*3.2. Outbreak Management and Implementation of Cohorting*

After the notification of initial cases on the 8 January 2022, the LMPHU declared the farm an outbreak site and initiated public health actions as per the public health and wellbeing act of 2008. An outbreak was defined as five or more cases in a high-risk residential setting in accordance with the DH COVID-19 control strategy. Identification of close contacts was completed, and requests for further testing and quarantine of all farmworkers were initiated, cohorting the positive cases after clinical assessment.

On the second day of the outbreak, an IPCAR referral was made, and a site visit occurred on the third day (Figure 2). The visit highlighted the need for all staff to undergo training regarding the recommended infection control measures to prevent further spread of the SARS-CoV-2 virus. This visit also reinforced a two-step cleaning approach with a detergent to clean before using a disinfectant, the use of facemasks, and physical distancing.

**Figure 2.** Timeline for key outbreak management interventions from date the outbreak was declared to date of stand-down.

Cultural support and translation services were engaged on the second day as well and complimented the efforts for contact tracing, testing, and quarantine compliance as all workers had indicated Samoan as the preferred language. Further onsite RA testing and daily clinical assessment of all workers were performed before the outbreak was stood down on 15 January 2022 (Figure 2), noting that this was no longer a transmission site, i.e., all workers that did not test positive had completed their quarantine period.

All outbreaks managed by the LMPHU have an OMT. In this outbreak, an OMT was organised with farm management, the workers, and other stakeholders including pathology services, cultural and support services, an IPC consultant, medical leads, a local tertiary public hospital, and the local rural city council—emergency management. This OMT ensured that the farm was adequately supported to manage the outbreak; this was achieved through the provision of personal protective equipment, rapid antigen tests, and food for workers onsite. At the time of the OMT, more than 80% of the farmworkers were identified as either confirmed or probable cases. Considering the risks due to COVID-19 disease epidemiology, the LMPHU in liaison with the farm management provided an exemption for all asymptomatic individuals with positive RAT to be able to return to work with appropriate introduction of personal protective equipment (PPE). This was authorised by the deputy chief health officer and aided in ensuring that food distribution was not impacted.

COVID-19 cases globally were mandated to stay at home and isolate. In workplaces, this minimised the spread of COVID-19 to workers who remained asymptomatic and tested negative, facilitating industry productivity and minimising impact on the economy as we transitioned to the "new normal" [14]. However, asymptomatic cases were able to choose to work from home whilst completing mandatory isolation, depending on their work requirements [15]. In this case study, after the initial screening, all cases were isolated, and, when more were identified, it was no longer possible to effectively isolate them but was much easier to quarantine their contacts. For this reason, all who remained negative could not return to work. The LMPHU recognised that it was important to ensure that asymptomatic RAT positive staff members were not coerced to attend work. As such, a cultural support officer external to the business regularly visited the site. This worker was able to communicate with cases in their preferred language and discussed with the cases their rights to ensure that they were not being coerced to attend work. The LPMHU director

and medical lead advised that only cases who were asymptomatic and consenting were able to attend work. A further stipulation to this arrangement was that the farm health supervisor would be required to monitor staff to ensure that they were not presenting to work with symptoms. All cases received daily health monitoring through the local health service, and food relief was provided by the local multicultural support service. Both the farm health supervisor and cultural support worker provided language support to the cases; this was to ensure that instructions were communicated in preferred language for donning and doffing of personal protective equipment and for the use of rapid antigen tests. Overall, this public health response ensured improved health and social welfare of both cases and contacts throughout the outbreak period.

The positive farmworkers were cohorted in the accommodation onsite, whereas the negative workers were provided with single-room accommodation so that they could safely quarantine. All negative residents had to quarantine until all positive cases had completed their infection period, and effective cleaning of communal areas had been performed. This was ideal as there were challenges with fewer areas for appropriate quarantine, and only 6/74 (8.1%) workers had remained negative during the outbreak. Furthermore, the LMPHU engaged the IPCAR team to offer COVIDSafe training for workers in liaison with farm management on how to safely work with COVID-19-positive cases, PPE, isolation and quarantine requirements, and their implications.
