COVID-19 update 13 September 2021 4pm

News article

13 September 2021

Prime Minister Jacinda Ardern will give a post-cabinet announcement today at 4pm. The Prime Minister will be joined by Director-General of Health Dr Ashley Bloomfield.


>> (SPEAKS TE REO MAORI) Good afternoon, everyone.

I want to begin by acknowledging Te Wiki o Te Reo Maori, Maori Language We, a chance for us to celebrate Te Reo Maori.

As you will have seen earlier, today there are 33 new community cases to report all of which are in the Auckland region. While this is a high number, it is important to note only one case is currently not yet linked to our known clusters. Virtually all of them are in a way expected cases. Including, for example, seven in just one household.

Likewise, of the cases reported yesterday, just one remains unlinked to the wider outbreak at this point. That is one of the hard things about Delta.

Every time we get a new case, if that person's family members don't already have the virus, they are likely to get it in due course. That means numbers do and are rumbling along. This has been evident in the last three days. This doesn't mean our collective efforts in Auckland are not making a difference.

Testing rates have been very good across the last week. Especially in suburbs that our testing teams have targeted.

Huge thanks to those people in Mangere, Manurewa, Papatoetoe, Otara, Henderson and Massey others who have done their bit and gotten tested even if a symptomatically our surveillance testing of healthcare workers and essential workers has not identified any transmission which gives us increasing confidence that control measures are working.

It's also clear there is not widespread transmission of the virus in Auckland.

I will repeat that again - it is also clear there is not widespread transmission of the virus in Auckland.

As we outlined yesterday, there are two key features of recent cases that are of the most interest.

One, we still have largely three clusters continuing to produce cases. Not in an uncontrolled way but so long as we have cases emerging, there are risks.

Two, the ongoing emergence of cases that are at least initially a mystery. What we often refer to as unlinked.

The number of these cases is not large. In fact, as of today, I can report that of all the cases reported in the last two weeks only 17 remain unlinked. And of those, only a handful have been highlighted by our public health team to be of particular concern. So that is really positive.

But mystery cases are still coming through. And the fact that we're finding them through surveillance and community testing instead of through contact tracing, that is what we are concerned about because that presents risk. It means that those cases, until we find them, are out and about in the community and could be the source of other cases, or themselves have been sourced through cases we don't yet know about.

So that leads us to very clear tasks ahead. The first is to continue with what we call active cluster management. That is the job our public health team are doing and are working day and night on.

The second is more surveillance and community-based testing. I will talk more about that soon.

There is one extra tool that continues to support our efforts to stamp out Delta, and that is the use of restrictions. Cabinet met today to consider the role that level 4 has played to date and what role it can continue to play at this stage of the outbreak. We discussed the settings for the rest of the country.

What we saw in terms of evidence and advise is that Alert Level four is working. At the start of the outbreak, the reproduction value of the virus was six or higher, meaning one infected person was likely to pass the virus on to 6 others. Alert Level four has reduced that value down to consistently below one. That has helped us at the outbreak under control. As you will have seen in the last few days we haven't finished the job yet. Level 4 remains our best option to beat Delta and contain the virus at this stage of the outbreak. We don't want to risk the sacrifices everyone has made and all the hard work you have put in by moving to Alert Level 3 too quickly.

On that basis and on the advice of the Director-General of Health, Cabinet has agreed Auckland will remain at level 4 until 11:59pm next Tuesday, 21 September. Cabinet has made an in principle decision that Auckland and that point will move to Alert Level 3.

We will continue with weekly reviews and cabinet to confirm these indicative settings, but we wanted to give people a sense of our direction of travel.

That brings me to the rest of the country. For many, the risk to the rest of the country may feel low. While it is true there is nothing to indicate that there is COVID anywhere outside of Auckland, there is still region -- reason to be cautious. If COVID were to travel over the Auckland border, the impact of that happening in a level 1 environment would be far greater than if a case emerged in a level 2 environment. It would mean far greater chance of spread if it were level 1 and a far greater chance of a return to lockdown. Nobody wants that.

For that reason the Director- General has directed and cabinet agreed the rest of New Zealand will remain at level 2 until Tuesday, 21 September.

Cabinet will review the settings next Monday also. As we have said before, we can only move down alert level's when we are sure we can do so safely and without putting people at risk. And while there is an outbreak in Auckland that continues to produce cases, there is risk.

To all Aucklanders, you have done an amazing job so far protecting yourselves, your family and your community. In fact, all of your hard work is the reason that the rest of the country is safe. We owe you a debt of gratitude. I hope you know and feel that huge appreciation that we have for you, and the hard work that you are putting in right now.

But the cases are telling us we have more work to do. The next week will be critical providing us with the additional insurance we need. Alongside active cluster management we're going to continue with testing, focused on seven suburbs of interest. At the moment, that includes Mount Eden, Massey, Mangere, Papatoetoe, and Manurewa. And also Otara.

I encourage everyone in those areas to remain vigilant for symptoms.

Testing another suburbs may be indicated in coming days and we will update you if that is the case. We will share in our regular briefings the progress we are making on these two tasks. We will make sure we continue to give a breakdown of cases that remain unlinked compared to those who are household contacts and relate to single families, for instance. I also have and ask of all of you. First, please stay in your bubble.

Four weeks into lockdown, it might feel tempting to open up, catch up with a friend, merge households. Please treat every day of lockdown as seriously as you treated day one. It is just as important now to get us over the line.

Second, stay home as much as possible. Try to reduce risk by having just one person from your household go to the shop or to the supermarket. If you can, make it the same person every time. If that person is vaccinated, even better. You will have seen from some of the locations of interest, when we have cases who have been out in the community, generally they haven't been breaking the rules, they have been going to the supermarket. The same ones that you have gone too.

Mask use and having fewer people in these places all help, but please reduce the risk as much as you can.

Third, get tested. Even if you have the mildest symptoms. Don't wait around to see if your stuffy nose, sore throat, or headache gets better and please don't put it down to the winter chills. We know right now there is not much of that going round. Flew tracker in particular is showing us that. COVID is, so please get tested -- Flu tracker.

I final ask is to get vaccinated. We want as many Aucklanders as possible to have had their first dose by the end of the week. If you have booked your first vaccine but it is not until October, jump online again. You will likely find spots have opened up at new sites much sooner than October. Please take them. Or you can take your whanau to a drive-through vaccination Centre today, no booking is needed.

Every extra person who gets vaccinated this week will make a difference in keeping people safe. Even partially vaccinated people make a difference.

Before I conclude, I want to share a reminder of the financial support available right now for those continuing to feel the impact of restrictions. Auckland remaining at Alert Level four triggers a third fortnight of Wage Subsidy Scheme's were eligible business which will open for application this Friday. Eligibility is not determined by the Alert Level your business is in, but rather by a drop in revenue caused by any part of the country being in Alert Level 3 or 4.

As the Minister of Finance said on Friday, following consultation with business, we have opened up another round of the Resurgence Support Payment. That round opens this Friday.

This means while I know these times are incredibly tough, we have more financial support in place this time than during our last set of level for restrictions. For example over the course of one month in Alert Level 4 last year and eligible business with 10 employees would have received around $23,000 in support where is this outbreak it will be about $35,000 for the same sized firm. Don't hesitate, if you think you are eligible for assistance, tap into what is there. Otherwise please look after yourselves.

We will now take questions. Jessica?

>> What is the difference between level 2 and level 1 for the rest of the country? You say there is still risk, but having level 2 doesn't seem like it would be much more than level 1.

>> So we do not believe we have cases anywhere else in New Zealand, but while we have an outbreak in Auckland there is still the risk of a case moving to other parts of the country. The best possible thing to do to prevent New Zealand, as a whole, moving into lockdown if that happened is still having a low level of restrictions that mean you won't see, for instance, super-spreader events. The kind of things that allow Delta in our first outbreak to get a head start. It simply means if a case arrives, we are much better placed to stamp it out very quickly.

>> This is a real challenge. When you look at moving the school holidays for Auckland?

>> That is a question that has been put to the Minister of Education. He is considering things that happened in the past, what might be possible. It is challenging but it is something he is thinking through all of the possibilities. I will ask him to give an update.

>> What happens if we don't get it under control, the case numbers, this week, will you extend to make

>> The person who advises us on that is Dr Bloomfield so I will hand over to him.

>> To reiterate the Prime Minister's comments from the start of her address, the signs are good. Despite high numbers over the last three days which give us cause for be incautious, the lockdown is working -- for being cautious, lockdown is working. Testing is at a good level, people are doing what is asked of them and it's only a small number of cases we are investigating very thoroughly to make sure there was no ongoing community transmission. So our view and advice is that another week in lockdown in Alert Level 4 in Auckland gives us our best chance to finish off the job here. The important thing is that we find cases. We want to find cases. Then we know we can isolate, test and prevent ongoing spread. And that is absolutely the focus for the next week. If everyone does, as the Prime Minister requested, then I have a high level of confidence we will get around this outbreak. What we want to do is use this week wisely. As much as we can to continue to get surveillance testing up, make sure everyone is doing their bit, as they have done to date, and on our side that active management as well.

>> When block and stopping use as a first resort?

>> What we are in this part of our strategy, which of course is focused on elimination, to allow us to make sure we safely are vaccinating our population, that is our absolute focus. Will then listen to the experts, as we have all the way through, and their advice on what the phase that we will move into thereafter looks like. But for now, the strategies vaccinate, vaccinate, vaccinate.

>> Other countries around the world who are living with the virus, and the high rates of death. Is there any number of deaths that we would be willing to live with?

>> The appointment I would make is when you look around the world, the think that is determining whether or not we are seeing that high rate of hospitalisations and very sadly, loss of life, is vaccination rates. It is the greatest tool we have been given in the COVID battle to date. And we must use it. That is the thing that is determining whether or not, for instance a COVID case turns into a hospitalisation and then turns into grave illness. The majority of people being vaccinated are not having that experience. That is why I asked people to please help us. We have this tool and we need you to use it.

>> Until we are vaccinated, we will have to keep using these lockdowns? At what point would you recommend to government not to continue with lockdowns?

>> As the prime minister said, we are vaccinating at a great rate and the important thing is people get vaccinated. Really, we have seen through the last month of the lockdown, that people have a recognised the threat that COVID is in our community. It is easy to forget that would be don't have the virus in the community. It is important we get to the highest rate possible, and also that we vaccinate all our communities. It is not good if our overall rates are high but there are vulnerable pockets of unvaccinated people. That is our aim. We are also looking ahead, and important for our future planning, the potential to vaccinate children from 5 to 11. We are planning to do that when the approval comes through and if the government makes that decision. The only other comment I would make is even if you do look and we are looking everyday at other countries with high vaccination rates, that have opened up, they are still having to use restrictions on and off to protect their population and to protect their healthcare systems, and that is regardless of how well resourced their healthcare systems are. There is a lot of water to flow under the bridge and at the moment our focus is vaccinating to the highest rate.

>> I think Dr Bloomfield makes a good point. Perhaps because we don't see as much coverage of it anymore, because perhaps it has been a long time, it is easy to assume other countries don't have restrictions, in fact most countries never lost that restrictions. They have had them through the entire fabric and they are finding that once they are vaccinating, then they are starting to is up, whereas we have not had them for long parts of the pandemic. I think today, I saw reporting that Denmark is one of the first in the EU to remove this, but they are keeping an eye on what winter means to them and what schoolchildren going back to learning environments means for them. The whole world is tentative at the moment, but what we do know is vaccinations make all the difference. They have for others and they will for us. I just continue to encourage people, get vaccinated today.

>> If Level 4 is considered to be too great a risk...

>> The outbreak as opposed to the alert level. That is not something we have yet had a conversation around and as I have said before, in good faith every time, we set them to the public health advice and we give consideration to those settings. I think it was the status of the outbreak in Auckland at this point, yes we do not have widespread community transmission in Auckland, but while we have the outbreak, we are using Level 4, the view is it still presents risk. Very few countries have internal boundaries that are ironclad and unfortunately we have seen in recent days, an example of despite the checks we have in place, people using some of the reasons for movement to get through, and that again just give you a bit of a sense of why we are taking the cautious approach.

>> The handful of patients Test handful of cases,...

>> One of the things that our public health team have made, while have 17 unlinked over the last 14 days, they are not equally concerned about all of them. There are a small handful. You will have let us talk about the one where there was -- it was difficult to get a sense of what would have generated those cases, so it was difficult. But there is really only three or four that we discussed in a lot of detail, because there is not an early hint of what has happened. That is when we do the testing around them. The view of the public health team is, while we have those unlinked cases, if we do enough testing, they can be the reassurance, even if we can't build a link. Sciver that is a good summary.

>> If enough people get vaccinated, will apply into your mindset?

>> One of the people! One of the reasons we are asking for that, is not to say despite these cases, we have enough people vaccinated. I have heard some discussion among modellers that they believe vaccination rates at least will make a difference, even in the short term, but ultimately this is a call to action because we want everyone in New Zealand to be vaccinated and now is a good opportunity, when you are in Level 4, there is permitted activities you can go out for and there are lots of appointments available so let's get on with it. If you do happen to be one of those mystery cases, I want you to be vaccinated.

>> When the cabinet first put the country into lockdown a few weeks ago, you said it was to be a short and sharp look at. What we have seen is anything but. Is the government underestimated the effects of Delta?

>> No, not at all. In fact the week before we unfortunately found ourselves in the position of having out of the case, we indicated based on what we are seeing overseas, we believe Level 4 would be required. And that was despite previously having used Level 3 for similar circumstances. We were very aware of what the emerging research from June onwards telling us about the way Delta behaves. We keeping a close eye on what we saw overseas. The reference to short and sharp was putting everyone into lockdown the same day we found one case. You would have seen around the world, people found it interesting that New Zealand would do that, but that is because of us taking Delta seriously and our elimination approach. Of course what we then determined is that we had cases probably generated over the course of more than a week, so of course that lend itself to an outbreak that was larger, with a SuperSprint event that has required action. Tippa when people heard short and sharp, they might have assumed you meant a short lockdown.

>> I think people have been through this process long enough to know that short, sharp, and go hard and early has been our response to when we see even one incursion, we move quickly while we ascertain what is happening. I think everyone understands that has been our approach.

>> On what level... Has cabinet discussed if it will go back to the regular level I or a pseudo number one?

>> There has been early consideration of that but not complete we will continue over the course of this week.

>> How many cases are being picked up by surveillance testing? You mentioned it is an area of concern. Can you give us an idea of the mix, contact tracing versus testing and how many have been picked up?

>> Surveillance testing has not produced any healthcare workers and no essential workers, because we have been going into essential workplaces surveillance testing and it has picked up nothing yet. Dr Bloomfield?

>> In addition to that, none of the community general testing has identified specific cases. The cases that are popped up, the ones that have been identified particularly at Middlemore Hospital were even if the person was asymptomatic, some of those people were swapped and they were found to have the virus. In a sense, that is surveillance because they were asymptomatic. But the general community surveillance testing at this point in time across those suburbs where that has been focused testing, has not thrown up additional cases as yet.

>> So expect more and testing is the link as time goes on for those specific suburbs?

>> The testing rates have been good, they are happy with the rates of people coming through for testing and -- in those suburbs which is why we give you thanks, but the ongoing call to action. We may get at others. In some cases one of the complexities of reporting cases against some of those testing stations is, some people will still go to them and order to be tested and they bring their coats to us, we then go to a manual exercise to identify that they are a contact who was required to go. That gives us a lack.

>> Is it more the middle more cases as opposed to broader testing within the community?

>> Yes and the one case that came in overnight of our 33 today, the one that has not been linked, is still being investigated to see where that case was identified, that was someone who was symptomatic and turned up or identified through asymptomatic testing. Will get more information tomorrow.

>> How problematic is it that lawyers and doctors who are meant to be trusted, are spreading misinformation?

>> I would say it is problematic anytime anyone spreads misinformation, but if someone who is a position of leadership or in a profession where people generally have high trusting relationships, then yes, that does make it difficult. I would call on everyone in those positions to please make sure they are well informed and likewise, they are sharing the best possible evidence and information with those who are in the communities. These are literally life and death situation.

>> Can you please go into what led to the rise of case numbers today?

>> One reason is that in households, we are seeing large numbers often. We have got seven cases today, that is just one household. And as we said before, Delta unfortunately, unlike before, higher rates of transmission within households. Dr Bloomfield may be able to provide to the breakdown of the number already in quarantine and isolation. We had it this morning and forgive me I don't have it on the top of my head, but these were already close contacts we have identified previously.

>> And to add to that, I mentioned yesterday about 16% of our very close contact and as of yesterday we had 352 of those, that on average about 16% of the day 12 test, have become cases. That in and of itself would generate another 50 cases over coming days.

>> Today you reported 17 mystery cases, yesterday 34. Have you sold 17 in the last 24 hours? Or change have you are reporting?

>> That is in the last 14 days. So 17 in the last 14 days so what they have gone and done is look at some of those that were earlier on. Sometimes they have a theory over what has happened but may not be able to draw a link. In those cases it is longer than 14 days, if they have not seen other things a spinoff, they are confident it was a mystery case but there is nothing from that they continue to be concerned about. So honing in on that handful of the ones that are more recent.

>> The reason we focus initially on the unlinked cases is if we are not exactly sure where they came from, we want to check there are not other chains of transmission at their we are missing. Once you get past 14 days, we feel we have confined the case, it is of no particular additional value, in terms of outbreak control. So we have taken those ones off, parked. The other point I would make is, the number does go up and down every day. I have just been in with the team who is going through every one of those unlinked cases and have solved quite a number today, but then you cases come at different times. At the moment as of 9:00 this morning, there were 17 that were unlinked but as the PM said, only a small number of those that we are worried about, even if we don't know the exact link of the rest of them.

>> One thing I will add is the whole gene sequencing process, which does take us time after we have a positive case, that will then be sent off to ESR for whole gene sequencing and that can tell us, even if we cannot build a person-to-person link, it can tell us where it fits in our outbreak. Sometimes it will tell us there is not much sitting between that person and someone else. It will often, without even having to do much more footwork, tell us whether or not these are the links that we need to be worried about. In some cases we don't build on every link, we can still stop people in and it has been such an amazing tool relative to what we had in the past.

>> What are the cases we are concerned about?

>> One has been... The Mount Eden case we spoke about before, we were trying to do some more source testing, so you will have let us talk about that before and one of the reasons Matt Eden is on our suburbs is. There are cases that have come into middle more, that yes, we do want to understand where they fit in, but those are quite recent and some of the tools like gene sequencing are giving us an indication of where they fit in the cluster.

>> There are two others to flag, one being the person who came into Middlemore Hospital on Saturday evening area unwell. That person has had another seven members of the household who have become cases and we are trying to get the link back to the outbreak. The other is our new case from today came in overnight.

>> With the household of course part of the work is to determine who got sick first. It could have been they were unwell sometime ago and it might link to early in the outbreak but then have set off a chain in the family so that is part of the case investigation.

>> Of the unlinked cases, are there any ages or locations? How many were picked up using surveillance testing?

>> Off the top of my head, there is nothing particularly that stands out as being a pattern - if that is what you are looking for. In my mind, they are mysteries, they don't have a particular age range they are falling on. A few of them are women, but I don't think that tells us anything.

>> Except perhaps women are more likely to seek healthcare in timely fashion. Compared to men.

>> That is not a generalisation, statistically it is true.

>> The other comment is the suburbs we outlined where there has been intensive testing, that is in response to these cases and where they live, whether households are. And you will have seen -- where the households are. Many have been presenting to Middlemore Hospital so that's an indication that South Auckland is where we're focusing efforts around testing and contact tracing.

>> But nothing else really stands out.


>> Obviously one has presented at hospital, another is symptomatic and got tested. I will come to a couple over here.

>> Do you have further information on the couple who went to Wanaka? Do you have any concerns there could be others who are abusing their essential worker permit in order to get out of the Auckland region?

>> There are obviously prescribed reasons, permitted activities that allow you to cross the border alongside essential work. Then there are personal exemptions. Those are the three categories for travel. I don't have much more to say on that. Obviously it is sitting with the police. We will allow them to do their job. My general comment would simply be that everyone needs to play their part. The rules are not there to be gamed. I think Aucklanders would take a very dim view of other Aucklanders who are not doing their bit, because they have for a long time and very diligently. Luke?

>> To follow up on that, do we know how this couple came to the attention of authorities?

>> I don't know, I don't know that I know for sure. I think I have had suggestion to that but perhaps I'll leave it to police because this may be the subject of part of their potential prosecution so I think I should leave it to them.

>> Do you know how they travelled back from Wanaka to Auckland?

>> No.

>> On a different matter, you talked before about preliminary conversations you have had about what level 1 might look like when we get there. How likely is it, because summer is fast approaching, it will be big festivals, Guns n Roses are coming in November, how likely will people in New Zealand be able to enjoy these events to make

>> That is exactly what we are working so hard towards. One of the things we have been thinking about, how do we give as much certainty as possible regardless of what is going on around the world? As much certainty as possible to our events sector and creative sector. Those are some of the things the ministers are thinking through. We know we need to work with the sectors and give lots of time and advance warning especially coming into the summer season so that is what we are spending a bit of time on this week as well.

>> So potentially level 1 could see New Zealanders going and enjoying all those things.

>> That is absolutely our goal. You have seen different tools being used overseas to ensure that is possible and we want to make sure people are able to do that here because that is what we had last summer so that continues to be our goal. Justin, I haven't come over to Thomas yet.

>> On the decision to keep the rest of the country at level 2.5...

>> Delta 2.

>> Sorry, Delta 2, have you seen any modelling or advice on the different levels of risk at level 2 verses level 1, how much of a difference does it make in the terms of the chances of an outbreak?

>> I haven't seen modelling but if you apply the same logic to the situation we dealt with at the beginning of this outbreak where we had cases we were not aware of, where we had the biggest super-spreader events they were in environments where there were large gatherings. For instance, in places of retail where there were no density rules. We have lots of examples where level 1 can exacerbate an outbreak, whereas level 2 is specifically designed to try and prevent that particularly with gatherings and density rules. Often modelling goes directly to the Director-General.

>> I haven't seen any modelling of this and our advice was not based on modelling but exactly the issues the Prime Minister has raised. The key thing is while we still have active community cases in Auckland and the potential with people travelling across the boundary for a number of reasons that are approved, there is potential for a case to be seated outside Auckland and therefore we want to minimise the risk -- seeded , we want to minimise the risk of a larger outbreak in the rest of the country.

>> We are doing as much as we can with regular surveillance testing at the border, asking people to do that on a weekly cycle. But if you simply hermetically sealed Auckland, that would almost be impossible because we still need to ensure that we have supply chains coming in and out. The number of freight and logistics companies that need to be able to move to keep the most basic services going for Auckland and the rest of the country requires movement to be there. And as we know with our managed isolation facilities, testing regimes provide some confidence yet again are not full proof.

>> Without modelling, how do you feel confident you are making a good trade-off between Delta 2.5 and 1 and the rest of the country with the economic cost?

>> Yeah, I know the way I work through these decisions, keep in mind that first the assessment is undertaken by our public health team at the Ministry of Health and then approved by the Director- General who shares it with us. My test, for instance, if I were to get a call from Minister Hipkins to say we have a case, for example, in Christchurch, the first question for me is going to be, what places was that individual at before we found out that case existed? And I know we have a much better chance of managing what the consequences of that if I know that they, that we have got mask requirements, they are unable to go to large gatherings, and we have density rules that will prevent that being a situation where we end up in a long level 4. That is what I apply. So long as we have an outbreak in Auckland, it is not impossible that that would happen. Once we get that under... Even more control than we do now, then we can have more confidence in the future.

>> You are both very bolshie on returning to COVID zero, everyone is really rooting for this. But after four weeks of lockdown, there is plainly a possibility this may not happen, do you need to level with Kiwis that it might not happen?

>> We have come down today and demonstrated that the numbers we have today, so long as you are able to demonstrate where they have been coming from - they are close contacts, they are in isolation, in facilities and, for instance, we have one unlinked case and that case you could have reported five but that one unlinked case still becomes something we are concerned about - that's why we will keep breaking down those numbers and sharing with people where we think we are at and what the numbers are telling us. But we remain committed and determined for good reason. Anything further from you, Dr Bloomfield?

>> To reiterate the final comments the PM made, our view is we are doing everything right. It is paying off. And we need to see this through. There is good reason to want to eliminate the virus again. And it goes to the comments made earlier about what we know we can do if we can get back down to Alert Level 1 as a country. Not just to safely vaccinate our population, but it allows us to enjoy a full range of activities and for the economy to really crank up again.

>> Prime Minister, what is the level of vaccination where the hospital system can cope with any out-brakes? -- outbreaks? And where you don't have to go to level 4 lockdown with a breach. The study in the Lancet a month or two ago showed even at 90% there would still be nearly 6000 hospitalisations per year and 500 deaths per year. So is there any level of vaccination that is essentially safe?

>> Yeah, and there are other illnesses that in the winter also surge. So it is not to say our hospitals don't have to surge for those illnesses and so on. The first thing I am going to say, at the moment our strategy is elimination and we have not changed that plan. We're going to continue to work alongside our experts around what the postvaccination environment looks like. I only say that because there was a lot of built-in assumption to the question you asked me. For things like modelling around hospitalisation rates, that's a question for Dr Bloomfield.

>> If you look at the advantage we have with taking this approach, we can learn from other countries and jurisdictions. And you can see, you are right, even with high rates of vaccination, you still need other restrictions to manage the load on the health care system. That is regardless of whether you are Singapore, the UK, or a number of other countries through East Asia that are also in similar positions. So we're watching very closely what is happening with other countries where they have got the virus in the community with high vaccination rates and the impact that is having on their health care system. The UK is a good example. Last Friday the Guardian was reporting 8000 people in hospital which would equate to 600 and New Zealand on any single day. That is a lot for our hospital system to cope with. So you can see they are now considering what other restrictions they need to put in place to help reduce the number of cases in the community. The best thing we can do is give ourselves as much time as possible just to see what is happening in other countries and therefore, as we plan for the future, what are the things we need to take into account.

>> Doesn't that imply that there is no level of vaccination high enough to actually move beyond elimination and level 4 restrictions?

>> I would reject that, no.

>> It is quite clear, and you can look at a number of European restrictions, and the PM talked about Denmark, Iceland is another one, where of their total population, in Iceland, for example, over 80% have had at least one vaccination. What you can see is the impact that has on their health care system is much less than in countries with lower rates of vaccination. So the aim for us, as it has always been and people have tried to put a percentage on us, is as high as possible. The higher we get, the better it is for everybody for a whole range of reasons including the impact on the health care system.

>> There is some really interesting analysis of hospitalisation and death in Canada which looks at over 600,000 cases there and looks at the proportion unvaccinated, vaccinated, who are presenting in hospital and so on. And it is very, very clear the impact of vaccination rates. So even in those countries where you continue to see hospitalisations, often large percentages of unvaccinated people or the complication of immunocompromised people as well in some countries as well.

>> Vaccinations for Maori are still only sitting around 15% for fully vaccinated, what is your thought on the?

>> Dr Bloomfield?

>> I would attribute that to the fact we have got more work to do to increase vaccination rates amongst Maori. The good thing is we have seen those rates increasing over the last few weeks, and particularly in Tamaki Makaurau. It has been very good to see the response there and there has been a lot of focus from the Maori health providers. It was there from the start, we saw through the first two or three months of the vaccination program, the rates for older Maori were as high or higher than they were for non-Maori. So the challenge and the focus now is very much on getting those rates up in the younger Maori.

>> Has the government underestimated the impact vaccine hesitancy would have on Maori and Pacific populations?

>> We have always been concerned about misinformation. We said it before, we were wary of it and we knew we needed to get out as much information as possible. We needed to provide places where people could access that. What we have seen over time is an increase in the number of people who said they are willing to get vaccinated so that has improved the more time people have had to see whanau get vaccinated safely, to get the information they needed, to make their decision to protect their family and their community and themselves. Just clarifying whether today's mystery case was someone who into middle more and tested positive?

>> No.

>> Do you think it is human nature to bend the rules?

>> I am probably the wrong person to ask, because it is not really my nature.

>> There has been authoritative measures to deal with that. Has the government considered an element of perhaps the carrot rather than the stick in looking at incentives to keep people complaining?

>> Do you mean incentives...

>> Batches so people comply?

>> So give someone who wants to go to Wanaka batches? I will just ask them not to go to Wanaka. Sciver we have heard some stories from people who suggest they are afraid or not... They are avoiding getting tested because they have concerns about getting moved into quarantine and therefore not having someone to take care of stuff at home. What would you say to them? And there has been a suggestion of putting out randomised testing, say at the supermarket, to see whether there is widespread community...?

>> The first thing I would say is for asymptomatic testing, the public health team in Auckland have been reaching out and doing work to ensure we do have asymptomatic testing in places where we really want those numbers. We have talked about whether or not pop up sites at places like supermarkets is a good thing to do. They have done that before and they actually have some experience of whether or not that has worked or not. We are keeping all options open but at the moment they have been able to get good asymptomatically testing another side. On the second question,... One of the things that we often talk about is the process forward someone told they have COVID-19. They get a call from a public health person who will give them that news. And then we follow-up with someone who then talk them through what happens next. A lot of work is done to make sure any concerns are met as to whether they are a caregiver or living with family who might be dependent on them. Support that can be given to keep them and their family safe. That is something that is done carefully and thoughtfully. But with a really good I do too ensure that we reduce the chances they might give COVID to the family members as well, which is a the focus.

>> Can I take you back to your comments...

>> You said earlier there is an in principle decision... Is the intention that the rest of the country goes to level 1 at that point going well?

>> We have made no indicative decisions. We made an in principle decision but nothing for the rest of the country.

>> Back to the comments you made when you spoke about short, sharp lockdown. He said we wanted to be short and sharp rather than late and long. If we comply, it lifts our chances of getting earlier. And people not look at that and look at the length of the lockdown?

>> Look at Australia. In a Delta world, we know the difference between what log means now. And so I would reflect on the experience of other countries. We are looking -- working very hard and doing well on a strategy to eliminate but the alternative is something very different.

>> A lot of mental gymnastics looking at how long they expect... How long is a piece of string basically?

>> I don't believe it is a case would be made and in principle decision. I also think people expect us to act on the information in front of us. No one thought after we had a large number of cases come quickly through after three days that we would be left where we were.

>> As I have explained, that was acting on one case, of course over the course of the three days, additional information can through and people expect us to act on that. It is no different to what we have done previously.

>> Yesterday you spoke about a handful of cases that were concerning to your. Other any new ones that have popped up of concern?

>> Some have been... Dr Bloomfield?

>> Several of the cases yesterday would have been in that handful, have now been resolved. And that includes a couple of the cases that have been identified at Middlemore Hospital over the last week, where not only have we Dean assured themselves there is no onward spread, but they have been able to identify the link to the main outbreak, both epidemiologically and through the whole gene sequencing. The handful -- Gino Mader sequencing. The handful has moved on yesterday as new ones a result the new ones come in.

>> A disproportionate number of cases hospitalised over the course of the outbreak have not been vaccinated. What lessons do you take from that? Is that a real-world data?

>> A good question. Perhaps... I have commented a lot on my thoughts on vaccination so I will head over to Dr Bloomfield.

>> We have got a very good data, even from just this outbreak in New Zealand, showing that the risk of becoming a case and certainly of being hospitalised is much much lower if you have... If you are fully vaccinated and lower even with a single vaccination. It is real world, real New Zealand evidence that being vaccinated protects you and your family and the wider community from COVID-19.

>> Trying to get more certainty about when we will stop using lockdowns as a first resort. Will be still be using lockdowns this summer, next year?

>> You would have heard me say before and I absolutely standby it, no one was to continue to use lockdowns and the reason we use them was because every single New Zealander was vulnerable. We had no form of effective treatment or preventative tall, like a vaccine. Now we have vaccinations. So we have something that is able to be used to move away from things like lockdowns, but we need New Zealanders to take them up.

>> We need to make sure that we have New Zealanders vaccinated in order to make sure we don't have to use lockdowns as a tool to prevent these large-scale outbreaks that take people's lives. That is why New Zealanders are empowered. They have the chance to move away from lockdowns, as much as we do by being vaccinated.

>> Can have more clarity around the length of time, heavy restrictions. For businesses, went can expect to get more information as to whether support will be all that more broadly?

>> Did that substantively last week. We saw more certainty around the way we would use the resurgent payment. You would have seen from the podium with Minister Robinson and of course with this extension of Level 4, it means another round of the wage subsidy becomes available as well.

>> What about more targeted support for political -- particular sectors it artist?

>> In some ways because of the revenue Jack and the eligibility of, for instance the resurgent payment, it becomes quite a targeted payment. And of course the wage subsidy, because it remains available even for a business in level 2, but is affected by another part of the country being in level III or 4, becomes targeted as well. It means level 2 businesses that are in the example, a rental car company on the South Island, heavily dependent on bookings out of Auckland would continue to be eligible if they me that revenue test.

>> There has been concerns raised with some of the organisations on the frontline suffering burnout. What is there to support the workforce, especially now for next seven days?

>> We have been working very closely, both with and through the DHB to support the DHB employed workforce. As well as the team in Auckland regional public health has been working hard for some weeks now, so that is included people from the ministries team going up there and to Auckland regional as well as staff from other district boards and public health units. I am also aware a number of those community-based providers have also been working really long hours and very hard. The DHB's are working with them to make sure they have got all the support they need and they can reach their staff and that may include using other providers to, for example, help stop testing or vaccination centres.

>> Can we get some clarification, are all positive cases and the close contacts still being moved to quarantine? And if yes, how many remain in the community at the moment waiting to be transported? And if not, why not and other any concerns around the facilities here?

>> There has not been a change in the policy. So yes, the approach is that for the vast majority of cases, they are moved. There is... On occasion, there might be an exemption given by a public health unit, but that is in a small number of cases and for very valid reasons. My understanding is, we have close to 150 available quarantine spaces, and they increase regularly, as we have those who have recovered to exit the facilities. I am not aware of any particular backlog because at the moment we have much smaller numbers than we have had in the past.

>> Seven of yesterday's cases were out in the community. Is there a breakdown on how many people in the seven have had exposure events or were infectious in the community?

>> Not yet but what I can say from the exposure evidence yesterday, you said there were seven, of those there were 15 exposure events. Only three of those were after the person had been told to isolate, and those were that person visiting a testing centre, which was part of the prescription. Of those seven people and the 15 associated events, they were things they were allowed to be out and doing before they found they were a contact and then became a case.

>> The most common we see our supermarkets, dairies, from time to time laundromats, which of course people are able to visit a laundromat. Testing, pharmacies, doctors, and the odd occasion will have report of a bubble breach, which is often a family member.

>> Can you clarify the case with there was two cases in one household?

>> Yes, correct. That remains un-result.

>> The Gino Mader sequence -- Gino Mader sequence, one member was the first infected and I said they both had two snips different, but it links back to quite early in the outbreak, so it does not obviously linked to 1 of the more recent subclasses, so it is work in progress still.

>> There is a third person in the household so... Who is fully vaccinated, so there was work underway to see whether that person may have been infectious but asymptomatic. They have tested PCR negative so we will see what can be done to get to the bottom.

>> Another good promo for vaccination giving it is a person in a household with two COVID positive people have tested negative. They were certainly asymptomatic consistently.

>> What would you say to the organisers, if they are planning for summer, and in particular, is it possible to get to the vaccination rate which will allow that sort of event this summer?

>> Some of my very close friends work in the creative events sector. But that is not the only reason I am determined that we will find a way to make sure that, regardless of the circumstances, globally and domestically, we are able to have events that make New Zealand summers. It is because it is part of who we are, it is about people's livelihoods, but it is also about the nature of our summers and what makes them fantastic for people, particularly our young people. That is one of the things that has been so successful about our approach, for the most part, yes there has been disruption, but we have consistently been able to hold large-scale events and I want to be able to continue that, so I continue I am committed to finding a way we will do that.

>> The event organisers are asking for the government to provide insurance schemes. What is your view on that?

>> I think there is a way to work through this where we get that certainty and those issues become less material. That is what we are focusing on because keeping in mind, it is not just music events. There are a events up and down the country, in cities and towns where councils, event organisers but a huge amount of work in so it becomes endless. That is why the best thing we can do is about the kind of God and second future prove events.

>> How would you like to see Kiwis celebrating the week?

>> I hope I am a member of the last generation that did not grow up with it being widely used in my education and more broadly, I have seen dramatic changes over the past few decades and in particular the past few years, over the use of its day-to-day. And with the ongoing exposure and availability in our education system, I will believe I will be the last of the generation has not had that exposure and therefore is perhaps a little less competent. I think the next generation will be confident and it will be a fantastic thing.

>> Any advice and not saying Kiwis?

>> I can say I have ever received advice and that, no. Thank you everyone.

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