to changes made in
Australia due to a possible case of transmission after a full 14-day isolation in MIQ (Managed
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Isolation and Quarantine) in Brisbane and due to an increase in the ability to culture live Delta
variant virus after 14 and 18.
The review did not identify a rationale for changing the current criteria for the infectious period or
release from isolation.
Comments from the group included:
•  Surrogates for infectivity will require development and further assessment as it is not
feasible to gauge the efficacy of changes to managed isolation based on the number of
cases causing infection in the community after leaving MIF (Managed Isolation &
Quarantine Facility).

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MINUTES: Technical Advisory Group COVID-19
Date:
Friday 17 September 2021
Time:
10.30 am – 12:00 pm
Meeting URL:
s 9(2)(k)

Location:
Meeting ID: 838 4804 8739
Passcode: Covid19TAG or Numeric Passcode: 6481015800
Chair:
Ian Town
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Anja Werno, Bryan Betty Erasmus Smit, Matire Harwood, Michael Baker, Nigel
Members:
French, Nigel Raymond, Virginia Hope
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Ministry of Health Attendees:
Andi Shirtcliffe, Daniel Bernal, Jeremy Tuohy, Phoebe Currie
Guests:
Stephen Harris
Collin Tukuitonga, Sally Roberts, Shanika Perera, Caroline McElnay, Emma
Apologies:
Hickson
INFORMATION

Welcome and Previous Minutes
1.0
Dr Ian Town welcomed all members, attendees, and guests in his capacity as Chair of the COVID-19
Technical Advisory Group.
OFFICIAL
Minutes of the last meeting (20 August 2021) were approved.
Ministry of Health Update on COVID-19 Response
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2.0
•  The Chair provided a verbal update about the ongoing Auckland outbreak response.

•  It was noted that the COVID-19 Testing Technical Advisory Group and the COVID-19
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Therapeutics Technical Advisory Group had been established.

•  Modelling is being undertaken to assess the interaction of aspects such as vaccination
coverage, public health controls, alert levels and the number of people coming across
border.

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•  It was noted that there are challenges in reaching communities who may have low trust in
Government, work is being done to consider vaccination options for these groups in the
future, such as the Janssen vaccine.

•  There was wide ranging discussion about vaccination and in particular the need for high
rates to mitigate widespread community transmission.

•  Concerns were raised by the group about the preparedness to manage higher caseloads of
COVID-19 in the community outside of MIQ and the potential impacts on the health care
sector. It was noted that there was an ongoing work programme progressing this matter.

Science Updates
3.0
COVID Science Updates (CSUs) 46 “Vaccination in pregnancy is not associated with miscarriage” was
included with the agenda for information.
Elimination Strategy/Reconnect Aotearoa New Zealand
4.0
•  An update was provided on the draft ‘Elimination Strategy and COVID-19 Directorate
Workstreams Priority Overview (2021)’. The fundamental principles have been discussed at
previous meetings.

•  The Elimination Strategy remains integral to the health system response. Work is underway to
consider the impact of ‘Reconnecting Aotearoa New Zealand’ while incorporating lessons from
the Delta experience and understanding what this means for health system readiness.

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•  The approach is moving towards reconnecting, with a cautious lens and greater sensitivity,
noting the many interdependencies that exist.

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•  The Chair noted that there are multiple pieces of work across agencies that are demonstrating
the necessary agility in this changing environment such as the recently announced self-
isolation pilot.

TAG feedback included:
•  Concerns were raised about the ‘Manage the Impact’ pillar, particularly in relation to impacts on
primary and secondary care. It was suggested that an addition is made to the document to
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reflect management in the community if COVID-19 becomes endemic.

•  Concerns were raised about the capacity of hospitals and ICUs and the associated staffing
required. It was suggested that if the necessary hospital capacity was not available then there
would likely be an increased need to use Nonpharmaceutical Interventions (NPIs) to manage
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COVID-19.

•  There was discussion around the language used in the Elimination Strategy in the context of
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reconnection. It was suggested there may be changes required, particularly in relation to
vaccination coverage and community protection.

ACTION: Raise with Stephen Harris the questions regarding language, particularly noting the
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suggestion of an addition regarding community management of COVID-19.

•  A member raised a question regarding the language relating to natural immunity and boosters.
The Chair noted that there is no formal messaging on this yet.
ACTION: STA to raise the topic of natural immunity and boosters with CV TAG.
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•  It was suggested that the ‘Keep it Out’ pillar needs to reflect the risk of the much higher
reproduction rate of COVID-19 and the risk to unvaccinated people.

ACTION: Andi Shirtcliffe to take offer of assistance to CVIP leadership and SRO leads across DHBs.

•  There was general discussion around vaccination, particularly regarding mandates, the
importance of high uptake and increasing the messaging on the benefits of vaccination,
focusing on reduced disease severity associated with vaccination.

•  Members noted the dynamic situation that COVID-19 presents, and that the situation could
change rapidly. It was suggested that while continuing to progress the Elimination Strategy, and

focusing on vaccination as a priority, there should also be planning for what comes next.  It was
suggested that a key consideration in this planning must be how to protect vulnerable people,
especially if the situation changes quickly.

ACTION: Raise with Stephen Harris the suggestion of continuing to progress the Elimination Strategy,
alongside planning for the future, particularly in relation to vulnerable people.

Māori Health Perspectives
5.0
•  Dr Matire Harwood provided a verbal update.

•  Increasing vaccination rates remains a key focus for Māori Health, particularly in Auckland.
There are several initiatives aiming to increase accessibility to vaccination, including drive
through centres and the newly established buses.

•  Another key focus is connecting with hard-to-reach and vulnerable communities, to assist
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with access to and knowledge about testing and vaccination.

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•  Members raised the idea of concurrent testing and vaccination for hard-to-reach
communities and/or areas of high prevalence, for which there was support.

•  The Chair noted this, acknowledging the potential risks such as a vaccination centre
becoming a location of interest and needing to be stood down, and advised work is being
done to understand community needs and that this would be followed up with the team.
ACTION: Provide feedback to TAG about concurrent testing and vaccination suggested by the group.
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•  It was noted that some religious groups are encouraging their members not to be vaccinated.
The success of the Elimination Strategy has meant some people don’t believe they are at risk
of encountering COVID-19.

•  The Chair responded that the Ministry is aware of this issue and the Ministry and Government
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are working hard to engage with these communities to promote vaccination.
Pacific Health Perspectives  THE
6.0
No formal update given, noting that Collin T is actively engaged in supporting the South Auckland
response.
Any Other Business
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7.0
•  Update on open action 68: The potential to change parameters in the App has limitations and
modifications to the current settings could potentially have large scale unintended effects on
Contact Tracing numbers by markedly increasing the number of brief episodes without a
significant improvement in the efficacy of Contact Tracing.
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Agenda Items for Next Meeting
8.0
None noted

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MINUTES: Technical Advisory Group COVID-19
Date:
Friday 22 October 2021
Time:
10.30 am – 12:00 pm
Meeting URL:
s 9(2)(k)

Location:
Meeting ID: 838 4804 8739
Passcode: Covid19TAG or Numeric Passcode: 6481015800
Chair:
Daniel Bernal
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Anja Werno, Bryan Betty, Collin Tukuitonga, Erasmus Smit, Matire Harwood,
Members:
Michael Baker, Nigel French, Nigel Raymond, Sally Roberts, Shanika Perera,
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Virginia Hope
Ministry of Health Attendees:
Andi Shirtcliffe, Jeremy Tuohy, Phoebe Currie, Harriette Carr
Guests:
Sharon Sime
Apologies:
Ian Town, Caroline McElnay, Emma Hickson
INFORMATION

Welcome and Previous Minutes
1.0
Dan Bernal welcomed all members, attendees, and guests in his capacity as Acting Chair of the
COVID-19 Technical Advisory Group.
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Minutes of the last meeting (17 September 2021) were approved.
Update on Open Actions
2.0
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Actions updated in table below.
Ministry of Health Update on COVID-19 Response
3.0
•
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The Chair thanked the members for convening as part of a wider group that was
consulted last week. There was a question regarding the notes for that meeting. These
were being managed through the administration of that group and were subsequently
distributed.
•  There was discussion around booster doses and several members agreed that it was
also important to focus on providing a second vaccine option for those who are hesitant
RELEASED about mRNA vaccines. This was noted by the Chair.
•  It was noted that there was an announcement detailing the Protection Framework by the
Prime Minister occurring concurrently to the meeting which would further guide our
response in future.
Science Updates
4.0
COVID-19 Science Updates (CSU) 47 – COVID-19 outcomes in children with Delta was included
with the agenda for information.

•  A member raised that this information would be useful for the community. The Chair noted
that CSUs are usually published on the Ministry website after progressing through internal
review processes.
•  A member suggested that the risk of severe outcomes in children could be more nuanced
by a more granular detail regarding the details, such as co-morbidities, and outcomes of
the children involved in the studies, the aim of this would be to increase understanding and
allay fears regarding this highly emotive issue.
•  It was suggested that there are many reasons to vaccinate children, one of the most
compelling is to reduce the transmission in the population. The Chair noted that
consideration of vaccinating children is dependent on MedSafe receiving an application on
this matter.
ACTION: Update CSU 47 – ‘Risk of hospitalisation and severe outcomes from COVID-19 in
children: Evidence from the Delta wave in the United Sates with further detail before publishing on
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Ministry website.
Risk Assessment and Categorisation of Healthcare Workers Exposed to COVID-19
5.0
ACT
•  Proposed changes to the Risk Assessment and Categorisation of Healthcare Workers
Exposed to COVID-19 were presented to the group.
•  The matrix has already received endorsement from the Public Health Advisory Group.
•  The NRHCC has requested that the requirement for using P2/N95 masks as source
control be removed and medical masks be used instead. Based on data from the current
outbreak there is evidence to suggest the risk associated with this change would be low
given that staff are highly vaccinated and familiar with PPE protocols.
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•  It was noted that the guidance is a living document and further adjustments can be made
in the future as required.
TAG Feedback included:
•  There was general discussion around the proposed changes, the group agreed with the
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suggestions and provided feedback.
•  It was suggested that the wording should explain the reasoning and efficacy evidence for
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the use of medical masks and note the option to wear an N95 is still available if preferred.
Managing the perceptions of the change is important to ensure this is not incorrectly
perceived as due to a restriction of PPE availability.
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•  A question was raised whether the changes would extend to HCW in the community. It
was noted that although Community HCW were in favour of these changes being applied
in the community and extension of these provisions to those groups would be appropriate,
the first priority was to address the impact on the Hospital based workforce.
•  A member suggested that the ‘high risk exposure’ column be edited so that the ‘Lab
worker handling COVID-19 specimens’ sentence is more specific to an exposure event as
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lab staff are usually wearing full PPE and not in frequent contact with patients so aren’t
considered high risk.
Categorisation and Management of Contacts
6.0
•  A memo provided with the agenda summarised the proposed change in approach,
endorsement of the proposed changes is sought.
•  Due to the expectation of large numbers of cases and contacts, it will be necessary to
make some alterations to our Contact Tracing processes and guidance.

•
The proposed changes to categorisation and management of contacts reflect the
additional protection vaccination status can provide.
•
Contact tracing will continue to have a strong focus on the highest risk settings and
management and monitoring of those settings and whether they need to be reviewed.
•
The group endorsed the memo and provided feedback.
TAG Feedback included:
•
A member raised a question regarding the criteria of self-management and concerns
around messaging and understanding what level of involvement is expected from primary
care. Feedback was provided to consider some individual circumstances that may bring
additional challenges to proposed self-isolation pathways and that linkages between
primary care, PHUs and the NITC would be important.
•
It was noted that there was ongoing work between the Ministry and NRHCC around this.
As the approach moves towards a community model of care, there is a shift away from
PHUs doing daily monitoring for every case.
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•
There was general discussion regarding vaccination status being used to categorise the
contact initially, and then determine the management pathway. Vaccination status is an
important variable for how contacts are likely to be managed in the future state.
•
A member raised a question regarding mask use in the matrix and it was noted that
establishing the masking status for every exposure is often difficult, and this is an
additional reason for vaccination status becoming the primary determinant for how a
contact is managed.
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•
Further feedback may be provided by the group via email, regarding the use of
categorisations in particular settings, such as by Police.
•
National application of these changes was queried due to varying prevalence across the
country.
Māori Health Perspectives
7.0
•
There is a further Māori leadership group being established which will aim to increase
vaccination rates and provide further input into the COVID-19 response going forward.
•
There is a focus on increasing vaccination rates, and new initiatives to assist with this, for
example door to door vaccination in some areas in South Auckland which are known to
have low rates.
Pacific Health Perspectives
8.0
No update given.
Any Other Business
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9.0
None
Agenda Items for Next Meeting
10.0
None noted.

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