COVID-19 media update, 4 August 2022

>> Kia ora koutou.

Greetings everyone and welcome to here in this Cook Islands Language Week.

Today's briefing includes our usually winter and COVID-19 response updates as well as an update on improvements in our vaccine data reporting and monkeypox.

Thank you for all for being here.

My name is Andrew Old.

I'm the Deputy-Director and head of the Public Health Agency within the Ministry of Health.

I'm joined by Dr Nick Chamberlain, the National Director of the Public Health Service, within Te Te Whatu Ora Health New Zealand.

He was hoping to be here in person, but the weather put paid to that.

So thanks, Nick, for being available online.

It is a technical briefing we have for you today.

There is quite a lot of detail for us to get through but we'll try to get through that in a timely way and leave time for your questions.

Today, I'm going to begin with an assessment of where we're at in the COVID-19 outbreak.

Followed by an outline of some improvements in our COVID-19 vaccination data, before handing over to Dr Chamberlain for an update on the country's monkeypox response following our third case that you will have seen reported this week on Tuesday.

He will also cover an overview of the health system's response to winter pressures and our ongoing efforts to improve COVID-19 vaccination rates.

But first, the daily numbers.

Today, we are reporting 6,152 new community cases of COVID-19, and 663 hospitalisations, including 14 people in intensive care, and 49 deaths.

As we've said recently, that those 49 deaths are people who have died with COVID in the previous 28 days and our website will have details of new attributable-to- COVID measure.

The media team.

worried I wouldn't be able to work the remote, so I've passed my first test! Last week we talked about cases starting to turn downward and we can see here on the slide that case rates have continued to trend lower across all regions for the second week running, dropping 18% in the last week to 31 July.

Cases amongst people over the age of 65, which is one of the age groups that has been hardest hit in this most recent surge, have dropped by 21% in the past week, and both of those falls are higher, more accelerated than they were in the previous week.

So while we know that some cases will always go unreported, testing of healthcare workers and our ongoing waste water surveillance also supports the conclusion that for now at least we're seeing a true decline in community transmission of COVID-19.

It's encouraging that this decline is occurring despite the increasing proportion of sequence samples being the more BA.

5 Omicron subvariant, which in the latest data is up to 76% of all samples now.

While lower cases are a good sign, we know that COVID-19 hospitalisations and COVID-19 deaths lag behind any decrease in cases.

I want to stress that our hospitals remain under significant pressure from COVID-19 illness.

In the week to 31 July, the same week our case rates dropped, the COVID-19 hospitalisation rate rose by 35%.

As you can see from this graph, all regions except for the northern region have seen hospitalisations continue to increase.

This is the fifth week in a row we've seen a national increase in the COVID- 19 hospitalisation rate.

Nick will speak shortly to broader winter pressures but I did want to take this opportunity to thank our health workers who continue to do an incredible job in very challenging circumstances.

Just turning to modelling - the latest modelling from COVID modelling Aotearoa shows we are tracking at the lower end of what was expected from a BA.

5 wave this winter.

You can see here, cases are already declining as noted, strongly suggesting we had reached a peak slightly earlier than the modelled line indicated.

While hospitalisations are still rising again our expectation is that peak hospitalisation will be at the lower end of what was modelled.

While we could still reach more than a thousand occupied beds we are tracking closer to a peak of about 850 occupied beds across the country.

We will continue to watch these numbers closely, as there always remains the potential for a resurgence in COVID cases and hospitalisations.

I want to thank everyone for continuing to take steps to protect themselves, their whanau and communities throughout the rest of winter.

Get vaccinated and boosted.

Wear masks in indoor areas outside your home.

Get tested and importantly stay home if you are unwell.

All of these things help reduce the opportunity for COVID-19 to spread and it's vital that we keep taking these steps in the coming weeks to protect vulnerable people in our communities, and support the health system and health workers get through the rest of winter.

Turning now to the vaccination data - I want to take - talk about an improvement in how we will be reporting data from next week.

From 8 August, 2023 people who used health services will be formally added to the population of New Zealand.

This is population is caught the Health Service user or HSU data set and it counts the number of people who used health services in New Zealand over a 12-month period.

Importantly, it counts actual people, so we know who they are, where they are and the details about them.

We are replacing the 2020 data set with an updated one based on interactions that occurred over the course of 2021.

It's important to note that these are technical changes and they make no difference to the total number of New Zealanders vaccinated, which remains the same and increases with the thousands of people being vaccinated every day ongoing.

The total number of people aged over 12 who've had at least two vaccination doses has increased 9.

6% in the past eight months going from 3.

63 million on 1 December last year to 3.

98 million on 1 August this year.

However, when we switch to the new data set next week our reported vaccination rates will show a drop.

Because as I said this updated data set has 233,000 more people in it.

Put simply it's the same number of people vaccinated but we're now dividing that by a bigger number.

So using that larger data set, two-dose coverage of the eligible population aged over 12 goes from 95% to 90%.

For Maori, it goes from 88% to 83%.

And for Pacific peoples from 97% to 89%.

Importantly, rates for all ethnicities for our most vulnerable people aged over 65 remain above 90% and overall New Zealand remains one of the world's most highly vaccinated countries for COVID- 19.

The HSU population count is ideal for supporting our vaccination efforts, because as I said, it represents real people who are here in the country interacting with the health system.

It means that we can target and plan our campaigns both at a community level, for example, identifying areas where coverage is low, but also at an individual level, for example, targeted text message invitations for vaccination.

I want to take a moment to thank Stats New Zealand who has peer reviewed the methodology used to create the data set, and have endorsed it as the right tool for continuing to measure vaccination coverage.

Helpfully, Stats New Zealand made a number of recommendations, which both have been accepted and have already either implemented or in the process of doing so, with one exception relating to a technicality in the ethnicity reporting as this is still subject to discussion with other agencies.

We're committed to updating the data set every six months.

There are two other changes taking place to the reporting of COVID-19 vaccination data.

The first is we're changing from reporting age at last vaccination to current age.

This is because we need to better understand who in the population is eligible for boosters as we go through.

So this change results in a more accurate indication of who is el jebl for both boosters and first vaccinations as new people enter the various age brackets.

The second change is removing the term "fully vaccinated" from a person's vaccination status, and replacing it "completed primary course".

So previously, a person was deemed fully vaccinated immediately after the last dose of a COVID-19 primary vaccination course.

So for most people, that was two doses.

And that definition did not include boosters.

Now, a person is considered up to date with their vaccinations if they have received all recommended COVID-19 vaccinations.

So, in other words, they've completed both their primary course and any booster doses that they are eligible for according to their age and other bt factors.

At this point I will hand over to Dr Chamberlain to talk about monkeypox.

Thanks, Nick.

>> As you will be aware, on Tuesday, we reported a third case of monkeypox in New Zealand, an initial positive test for this case who's isolating was yesterday validated by ESR.

I have spoken to the medical officer of health this morning, reading the local response and the patient is doing well.

The first two initial cases have now recovered and none of the three cases are linked.

There's no evidence of community transmission from any of the three cases.

So monkeypox cases globally are continuing to rise.

The latest estimate from the University of Oxford is that there are more than 23,000 cases in 78 countries, and people are at highest risk are those who've had skin-to-skin or sexual contact with pool who have monkeypox, such as large parties or sex on promises venues.

Most people are not at risk of monkeypox, though we note as recently described by a colleague, monkeypox is a very democratic virus and can infect anyone.

Advice on monkeypox is available in the public health measures on the Ministry of Health website.

An advice to travellers is that all three cases in New Zealand have been in people infected from overseas.

So New Zealanders heading overseas should take appropriate precautions when travelling, particularly around practising safe sex.

We note the majority of cases in the current outbreak have been reported in Europe and the Americas.

With respect to vaccination, cap health New Zealand and Pharmac have been working on vaccines since we had our first case of monkeypox.

The vaccine is only manufactured by one company in the world and there is a global shortage.

It is only available to national suppliers and can only be purchased in large volumes.

For those reasons, there's considerable international demand.

We're developing an implementation plan for when our vaccine order arrives, including issues around eligibility, distribution and work force.

So it's unlikely that we'll have a campaign in advance of community transmission.

Vaccination is an important tool, but it's certainly not the only within we have available to prevent community spread.

We're working with the community and the foundation to ensure the correct health promotion are available and accessible.

T his concerns infection prevention and control measures, as well as early detection, accessing care, isolation and contact tracing.

All public health services are fully aware of the pathways that have been developed.

The national Public Health Service has a dedicated team who have a plan covering the points that were made recently in a letter from the Burnett Foundation that was reported this morning in the media, and will ensure that they are part of this team going forward.

I will now move to a brief winter update.

Turning now to the wider health system - I would like to acknowledge the ongoing hard work of our health care work force across the country as winter continues pressure.

I am very aware and see how hard everyone is working at our hospital and throughout the health system.

We're continuing to do all we can to support these hospitals and emergency departments and I want to also acknowledge the tireless works of general practices, pharmacies, other Health Service providers in this all- important time.

This includes recent changes to boost access to COVID-19 anti-viral medications, expanding access to telehealth support services and after-hours options for patients and improved access to community services.

I'll give an update on vaccination initiatives.

Vaccination of course still remains a cornerstone in our response to COVID-19.

The updated HSU data that Dr Old has mentioned is just one of the ways that we're continuing to improve the vaccination program, and drive vaccine update.

This approach includes using a wide variety of providers, promotion al campaigns and supporting communities to lead vaccination efforts.

We're also mindful of the need to ensure that our Maori and Pacific health care providers are supported to help ensure equitable outcomes for their communities.

This remains at the part of the program.

To that end, we're excited about a $3.

5 million investment to increase data capability of Maori providers and the usability of the data we provide to our partners.

We are also looking at ways to share these learnings across providers and create a community of practice to increase broader capability.

Our other work involves supporting Pacifica providers in community-led vaccination events.

A recent vaccine calls a health care collaboration with Samoan health care community group in Auckland in late July.

They administered over 400 COVID-19 vaccines.

These sorts of initiatives are occurring throughout New Zealand.

Additionally, to make sure providers like these can continue to support whanau through this Omicron response, 26.

9 million has been indicated under the recently announced Maori and Pacifica Omicron response team.

Accordingly a portion of this fund is focused on supporting work force.

The ministry has invited more than 140 Maori health and disability providers to apply for this funding.

Equity remains at the heart of the caring community program.

Expectations are laid out in the COVID care in the community Omicron framework.

So far, 54 hubs set up and many are Maori led.

All the hubs are providing a range of services for whanau, including the delivery of medication, financial support, alternative accommodation, coordination health services and manaki services.

In addition, Maori health providers Mon torn the recovery of those who have tested positive and offer the opportunity for vaccination if appropriate and when eligible.

Vax - we have current promotional campaigns which focus on the importance of vaccination for children.

The program is building on the success of the robust data sharing partnership Maoried and Pacific providers for COVID-19 and influenza vaccination data and we're working to extend this approach to include childhood vaccinations.

Back to you, Dr Old.

>> Thank you, Nick.

We're now happy to take questions.

>> Dr Old, in regards to monkeypox - now that we have this third case, how would you categorise the risk to New Zealanders?

>> Nick, do you want to take that one?

>> Sure.

We'll be a tag team, but generally I'll take probably most of the questions around monkeypox because I'm taking the lead with this.

So the risk is still low.

Very low.

And we will, though, undoubtedly see more cases imported from New Zealand, and at stinl we will see community transmission.

>> Apologies, just because of that computer sound, would you mind just repeating that answer for me?

>> Sure.

The risk is low.

But we will continue to see cases and these are likely to be from international travellers, as is currently the case, and at some stage, looking at the international experience, there will also be community transmission.

>> And when it comes to the government's response, in that letter that included the Burnett Foundation to the Prime Minister and other ministers, they talk about being a bit of a piecemeal kind of approach so far.

There any be improvements made with the approach?

There will be a cross-agency team on this?

>> There already is a cross- agency team.

I think the letter from the Burnett Foundation was a good one, but it probably wasn't aware of all of the activity that's going on.

We do have a plan and we have a dedicated team, and working across agencies, we have engagement with the Burnett Foundation and our plan contains most of the actions that are outlined in that letter.

>> (Inaudible) vaccine, please.

>> I didn't hear that.

>> Have you ordered monkeypox or the smallpox vaccine, how much and when?

>> As I said, from the moment we had our first case, we commenced discussions and working with Pharmac to try and procure some of the vaccine.

We do not have any guaranteed supply of vaccine yet.

We are part of a large number of countries who are endeavouring to access vaccine.

Many have been unsuccessful at this stage, and even large countries such as the US and Dr Old shared with me a New York Times article where there's significantly less vaccine available than is needed for the US so we took action as soon as we had our first cases and are still working really closely with Pharmac.

That's the organisation that procures this and they have huge experience in procuring both vaccines and medications.

>> Can you just explain again.

>> The charge against the government was that you were too slow to order COVID vaccine.

Are you too slow again to order monkeypox vaccine?

>> No.

As I said, we've ordered the vaccine.

or attempted to order the vaccine as soon as we had our first case.

Now, I think that's probably as quick as anywhere.

>> The letter from the health advocates, it really highlighted that, for them, they think we have a disconnect between the approach and the disproportionate rate that monkeypox is affecting communities.

You see that you have engagement but they didn't know what was happening.

Is your approach then actually going to reflect that disproportionate impact on queer community, even though it's not their fault?

>> No, we don't believe our approach is.

So we have been working with the Burnett Foundation, both Dr Old and I have an appointment with the CEO next week, and we will ask the Burnett Foundation and the New Zealand sexual eight society to participate in our ongoing planning and be involved in the dedicated team that are engaged there.

So I believe we've taken a careful approach and we've been quite deliberate and ensured that we have covered off pretty much all of the actions that the Burnett Foundation have put in their letter.

I looked at the letter as a prompt rather than a criticism of us.

>> One of the thinks that Jo Rich said to me was that part of this was he thinks there is too much of a close following of approaches taken in the Northern Hemisphere, and that we could fall behind there, because their approachs have failed.

>> Yeah.

And that's fair enough.

I think some countries, the approach has worked, and in some it hasn't, and we'll learn from all of those international approaches.

But we also, as I said, earlier, want to make sure that our core messages are right, and we've worked with Burnett Foundation to make sure those are there, and that we're providing those promotional messages in the right places and in the right time and we'll also ensure that we've got all of the other infection prevention and control measures clearly communicated that we have appropriate contact tracing, isolation and support for isolation, because that's the other aspect to isolation, as well as support for clinical care for these patients.

>> And is the anti-viral you're looking at Tekoviromat?

If so, that needs to be cleared, because it's not approved yet.

>> That's correct, although some of these medications and the vaccine itself can be imported and brought in and distributed under section - I think it's 26 or 29.

>> I should just say, Nick can't see you, but just to really emphasise a point that Nick has made there, although there's a lot of focus on vaccination and therapeutics and that's the case internationally and I think where we've seen some of those countries not do so well, part of it has been because of a focus purely on sort of narrow vaccine and therapeutic approaches, the point that I think is being made here is that we have a really good chance now, because we don't have any community transmission, to get ahead of this with broader public health approaches and I think the point that you made and the point that the Burnett Foundation has made I think we'd completely agree with, is that we really need to be working really, really closely with them and the community in terms of designing what those health promotion messages look like in a way that ensures that people who need to hear them are hearing them but we're not stag mitt advertising people either, so it's a very collective approach.

>> Can you just explain again what New Zealand are doing to get around this shortage, what actions are being taken?

>> Nick spoke to this just before, but basically, Pharmac is our lead agent for vaccine procurement and the challenge that we have is the same that countries all over the world have.

There is a single vaccine manufacturer.

It's not available for purchase commercially.

It's only available for national supply.

And there are a number of countries, basically, you know, most countries now are trying to get their hands on supply, and the article that Nick referred to is even a country with the forward ordering that they have like the US has only got about a third of the supply that they want to manage the outbreak that they currently have.

So I think we are doing everything that we k I think is the message but there is a reality about whether we will be able to be successful just purely based on the fact that the vaccine doesn't exist yet.

In the numbers that we need.

>> So yesterday, I met with the CEO of Pharmca.

I believe they're doing absolutely everything they can as well.

So I don't think there's more we can do at the moment, and we are doing everything we can to try and secure a supply base.

Dr old said it's only one of the tools in our tool cupboard.

It's certainly an important one but the important thing is not to just focus on vaccination, because that is going to take us some time to access.

>> How many vaccines are you hoping to order?

You know, if supply freed up, how many would you like to have?

>> Probably around 20,000, which is what we've been trying to access.

We'd take 10, but I believe that that is the smallest volume that you can purchase.

20,000 would be our optimum.

>> Dr Chamberlain, you said the risk to people is low at the moment.

At what point does that race, how many cases would we need to be seeing, and in the vent of getting a vaccine here, do you foresee any sort of roll-out issues for access to marginalised community issues to vaccinate them?

>> So I can't answer, and I'm happy to get back to you, what categorises the various risk levels and whether there's ever been any decision on the definition around risk levels.

With respect to the actual roll-out of the vaccine programme, we are.

continue to work with the communities that we need to work with, and ensure that that roll-out is successful.

We've had, as have many places, had significant experience around vaccination programs.

This will need to be different.

We won't have large amounts of vaccines, so we are thinking that the vaccine will need to be distributed through sexual health clinics, Public Health Units and districts, public health nursing, etc.

It won't be able to be distributed through general practices, because you're spreading 10 or 20,000 vaccines far too thinly.

But we do need strong geographic coverage and like all our vaccination programs we'll also consider outreach perhaps, etc.

>> Just given it's moderate in the Northern Hemisphere at the moment, how likely is that the risk level will move up in New Zealand and there any idea for any time frame as to how long that could potentially take?

>> No, I don't have a time frame.

I'm not sure if Dr Old has any and that really depends on the number of international travellers bringing it back, how quickly we get community transmission, and so I think that would depend quite significantly.

Obviously, having a border which is an airport der, as it did for COVID, protects us somewhat.

But not completely.

So it may be slower nan some other countries.

I've not seen any modelling on the growth.

Dr Old may have more information.

>> I mean, it's a good question, and one of the important things to note which is going in our favour in terms of monkeypox is that it is much less transmissible than things like COVID or like measles.

It does require very close contact to catch it, which is why some of those other public health measures, like contact tracing, for example, can be really effective.

As Nick said, we don't have particular thresholds that say when we have this many cases, we change the language that we use.

But the first sort of obvious difference is when we go from having isolated imported cases to having confirmed transmission within New Zealand.

If you look at the situation in Australia, they've had 40- something cases now, and still relatively contained.

They still describe their risk as in that low to moderate type space and I think it comes back to the earlier conversation about the call to action from the Burnett Foundation about the window of opportunity and so I think it's beholden on all of us as Nick said to be working across the system to make sure that we've got everything in place now while we have that opportunity to do so.

>> On the vaccine data review - as soon as it was revealed HSU data was being used to measure (inaudible) particularly around the Maori, it was known that (inaudible).

Why has it taken so long to update that?

>> A few things in there.

So the first thing is, this is as early as we could be using this data.

So we've got.

this is a 2021 calendar year, and because we're putting it together from a range of different data sources, there's a whole lot of cleaning and other associated data work that needs to be done to make sure that it's accurate.

We also need to make sure that we've had time for particularly mortality to sort of flow through so we're not inadvertently trying to approach people or their whanau who have experienced the loss of a loved one.

So there's always going to be about a six- month lag, which is why part of what we've agreed to do is to have a rolling six-month review cycle.

I think for the 2021 data set that we've got now, it basically only existed as of 1 July.

So this is really the earliest we could use it.

But we have got that going for it.

I would say just in terms of the question about the undercount of Maori, I think part of the reason for making these changes is because we really want to be using the best information that we can to make sure that we know where people are and that we can vaccinate them.

The 2021 data set has about 35,000 more Maori in it than the 2020 data set did.

And that's due in large part to the success of the vaccination campaign, finding Maori who had not previously been engaged with health services so that's a significant win.

The other comment I would make is that the stats, Stats New Zealand projections are projections based on census data.

So they're sort of modelled numbers.

The advantage of using HSU is that they're real people.

We know they exist.

They've interacted with the health system recently so we know that they are able to be vaccinated.

But the question about why are there more Maori in the stats numbers generally is to do with ethnicity classification, and that's one of the technical pieces that we're still continuing.

>> The government were basing a lot of their decisions on vaccination rates, the numbers of people vaccinated, seeing the percentage drop 5%, does that not raise questions about (inaudible).

>> I don't think it raises questions about the decisions.

I think.

this was the largest sort of, you know, undertaking of this sort that New Zealand has ever attempted to do.

We didn't have a national data set that we could use.

So we were sort of building that while we went, so it did mean that the data that we had was not as good as it could have been.

But we used the best data that we had available at the time.

Now, we're able to take what we learned through the vaccination program, put that in and get a better idea both about what our real underlying rates are, which as I said, it's important to note, we are still, even with those drop, we're still in the top of sort of tables in terms of our overall vaccine coverage, but importantly t gives us much better information for future to be able to actually find and follow up people.

>> When will you make decision business expanding the second booster eligibility beyond (inaudible).

>> Ooh, that's a really good question.

Nick, do you know if immunisation programs.

>> Sorry, I didn't hear the question.

>> The question was: decisions about expanding second booster eligibility.

Do we have an update on that?

>> It is being considered, and I think Pharmac have the role around making that decision, so that's moving to I think the 30-50 age group.

No decision has been made yet.

>> We can come back to you on that one.

>> Is there a particular hold- up.

You obviously have enough vaccine.

Is there a particular reason why you wouldn't during the winter months to get it out there?

>> It's the balance of evidence.

The evidence for repeat boosters in over 50s is pretty good.

In the younger age groups it's less clear and so when you're asking people to go and do something, we need to be sure that actually it is going to give them a really good benefit.

So my understand something that at the moment, that evidence is still being considered and coming together, and if we get to the point where the balance suggests that actually it would be good for the individual and good for the population to be vaccinating that cohort, that's when we would move.

As you say, vaccine supply is not the constraint.

>> You've obviously said that the cases look too have peaked.

When do you expect deaths to peak?

>> So we know that hospitalisations and deaths tend to lag.

Hospitalisations tend to lag one to two weeks and deaths a little bit longer than that.

Sometimes maybe two or three weeks out.

Part of the reason why we are seeing more deaths now is because it has shifted into older age groups and so, again, I guess it's just a good opportunity to remind people that the second booster for older adults is effective at keeping people out of hospital and reducing deaths, so I really encourage people to take up that opportunity.

>> Dr Old, back on monkeypox - because Australia's secured some vaccines for monkeypox for their population, does that put the pressure on New Zealand and ideally when would you want to see vaccines arriving here?

When do you want to secure them by?

>> Could I answer that?

>> Yes.

I'm looking at you! >> So my understanding is Australia have only secured very small amounts of monkeypox vaccine.

We're also in a queue around this global supply challenge.

I think it's a little bit confusing if we say that Australia has secured significant supply.

- we're also in a queue.

They are ahead of us but they also were ahead of us with the number of cases and those in the community as well.

>> In terms of monkeypox communication - do you guys want to see anything at the border, if that's where the risk at the moment is, do we need communications at the border so that people coming across the border know where to look, if it's foreigners they mightn't know to look to local health advice.

Has that been considered?

>> I think the whole communication strategy is complex, and we've been working with the community and Burnett Foundation as to what are the best approaches.

That may well be one of those.

There's multiple both types of communication, as well as locations for communication.

>> I guess where is that communication planning at then?

Because from what that letter says, it's clear that they want stuff out now, but from what you're saying, that still needs to be worked on.

So is there anything?

>> I've got a plan with time frames for various aspects of the plan and communication to be completed.

My understanding is within the next couple of weeks or so.

So it won't be long.

>> >> So we could see cases before the communication plan?

>> You asked specifically about ordering.

What I'm saying is there is a really a comprehensive approach to communication.

That's only one of those.

>> Indeed, but I guess just going on that broad communication plan.

So we could expect something in a couple of weeks, but then we could still expect cases in that time, before there is a communication plan?

>> Yeah.

That doesn't mean that there isn't communication ready available and going out there.

Today is one opportunity, obviously, but the Burnett Foundation are communicating, we're communicating.

We've got good insight to that information, as I said.

So there is information available already.

Communication is out to GPs and other health providers as well.

It's a staged process and I don't think it will ever end, but we're wanting to complete it, the broad communication plan, and actions.

>> I understand.

Sorry to sound quite blunt, but do you recognise that people, particularly the Burnett Foundation, the sexual health group, they essentially are saying that what exists at the moment isn't good enough and I guess two weeks is quite a far away.

>> >> So as I said, two weeks for the whole of the communication strategy, but there are things happening already, and, yes, I recognise all of the points the Burnett Foundation made and we are working with them.

There has been quite significant engagement already.

>> I guess further to that, if I can slide in, there's unique nuances here because of the disproportionate rate that it's affecting gay communities.

What is playing into some of that, I guess, someone high lighted to me, and in one of the interviews for that story was you have the challenge of someone might have to go ice late.

It could be up to four weeks, which is much longer than a COVID isolation.

That could be a closeted person.

You have the risk of outing them to their families.

Someone could end up in isolation who isn't gay but that just attitudes towards him for going into isolation.

Is this a really challenging communication response to form?

>> Absolutely.

You've just articulated many of the challenges for us, and so that's why we are really clear that we won't be doing this without a community involved and advising us.

So yes, it is a challenging communication.

>> Alright.

Time for one or two more questions.

>> One on COVID.

You mentioned that it's spreading a lot more in older age groups than the first Omicron wave.

Is that the full reason behind the much higher death rates we're seeing today, versus at the peak of the first wave, or is there something else going on as well?

>> Look, it's a good question.

My understanding is - and we will be publishing a review of COVID mortality, probably in the next week, which will go into a lot more detail, but from the preliminary look that we've done there, we think that that does explain most of it.

Certainly the groups that are driving those higher death rates are older adults essentially, yes.

Right.

Thank you all.