COVID-19 update, 13 May 2022 1pm

Welcome back after a bit of a break to the Ministry of Health.

Thanks for coming today.

As you will know, we are nearing the end of New Zealand sign language we, a celebration of sign language as one of our three languages in Aotearoa.

-- week.

We acknowledge and celebrate our Deaf community and pay in - - pay tribute to our interpreters.

I have vertically enjoyed working with our New Zealand sign language interpreters over the period of the pandemic, in particular at the one pm stand- ups.

They do a fantastic job and it is help communicate information to a crucial part of our community so I want to thank them for their work and this week we are celebrating sign language and I want to acknowledge death Aotearoa who have helped me participate in the sign language challenge.

To celebrate sign language week.

To the right you may see a lovely clock that has the numbers in New Zealand sign language symbols.

Thanks very much for that as well.

Today I want to provide an overview and assessment of where the Omicron outbreak is at and look ahead to the coming months, in particular, winter and what we can expect from both a COVID perspective and also an influenza and respiratory, RS C perspective.

I will start with case numbers.

They come out in the 1pm statement every day but today the number of new community cases is 7441 and are rolling seven day average - and this is the important number because you will see them fluctuate, they drop down over the weekend - it is 7548, very similar to what it was last Friday, 7555.

The impact of Omicron, even though it is a less severe variant of COVID than Delta, the impact in terms of the severity of illness is still visible and we've got 398 people in hospital around the country today and six of them are intensive-care or high dependency units.

Sadly today, also, we are reporting a further 29 deaths with COVID-19.

The total now comes to 900 the total now comes to 940 deaths in the seven day rolling average is at 14.

Just a reminder that the number of deaths reported each day fluctuates.

We saw three at one point one day over the weekend.

A large number today and on today's number, 14 of these deaths are ones that we have found through a reconciliation of all the deaths reported through the deaths document database over the last weeks and months.

I mentioned a couple of weeks ago we are also looking at how those debts are categorised and we are very nearly through that work of categorising allūtia aua nama reported deaths and those that were absolutely clearly from ū i te katoa COVID-19, those for COVID-19 was a contributing factor and those where it was incidental but the cause was another cause.

-- death.

We will be able to update that on a daily basis once that is reported because coders will look at data every day with a special workaround.

I want to pass on my condolences not just to the whanau and the friends that have died, but those who have died throughout 10 day -- pandemic.

I want to show slides to illustrate what is happening with the outbreak in New Zealand.

First, and this is a slide shown before, and we can make the slides available in softcopy after if you would like to either ask Luke, our media adviser, or email our media team.

This is cases per thousand people by regions, the Northern Region, the central region, around Wellington and also Wellington and the southern region, all of the South Island.

The important thing to note here is the orange line, which is the Northern Region, and you will see that, whilst it is not the highest at the moment, the highest rates are in the southern region, and we can see that in case numbers and hospitalisations, especially in Canterbury and in Dunedin, Southern.

You can see the Northern Region case rate creeping up again over the last two or three weeks and you would have heard commentary about this.

That suggests there is more infection again in the Northern Region.

But I would say that alongside that, we have not seen an increase in the quantity of virus found in wastewater testing in the Northern Region as yet.

It is still level.

Like wise, the positivity rate of people presenting to hospital and everyone is tested when they are admitted, the positivity rate is steady at around 5%.

Some of this apparent increase may well reflect more people reporting, for example, if people were away over Easter and the Anzac period, they may not have been quite so inclined to or may not have reported infections, but now they are back home and we still have that isolation period of seven days required.

They are reporting there.

We have got increases across, in the number of cases in the seven day period to 8 May.

It increased in seven of our DHB regions, Auckland and Counties Manukau.

Modest, not the 50% increase that people have been talking about, and also in the Waikato and Hutt Valley and the Capital and Coast.

Really centred around the Northern Region and Waikato and here in the capital, Wellington.

We know some cases are not reported and we try and estimate the level of reporting we think we are getting and one of the best ways we can do this is look at the positivity rate of our order work undergoing surveillance.

Based on that, we think probably about half of cases, actual cases, are being reported, and some cases not being reported because people don't have symptoms, so they are not testing.

Others - symptoms may be mild so people do not get tested whilst others may be testing but not reporting the results.

On testing, you will recall, and as part of our standard practice through the review, through the pandemic, we have reviewed our ongoing response, particularly when things have not gone as they should have and in March I commissioned a review to look at the backlog of PCR tests we had in the early part of the Omicron outbreak and when we made that shift to rapid antigen test income I receive that review, that external review, my team is going through it, we are developing our response and I will speak to both and release a review and our response to it in early June.

Our second slide has got a few things in it, but what this is showing is our modelling of hospitalisations as we expected and the outbreak to date.

Then the black line with all the dots is the actual hospitalisations and how that is mapped and then it is looking forward to 2 scenarios that are modelling suggests could happen through winter.

I will come to those a little bit more, but the scenario, letter A, the blue line, is a lower peak, perhaps delayed to around August, September, so later in winter, but the scenario that it poses to plan for is the second scenario, scenario B, and we may see an increase in cases and hospitalisations remain and then another quite large peak, not outbreak again through winter.

-- we know that winter tends to bring more respiratory illnesses and so there is a greater tendency for the virus to spread.

We can see there has been a decline in hospitalisations that peaked about with the modelling suggested, just over 1000 on 22 March.

But they decline the decline in hospitalisations has been lower and I dare say in the case of both cases, we thought our case numbers would come back to a baseline of around 3 to 5000 a day.

In fact, they seem to have bottomed out at around 7500 a day and hospitalisations have levelled off at the mid-300s.

We can see today 398, may be going up again.

So it seems we have probably reached the bottoming out of both cases and hospitalisations from this outbreak and we may well be on our way back up again.

Again, that scenario, the one we are planning for, scenario B, is potentially for another quite large outbreak in winter.

I will come back to that.

I have a couple of slides on that show the impact of flu and RSP and COVID.

But before I do that, a quick summary of key international developments.

In North America, we can see cases starting to rise again.

It started on the east coast that it had all the outbreaks and moving across the country and of particular interest is that the predominant variant that is driving most of that increase is the BA 12 one side variant and we have detected a few cases of that in New Zealand, all having come from the USA.

It now makes up 40% of cases in the USA and they hospitalisations are also increasing again.

It will be interesting to see just what sort of cross immunity people who have been infected with earlier sub- variants of Omicron have got against this new sub variant.

South Africa we know about.

It has seen quite a big surge in cases driven by the BA4 and five subareas.

We have found a few cases of each in New Zealand.

And likewise, looking at the UK and Australia, they have experienced to quite distinct outbreaks.

Initially an early BA related one, December, January and then a BA BA related one, December, January and then a BA2 one in March and April, each having a significant increase in cases.

New South Wales is following a similar pattern to New Zealand and the cases have plateaued down again at a level may be similar to ours and that is driven by BA and that is driven by BA2 sub variant.

The important thing about this is we have some early evidence about perhaps a slight transmission advantage for some of these new variants - the BA - the BA4 and five and the XE sub variant and the others but what we don't know yet is if they cause any more serious disease than the BA than the BA2.

The other thing that is emerging internationally is more information about the importance of vaccination and providing protection even if someone has had COVID.

There is a phrase coined for this describing this as hybrid immunity.

Some studies that have been published recently that show that for people who have had Omicron infection, if they go on and have a booster dose after a delay, that affords a much higher level of protection than just the protection afforded by the.

By having been infected per se.

This is a very important message for the many people who have been infected over recent months and who may not have had their booster.

Yes, our advice is to wait three months, but it is absolutely worthwhile going and getting booster dose, the third dose, as soon as you are eligible to help protect yourself from potentially being reinfected and protecting others around you.

On the subject of reinfection, we have just provided some updated guidance to the sector around how to whether and how to test people who might be reinfected with COVID.

There is a risk.

It seems a small risk but there is a risk of being reinfected with COVID within 19 days of the first infection stop it happens rarely and the guidance we have provided out of the health system is designed to support appropriate testing at management in that case.

We are continuing to monitor both our international.

Both international evidence and our own experience around reinfection.

What we need.

What we are looking in particular at is if these new sub variant are more likely to cause reinfection for people.

Just to say again, all the measures that help prevent you getting infected in the first place will help prevent you getting reinfected.

That is a risk, so the usual things are very important - get that booster if you have not had it, as soon as possible, use masks outside of the home and of course stay home if you are unwell, whether COVID or not.

A little more on our winter modelling.

We have passed the peak, it seems, of the current Omicron outbreak, but we are preparing as that earlier slide showed for a potential picture in winter and that could be quite high.

At the same time, we have been anticipating and planning for concurrent infections with influenza.

We are already finding some here, particularly in the lower part of the South Island.

They have found influenza A and it seems there is some in the student population, Dunedin, and now some in Queenstown, and what we have seen in the northern hemisphere is the flu and RSV season through their winter were quite low, but actually they have a bit of a surge again now.

Recently, Australia is finding some influenza A especially.

The good news is, in Australia where they are a little ahead of us, the current flu vaccine and the strains in it afford a good level of protection, including against that influenza A.

We know also the evidence people can be coinfected with flu and COVID at the same time.

Around 3% of people, they have found this in the UK and people can be particularly unwell with that so all the more reason to prevent.

Do everything you can from getting a respiratory infection, masks and so on, but also to have both a flu vaccine and be up-to-date with COVID vaccination.

On then to our winter planning.

What this slide shows is our typical winter and what is modelled here is what happened last season where that blue level of admissions to hospital around the country for respiratory illness, you can see it peaks during winter and that is mostly because of flu, but on top of that, we have put that RSV peak that we experienced last year.

It was really quite significant and you will recall how much pressure it button our hospitals at the time.

-- put on.

We are expected to see that but what we have also done and this is the next slide, as we have model that RSV peak, which we may see, with, under the blue colour there, what we would expect from a normal flu season and we have put our modelling of COVID-19 on top of that and you can see when it really picks, perhaps July or August, that is a pretty significant number of people in hospital with respiratory illnesses including over 1000 potentially at its peak with COVID alone.

Of course all our District Health Boards and nationally, we are doing quite significant planning ahead of winter and the potential for that search.

Flu vaccination is imperative here.

We have already had approaching 700,000 people who have had the flu vaccine since we kickstarted the campaign on 1 April and particularly important is many people over 65, around half are over 65 is already, which is great.

Many people are eligible for free flu vaccination.

Get one if you are eligible, for free, flu vaccination and even if not, please consider doing so.

It is relatively cheap.

We are also finalising our eligibility criteria and the detailed operational rollout for a full dose of the Pfizer vaccine.

For vulnerable groups including older people.

We will have an update on that soon, as final decisions are made, I but I would make two comments.

First, something guiding decisions is our technical as vice is debate six months before that though does.

Advice.

The move -- for the vast majority, they have not reached six months and the second is, critically important for older people, we are keen the happy community from that full dose at the time of the projected winter peak of Omicron and that is not till July and August so there is no hurry to get people that both dose and we wanted to get the timing just right.

June will be the time when we are aiming to roll out the program but we will have more on that when final decisions have been made and we can provide the detailed operational information.

Finally, and then we will have questions, the three things that I would remind everyone to do - make sure you go into winter as prepared as possible.

You will see from that last slide still on the screen, our health system will have a heavy load of respiratory illnesses through winter and everybody can do their bit to help reduce the impact of that potential load by being up-to-date with all vaccinations and that includes four young people and two children, MMR, as well as flu and COVID-19.

Secondly, wear a mask.

A good rule of thumb is outside of him, any indoor environment, wear a mask as much as possible.

Finally, and this is really important and why we are still recommending an isolation period for cases and household contacts with COVID-19, is stay at home if you are unwell.

Test, get rapid antigen tests and then report a result, whether positive or negative.

To all those who have done so and continue to do so every day, thank you very much.

It is important for our planning to stop I'm happy not to take questions.

>> (INAUDIBLE) around the 50% mark.

>> Just to rehearse some of the comments, some of this is real.

No doubt.

We are seeing hospitalisations go up at not seeing an increase in positivity rate of people turning up to hospital, so everyone, for whatever reason, going into hospital gets tested and that is staying steady as is the wastewater testing, so some of that apparent increase may be an increase in both testing and reporting of testing.

>> With the reporting of the results, people reporting them?

How great is the underreporting?

>> The first comment I would make is I am actually really, really impressed with the number of cases being reported.

7500 cases every day, people not just in the test but are reporting them, and about half of artists that are reported, rapid antigen tests, are positive so we have another seven or 8000 people every day reporting their negative results.

This is impressive and it is absolutely essential and important, so I want to thank people.

Our estimates are it is probably about as many cases again out there that are not reported although some of those it is because people are not symptomatic so they are not testing but for those who are testing, please do report your results.

>> Should we consider your resignation if there was another big outbreak?

>> I am confident we have in the system the people, the processes and all the services in place to deal with another outbreak, so I will not be reconsidering my resignation.

Thanks.

>> If the flu jab is so important why can't it be free for everyone like the COVID jab is?

>> It is something we have considered and talked about with both (INAUDIBLE) and ministers and the groups that can access it for free this year have increased and that includes all Maori and Pacific people from 55 over, so quite wide access for free.

Actually, if we could get more people who are eligible for it for free to get vaccinated, particularly in our Maori and Pacific communities, that would be hugely valuable.

Likewise, many employers provide it for free or at a heavy subsidy for their employees and I have sent a message to employers to encourage them to vaccinate their staff in winter.

>> What percentage of the population is eligible for a free vaccination?

>> I will have to come back exactly on that, but the important thing it is not just a significant proportion, but the people who we know would have the worst outcomes if they did get the flu and so that is who the free vaccination is focused on.

>> Should be universally available for free?

>> Certainly universally available and I would encourage everybody to get.

We have had a look where to provide it for free and I'm pleased with the extension for eligibility.

>> Not universally free for financial reasons or epidemiological?

>> More for epidemiological reasons.

>> (INAUDIBLE) how is (INAUDIBLE) tracking with the modelling?

(INAUDIBLE) shot and how that period is spreading through the states.

They will all come here with no predeparture testing.

How is that effecting modelling?

>> We still have predeparture testing at the moment and we then have and an intent to maintain a requirement for everybody coming in to be provided with rapid antigen tests, to do the testing twice and to report the test result and then we can keep our surveillance going for those new variants.

Those people that test positive who have arrived recently are required to isolate for that seven day period, so that maintaining.

Maintaining that isolation requirement for cases is absolutely fundamental to our ability to control the outbreak in New Zealand and including any onward flow of any new variants that might come into the country.

Many countries do not still have that requirement for isolation.

For testing on arrival, which is much more important than actually predeparture testing, but at the moment we still have the latter in place.

>> What, if any, initiatives or events have health officials planned to encourage an uptake in boosters?

>> This is vexing us.

We have pushed for this quite a while, very hard with advertising and all infrastructure is still out there to get booster rates.

I should say are booster rates have levelled off, almost identical rates to what other countries that had very high initial rates.

It seems an issue internationally.

We are looking at that and in particular how we can get those rates up and our paediatric vaccinations are up which are not at a level we would want and what we are hoping for, so our approach now is one of really positioning it around getting ready for winter.

That includes a range of things including flu vaccination.

>> (INAUDIBLE) Super Saturday- type event.

>> We have not planned for that but we will keep every option on the table.

>> How many kids in school have had COVID since the holidays?

>> I don't have that information.

We will provide a breakdown and it may be in the age breakdown.

At the moment, still majority of cases are in our younger age groups, so that is under 35.

For those in that age group, you are still young, but the vast, most vast increases in older cohorts.

(INAUDIBLE)

Vaccination passes, how you have been affected but have not had a booster, you can still get the vaccine post.

How much is that an honesty system?

If they have to get brought back, how much is that relying on people to do the right thing and say they have been affected when they could live?

>> M let -- live.

>> They have recorded a rapid antigen test online.

For most people that will be the case and so we can verify.

There will be some people who have been infected, did a rapid and antigen test and may be did not uploaded and that would require honesty but there would be a process that we will make public over the next couple of weeks as to how they can get a temporary vaccination pass until they are due for their booster, which will be three months after their second dose, sorry, three months after their infection.

>> (INAUDIBLE) to feel left out in a lot of previous decision- making.

How much engagement will you do in future sessions?

>> What I would say, and I have looked at the report from the disability Commissioner, and our response to it, the majority of those issues identified, we had already started engaging with much more.

Robustly and appropriately with the disability community, so I am confident that our engagement with the disability community around care in the community model, around vaccination and around the build a response is much stronger than it was early on and those with issues in the disability community rightly pointed out we could have done better on.

>> I want to go back to Auckland if that is OK around that.

I guess the increase in cases now - are you concerned we will see a second wave much earlier than winter at all?

>> It is possible.

I will go back to that slide there where you can see one of the scenarios modelled showing the possibility of another smaller surge during May and then dropping down again before that peak.

It is too early to say but this might be what we are seeing and if it happens, we will likely see it in Auckland first.

>> I was going to say, are we seeing.

Are you aware of any staffing issues at present in the Auckland Hospital is due to infection?

>> The staffing issues are less severe than they were in the middle of the early outbreak in Auckland and around the country.

But the issues caused by the outbreak were on top of kind of existing staffing pressures, so this is one of the key things that as part of the DHB plans for winter, is working out how they will anticipate staff absences may be of 10 to 15% and at how they will redeploy staff, not just inside the hospital, but potentially into age residential care to support age residential care if their staff members have to stay off as well, so that is a fundamental part of the planning.

>> Dr Bloomfield, in March, it was voted in reported that doctors and health services were trying to get information about long COVID.

How much progress has been made and what support is available for people with long COVID?

Some have reportedly had a lot of trouble getting help for free.

>> Yes.

This is clearly an emergent area.

But understanding of long COVID and then what can be done to support and help people manage their symptoms.

.

.

We've got a good stream of work on this and we did a briefing on it about a month ago.

I had Doctor Ian Town talking about that.

I would like to be given the opportunity to get an update and perhaps at the next briefing I can have that as a focus on what else we are doing to support people with long COVID and what specific services are available to them, including those which they may or may not have to pay for, but we are absolutely working on this.

>> (INAUDIBLE) how satisfied are you (inaudible) slow?

>> I am satisfied with our progress.

I would prefer more detail and I could give more information.

>> (INAUDIBLE) around reopening New Zealand.

How satisfied are you they are still taking your advice?

Are you satisfied they are still following the best health guidelines?

>> Right through the pandemic, my advice has been alongside the advice of other colleagues, and the public health advice has been a central part of our response and it remains so so I can say we still have meetings with colleagues from across government, with the Prime Minister and senior ministers to discuss the full range of issues and much of the advice going into the Reconnecting New Zealand Plan is coming out of this ministry.

It is around issues like testing at the border, testing of the workforce at the border, vaccination requirements and so on.

I am confident our advice is still very much at front and centre in the decision-making, not just by ministers, but also by my colleagues across government.

Any final questions?

>> Going back to long COVID - for people who have symptoms, people who may have long COVID now and WHO said (INAUDIBLE) people might get long COVID.

What advice do you have for them now?

They could be tens of thousands, maybe more, in New Zealand who have long COVID.

What should they do if trying to get help?

>> Most importantly, seek that help through the usual health provider and that would most likely be a general practice or primary care provider and I can say that increasingly, those providers have got better information all the time about what the symptoms are, how to manage the symptoms and what support are available and we got a stream of work here led by our chief Allied health professions officer because a lot of the support and follow- up the people will be in the rehabilitation area.

It is not about specific treatments per se.

>> How expensive do you think will long COVID be to our society?

It sounds like maybe potentially they will be long running costs to the economy and society.

>> It could be and that is all the more reason for people to continue to try to prevent getting COVID and if you have it, rest up.

Thanks very much.

Really appreciate the session today.

Go well.