COVID-19 media update, 14 July 2022

>> Tena koutou katoa

and thank you for coming today for this COVID-19 update.

I am joined by health director Dr Ashley Bloomfield and by Zoom health New Zealand executive Margie Apa.

There's no doubt that this winter is one of the toughest seasons our sector has ever faced.

And COVID-19 cases have been steadily trending upwards with flu and other respiratory illnesses also placing significant pressure on the health system.

Today I'm going to outline some of the measures that will help us get through this darkest part of winter.

They will help New Zealanders stay well, reduce the chances of those who get sick becoming severely ill, and take some of the pressure off our hardworking healthcare workers and health system.

But before I do, I will hand over to Dr Bloomfield to give an update on where the outbreak is at and where it is predicted to hit and then Margie Apa will speak about what is happening at the front-line of our hospitals.

>> Kia ora.

I want to start just by briefly mentioning what's happening with the pandemic overseas.

With more open borders and an ever increasing number of cases detected at our border, this has never been more relevant.

What we are seeing globally is the number of new weekly cases has increased week on week over the last month after previously declining since March 2022.

And this is happening even though we know that testing rates have dropped in a number of countries, especially in the northern hemisphere.

It's quite clear this has been driven by these new BA.

4 and particularly BA.

5 sub variants of Omicron.

And we are seeing a very similar pattern to what we're experiencing here in a number of Australian states, in particular, NSW.

Of course, thinking across the Tasman, their preparation and response there is informing our response and vice versa and we remain in regular and very close contact with our Australian counter parts.

So moving to New Zealand, today we are reporting 11,382 community cases and that includes 412 reinfections.

There are 765 people in hospital with COVID.

And we're reporting 23 deaths.

So the seven day rolling averages have increased for all three in the last week for cases that now sits at 9,826 hospitalisations as at 673 and deaths, a seven day rolling average of 20.

I want to now use a few slides just to outline what's happening with the outbreak here in New Zealand and you can see from this first slide that's on the screen, that case rates across all four regions around New Zealand have trended up wards in recent weeks.

So in the week ending 10 July, there was a 32% increase in case rates compared with the week prior.

And, in particular, this will be what is driving our increase in hospitalisations which has been quite rapid, among people 65 years and older, they have increased by 33% in the week ending 10 July.

So quite significant and rapid increases.

Early on in our first Omicron wave, we didn't have our over 65s so impacted and we're seeing those higher case rates there.

The test results of our border workers and our waste water reporting suggest that there is the significant increase in case rates across all regions in recent weeks.

And I know there's interest always in what proportion of cases we think we are detecting through our testing.

We're back to, we think, around half of cases.

So pronl about double the number of cases out there compared with what our testing is showing.

Some of those will be people who are asymptomatic or very mild symptoms and some may be testing but not up loading their results.

There may be some people who are simply not testing and we will come back to that.

So the up ward trend in case rates is primarily due to this increase in the Omicron BA.

5 sub variant and you can see this in the next slide.

This shows the proportions of the different Omicron sub variants since the outbreak commenced.

Early on it was B A1 and then B A2 rapidly took over.

You can see over these last few weeks here quite a rapid increase in the proportion of cases that are driven by BA.

4 and BA.

5 and, in particular, the latter.

And that is going up week on week.

So the latest showing that we are at 47% of cases related to BA.

5 and that will continue to increase and will almost certainly over the next few weeks become the dominant variant.

There is no evidence at this stage, as we have said before and we're watching closely, that the BA.

5 sub variant causes more severe illness than B A2 and likewise, early analysis of BA.

5 shows no substantial variation or reduction in vaxing effectiveness of three doses of the Pfizer vaccine relative to the B A2 variant.

However, BA.

5 is clearly better at evading immunity and this is important for people who have been infected previously.

It does not mean you are immune to being reinfected and we are seeing a study number of reinfections which we are now reporting every day.

It is still around 2 to 3% of our total infections.

But we are expecting it to increase.

So it is very important that even people who are fully vaccinated and or have had COVID in the last few months, to take precautions and we will emphasise that today and talk more about.

Just a few quick slides on modelling this first slide is effectively what we are modelling will happen with our hospitalisations if we do nothing.

In other words, if we maintain the current levels of mask use and so on.

It shows a peak of more than 1,200 beds occupied per day and that is higher than the peak hospital occupancy we had back in March.

This is, as I said earlier, in part driven by the higher infection rates amongst other over 65s.

And like wise in this scenario, our rates of community infection are expected to peak at around 21,000 cases per day, similar to what they were in the first peak.

However, we can see that if we do something here, this peak in hospitalisations, and this is critical, we can lower that peak if we take steps.

If we all take steps to limit our exposure to the virus and protect ourselves, we will reduce that peak of hospital occupancy to under 1,000.

Around 950 is what's modelled.

And our community cases peaking at under 18,000.

And so we can see this next slide really showing the difference there.

And you will all be aware of the pressure our hospitals, indeed, our wider health system, including our general practices are under, and so it is incumbent on all of us to do what we can to help reduce the number of infections and the impact on our health system.

So what can you do this winter?

Well, we anticipated a second wave of Omicron.

We are seeing the impact of the BA.

5 sub variant.

We've planned for it and our colleagues across the system are doing Stirling work and my colleague Margie Apa will talk to that shortly.

But the public health measures in place and the actions of us all are what will make the difference here.

So those steps need to be put in place to protect our vulnerable community members, our health system and I might add, our businesses and economy as well to make sure they can function well.

So correctly wearing an appropriate mask such as a surgical or N95 mask can help reduce the chance of being infected by at least half if you're doing it well.

Now if any of people out there are not wearing masks because it's a bit of a hassle or uncomfortable, I just want you to think of our health and disability workers who are wearing masks day in, day out during their entire time at work while they are dealing with this pressure.

My plea to you is if they can do it, then you can do it.

And if you do, that will hen epwe all get through winter in the best -- will help ensure we all get through winter in the best way possible.

Testing, of course, remains crucial and reducing transmission and supports people following through on isolation, unlike most other countries, we still have a requirement for everybody who tests positive and their household contacts to isolating unless they've got a special exemption there which is there to help keep our businesses operating.

And likewise, vaccination.

We've widened the accessibility to the flu vaccine, you will know we have recently started our roll out of the fourth dose of the Pfizer vaccine with one of the widest eligibility criteria in the world.

I might add.

A nd our priority is on vaccinating those priority groups, our older people, people with pre-existing conditions, and anyone over 50 and our health workforce.

We are keeping under close watch the interval at the moment it is six months, we will look at whether or not there is indication to reduce that once we have really gotten to those priority groups vaccinated.

As well as potentially extending and widening the eligible groups, we will keep that under advisement but at the moment, there are more than 1.

7 million people who are eligible and those are the highest risk people and the ones we want to vaccinate first.

So we have in place a number of strong protective measures, including those I've outlined above and if everyone does their bit, we will get through winter as the minister said.

It's a very tough winter for our front-line staff.

We know that.

And my plea to you is to everybody in New Zealand is to do your bit for this next period of time.

A couple of months to just help us get through winter in particular, our health system.

Now, I'm going to hand over, we will see the change on the screen, you will see Margie Apa, the Chief Executive of Te Whatu Ora Health and she will talk about some of the pressures on the health system and how they are being responded to.

Over to you.

>> Good afternoon Minister and colleagues in the room.

Look, I would just like to start by echoing the minister's comments and acknowledge the hard work of our front-line healthcare teams.

Who are providing care for patients in our communities.

Particularly at this time of significant challenge for our system.

The work you do is important and valued and our communities are really appreciating that effort.

I also want to acknowledge that to help with this capacity many of our staff are supporting each other.

Many doing extra shifts and supporting teams that they might not normally work for.

So in this time, I want to just acknowledge that extra effort.

As a unified organisation, we are closely morentsing the pressures across our healthcare system because we have come together, we are monitoring and gathering data to support regions and districts to support them in their care.

Workforce is facing high demand in many areas, including primary and community care and Emergency Services as well as hospitals across most regions as we all know.

We know that people working in the health system and hospitals and primary community care are impacted by the same winter illness because we are part of the communities that we serve.

And we are seeing the rest of our country, high numbers of staff away, unwell, or caring for dependents this winter more than what we have seen in previous winters.

So all of this increase demand does mean it can be harder at different points in time to get an appointment with your preferred health provider and in some parts of the country there can be longer waits than we would like to see.

I understand this impact this has on patients and their family.

I want you to know that Te Whatu Ora Health we are moving to roll out our national regional and local initiatives to help manage the system capacity.

We are working regionally to manage demand, to prioritise urgent care and to deliver as much planned care as possible.

We do understand how distressing it can be if you are non-urgent surgery or outpatient visit is deferred because we've not been able to find the staffing.

This is not our preferred way and I just want to acknowledge this is a daily operational decision.

It can be affected by how many staff might ring in sick on any one day in the hospital.

So hospitals are coordinating their daily planning, sometimes two or three times daily, to ensure that resources are deployed and shared to support access to care where it is needed.

So we ask for some patience for our communities.

Those who are urgent and need immediate care are getting access and we know that many hospitals have been able to maintain planned care.

The pressure is particular in our large metro urban based hospitals who are seeing some hospitals have reported this week over 200 people reporting in sick in any one day.

But we actually recognise that the need to support primary community care and age residential care so that they can in turn support hospitals and avoid placing additional demand on them, but actually, it is much more convenient for our families and communities to get care before even needing to leave home.

So we are working on some initiatives to expand Telehealth to alleviate pressures on ED.

And to provide more after hours options for patients.

We do have initiatives that we can turn on if a hospital at any one particular point of time, and you have seen us exercise that, where we do need extra urgent care to support those districts.

Providing Telehealth support for patients in the ED and enabling emergency ambulance services to have access to a GP or nurse over phone so they can see and treat patients at the scene and reduce unnecessary admissions into hospital.

We are working on national platforms to make it easier for GPs, ambulance services, and health line to make direct referrals to radiology, reducing further the need for ED admissions or people waiting in hospital when they are otherwise well for a diagnosis.

Opening hours for urgent care will also be extended into evenings and weekends where there is capacity to do so and we want to acknowledge that they are facing the same kinds of staff illnesses as hospitals are.

So that is to support people accessing care they need.

Our focus is to make sure people get a right care at the right time in the right place and seek health advice early when they are unwell.

By focussing on ensuring people access care early and receive appropriate care or advice in the community, we can help our urgent health services remain available for those who need it most.

Like all pharmacists, are a useful point of advice and guidance in managing winter illnesses and they can make recommendations on the best over the counter medicines.

If someone is sick, before you leave home, call health line on 0800 611 116 any time, day or night, if you are unsure what to do.

And if they can offer advice, quite obvious some other things to do before you even leave home.

So it also helps our health services in just echoing the direct general's guidance if everyone can help us get through winter in good shape.

Thank you.

>> Thank you Dr Bloomfield.

To get through this stage of the pandemic we're going to have to use the most effective measures we have to reduce the spread of both COVID-19 and influenza and by doing so reduce the pressures on the health system and leave resources for those who are most in need.

We have weighed up with a moving to rid the setting under the COVID protection framework would make enough of a significant difference to slow or reduce rising case numbers.

The main difference in the red level gathering limits would likely only offer an incremental benefit.

The vast majority of disease transmission is most likely to be occurring in places where most people spend the most time.

Their homes and work places of any size.

Wearing masks, getting boostered, testing, and staying hope if you're sick are the most effective ways to stop the spread of COVID-19.

Our response to the pandemic has to be fast and flexible.

But it also must be proportionate.

We need to balance restrictions with practicality and effectiveness.

There is measures also help reduce the likelihood of catching flu and other winter illnesses.

So that is why we are remaining at Orange.

However, we can improve how we are using the tools available to us at Orange, particularly masks, rapid antigen tests or RATs and anti virals.

Under the Orange setting, masks are required on public transport and shops and in aged care facilities.

You might think if you've had COVID-19 you don't need to wear a mask any more.

But the rapidly rising rates of reinfection show that that is not the case.

Now is not the time to stop wearing masks.

Evidence tells us wearing a mask halves your chance of being infected with COVID-19.

It also helps protect you against influenza and other winter illnesses.

So if you don't wear a mask for yourself, please wear one for our healthcare borkers, especially over the next couple of months -- workers.

To help more people wear masks, we will soon be providing free medical masks with RAT kits at all existing collection sites.

P2 or N95 masks will be provided to those who are clinically vulnerable and high risk individuals.

We want people to test more.

That's why we are removing the eligibility criteria for free RATs for individuals and their household members.

You no longer have to say you have symptoms or be a household contact to get your RAT kits for free.

However, please do continue to use the request a RAT website to request RATs before you rock up to the collection point.

It helps our team make sure we have the stock there for you.

Also, the ministry of business innovation and employment will be gauging with businesses to ensure that they are aware of the guidelines for creating safe work environments.

This includes ensuring people don't work when they're unwell, that mask use is encouraged, and that there is good ventilation at work places.

Our message to business is simple.

If you want to reduce the chance of your employees and customers getting sick, follow this public health advice.

You're more likely to keep your doors open during winter.

As you know, we have also recently announced a one-off supplementary energy payment to help schools determine.

schools better ventilate their classrooms without unaffordable and energy bills and we have provided medical grade masks for teachers and made child sized masks available for children in years four to seven and regular sized masks for children year eight and above.

If schools take up the support in the coming term, the students will have more days at school and be healthier.

Please use it.

We are also launching a new campaign to encourage more people to get their booster shots and flu vaccinations.

Health officials are calling and texting those who are eligible.

If it's been six months since your first booster, and three months since you've had the virus, please go get your second booster.

Do it for our health sector and to keep yourself out of hospital.

Importantly, if you feel sick, stay home and please, test, test, test.

For those who contract COVID-19, we want to see anti virals used much more widely as they are so effective at preventing hospitalisations.

Today, Pharmac are will be announcing credibility.

The change will take the percentage of people for these drugs 22% to 10% on cases.

So approximately 400,000 people.

The change will include a substantial simplification of the criteria.

Anyone over 57 years of age will be eligible and there will be improved access for Maori and Pacific people.

They will release the full criteria that includes these other risk groups today.

One of these medicines reduces the chance of an at risk person going to hospital by almost 90%.

And to give you a sense of the personal impact on that, yesterday more than half the people newly admitted to our hospital were over 70.

To realise the benefit of these medicines in this outbreak, we have to make sure they reach the people who need it when they need it.

Now, currently, many people already access anti virals through the general practice.

In addition, our care in the community team also identify people at high risk who report positive RATs via the website and then they prioritise them for a call from their GP to make an assessment and issue a prescription.

This is a great system but we need to do more.

Firstly, we are encouraging GPs to identify high risk people under their care and advance of them becoming sick and assess them, if they are eligible for anti virals, and if, so write them a prescription to be dispensed when needed.

This just in case approach is what we call a back pocket prescription.

The approach is widely used for antibiotics and we can use it for anti virals too.

Secondly, we will ensure patients know they are eligible for anti virals by directly messaging them.

So they know to seek care when they're unwell.

Thirdly we will make anti viral drugs available at pharmacies as farmcy only medications.

This requires changes to regulation and because these drugs have side effects we will also offer training modules before this is taken up.

So this change will be phased in over the coming fortnight.

Also masks, ventilation, and staying home when you're sick are the most effective measures we have.

They are simple, but if we all do them, we lessen the burden and the burden on our health system.

I know some people have said that the protections are too complicated for people.

But they underestimate New Zealanders get vaccinated, wear a mask, stay home when you're sick, open a window.

Finally, I want to reflect on conversations I've been having with friends and former colleagues working in the health system.

They all reflect.

they all report stories of the pressure that they're under.

Rosters are tight.

As you've heard from Margie, they are cross covering and wards are busy.

There can be delays getting people into ward beds or discharge and that means they're having to provide care in ways they're not accustomed to.

All of these deviations from normal practice carry some clinical risk and managing that for the sake of our patients is tough on our professionals.

I know they are busy.

I know they are frustrated.

And they also don't like to see planned care deferred as we have seen in some instances.

I know they are tired and I want to thank them for the amazing work that they do.

I also know that everyone is tired of COVID-19.

We need to take these extra measures for a short time to get us, and the healthcare system, through the winter months so please do your bit.

Dr Bloomfield and Margie Apa will take questions.

>> It is the middle of winter and (inaudible) the sort of start of the outbreak, how has it got to this point before the intervention?

>> We have optimised the interventions that we've had in place for a long time and you will see that what we've discussed today is improvements of a series of initiatives so we've had the vaccination initiative in place for a long time.

We brought that through with the change in parliament to enable the fourth dose over a month ago.

We've had to make sure that we've refocussed the initiatives in schools.

We've had access to anti virals but as case numbers go up, we didn't see them increase at the way we wanted to when the pressure came on, that's why we have made this adjustment.

And in terms of free testing, we've made that adjustment as we've seen that perhaps test numbers were going down over time.

So, of course, we have had systems in place all along but they do have to be optimised in response to the facts on the ground.

>> The last time we saw case numbers like this, we were at red.

So if not now, when?

Or is red essentially now redundant?

>> No, it is not redundant.

I think one of the things that Kiwis have seen as we've gone through this pandemic, especially since September last year, is this is a virus that keeps changing.

And therefore we do need a flexible response system.

That is the purpose of the traffic lights.

If you read the stories you will know that we've had new variants on the horizon reported overseas out of India just in the last coming week.

So we need to be able to continue to have a response that we can flex but for the reasons I've outlined, we believe we can get through focussing on the basics of masks, vaccination, ventilation and staying home when you're sick.

>> But if given the absolute strain that all three of you have stood up there and basically begged the public to avoid going to the hospitals, do everything they can to get into the public health system, that speaks of the strain it is under and the case numbers that we've got, if we're not moving to red now, will there ever be a time that we move to red?

Doesn't that undermine the whole traffic light system as it stands?

>> As I've explained, this virus can mutate and we need the ability to be able to change our response and that's why we need a gradated system like the traffic lights.

Indeed, we know that the health system is under pressure.

And that's why the imperative is on us to use the most effective measures.

Those are vaccination, mask use, staying home when you're sick, we're supporting that with testing and widening the scope of anti virals.

>> Why not wider mandated mask use then?

>> What we need to do is to make sure that everyone knows right now wearing your mask will make a great difference to the situation and our health system.

>> The main reason you've just said for not going to red is that you believe that this is not where the transmission is occurring, the others that will be clamped down on at red.

So to further on Amelia's question, what would be the circumstances where you would see the transmission in those areas so that you would go to red?

If not now, I can't really see - can you explain when?

>> As we've seen throughout the pandemic we've seen the transmission characteristics of the virus change as it mutates.

One of the things we've seen at the past is quite a dispersed range of different transmissions situations and a big concern about super spreading events earlier on in the pandemic.

Those are the sorts of situations for which gathering limits might be very helpful.

But if you look across what's going on now, people are catching COVID in their homes and work places.

And you know, it's pretty obvious just looking around that that is where the vast majority of transmission is happening and that's why we need to focus on that.

>> Look, there is getting increasingly slack, people just aren't wearing masks like they used to, is really making free collection points going to make a difference?

>> We to have make sure there are no barriers in good mask use, including the cost.

So we will make them more and more available.

Including in N95s for medically and vulnerable people.

So I think the onus is on us to make sure there's no barriers to that.

And also to make sure there's a very clear explanation to the public that masks are just critical right now for making sure we take the pressure off our hospitals.

>> How critical mask use is, was it a mistake to tell schools that they didn't need to wear masks?

And to tell students it was up to them if they wanted to wear those masks.

>> Look, we at every level of the traffic light framework encourage, recommendation mask use in schools and what we mean when we recommend mask use is that you should do it.

>> Just on the barriers question.

Why haven't you guys essentially given everyone N95 masks instead of just the vulnerable when you guys know that N95 masks make a massive difference in reducing transmission?

And also just on the flu vaccine, why haven't you increased that allowing everyone to get it for free?

>> So with medical masks, we know that they're incredibly effective and they are practical and the guidance as for most people in community settings, they are good protection and I wear an medical mask for that reason.

We will provide N95s for those who are medically vulnerable and that will come through at our collection points shortly.

In terms of the flu vaccine, look, the advice that we received was that the flu vaccine to be effective, dodeur, the flu vaccine is mostly targeted at the group that's were currently providing it to freely.

And that's the basis.

>> But essentially we are creating a campaign to encourage people to do it, isn't payment a barrier to that?

>> We think that flu vaccine is targeted at those - it is funded for those groups most at risk of hospitalisation.

>> Just the RATs that will give an incremental benefit, to use your words, is the traffic light system fit for purpose dealing with the Omicron and the sub variants that we're seeing now?

>> I think the second part gets at precisely the point that we need flexibility in order to respond to a virus that frequently changes.

And indeed having the options of trading up protections should we need it is incredibly important for our safety for the future variations.

>> So you're saying they aren't aligned with the transmission dynamic that's we're seeing so why not.

shouldn't we have a traffic light system that you can actually move between levels to respond to the situation in the community?

>> Well, I've explained that we do have the traffic light system in order to be able to respond to changes in the virus but I think the most important thing here is that currently what we are seeing is a virus that masks, vaccinations, and testing and staying home when you're sick and anti virals will be incredibly effective.

So whether we were going to red, whether there are more mandated settings, wouldn't impact even at red, I would still be asking people to do exactly the same things that we are asking them to do at Orange.

>> But you would have to rewrite the.

>> When did you start looking at this one access?

Has this been something in the works for a while because this could have been brought in in the last week.

>> Access to anti virals?

>> Access to RATs and masks?

Has that been in the works for a while?

>> We've been working on that particular part for a couple of weeks, yep.

>> Was that not ever considered in the initial Omicron outbreak?

>> Indeed, different settings were considered but were in quite a different situation in terms of RAT availability and we've seen how it's being used.

I think that's the important thing.

We've been concerned that the test positive rate is going up and it means people may not be testing as much as previously and so that was one of the prompts we made the change.

>> The advice on targeting the flu vaccine was broadly correct or do you with hindsight wish the advice was broadly targeted with flu vaccine?

>> I haven't given it much consideration but it is certainly appropriately targeted at those with the highest risk.

>> Public health experts are saying that we need to be moving towards becoming a mask wearing society, including having to use public health campaigns, ala don't drink drive, wear your mask to protect others.

Why are we not rolling out a public awareness campaign like we do with drink- driving?

>> We are rolling out a campaign to promote greater mask use and you've heard that message consistently from Dr Bloomfield today and we will have.

and I and we will have an advertising campaign promoting the message that masks matter, heading to the screens very soon.

I'm just going to pause here because as you know, Margie Apa will be leaving us soon.

So if you have any questions for Margie about how the health system is responding to these demand pressures, would you like to ask her now?

>> What is going to - it is already under pressure, what's going to happen when we hit those really high numbers in a few weeks time?

>> I think much of what we do at the moment (inaudible) is monitor the situation daily and we deploy people as we are now.

We are, of course, helping each other.

We've got people who are doing more work or shifts and we to have make sure that we are keeping them well and not burning people out.

So those daily operational rhythms of monitoring what happens and how we move resources around to support.

What we have now, which we didn't have before 1 July is much greater regional accordination and collaboration.

Looking at escalation models, individual hospitals and where regions are able to support each other.

So all of those operational rhythms are part of how we will manage this system.

And supporting our workforce.

>> If I could just go back to the masks.

Thank you.

So if you are rolling out this mask campaign now, why have you waited until the middle of winter when we're getting 13,000 cases a day, why not roll this out at the start of winter when clearly this was going to be coming down the traps towards us?

>> I think what we're talking about is a refresh of a number of government messages but we, in particular, want to - and we have had supply and we have had recommendations for masks for some time now.

So what we're doing is just reemptcising as we should, when our health system is under so much pressure.

>> The most vulnerable and that age cohort, that's right, but when they go in to get vaccinated they take (inaudible) why don't you just allow lots to be vaccinated rather than still targeting that age cohort which didn't work for us the first time round.

>> Yeah, so firstly, we recognise being Maori or Pacificer as a additional risk factor which is why the recommendation for vaccination for a fourth dose or a second booster has a lower age level for both Maori and Pacific people.

We do encourage them to come together to be vaccinated which might not just be for COVID.

It might be for influenza and so we're making those opportunities available for Whanau at once but I think just the lower limit of who we are offering the vaccine to, it is really important to be aware that there are rare side effects that become more frequent at the younger age group and that's why we have a lower age limit at the moment.

And we continue to track whether or not it's safe to widen access there.

>> How confident are you that Maori organisations are confident that this strategy will work for them?

>> So we've worked closely with Maori organisations, both at the ministry and the level and increasingly, township by township level, particularly for the Tamiriki vaccination.

So we have got to a place where there are multiple points of contact between the vaccination roll out and actually the health system as a whole and the groups.

>> You said. >> Are you - what was the recommendation for mask use, was it to expand the requirements in certain settings at all?

>> The recommendation for mask use is the one that's been picked up and that is just a reminder actually there are still a number of places where people are required to use masks.

We've seen a drop off in that use of masks in places like supermarkets, public transport and so on.

So the first thing is reiterating for people that's important.

For the last few weeks you will have heard me saying and you will have seen in our media releases a good rule of thumb is to wear a mask in any indoor place outside your home.

The key thing we're doing here is, as the minister said, making sure that people are able to access those masks.

I would say that's not a new thing.

We have already distributed hundreds of thousands if not millions of the medical masks and indeed the N95 masks out through Maori and Pacific providers disability providers and so on.

So they have been out for some time.

What we're doing now is just ramping that up and also ensuring that masks are provided with rapid antigen tests as well so there's strong support for people to use masks whenever they are outside the home.

>> Do you support the calls that it should be - we should be more of a mask wearing society, that it should be looked at like we look at sort of smoking and restaurants or drink-driving, we need to move to that sort of more long- term end.

>> Absolutely for the time being and this is the point is we're in the middle of an Omicron resurgence with a new variant.

Mask wearing should be like wearing a seatbelt.

Absolutely.

That's why we still have an order which requires people to wear them and a number of indoor environments.

And we're encouraging and supporting people to use them and a wider range of indoor environments as well, including in schools as the announcement was a couple of weeks ago, providing masks to schools for children and staff.

>> So what is the strategy for (inaudible) we have got a lot of reports about them being abused because they simply cannot.

What is the strategy for them?

>> I think it is for us to all take that on board.

That there will be some people who are unable to wear a mask and those people can and many of them have applied for an exemption which is a legitimate exemption and we must be open and generous and kind to those people who can't wear a mask.

By the same token, those of us who can, should show an example and wear masks, including to protect our vulnerable people who are not able to wear masks.

>> (Inaudible) supermarkets there is an example, being abused by bus drivers not being allowed on the buses, what do you - how will that be over come?

>> I think our supermarkets are very aware that if people have got an exemption, then it is - they should be and I have not seen reports or we haven't heard reports of problems in supermarkets.

I certainly read the story in the media today and I think that is an important reminder to everybody, including our businesses and our bus drivers, that some people will have an exemption and if they do have it, that will be a legitimate one.

>> You said before you showed the modelling before of the peaks in the sec wave if we didn't do anything.

Can you just say where you're expecting this wave to peak and are you sort of seeing some modelling in terms of Auckland peaking first in the second wave or regional, you know, differences in that case?

>> You saw on the first slide that rates are going up right around the country.

So it's different from when we had the first Omicron wave which was very much Auckland baseed to start W like wise hospitalisation are increasing.

So we have got high numbers in all of our districts and regions around the country.

In terms of the peak, we have seen that increase in the seven day rate of positive cases.

However, the last few days have been quite steady.

The point is here it is up to all of us, and we have it within our reach, to actually level off that peak.

At either this current level or not much higher and that is what will make the biggest difference to the number of hospitalisation because our more vulnerable people, including our older citizens are less likely to be effected if we all take those measure that we have talked about today -- infected.

>> When are you expecting the peak to be reached and, yeah?

>> At the moment, the modelling is suggesting or the peak in cases will be about a week before the peak in hospitalisations.

So sometimes in the second half of July is what the modelling suggests.

>> There is a lot of language around.

>> What would you advise cabinet, that cabinet should do (inaudible)

>> No, our advice was to remain on the Orange setting.

But one of the things our team is doing and they are doing this today is to look at, as the minister described, if we were going to have to add in more stringent measures, either through this Omicron wave or because of a variant in the future, what are the settings that perhaps we should have in red, including indoor gatherings size limits and so on.

Because our sense was that the current indoor gathering size limit was unlikely to make much of a difference and that these were the important measures and the measures in Orange that we've talked about today are still the fundamental measures in red as well.

>> Would you say that the traffic light system, as it is now, isn't aligned with what we need to fight BA.

5?

>> I think that the Orange setting, including the mask requirements and so on, are good for now.

However, we have been - we have offered to and been asked to have another look at the current red settings to see if they did need to be deployed, whether they would actually make an incremental difference, in particular, if we had a new sub variant that or a new variant that had a greater impact than Omicron.

There is a question at the front here.

>> Encouraging people and telling people to dot right thing.

Sure, you're making masks more accessible to people.

How are you going to enforce it?

Compliance has gone down.

Why - what can you do to actually enforce this and tell people that that peak is going to hit if you don't do did?

>> That's why we're here today.

Just a reminder to people that there are many settings where masks are required.

And we're reiterating that and also supporting them to do that.

The minister may want to comment as well.

This is why we're making masks more available.

However, ahm I confident people will listen and follow through on the message?

I am.

Because we've seen that New Zealand's successful response in the pandemic to date has relied on people doing the right thing.

There is no way we could police our way through a lockdown.

It relied on people actually doing the right thing and they did it.

And our message here today is it's important that people again recommit, you know, we're not through this yet, it is time limited, we need to help our health system and indeed our older people get through winter in good shape and that's why we're here today.

Asking people to do that and also showing what we're doing to support that.

>> What are RAT and mask stocks, what are they looking like?

>> Very good.

That's one of the reasons why we feel confident that widening access is not only a good thing to do, but it's doable in terms of our stocks and we would rather have these things being used than sitting on the shelves.

>> How many people can go out and claim?

Can they just go out and hoard them?

>> Definitely not.

The people should - the whole idea is to enable and support people to use them appropriately.

The RATs are not there for businesses to pick up to do whatever testing they might want to in their businesses or masks.

It is not a replacement for businesses doing the right thing.

It is to enable individuals and Whanau to use masks as and when it is appropriate and to have access to tests and a good example might be if someone - most important use of using the tests if you're symptomatic or a household contact.

Someone might be visiting an elderly relative, they might have been exposed a couple of days ago to someone, they have heard about, they might not be symptomatic but they might want to do a RAT before they go.

So I trust people to be sensible around that.

>> Going back to the framework.

>> Is there any indication that Be >> Could be applied and perhaps the red or Orange setting that you have been Kia looking at.

>> Actually, New Zealand has got some of the strongest ongoing settings of any country, rapid antigen tests are only free for a portion of the population and that is about to finish.

We have had some of the wider access to fourth dose, Australia's just gone a little lower but they were behind us.

We've also were one of the first to move on that shorter time period for reinfection.

We're one of a handful of countries that are still requiring people who are infected and their household contacts to isolating for seven days.

So we've already got, I think, some of the strongest settings of any country or jurisdiction.

>> To go back to the framework.

Previously sort of the tipping point from moving to red was 10 thousand cases a day.

We are now well beyond that and everyone knows how much pressure our hospital system is under.

What is the new tipping point for this red even if the red needs to be rewritten?

>> I think it was said throughout the pandemic that we don't have magic case numbers in terms of when we make decisions at red and it is a global picture that accounts for both cases and the pressures on our health system.

But it has come back to the point of the decisions that we've made that the most effective measures that we're going to have will be masks and vaccination and staying home when you're sick.

That's why we've announced the things that we've announced today.

>> But I guess.

>> Just on the back of Thomas's question, you said that you have come up with this over the last two weeks.

Is that a bit of a knee-jerk reaction?

>> Only part of the announcement which was the part about rapid antigen tests and there has been a period where we have been worried that maybe people aren't testing as much as they have previously.

I mean, I think it is important that we're constantly looking across the things that we're doing and fine-tuning them when we think it's needed.

>> How much are they going to cost?

>> How long have you been considering this?

These changes?

>> I mean, well, this is what we do all the time is keep our eyes across the various measure that's we have, both the framework settings and the measures within that.

What we're talking about vaccination, rapid antigen tests, mask use and constantly re-evaluate them.

So they are all different.

For example, the anti virals component had been under consideration for longer, for a month.

>> Why do you think the number of critical care patients is noticeably rising.

>> It has been something that the WHO has observed around the world that the current wave doesn't seem to be putting as much pressure on intensive care, you know.

It's a promising indication.

It is not as severe as previous variants but an indication only at this stage.

>> Are you aware that there's been faulty RAT tests distributed to the public?

>> I'm not aware of a particular report of that.

But we are very concerned to make sure that RAT tests are of a high quality.

Which is why we have a limited set that are approved for sale in New Zealand and also the Ministry of Health works closely with counter parts in Australia who do post release assessment of whether the RATs perform.

>> How much have you set aside for these new free RATs for all?

>> We have a million RATs.

Sorry, 100 mill yol RATs in stock.

>> Sorry, we've got them in stock and we're just releasing them to the wider public now?

>> Correct.

>> In terms of access to the anti virals, are you having to purchase more anti virals?

>> No, this is within the purchase volumes that have already been announced.

>> What is the picture looking like for the COVID response, like contact tracing and gathering them is no longer important, what new tools is the ministry looking at to combat this virus?

>> I think just two important podeujts there.

The first is -- points there.

In terms of the future COVID-19 response, we set that out when we talked about our future approach to variants because I think that is it key overarching learn is that this virus changes and therefore we need to have resilient and flexible systems in order to manage that.

I would just - on your other question, I mean, we are always looking for new technology.

The Ministry of Health has a group that looks ahead at what's available and the testing space very comprehensively around the world.

We have a similar process for vaccines.

But actually some of the most effective things are hundreds of years old in terms of isolation, quarantine, staying home when you're sick, opening a window, you know.

We have discovered that during the tuburculosis outbreak.

It is the basics that are going to get us through this.

>> Is mask use and we live with it for ever?

>> I don't believe the current variant can eliminate it.

So we need to make sure that our society is resilient to it.

So no, it is not just mask use.

It is making sure we have high levels of immunity, by having good vaccination, it is making sure we have a system for making masks available and encouraging people to use them.

We have a system for diagnosis that is disseminated throughout the community, whether that is RATs or more sensitive tools when you come to hospital.

That leads you to get high quality treatments.

I mean, there are quite a few things in place to make sure that people are well looked after.

>> When we spoke a couple of weeks ago about the survey and the ministry sl doing, any updates when that might be in the field and when you might start to report back?

>> I don't have the information with me but we will follow up on thahrmt I understand it was heading into the field in July.

So that would be the case.

What I would say about the prevalence survey is a number of countries and jurisdictions in the UK's a good example here, are now relying on prevalence, regular prevalence surveys to have a feel for what level of infection there is in the community.

We've actually got very strong surveillance in place in addition to.

I do want to commend the people who are still testing and a lot of people are.

We've got high testing rates.

We're getting a high pick up relative to other countries of our positive cases.

Waech got our waste water surveillance and our border worker surveillance which is giving us a good idea of the existing infection rates.

Whereas other countries are relying on that.

What we will be able to do is the prevalence survey is have a look and see how many people have either been infected and/or have been vaccinated and have got some ongoing immunity.

So we will be doing that as well as a point prevalence of infection.

>> Is the government following and surveying on compliance (inaudible) a while ago and if, so what does it say about people's ongoing willingness to comply with the rules?

>> Gosh, minister, we got a report on this I think last week and that's certainly been one of the inputs that has guided us.

One of the reasons why I'm optimistic that people will actually pick up the messages.

Because there's still a high level of understanding of what the important measures are and a willingness to do them should they be important.

I guess what we're doing today is reiterating the importance of them and we would hope that many people will heed the call and do so.

>> So the survey hasn't seen a softening of peoples willing ness to follow the rules?

>> Not over recent months.

>> (Inaudible) >> Yes, indeed, yes.

Over time they have declined but there are differences between age groups as well.

>> If we did go to red, people would basically react against that, it is just a step too far.

>> I think any one of the changes is made and this is right through the pandemic has to be justified and juchable.

People are looking for the rational -- justifiable.

My sense is if people understand and trust the rational, they are willing to and we have seen time and time again to do the right thing.

>> Is the hospital system in a crisis?

>> That's a question that's been put around a lot lately.

I think there's no doubt and the minister and Margie have talked to this, that there is enormous pressure on the system.

Like Margie and the minister, I have been talking to colleagues, out and about in the sector and they are feeling that.

Whether one call it's a particular word or not is not the important thing much the important thing is what we do about it.

I've said this in this forum before.

I'm not a big fan of the word "Crisis" because it tends to suggest that people have no agency and that there is nothing we can do about it.

In fact, there is a lot we can and are doing.

And just this morning Margie, myself, the Chief Executive of Te Whatu Ora Health, Margie Apa and some of my senior people had an hour with minister Little talking through the work that is already underway and the immediate things that we can do to continue to support our fantastic health workers to cope through winter.

What we're here today to ask is of New Zealanders to do their bit to support them as well.

>> Has there been any consideration.

>> Two more questions perhaps.

>> Any consideration for just a short, sharp, circuit breaker lockdown?

>> No.

And just to go over the rational for that.

A disease that is this transmissible can find ways out of a lockdown.

We still - people still move in a lockdown because, of course, we all need food and essential medicines and that sort of thing.

And as a variant gets more infectious, the effectiveness of lockdowns decrease.

So we don't think that's an option for this variant.

Final question.

>> Hospitalisation modelling that you showed earlier, given the hospitalisations (inaudible) do you expects to see a peak in the next one or two weeks perhapses, that does mean we need to see behaviour change right now in order to get that lower scenario (inaudible) >> Absolutely.

It is today.

These are today actions just as they were last week and we're just reiterating them.

The masks and wider availability of RATs will be coming on stream very quickly.

So everybody can make a difference in terms of their actions today.

So that is the plea.

The sooner they do, then the lower the peak will be and the lower impact on our health system.

So thank you very much.

Appreciate it.