COVID-19 media update, 27 July 2022

>> (SPEAKS TE REO)

Thank you very much for coming to today's stand-up.

I'm joined today in the room by Dr Andrew Old, the Deputy Director-General Public Health Agency and Dr Pete Watson who will be on the screen shortly after I've gone through some slides as part of my opening comments so welcome again.

Thank you for being here.

Today just starting with an assessment of the current outbreak of COVID-19, how we're tracking against the modelling and also some analysis from our recent - sorry an update on the recent analysis of our deaths here in New Zealand from COVID- 19 and then I'd like to briefly discuss or refer to a directive that I've made to certain local authorities regarding water fluoridation today.

Pete Watson will give an update on the health system response >> The winter pressures which are very real and Dr Andrew Old will speak to the country's monkey pox response following the WHO declaring the virus in the current outbreak as a public health emergency of international concern.

Turning to the COVID-19 numbers today, there 8,730 new cases in the community with 808 people in hospital.

This is day two of our new approach to reporting deaths that are attributable to COVID- 19 either as the underlying or contribute cause.

There are now a total of 1,427 deaths confirmed as attributable to COVID 19, either as the underlying cause or a contributing factor and the seven-day rolling average of attributable deaths is now 17.

I've got some slides up here now to speak to and you can see in this first slide that case rates are trending downward across all four regions in New Zealand.

This finding is supported by what we're seeing from the wastewater results and the test positivity and people being admitted to hospital.

In the week to 24 July, the case rate from reported test results decreased by around 12% compare would the previous week and pleasingly we are seeing that case rate decline as well in our over 65s who have had the highest case rates amongst our groups at the moment and likewise our hospitalisation rate to the end of last week did decrease but you would have seen the numbers did go up again over the weekend.

They've come down again now to just, as I said earlier on, 808 people in hospital.

This is our regional weekly hospital occupancy rates related to COVID-19 and you can see in at least three of those regions last week they did level off.

So in some regions in the south island and Midland region they stayed steady or increased.

Our third slide shows an update on the different subvariants of Omicron and you can see, as expected, that the BA.5 subvariant continues to become the most dominant variant and as of 18 July, just over 60% of our cases were because of the BA.5 subvariant and we will expect that to continue to increase so we'll probably see an almost full takeover by BA.5 by early August.

A couple of weeks ago I shared some initial modelling from the COVID-19 modelling Aotearoa group that showed the possible size of this BA.5 wave.

The modelling has been updated with two significant new pieces of information.

First of all, there is international evidence that suggests a previous COVID- 19 infection, in particular a previous Omicron infection provides stronger-than-expected protection against BA.5 reinfection.

Second, the modelling now accounts for updated data on second booster uptake and the expected future uptake.

So the slide here shows COVID-19 hospital occupancy in the up dated modelling.

We can see that while there is still a chance - and there is the grey bands showing that hospital occupancy could still reach more than 1,000 occupied beds - we're tracking closer to a peak of 850 and we got close to that over the weekend.

The number's come down a bit.

We know that hospitalisations tend to track about a week behind cases and we have seen the cases dropping.

Similarly, while the seven-day rolling average of cases could reach a peak of 16,000 a day, the model now indicates that it is more likely to peak at around 12,000 and currently, as you know, we are trackbug low that and it looks like our case numbers are declining.

What is apparent is the worst-case scenario that our modellers had suggested a couple of weeks ago with up to 1200 beds occupied and over 20,000 cases a day is now highly unlikely and I'm sure we're relieved to see this.

We're continuing to mount a robust COVID-19 response and I want to thank everybody who has taken steps to protect themselves and their whanau not least the people who are testing when they're symptomatic, who are uploading their results and then, most importantly, are isolating and their family members are.

This is almost certainly a key driver of this turn-around we are seeing and it's great to see even this far into this Omicron outbreak that so many people are still doing this.

Just on to the data we've done looking at our mortality statistics and we are still seeing quite significant numbers of COVID deaths each day and we will continue to see quite high numbers until case rates are ready to climb quite significantly.

To better track the risk factors of dying from COVID-19 we've done some preliminary analysis of COVID- 19 attributed deaths and I want to share one aspect of that for you now.

It shows convincingly here in Aotearoa that getting boosted is one of the most important things you can do to reduce your risk of death from COVID-19.

Very consistent with the international evidence.

Across the population, people not fully vaccinated against COVID-19 - that is they've had less than two doses - are six times more likely to die if they catch COVID-19 compare would someone who has had at least one boost dose, that's once you adjust for all other factors.

For people under 60, this risk seven higher, more than 13 times greater for those who are unvaccinated or less than two doses compared with someone who's boosted.

Many of those who have died under 60 have had underlying health conditions and getting boosted is particularly vital for those people.

They will either be eligible now or shortly be eligible for a fourth dose or second booster.

Please do so.

For those who died.

who were between 20 and 60 years of age, we've estimated around half of those deaths could have been avoided if all those people had been boosted.

We'll continue to update and make public those a analsays as they continue.

Currently, around 25,000 New Zealanders on average have become eligible for their second booster and our daily number of boosters yesterday was around 11,000 so there are still plenty of people who are eligible for booster doses, the second booster, who can and should be going and getting it and my message to those people is: Please do so, it could save your life.

Finally, from me, a comment on community water fluoridation.

Fluoridation is well proven to be a safe, affordable and effective method of preventing tooth decay that benefits everybody but particularly children.

Maori, Pacifica and our most vulnerable.

Unfortunately, New Zealand has relatively high rates of preventable tooth decay with very significant inequalities.

Today, I have written to 14 local authorities directing them to fluoridate their drinking water supply.

This the first time that I have issued directions to fluoridate water since legislative changes last year passed responsibility for this health-based decision to this role, the director- general of Health.

The time that each local authority has to fluoridate their water supply varies between 6 months and just over three years depending on the circumstances of the supply currently.

These directions will take the proportion of New Zealanders benefitting from fluoridated water from 51% to around 60%.

I'm very pleased to be able to do this in my last week in the job.

I want to now hand over to Dr Pete Watson who will come up on the screen here to update on the health system response to ongoing pressures in the system.

Pete, over to you.

>> (SPEAKS TE REO) great to be here alongside Ashley and Andrew today and Ashley's last week y actually do want to take the opportunity first on behalf of the whole health system to recognise and thank and applaud Ashley for his leadership as he concludes this week in his time as director-general of health.

I know that far and wide, Ashley's presence, wisdom and reassurance provided at these stand-ups will be missed but I also want to recognise the sacrifice that Ashley and his whanau have made on taking on what must have been one of THE if not THE most challenging public service roles in the history of public service in New Zealand.

A huge debt of gratitude to you, Ashley.

We wish you all the best as you go forth into your new chapter of your life.

(SPEAKS TE REO)

and so back to this week's update and on behalf of Te Whatu Ora I can say we are all continuing to work as quickly as possible to provide all the ongoing support we can to our health system as winter pressure continues.

I'm here today from middle more hospital and I can tell you my experience here and from unless figures reported to Te Whatu Ora that there's clear recognition and awareness of the significant pressure on our health system currently.

This correlatewise the significant pressure and impact of COVID-19 and also the other winter illnesses including influenza.

This impact isn't just on increases demand of people seeking and needing healthcare, but also the much greater than normal staff absences in our system due to the winter illnesses.

This impact has been felt across our healthcare system, the community, primary and hospital care.

Here at middle more it has been pretty full on as it often is but it is the same across Aotearoa.

We've seen high numbers of patients going to GPs and urgent care facilities, fronting up to emergency departments and being admitted to hospital and we all are really struggling with lots of staff absence due to the illnesses and I'm continually impressed every day with how our staff are responding to ensure safe quality care is delivered to patients and whanau.

As the director-general has said, the national body suggests that over the last couple of weeks the number of cases of COVID-19 have eased off but, in fact, in our hospitals and in our GP practices and emergency care the pressure continues and we expect that this will continue for some months before it eases off.

It continues to place the system under considerable pressure.

We are supporting our colleagues working as service providers in primary care as well as district and regional Te Whatu Ora teams implementing on-the-ground responses as required to ensure our health system is able to manage both the demand and risks of greater work illness.

How are we doing this?

The first thing is that we are part of a unified health system including of course the Ministry of Health which is working together to address these demands.

We have a national plan that supports national consistency, regionally learned initiative s that are locally managed.

I know our Te Whatu Ora CE Margie has spoken to this before but I wanted to reinforce the core principles of our winter pressures operating model.

These include, first, ensuring a safe and available health delivery system.

Two, implementing public health measures that reflect the COVID response.

On the ground, we're supporting the availability of primary and community services by expanding capacity in our operation but also we very much leant into and expanded the use of telehealth in that part of our system.

We're supporting hospital flow management to optimise performance and create capacity.

That's from the front door at emergency departments through to ward management and facilitating discharge.

We're also very attuned to our support for our staff, to support them when they are unwell, to get well and to return to work well.

We are very appreciative of our staff flexibility and support during these times.

I wanted to talk about an additional step that's previously been signalled is being introduced tomorrow to boost access to COVID-19 medicines.

These are the antiviral medications and it's very much expected this will continue to support easing pressure on our primary care and hospital care practices.

So as of tomorrow, more than 400 pharmacies will be able to start supplying antiviral medicines to eligible people with COVID-19 who are at a higher risk of becoming sick but without needing a prescription so these are over- the-counter access to those medication.

The criteria of being expanded from 2% of the at-risk population to 10%, again acknowledging some people are much more at risk from becoming very unwell and requiring hospitalisations.

This is about easier and more timely access to COVID-19 medicines that have been proven to reduce hospitalisation for those most at risk of severe disease.

In closing, and although we have seen some encouraging signs in the COVID- 19 numbers in recent days, I know that the director-general is very fond of saying we aren't out of the woods yet.

And I just want to echo those words.

This will continue for some months.

The numbers will continue to be high because of our winter pressures and our health system, whether that's at hospital, primary care or community care, we'll need all the support it can get.

We are coordinating our activity, seeking opportunities to reduce and manage the demand.

We are sharing our successes and learning from each other all with one end goal, to provide timely quality care for our patients and reduce pressure on our teams and people as they go about their work.

(SPEAKS TE REO) I'll hand over to Andrew.

>> Thank you, Pete.

And (SPEAKS TE REO) so I've got two things I want to talk to you about briefly this morning.

First is monkey pox then I'm going to talk a little bit about mask use.

So firstly, I just want to confirm there are no new reported cases of monkeypox in New Zealand so our total currently still stands at two.

I'm not going to give further details on those cases except to say both are now considered recovered so we have no known active cases of monkeypox in New Zealand.

So while we have no new reported cases, unfortunately case numbers globally are continuing to rise.

We've got now over 16,000 cases reported across more than 60 countries where monkeypox is not usually endemic and that includes over 40 cases now in Australia.

So concerned with those rising numbers and the different distribution from previous outbreaks of monkeypox, the World Health Organization moved this week to deem monkeypox a public health event of international concern.

For context, a public health event of international concern is the highest alert level that the WHO can issue.

There's two organise s currently in effect -- two others currently in effect, one for COVID and one for polio.

As a result of that declaration we are working through the WHO's recommendations to ensure New Zealand remains in the best possible position to minimise the risk of possible community transmission here.

Those recommendations include areas like implementing a coordinated response which we're working with our partners in the national public health service to do, engaging and protecting our communities, surveillance and public health measures and clinical management and infection prevention and control.

Part of that also means that we are currently reviewing our case and context definitions and the guidelines associated with them to ensure they're in line with the most up-to-date evidence as it evolves.

Our public health teams have been working on planning since the start of this global outbreak in May, taking steps to avoid community transmission here.

We made monkeypox a notifiable disease in June which has supported us and will continue to do so with enhanced surveillance and our ability to follow up cases if and when they occur.

We've been in constant and regular communication with public health units and other groups in the community' including providing updates and advice to clinicians across the country.

It's important to ensure our messages to the public are regularly updated and include information about transmission, symptoms, prevention and what to do if you develop symptoms of monkey' pox, infection prevention and control measures for healthcare workers and advice for primary care and sexual health clinics and we are continuing to update that advice as new evidence emerges.

Work continues between ourselves and Te Whatu Ora health New Zealand and Pharmac on securing a supply of Invermex vaccine, suitable for smallpox and monkey pox and the vaccine used mostly in the UK and US.

We're still finalising that supply but it is important to note that even if we had a vaccine the mainstay of our response would be based on many of the measures we already have in place including testing, isolation and contact-tracing.

Just to reiterate, there is no community transmission of monkeypox in New Zealand at the moment.

It is not as infectious as COVID-19 but, as with the early days of COVID t is important we understand the risk and we do everything we can do to minimise that risk now because we'll almost certainly get more cases, particularly coming in from overseas, and the risk that they will seed into the community.

As a colleague has said this week, monkeypox, although it's been concentrated in certain populations s a democratic virus and in those areas overseas we're starting to see cases in much wider groups of the population so important to be really vigilant.

Finally, an additionalply plea for mask-wearing this winter.

We've got a new graphic which will be up on social media and other channels later which really just makes the point about mask use and the restrictions of transmission that that helps with and really makes the point that one mask is good, two masks are better and although this is based around COVID, as we've said many times before, there are lots of respiratory infections out there at the moment, lots of things transmitted by respiratory droplets and aerosols and masks are a great protection against all of those things.

Now the school term has begun we're strongly recommending, as we mentioned last week, that face masks are warn at schools for students years 4 and above for the first four weeks of this term which will get us through the worst period of winter that we have to go.

The ministry has previously provided advice to government which resulted in the provision of funding for free masks for students and additional funding for schools and ECEs to support better ventilation over winter months.

The first four weeks will see us through this current period of winter illnesses and increase COVID-19 cases and we are asking students to wear in all indoor settings where they can, of course there will always be activities where face masks aren't practical such as while eating, drinking and playing sport.

We know correctly wearing an appropriate mask such as surgical and N95 masks can reduce the risk of transmission by up to half that you will spread COVID-19 or other respiratory viruses and I would refer you back to the director- general's video on how to wear masks appropriately which is available from our website.

I'm just going to take advantage of being in front of the microphone to also go off script a little bit as Pete did and offer my thanks and acknowledgment to Ashley.

For those of you that are counting, we think this is/'s 307th stand- -- that this is Ashley's 307th-stand-up which I think you'll agree is a Herculian effort and a testament, I guess, to the incredible work that he has put in right since the beginning of the pandemic.

Many you may not be aware that at the weekend Ashley was at the GP conference in Christchurch where he was awarded an honorary fellowship of the Royal New Zealand college of general practitioners.

Those honorary fellow schps are only given to people who have made an outstanding contribution to general practice or the medical profession in general.

He was nominated for his work as director-general of health and using evidence-based decision- making to inform government.

In their citation the college said Ashley had communicated with vulnerability, honesty, compassion and logic and reinforced public health messaging by being a strong role model and in presenting the fellowship the college President thanked Ashley for his calm steadfast approach over what we know has been an unprecedented few years and for his advocacy for GPs and the rural hospital medicine workforce over the course of the pandemic.

I think we would all agree that in place of GPs and rural hospital medical workforces you could exchange that for almost any other section of the health sector or indeed society at large and find the sentiment expressed by the college rings true for all of us.

I personally would like to offer my thanks to Ashley although perhaps not for handing the baton of media stand-ups and wish you all the very best for the future.

Thank you, Ashley.

Go well.

>> Thank you Andrew and Pete for your updates and kind words.

As mentioned, this is my last press briefing as director- general of health.

I want to do one last thing and that's is to thank all of you, the news media.

An effective COVID-19 response has relied fundamentally on and continues to rely on an informed public.

Throughout the pandemic, people have been able to open their newspaper, switch on the TV or radio, check their phone, to be informed about what COVID-19 means for their lives and how to act and an important role for the media is to hold those in public office to account, to ensure we are not just doing our job but constantly challenged to do it better.

From where I've been standing, it feels like you have fulfilled that responsibility.

It feels like an age since we hosted our first press briefing in January 2020 in the room next door to here.

I don't know if any of you were in the room then but I am seeing some nodding around here.

That was to discuss the novel coronavirus emerging in China.

Since then, we have been through lockdowns, many different COVID-19 variants, rolled out vaccines several times to over millions of New Zealanders - to millions of New Zealanders and learned a new vocabulary from household bubbles to RATs.

I feel honoured to have led the Ministry of Health at this time and I am wholly confident in the people, including those who are here with me today, across the ministry and Te Whatu Ora Health New Zealand who will lead the COVID-19 response into the future.

I'm happy to take questions for the last time.

>> Why aren't you making all the councils fluoridate their water?

Why just 14 at this stage?

>> On the topic of fluoridation, we wrote to all councils who currently do not fluoridate their water to ask of them what they - how long they thought it would take to fluoridate their water and how much it would cost.

On the basis of the responses we had from the councils we then triaged those who felt they were able to do it sooner and for whom the cost could be accommodated within an envelope of around $11 million that we have available to support capital works that will allow them to fluoridate and so we've started off with that first group of councils but rest assured I have written to all of them and in particular some that have got quite large populations receiving unfluoridated water and made it very clear to them that we will be following up with them to also look to fluoridate their water in the near future.

>> What is the timeframe on this?

When do they have to do it by?

>> The 14 that have received the directive today will be receiving that directive - will take anywhere between six months and three years depending on the nature of their current supply and just the extent to which they need to install plant.

Some of them have got the plant there ready to go so it is a much shorter timeframe for starting to fluoridate.

>> How important was it for you it issue this order in your last week in this role?

>> I've actually been a long- time champion of fluoridation.

It's an incredibly effective - one of THE most cost-effective public health interventions and it is great way to address inequities in outcomes particularly amongst children so I'm thrilled to be able to give these initial directives under the new legislation before I finish up.

>> Given issues that Wellington Water has faced with fluoridation, how urgent is it that the capital gets neuridate back in the water supply -- the council gets fluoride back in the water supply?

>> I have been investigating what happened in the capital and remedy the fact they haven't been fluoridating and that work is progressing at pace.

I will have to come back to you on the actual timeframe for when fluoridation will be reinstated to a couple of those specific supplies.

There are many welling tonians still receiving fluoridated water but a couple that it needs to be reinstated and I know progress has been made apace.

>> How concerning was that development that came out about the independent probe and the issues Wellington Water has faced over the last six years?

>> It was very concerning and underscores both the importance of the legislative changes but also the importance of the local authorities maintaining a clear oversight of fluoridation of water and regular reporting on the status.

>> How urgent is it these councils you have mandated to get fluor get it as soon as possible >> I would encourage those councils and I ones that I haven't yet directed to fluoridate their water as soon as possible.

They don't need to wait for a direction from me.

>> .

On the COVID-19 vaccine for under fives.

>> For under fives, what is the latest advieps on the COVID-19 vaccine?

-- advice on the COVID-19 vaccine?

>> Some countries have approved vaccines for under fives, mostly to date with the Moderna vaccine.

We haven't yet had an application for vaccine for underfives with the Pfizer vaccine, we don't have Moderna in New Zealand at this point in time.

Once we receive an application we will assess that.

We are continuing to look apt emerging evidence and our technical advisory group, vaccination technical advisory group, will provide advice on the balance of risks and benefits of offering vaccine to that group.

A question down the back.

>> How comfortable are you with where you're leaving the COVID situation?

Is there a pathway out of the woods that you see?

>> Indeed, out of the woods.

Look, as I said, I'm wholly confident in those who will be continuing to lead and deliver the response and two of those people are here with me today but there are many others and many of the teams that have been doing the work in the ministry have transferred now to Te Whatu Ora Health New Zealand but it is the same people and they are very able and will continue to do a good job.

Like every country, we are of course keeping a strong forward view on this and looking for what is the pathway to reducing the impact of COVID-19 both on people's health as well as our health system and wider society and so the only other comment I would make is it's very important that we do continue to maintain all the measures we have got in place for the time being especially as we get through winter you will see globally that even in northern hemisphere countries in the middle of summer, COVID continues to have a significant impact including on health systems.

And we clearly want to keep every tool in the tool box that we can to avoid getting ourselves into that position as we come utof owinter.

>> Could you talk about the biggest changes in your thinking about COVID over the last two and a half years?

I remember being at one of those early press conferences when you said there was no evidence that mask-wearing would help and things like that.

>> Yes, well, this is one of the beauties of daily stand-ups is that one is forced to be humble in this role.

Look, what I would offer is that we've kept really up to date with the emerging evidence and not hesitated to change our advice where we see new evidence and sometimes, of course, we've had plenty of external commentators who have been suggesting we should or shouldn't be doing certain things but of course the responsibility we have is not just to look alt that evidence but to think about what are the implications of that and most importantly how do we make sure we implement any changes effectively?

One thing I would say, and I was speaking at a conference over the weekend in Sydney, where it's compulsory to wear masks on public transport.

Obviously, compulsory in New South Wales means only about 10% of people need to wear masks so it's very important here in New Zealand that we continue to do things and take people with us and I've made this comment before about the role of mandates or not mandates.

>> Biggest regret?

Biggest success?

>> No regrets in the sense that we gave the very best advice we could based on what we knew at the time.

One comment I would make, and this is really a big lesson for me and something I think others have learned as well, we tend to underestimate the capability and capacity and resourcefulness of our communities and, in fact, providing them with the resources and the information to get on and do the right thing can lead to enormous success and I think, again, a great part of our success as a country has been the way that communities have responded to the information that's been provided and then the resources we have provided either directly or through a range of providers.

I think there's a great lesson there for us that actually our biggest healthcare workforce are our citizens.

They deliver most healthcare every day to themselves and their families and their communities and our job is to sometimes get out of the way and make sure they've got the support they need to do.

>> How many councils in New Zealand aren't currently fluoridating their water?

>> Sorry y don't have the number there but one of my team will be looking that up right this minute to provide to you as soon as possible.

I do want to emphasise a point, the this is a safe highly effective, highly cost effective intervention and councils don't need to wait for a directive to get on and protect vulnerable citizens from tooth decay.

>> What response did you get from council said when you issued the directive because some have been famously anti- fluoride.

>> Variable responses.

Some of the large ones I rang, personally rang the mayor and again got responses that ranged from great enthusiasm to much less enthusiasm for that.

>> When would you hope to get - like this is going to be 60% of New Zealand water fluoridated so when would you hope to get to 100% and is that achievable?

>> It's not achievable to get to 100% because many of our water suppliers are much smaller suppliers supplying small communities and it's really more difficult and not cost effective to fluoridate those supplies so other mechanisms need to be used there.

But if we get all larger water suppliers fluoridated then we will get up to - I don't have the figure but I imagine closer to 80% of New Zealanders able to access fluoridated water.

>> When would you want to get to that point?

You've said some of the councils you haven't issued the directive yet.

>> As soon as possible.

>> Where are we seeing the most pressure at the moment in terms of winter illness?

The south island was mentioned earlier.

Can you be more specific in terms of hospitals and regions?

>> That might be a good question for Pete.

Pete, did you grab the question about the greatest pressure at the moment?

>> In terms of winter illness I think it is pretty spread actually.

I don't think there is a particular, you know "it's in the north or the south.

" It is right across the country currently we are seeing.

It is a slightly different to how we might have started in the Auckland metro and rolled south, at this point it is pretty well spread in bight southern - we know particular areas, Canterbury through to the northern regions.

No, I don't think there's a particular geographical region where we are seeing more and it does vary over time, often.

I think that's the pattern we will see now, there is a more consistent pressure across the system.

>> Which hospitals are only doing acute surgery?

>> All hospitals are doing some - if you're saying the opposite, some are all doing some plain care but the amount of planned care is prioritised depending on what they are actually - what their capacity is so I'm not aware of can any hospitals that are not doing any planned care but the most urgent planned care is being prioritised where they are having to ensure they've got enough capacity for the winter pressure.

>> We just told tomorrow with the aesthetic technicians striking there will be disruption for the hospitals that they predominantly work in.

I know middle more is not part of them but how disruptive are you expecting that to be for surgeries?

>> We are making preparation as we always do with any strike action to ensure the safety of clinical care can be provided so I am - we aren't experiencing any here but I know across other districts there will be.

We are looking forward actually to being able to get through this period of industrial disruption which is really challenging at a time when we've got such pressure from the winter illness but if we've got further questions about that we can provide a more detailed statement following the stand-up.

>> Thanks, Pete.

A question down here.

>> On the COVID deaths, there was likely a conservative count given some older patients may not be tested.

Do you agree it could be much higher?

>> We've got quite a high level of confidence in the numbers because everyone of the numbers we're now providing in our total has been recorded as a death from COVID or related to COVID on the death certificate and then our coders have gone through and made sure that is then reflected in our numbers so I would say New Zealand's got as good a tally of this as any country has but also of course we are still collecting the number of deaths.

anyone who dies within 28 days of an infection so those where there's uncertainty are looked at carefully to see if COVID could have been a contributory cause.

I would say we've got a pretty good estimate.

The other thing is, and I'm sure Professor Baker talked about this as well, we're also looking concurrently if there is evidence of excess mortality in New Zealand and that would give a further indication if there were COVID-related deaths that perhaps were over and above the deaths we would otherwise expect.

>> How is that currently tracking?

>> At the moment, my understanding is weir not seeing excess mortality but we can provide an update on that next week.

>> (INAUDIBLE QUESTION) There is maybe a misunderstanding that people had other illnesses that they're dying from and not so much attention to it.

Are you able to explain a bit more about that?

>> Every death from COVID-19, of course, is a great loss to a family and the community and what we can say is, as in other countries, we see the highest rates of death amongst older people so age is by far the strongest risk factor.

We also see pre-existing other conditions, particularly heart or respiratory conditions, also pre-dispose people to dying from COVID-19.

So saying, I do want to focus on the information I did give showing how protective vaccination is particularly if people are boosted.

It is a great intervention.

It's something that everyone can do to reduce their risk of hospitalisation or death from COVID-19.

>> There's some concern in Australia as to the efficacy of RATs and a product that we have approved here has been taken off the shelves over there.

Are you going to be - probably not you but will someone be reviewing the efficacy of RAT testing here?

Are you looking at removing the same product here?

>> We'll keep a close eye on just what other countries are doing around products and if they've got concerns about specific products.

I don't have the detail around that one but what I would say is since we started the rollout of rapid antigen testing here in February, they've served us very well and continue to be a really key part of our response and, again, just to thank everybody who is using rapid antigen tests.

I think it's become part of what we do and the fact we're still providing them and getting 90% of people crossing the border doing the rapid antigen test day zero-one and upload ing the result is great.

>> How many PCR stations are still open and how does it compare with the peak of the pandemic?

>> I couldn't tell you how many stations are open but PCR testing is widely available in general practice and general stations.

>> How are staffing levels across the stations?

Are they under pressure?

>> No, they're not under pressure.

We are making sure we're not over-staffing those stations when we're not using PCR testing quite so much, when we could use those staff in other parts of the system.

>> A couple of weeks ago you announced a couple of health changes, particularly around availability of the flu vaccine and COVID-19 vaccine.

Are you confident that those changes had an impact and have reduced the case numbers and the load on hospitals as well?

>> I think they are definitely playing a role.

So far, we've got about a third of people eligible for that second booster have taken it up and that's several hundred thousand people so that's great.

That will be making a difference.

Likewise our flu vaccination rates continue to increase.

There's still merit, if you're eligible, for a free flu vaccine and going and getting one.

All of these will be contributing and we have seen our rates of flu in the community decline over the last few weeks as well.

Just back on the fluoride, obviously $11 million has been made available at the moment to help those councils put fluoride in their water.

Would you like to see more funding for it?

>> That's something we will be looking at, at what further financial support might be needed and might be available in the future for further councils to fluoridate their water supply.

>> In relation to nursing students working at Dunedin Hospital, the nurses koergz says families of patients should be brought into help instead.

Is that acceptable?

>> I'm going to pass to Pete but in my experience families are already and do play a really important role already in supporting the care of their loved ones when they are in H.

Pete, did you want to respond to that?

>> Yes, that's right, so whanau play a really important part in being healthcare partners in hospitals already but in addition to that to try and support staffing issues that we are facing, we have been looking to others including student nurses to support with non-clinical tasks on wards for when people are available and the need arises and we're using that flexibly but Dunedin is one place that has been happening so such activities as supporting assisting with mobilising patients, hygiene needs, meals, those non- clinical things which many of those nursing students I understand are towards the end of their degrees and can help with but I want to reassure everybody that where this is happening it is under the direction and delegation of registered nurses so this has been well supported and supervised where this is occurring.

>> Thanks, Pete.

Can I make a comment on students.

Many of our nursing, medical and allied health students over the last two or three years have had their educational experience disrupted and they have been fantastic.

They played a critical role in supporting the COVID-19 response.

Many of them in hospitals supporting testing, supporting the vaccination rollout as well so I do want to take the opportunity to thank them for what was really quite a disrupted educational experience but they've really pitched in and played quite a key role over the last few years and I want to thank them for that.

Follow up question.

>> How many hospitals - it sounds like that's quite common.

How many hospitals is this happening at around the country, having student nurses working?

>> Pete?

>> We'd need to get back to you on that.

I wasn't specifically talking about student nurses in that regard, I was talking about the use of staff more broadly within hospitals.

For instance, here at Middlemore we have tasking teams where people volunteer from one area to help in another area in the non- clinical task areas.

It is an internal process.

That's something that has been found to be useful additional approach when we are really facing challenges in terms of our normal rostered clinical staff on wards.

>> You were waying with nursing students you're grateful for their work.

When it comes to the students they have to do 1100 clinical work, all unpaid.

Do you think that's fair given we are trying to get more nursing students through the system and into the workforce?

>> Student experience as part of their education is unpaid not just for nursing students however we know for some students that does create a real financial pressure and it could be something that's contributing to drop-out during their study.

I know that is one of the things that is being looked at as part of future workforce initiatives.

>> How concerned are you about the level of deaths in 80-plus people with COVID?

Seems to have been quite a spike in recent weeks.

>> In people over 80?

>> Yes.

>> Certainly our highest deaths are in those over 80.

That's something we keep a very close eye on and a real priority for getting that second booster dose out has been into our older age groups in particular those in aged care residential care settings because we know they are at the highest risk of dying and therefore the greatest benefit of vaccine.

I'll come back to you and we can get a breakdown of vaccine coverage by age group.

>> What advice did you get from officials after asking them to look at the red setting?

>> Oh, the advice I got has been passed through to ministers and is currently being considered.

I don't want to pre-empt that consideration or any decisions ministers make.

>> Where would we be at for a monkeypox vax?

A vaccination for monkey pox, what stage are we at for rolling that out?

>> We're still working on getting that vaccine for New Zealand and I think Andrew talked about the discussions that Pharmac is leading with the manufacture going ewell but the point here being at the moment we've got no ask community cases and vaccination might play a role but it's not the first measure we'd implement if we did have any community spread here of monkeypox.

Final questions?

>> What's next for you?

>> Lunch.

(LAUGHTER) But from Saturday a jolly good break and thank you very much.

Can I thank you again.

That's over and out from me.