COVID-19 and winter response update, 17 August 2022

>> Kia ora koutou.

>> Kia ora koutou katoa welcome to Tamaki Makaurau for this briefing today.

And welcome here to the Tamaki Vaccination centre.

My name is Andrew Old, I lead the Public Health Agency and I am joined by Doctor Pete Watson -- lead the public health agency.

W elcome to both my guests and thank you for your time today.

Today I'm going to begin with the assessment of the current outbreak.

We will also talk about how the health system is tracking, and how Maori providers are continuing to respond to COVID-19.

Then we will have some final remarks before opening up for questions.

Today we are reporting 4489 new cases of COVID-19 and 496 hospitalisations, with 13 people in the ICU and 16 new COVID-19 related deaths.

Taking a step back from today's numbers, broadly community transmission of COVID-19 is continuing to trend downwards.

The seven-day rolling average of case rates continues to trend down across all regions.

Pleasingly the case rates among the over 65s, one of the most vulnerable groups to severe disease from COVID-19, has also dropped for the fourth week running.

Finally, case rates among healthcare workers have declined for the fifth week running and the level of virus circulating in wastewater across the motu is continuing to decline also.

Moving now to hospitalisations, in the week ending 14 August we have seen a further decrease in the seven-day rolling average of hospitalisations due to COVID- 19, down 11.

1% on the week before.

Hospitalisation rates have dropped in three of the four regions in the country, rising only slightly in the central region which represents a plateau for them.

This is the second week with a drop in hospitalisation rates after five straight weeks of increases.

As we have said before, hospitalisations tend to lag behind trends and case numbers by a week or two and that is consistent with what we are seeing this time.

He remains an incredibly busy time for our hospitals and Pete will talk more broadly on this shortly but it suggests there has been a sustained reduction in people with COVID-19 requiring hospital care, which is fantastic.

Trends in deaths also usually lag reported cases, and as you know it can take time to assess whether a death was caused by someone having COVID-19 at the time or some other reason.

We now have 1782 deaths that we are attributing to COVID.

But keeping this in mind, it's important that we are not quite ready to assume that we have deaths from COVID-19 truly peaking, although we are very hopeful given the trends we are seeing.

Thanks to our low levels of community transmission early in the pandemic and our high vaccination rates, New Zealand continues to have a low rate of deaths from COVID-19 since the start of the pandemic compared to many countries.

For example, based on a recent analysis in the UK, the COVID death rate was.

And in the US 3077 deaths per million.

If we had the same rates, we would be reporting over 13,000 deaths, or 15,000 deaths if we were looking like the US.

This is no consolation to all the people who have lost loved ones to COVID-19, and our thoughts as always with them at this time.

But it does help to put into perspective the significant effort and relative success of the New Zealand approach to COVID-19 over the last 2.

5 years.

Looking ahead, the modelling from COVID Modelling Aotearoa shows we are continuing to track at the lower end of what was expected in terms of a second wave this winter.

We passed the peak in cases earlier than modelling suggested and now hospitalisations are also declining, suggesting these have also peaked.

Sitting somewhere between 800 and 850 occupied beds across the country in late July.

With that, I will hand over to Pete.

>> Thank you, Doctor Old.

And it's great to have Rhianna here with us as well.

Tena koutou katoa.

The recent drop in COVID-19 cases is an encouraging trend.

By each one of us sticking to the public health measures, we are making a difference.

That is despite the fact that over this winter we and our health system have faced a really huge set of challenges.

Never before has Aotearoa been tasked with managing such a high prevalence of COVID-19 cases alongside a really big season of influenza as well as increases in other winter illnesses.

Not only has the high demand on our health services, not only has this demand been at record highs but it has major impact on our workforce.

Despite the pressure, Winter 2022 has made me incredibly proud to be part of this system of health workers striving every day to make a difference to our patients, whanau and communities.

I have seen us supporting our partners in aged residential care.

I have seen GPs and practice nurses being incredibly busy on the frontline, in their communities, providing a huge range of services to support patients in their homes and also ambulance services doing their typically terrific job.

I have also seen hospitals, including all of our clinical and nonclinical teams taking all actions available to ensure patients get the care they need in a timely manner ensuring as little disruption to planned care services as we can manage.

I can honestly say this has been a truly epic task.

As a country we are very grateful and fortunate to have such a committed, high quality workforce.

And so to hospital capacity, the health sector has planned for a challenging winter.

We have got it and as a result of the planning, my colleagues around the motu have been able to work together consistently to keep delivering.

At the same time, districts have been experiencing their own winter demands.

The need for staff to isolate or to care for isolating whanau or other care in their families.

But with cases of COVID, influenza, and other winter respiratory illnesses signalling encouraging signs of a downward trend, we are hoping some of the pressure on our health system will start to ease.

In the meantime I can report that our work across Te Whatu Ora regions continues to work to keep New Zealand as well.

In the Northern Region Nundah for a book care such as cancer treatment, birthing, Labor -- non-deferral, as well as less urgent planned care is increasing as capacity allows.

Services across Te Manawataki region are experiencing high demand.

Resourcing is assessed daily.

In the central region, acute or emergency care as well as non- deferral care such as cardiothoracic, cancer and paediatric care is largely continuing as normal and a fantastic testimonial to being able to deliver these cases.

Across Tee Wai Pounamu cases are continuing as normal -- te.

We continue to work together to utilise available resources.

For instance, South Canterbury is supporting the southern district joint replacements and Canterbury as well in the ENT and gastroenterology lists.

So while we expect a continued longtail of COVID-19 cases and workforce illness, the recent decline of cases is now flowing through to a reduction in severely ill people with COVID-19 who might have been requiring hospital level care.

And this eases pressure on our system.

What about RSV?

In the Northern Region, this has been a particularly common cause of hospitalisation for lower respiratory tract infection for under two-year olds.

Last year at this time in the Northern Region, we had 3800 cases.

At this time, we only had 248 positive cases.

In fact during the peak of last year's RSV outbreak, the end of July, start of August, the northern region was dealing with more than 600 cases per week.

This year weekly cases have so far remained under 100, averaging around 60 per week.

Of those positive cases, those who have required hospitalisation, the average stay in hospital has been two days.

We are also not seeing the same week on week increase in cases as we saw last year.

So again, these are encouraging signs.

We are continuing to monitor these RSV numbers alongside other conditions, and encouraging people to keep up with their current health measures.

I would like to turn to vaccination.

Vaccination of course remains the cornerstone in our response to COVID-19, but also to influenza and many other conditions, particularly childhood conditions.

It's a very important and critical prevention of measles.

We have said before - vaccination saves lives.

It also reduces severity of illness and likelihood of hospitalisation.

This winter the government has widened access to the free flu vaccines for people including children who are at more risk of hospitalisation, and made second COVID-19 boosters available six months after the first booster for older New Zealand people and other groups.

That has made it easier than ever to get vaccination.

So I would ask anybody, if you are due your flu, COVID-19, or measles vaccination, please don't delay, go and get it today.

In closing, I want to reiterate the simple things which count.

Vaccination.

Mask wearing.

Isolating when unwell.

Testing.

And self reporting results.

It is these basic health measures which have served us well to date.

If we do these basic things well, we help protect not only ourselves but also our most vulnerable, our tamariki, our older people, Maori and Pacific communities, disabled people, pregnant people and people who are immunocompromised.

We all know and care about someone in one of these groups and our actions to date have helped to protect them.

Let's keep caring about them.

Kia kaha, kia ora, kia ora koutou katoa.

Thank you, I will now hand over.

>> (SPEAKS TE REO MAORI) Good afternoon.

I have just got a few things to add.

I really want to acknowledge first and foremost the hard work that has been done on the frontline all throughout the motu not only by our kaupapa Maori providers, by our iwi providers, and by all of our providers as mentioned by my colleagues.

I want to reiterate and acknowledge the importance of vaccination and the role it plays here for our people.

It remains the best protection against preventable disease in general.

I now want to talk to and remind ourselves that COVID is not a seasonal disease.

Or a virus.

While numbers may be decreasing, our Maori providers are still too aware of the work that lies in front of them.

And while those providers are out there working every day, I want to acknowledge they are a Defence Force who provide unwavering commitment to our Maori communities when called on.

And not just the Maori communities but all communities around the motu.

Across the country they are working at pace to keep providing the services that are not just services around hauora, but also acknowledging health and care in the community and those who are isolated.

Outreach programs which are collectives and collaboratives Te Tai Tokerau of providers, they mobilise, they get out to hard to reach areas of the north.

They set up in June this year and include six providers such as Ngati Hine, and others.

They have purchased camper vans that provide these services.

It's an opportunity to be mobile, to reach more remote communities.

While we have clinics and hubs in our more urban centres, we have to remind ourselves of the need of our rural communities.

And also I want to acknowledge urban initiatives such as Tamaki Health Hub, where we vaccinate here every day and also offer a social supermarket, full health checks, vaccinations and childhood immunisations.

I just want to point out that the initiatives that have popped up during COVID such as the social supermarket have been some of the most amazing disruptive innovations.

And I also want to acknowledge that prior to COVID, kaupapa Maori providers would often reach out and provide these services.

So having them recognised and ongoing funding available means our communities and whanau wherever they maybe are able to access basics such as kai, housing support, and of course this all goes to improving well-being for our people.

On that note, one final shout out to all those providers, kia kaha.

(SPEAKS TE REO MAORI).

Just to acknowledge, we know you are there on the frontline, we are going to be doing anything we can during this process of Te Whatu Ora, Te Aka Whai Ora providing better services for our people.

>> kia ora, thank you both.

In summary, there is some good news on the COVID-19 front.

We have decreasing cases and hospitalisations, and we are hopeful we have turned the corner in terms of deaths as well.

I want to emphasise, however, that COVID-19 is continuing to have a significant impact especially among our most vulnerable.

While cases and hospitalisations have declined, we are continuing to see deaths on a daily basis and we cannot take our eyes away from that.

I would emphasise also that despite the recent decline in cases, and that is clearly good news, this pandemic still has some way to run.

There remains the potential for a resurgence in COVID-19 cases, and as Rhianna just said, we have seen overseas significant waves of COVID through the northern hemisphere summer.

So it is not going to behave as a seasonal disease.

That means it's important we all continue to take steps to protect ourselves, our whanau and communities.

Please get vaccinated and boosted if you are eligible.

Continue to wear your masks in indoor areas, outside your home.

Get tested and stay home when you are unwell.

All these things, as Peter said, help reduce the opportunity for COVID-19 to spread.

The final thing is to reiterate the call that has already been made to think about things other than COVID-19 as well.

Particularly a focus on childhood immunisations.

We know that we are at risk of outbreaks of other diseases.

Pete mentioned measles.

So I really want people to use this week to check that they are up-to-date themselves with their vaccinations, and if you have children, that they are up-to- date with there's.

It really could make a difference -- up- to-date with their vaccinations.

It could really make a difference in the weeks and months ahead.

With that, we will take questions for all three of us.

>> We have seen cases dropping for a number of weeks, so it's really safe to say we are over the second wave now?

>> I think that's a fair assessment.

We are always a bit cautious about calling those things to early.

Certainly in terms of the second wave, yes, we seem to have passed the peak and we are coming down into the next plateau.

The question that we have now is, how low will we go in terms of daily cases?

We didn't drop quite as low as we expected between our earlier peak and the second peak.

That's going to be particularly important in terms of the ongoing impact of COVID-19 over the next few months.

>> As you said, we can't become complacent.

COVID is here with us and has been for some time.

Has any modelling been done about when we might see the surge of cases again?

>> There is modelling underway to look at that.

We don't have it available here yet.

The modelling that has been done recently in Australia, out of Victoria, is probably instructive for what we might expect.

We now have reasonable information from around the world about how COVID behaves.

Lots of caveats about the fact we are always modelling based on what we know and new variants are always concern and how they might behave.

But we would expect to see continued waves of COVID-19 for some time to come.

The questions which the modellers are desperately trying to answer and are really important for health services like the ones that Pete represents is, when and how high?

Those are the questions we are trying to answer.

>> About planned care, probably for Pete, talking about what you quoted before about what is happening with planned care around the country.

It's quite general.

For example Te Wai Pounamu,, it is as and when it can.

Can you give us any more detail about planned care, delays, and how often that's happening?

>> I don't have district by district specifics but everywhere is itching to do more.

That's the good news.

As capacity becomes available, we are doing more.

Everyone has got that very much in the Te Whatu Ora districts as something we need to get on with.

I know the work for the planned care task force will also be released in the not- too-distant future which will provide further guidance and advice about how we go about tackling this because it has become a big issue we all recognise.

But everywhere is doing the clinically urgent and indicated work.

And to a varying degree, other less urgent work.

But it is done by list, service by service, district by district.

As I referenced, we have seen within Te Whatu Ora and the new system a greater, a much greater degree, I believe, of collaboration and cooperation.

The example of South Canterbury being able to pick up work from their neighbour is just one example but that is happening across the different districts.

>> Are there any cases on any day where some of that urgent planned care.

>> Not that I'm aware of.

As I understand it, all of the cancer and P1 work has been done.

In some areas, some of the P2 work which is the work that is not quite as urgent, needs to be deferred.

Less and less of that is being deferred and in some places they are even moving into the P3, the work that can wait the latest.

-- Longest.

>> What about colleagues, not just planned care, but pressure on hospitals, what are they telling you about how busy things are?

>> The health system has been under pressure and continues to be under pressure.

While the COVID cases are decreasing, we have experienced the big surge in influenza.

We are over that as well.

But there is everything else that is still presenting.

And this is a cross primary care, aged residential care, and is also in the emergency department in the hospitals.

And part of that is as I referenced, the pressure on the workforce.

The workforce is susceptible to the same will to illness -- winter illnesses as the rest of us.

So there's been high levels of sickness and absence and that is part of the real pressure on the system.

That remains a big focus to supporting the workforce to be able to deliver this service.

>> Today marks a year since Delta arrived in the country and we went into lockdown.

I was after a reflection from you on the past year.

Yesterday was the last day we had zero cases of COVID in New Zealand day, just your reflections on how things have changed.

>> I might ask others to comment as well.

But it has been a year, as I think I highlighted, it just has presented enormous challenges for us.

I think as a country, as communities, and the health system in particular has been, you know, really tasked with something we have never seen before in terms of the volume and how we were going to face that.

I am incredibly proud of the response.

It has been really hard.

We have got through it and I think we have done a pretty stunning job when you look around and you see how we have managed compared to other countries by comparison.

We saved a lot of lives, and that I think is a direct result of what we had done to address it, prepare and be able to manage.

Perhaps I will hand over for other comments.

>> I would say almost a year to the day we found the first cases in Coromandel, for instance.

I was on the front line during that time.

When I stand here and reflect on the year that was, it has been an incredible year where I have seen people collaborate, operate.

We have had teams on the road for seven days a week during those peak times.

We have had people running kai to communities.

We have had a country that collaborated like I have never seen before and of course, on July 1 we launched a kaupapa that is really dear to my heart.

So through it all, we have maintained whakaaro, 'Let's stay together'.

This >> Thank you, both.

Maybe to build on that a little bit to say, at the point that we went into lockdown a year ago today, just 23% of New Zealanders had received two doses of vaccine.

By the time the COVID protection framework was announced three months later, that figure was 82%.

So I really want to echo the comments that both Pete Riana and made about the incredible effort that not only the health sector but the community at large put in to keeping us all safe through that time.

It has been an amazing year to be part of.

It has been incredibly tiring at times, but I think the way people have pulled together has been incredibly inspiring.

The other number I have got here, which floored me a little bit, is between 17 August last year and 15 August, two days ago, we have administered 9,039,000 and 444 COVID-19 vaccinations to New Zealanders.

So I think that puts in perspective the size just of that part of the effort.

>> You mentioned vaccination.

In the UK, talking about the dual vaccinations, is there any indication to have that happening here?

>> We are watching really closely what is happening overseas with the development of new vaccines for COVID-19.

The vaccine we are using, as people know, was developed really quickly early on but it was designed against the original strains.

We are lucky it continues to provide really, really good protection against severe disease and death but what it is not so effective now is preventing transmission between people which is partly why we have had the waves of Omicron we have had despite the high levels of vaccination.

So we are watching those developments really closely.

Those companies have not made applications here, to my knowledge, yet but we are certainly building in some of those things in terms of our future thinking because I would expect them to become part of our toolkit in the future.

>> Coming down from the peak now, would you like to see isolation rules changing?

>> That is a really timely question.

One of the things we have committed to all the way through is constantly reviewing the set of protective measures that are in place, to make sure they continue to be both protective and proportionate to the risk that is there.

We are in the middle right now of reviewing the range of measures that we have available to us.

As I say, the process is underway now.

We will be providing that advice to the government for their decision-making process in the next week or so.

>> So if isolation rules might change, do you have any advice at this stage?

>> I don't want to pre-empt that process but just to say all those things currently in the framework and other protective measures are being looked at to make sure they are still appropriate and proportionate, and after that advice has been provided, government will make its decision.

>> A question about monkey pox, if that's all right.

Are we any closer to rolling out our public health response to monkey pox?

Are we any closer to knowing when we might get vaccines?

>> I can start to answer that, I don't know whether Pete wants to add anything.

In terms of our public health response, it is well underway.

There is a group working now which includes a community representative from the Burnett foundation, with a real focus on the health promotion aspects of prevention.

We are really fortunate at the moment we have just had the four confirmed cases of monkey box in the country so we have time to prepare.

-- Monkey pox.

The biggest defence at the moment is making sure people understand what monkey box is, how it transmits, and what risk behaviours look like in terms of being able to keep people and their communities safe.

That work is very much going on.

In terms of a vaccine, we are actively working through Pharmac with the vaccine manufacturer.

Contact was first made in May at the time the first cases were identified.

There is a challenge with the global supply at the moment.

There is only one manufacturer third-generation vaccine we are seeking and global demand is high.

Essentially the manufacturer is prioritising countries that have significant outbreaks.

So that means we are likely to not be at the front of the queue, but we are hopeful we will have more information about a confirmed timeline share in the next week or so.

>> About the man masquerading as a doctor at Middlemore, where are your investigations at in that investigation?

>> As you know, that person is no longer employed by Te Whatu Ora Counties Manukau and its with the police.

I understand investigation is being undertaken there.

I can reassure people that we have undertaken a review of every patient seen by that person, and there have been no concerns found.

At this point.

We are also taking the opportunity, and I guess this talks to the move into Te Whatu Ora as a national system to ensure all our employment processes are where we need them to be.

>> And you were also reaching out to talk to patients, how many have you been able to talk to?

>> I caught up with that this morning.

We are making really good progress.

We haven't contacted all of them yet but all of those we have, there have been no issues identified.

>> We heard there was about 80, is that correct?

>> That's correct.

>> Just a couple more questions, folks.

>> I had a couple four, Riana.

There was a case this week about a Maori man in Whanganui.

There was a suggestion of bias in his treatment.

In terms of what the Maori Health Authority can do, of course Maori people are still going to be treated within the mainstream health system, where do you think the Maori Health Authority's role is in trying to prevent that?

>> This is where the importance of partnership between the organisations and three of our organisations is imperative, to make sure cases that are preventable, and of course our aroha goes out to the whanau and that gentleman because that's not the ideal.

That's not the value proposition we want to be able to offer our people of Aotearoa.

But dealing with bias in a system is important.

Remembering during a time of COVID when we have had that much pressure on the frontline and people make assessments, and of course we make judgements, and we want to support to make sure all of our kaimahi throughout the system are able to make judgements that don't include any bias whether it is against people who may have a drug history or people who are Maori or people with disability et cetera.

So I think moving forward, our focus has to be on the future, how do we create a better system?

How do we make sure that people don't fall through the gaps?

How do we make sure, for instance, otitis media is treated in primary care?

That people have better access to make sure things that are preventable are dealt with sooner.

>> There are calls for a Maori nurses workforce to be prioritised.

>> Which is absolutely on our program.

We are about to release our chief advisers which will include a consortium of chief adviser medical, nursing, midwifery, allied health, and most importantly kaimanaaki, and I say that because during the COVID response, and here in this building, you will see the kaimanaaki workforce has stood up and become vaccinated and done the PCR testing when we didn't have the numbers to do so.

So we want to make sure there is a space at the table to make sure we can have a conversation and work out what more that workforce can do in terms of mobilising responses.

So absolutely, tautoko, and because I am a registered nurse, I want to make sure there are more like me out there.

>> Thank you very much.