COVID-19 update, 14 June 2022 1pm

Tena koutou katoa, thank you for coming, I'm glad the weather is better than yesterday.

Today I want to give a brief update on the Omicron update, what we think will happen next and an update on the planning we have done for winter and how that is rolling out.

I will outline the findings of an independent review we are publishing today into the PCR testing capacity in the early stage of the Omicron outbreak in February.

Dr Ian Town, the health ministry's Chief Science Advisor will join me on our hospitalisation data and what that is showing.

I note the Ministry's regular 1 PM statement is going out with today's case numbers, for the first time is in over 300 stand-ups I won't go through those numbers I'll let the statement speak for itself.

Internationally the number of new weekly cases and deaths is declining.

We know a number of countries have reduced their testing since March.

That would flow through into reduced case numbers, but we are also seeing a drop in reported deaths internationally which suggests the drop is real.

Saying that, one of the key contributors is most of the population lives in the northern hemisphere when they are going into summer and I can say for my recent trip to Switzerland that northern hemisphere countries are looking at New Zealand and Australia and what happens this winter with COVID and in particular the impact of the rollout of the fourth dose of the vaccine and the protection that affords our vulnerable populations.

They are very interested to see what we do ahead of the next northern hemisphere winter.

I have a couple of slides today, the first shows what is happening with case rates around the country.

The grey line is the national all of New Zealand rate and that is on the decline, in the middle of the coloured lines.

We can see in the northern region, the orange line, as well as the southern region, and the Midland region case rates are going down but they seem to be going up again in the central region, the lower North Island region.

Overall we are continuing to see a drop in case rates and numbers.

Our average numbers of cases over the last seven days is under 6000 and the rate per thousand has dropped in the last week to the weekend in 12 June, 8.3 per thousand down from 9.3 the week before.

During the Omicron outbreak we've looked at other metrics during our wastewater testing results and doubts availing its availing of border workers to see the proportion of cases we are picking up in the community.

Up to 12 June our border worker testing was showing a rate of about 1.4%, 14 per thousand, we are probably picking up two thirds of the cases with community testing which is pretty good this far into the outbreak.

Back about a month ago we thought it was only 50%.

One of the things that has helped our response here is that people are still testing and uploading those results, we are getting a pretty good picture of the burden of infection in the community.

Of note in that last week as we are seeing an increase in case rates among over 65 is, that's important our older people are more likely to have severe infection and more likely to be hospitalised or die from COVID- 19.

A message to everybody, please continue to protect our older people and those who are vulnerable because of pre- existing conditions or being immunocompromised wearing masks and not visiting them.

If you are unwell, stay-at-home.

Encouraging signs in terms of case numbers but the rate of 6000 cases per day on average over seven days is still double what we had initially modelled we would have at this time, a high baseline rate.

Moving to hospitalisations, this is nationally and looking at hospital occupancy compared to what we had modelled, we had seen it come down but slowly, and levelling off somewhere between 350 N400 people in hospital on any day.

Again, twice the number of hospitalisations we had modelled a couple of months ago.

As you would have heard over the last week, a number of places around the country are significant burdened, not just on hospitals but primary care.

Interestingly, only 20% of people who are admitted to hospital at the moment with severe acute respiratory infection, only 20% of those people have got COVID.

Well over half have influenza and it's the influenza A type that is rampant in the community.

COVID is part of the burden but we have these other infections.

We are not seeing RSV, the one that tends to infect younger children yet, but it is there in Australia so we are watching closely for that.

The other thing I would say about the influencer A in the community is our early data suggests that the subtypes in the flu vaccine in New Zealand are good match for those subtypes we are seeing in the community.

Yet another reason if you haven't had your flu vaccine, we are approaching 1 million doses administered, we have over 2 million, if you haven't had your flu vaccine yet, particularly if you are in a vulnerable group, please do it and it is free for many people.

Turning to the PCR testing review, as we have done through the pandemic, both ourselves and others have done externally, we have reviewed our ex- response to the Omicron variant and the delay in processing PCR tests in February.

When our case members -- numbers with the rapid onset of the outbreak, as they increased quickly we reached a point where we had to make the switch from PCR testing to RAT testing because we had a high enough prevalence of the virus in the community to merit rapid antigen testing.

However it was not a smooth transition.

It became clear our PCR testing was not keeping up with demand, we had a backlog of 32,000 tests, mostly in Auckland, and on 1 March I spoke about those, outlined the delays and what we were doing, and apologise to the people whose results were delayed and who were affected by that.

As of 1 March, one third of the people with a delayed test result had been retested and we processed the full backlog by mid-March including sending some to Australia.

At that time I commissioned an independent review about what led to the processing delays and also a look at our forecasting of lab capacity and why they seem to be a gap between testing done and our capacity we had forecast.

Today we are publishing that reviewed and a number of other relevant documents and our response to the review.

The review found four areas that contributed to the delays, an issue around lab capacity, the planning, it could have been better, our reporting of lab capacity and some aspects of organisational internal design.

As one does with these reports, I welcome the report and the recommendations, it's a thorough piece of work and I want to thank the team that did it.

And I can confirm that work is underway to implement the recommendations.

We have strengthened our testing expertise in the ministry and alongside Health New Zealand we are working with our labs to make sure we put these recommendations into place.

And also we are in the process of procuring the PCR capacity we need to take us through to the end of the New Year.

The improvements are being embedded in the responsibility for testing around COVID has transferred to Health New Zealand and we will work closely with them.

The review examined the Ministry's role in the circumstances that led to the resident delays -- which meant we had in consisting reporting of testing capacity.

It's clear from the findings we could and should have done better on both estimating the capacity and communicating that clearly.

We were updating it on a regular basis but when I became aware of the inconsistencies I informed ministers, and work with our testing team so we could get a consistent picture of testing.

I want to emphasise of course the issues arose at a time when the health system including our labs and testing team at the Ministry were working extremely hard, we were responding on a minute by minute basis to a rapidly evolving outbreak with a highly transmissible variant.

The teams were doing their best at the time but it's clear we should have done better.

Lab staffing was affected at the time by what had been a sustained and prolonged response, remembering we were just off the back of the delta outbreak, some of the workers tested positive for COVID-19 and they were down on staff and there were challenges around test reagent availability and distribution.

I want to emphasise, the delays that happen were not the fault of our labs or lab staff and I have worked phenomenally throughout the pandemic as have, 7 million tests from a standing start and it's been integral to our effective public health response.

It's a mammoth effort and I want to thank our lab staff, I've met a number of them as I've travelled around the country over the last six months or so.

As well as the PCR review which is on our website with a range of other documents, we are releasing some other reports I know will it be of interest.

One is a review into our response last year to the delta outbreak which started in August and had all but been stamped out by the time Omicron came along, we were down to a handful of cases a day.

That review was conducted late last year and identified areas for improvement around a more equitable approach to supporting Maori and Pacifica and disabled people, that will be coordinated in our response and ensuring we sustain our COVID-19 workforce into the future.

A useful report, thanking the author's very much for that, it's been published alongside our response.

Other documents have been published including two briefings by the implementation unit and the Department of Prime Minister and Cabinet about contact tracing and case investigation and another on testing.

A briefing from the COVID-19 independent continuous review and advise group chaired by Sir Brian Roach and that report was to the previous Minister for COVID-19 response, Minister Hipkins, regarding the broader response at that time.

It is probably a good time for me to hand over to Dr Ian Town and I will make closing comments before we open to questions.

>> Thank you.

Today I am providing an update on our hospitalisation data and some updates relating to surveillance and testing, which I touched on in a more detailed briefing be held here last week.

A key part of being able to respond to current and future outbreaks is having a clear picture of the impact of COVID 19, equally amongst those who have experienced a more severe illness and require admission to hospital.

Over recent weeks, in partnership with our colleagues in the DHB sector, we have been working to improve the collection and recording of information about people who have been admitted to hospital.

As you know, we regularly report about the number of people that are in hospital on any given day, but there is significant value to us in understanding the underlying cause of hospitalisation.

How long they spend in hospital, whether or not they require more intensive support, for example in an intensive care unit.

The data I have got to share with you today is reasonably preliminary, but we will be working this up into more detailed reporting in the weeks ahead.

One of the things that we are aware of from our clinical colleagues is that when people are admitted to hospital, it is important to know whether or not they actually have COVID as the main underlying cause or a contributing cause and our information.

The data suggest that that is around two thirds of cases.

Whereas conversely in about 1/3 of cases, the reason for admission is quite a different condition and they happen to test positive for COVID during that time.

That is an important differentiation if we are considering the impacts of COVID on individuals and indeed the wider hospital system.

In regards to vaccination, the data shows that for those that have been hospitalised with COVID and are not vaccinated, the rate is about six times higher for the group that has not been vaccinated or boosted.

It also shows that those who are unvaccinated when they are in hospital have a more severe course of their illness and are about three times more likely to end up in intensive care as a result of that admission.

So, that really underpins the Director-General's call for everyone to continue to get vaccinated and, where eligible, have a booster.

There has been a lot of publicity in recent days about the demands on our healthcare system more broadly and our hospital system in particular.

There is no doubt that our hospitals are busy and there are many people as is often the case over winter who are presenting to primary care and secondary care with acute respiratory illnesses.

This is a passage that our hospitals are used to and it occurs every with a.

At the moment, a number of these folk are also presenting to our emergency departments as well as general practice and our acute medical centres.

We do acknowledge that at times, there have been longer waits than would be desirable and we are very conscious of the impact this has on patients and their whanau.

We are especially grateful to our frontline healthcare teams around the country who are providing excellent support along with our colleagues that work with Healthline.

Al agency hopes that make our agencies have been acting have been preparing for winter and ensuring they can manage demand and to fully prioritise those that require urgent demand in energy manner.

And of course, continuing to deliver as much pain care as possible during busy periods.

So, the Director-General is already mentioned the flu vaccination which as he notes as appropriate for the strain that we are identifying both in Australia and here in New Zealand.

So, getting that flu vaccine is a key strategy to keep yourself well over the coming weeks.

Last week, you will recall, we talked quite a bit about the surveillance strategy and identified seven broad areas where we were working to keep up surveillance, particularly for new variants when they arrive here in New Zealand.

One of the key tools that we use and here, we are working very closely of course with our science colleagues at ESR, we are working to increase the number of samples that can be processed.

ESR and the laboratory teams around the country are increasingly using automation, using a digital platform to help the data sharing and sample identification so that we can keep up that timely assessment of those that test positive at the water -- border.

That is with the rapid antigen test and then go on to have the PCR test as we discussed last week.

Those that are in high risk areas or situations and of course, as I mentioned, we are routinely testing people that have been admitted to hospital with a PCR test and the whole genome sequencing.

Lastly, we also had some discussion about the reinfection advice and since that presentation, last Thursday, we have been working hard with our public health colleagues and a laboratory colleagues to provide updated advice in the near future.

We hope as early as Friday this week.

So, thank you Dr Bloomfield, I will hand back to you and take some questions.

>> Thanks again, Ian.

Great to have you here.

Just a couple of closing comments.

There is no doubt the next three months are going to be tough.

And the health system cannot do it alone.

There are things that we can all do to help protect each other.

And to make sure that our health system is not overloaded and that people who need care can receive it.

So, we need everyone to do their bit to help us get through winter in good shape.

Being up-to-date with COVID 19 vaccinations and very soon, of course, we will be starting the rollout of that fourth dose to our groups who are the most vulnerable and whose immunity may well be waning now.

With that six-month gap between their third dose and this next one.

Wearing a mask.

I can tell you, having been in Switzerland, where there was not a mask to be seen, that it is an incredibly important thing that we can all do to protect ourselves and others.

Staying at home and in particular, not visiting people who might be vulnerable if you are unwell.

This is fundamental to us, not just getting on top of COVID, but as I said, a lot of those winter illnesses out there now are actually influenza or other viruses.

The action is the same, please stay home if you are unwell.

And do do a test and if that test is positive or negative, please upload the result.

Gives us a very good picture of what is happening out in the community so we can apply our public health system and public health resources appropriately.

Alright, now open for questions.

>> You knew on February 20, the National laboratory network was at capacity.

So, why didn't you inform the public of this at the time?

>> Actually, what we did do was be shifted very much with -- within the next day or two after that to use a rapid antigen test.

The reason we did that was because the PCR testing was at capacity.

So, I would counter that perhaps we did inform the public and that is what underpins our shift then to the use of rapid antigen test.

>> When you and others told the public PCR capacity had increased to 50,000 cases a day, why did you asked actual lab scientists if this was accurate before time the public in a challenge like the figures we were using for both pools and on full capacity were on the basis of the information we got from the labs.

Back in December after a conversation with the minister at the time, we started to report not just the pools, but the un-pulled capacity and it was a figure of around 30,000.

One of the things that puzzled us was that even as we got through February, our testing numbers were around 15 to 20,000 a day, but we knew we actually had capacity for that non-pulled testing numbers of around 30,000.

What became apparent and I talked about this in March, what we should have done and we didn't was interrogate whether or not there was the ability to move those samples around the country.

What became apparent, although we hadn't anticipated it, was once samples were in a loud and were logged on and in the system, it was virtually impossible then to move them to other parts of the country.

So, the backlog started in Auckland.

They reached capacity even while we had spare capacity in other parts of the country.

What we hadn't anticipated, and we should have, and this is where if we had dug a bit deeper with the labs themselves, we would have gotten this picture.

Is that actually, we couldn't readily move samples around the country and that is what was a major contributor to the backlog.

>> The report says that modelling had predicted there would be a breakpoint essentially where demand for testing would exceed capacity, but that was never said that you or ministers.

How does that happen?

If you have got someone with a (inaudible) says you will not be able to test passes number and it doesn't make it through to you or ministers, do you have any idea?

>> The factors that way into whether or not we would reach capacity where the positivity rate and the positivity rate went up very quickly, more quickly than we had anticipated it would.

We knew we had capacity of around 30,000, but I think this is the point here, even the modelling itself I don't think took into account that we couldn't readily move samples around the country between different labs with different Information Systems.

I think that was a key factor in what led to the backlog in Auckland.

>> More broadly, this outlines multiple points of failure in planning and communication and data collection.

Who was responsible for picking up these errors?

Who should have and why did that happen?

It is across-the-board, it is not in any one part of the system.

>> That is right.

For my part, I am responsible for the system.

That is why I was the person who fronted the media stand up on 1 March.

First of all, I identified that we had the problem and that is why I commissioned a report.

It is only by doing that deep dive that we can identify actually where the areas were that we should have done better.

>> The National Institute of medical lab technicians, they say the ministry essentially ignored them and refused to have them at the decision- making table.

What you say today?

>> I am not sure that is what they were saying.

We were meeting on an almost daily basis and I myself was present at some of those meetings with the laboratories.

Actually, we have got a very good relationship with them.

So, I think one of the issues that the labs have pointed out, be that society has pointed out, is that there are long-standing issues around the sort of delivery of lab services in the country and some of these of course became very stark and acute when we had the Omicron outbreak and the pressure really came on the system.

I think, you know, I want to reiterate the relationship is very good.

It has been throughout the pandemic, the labs had done an excellent job.

And it has continued to strengthen.

>> Millions have been kind of allocated to improve testing and that capacity over the pandemic.

Where has the money gone and why has 5% of the love workforce left the profession?

>> Well, I can't speak for why the lab workforce has left the profession, but I will make an observation.

These people have been working incredibly intensely right through the pandemic and certainly, whenever we have now broke, you would see the testing volumes would go up incredibly rapidly and people were working very long hours to process all of those tests.

There will be a range of reasons why people have left and there has been a significant investment in the labs to deliver on the PCR testing, including equipment, but also in the payment for the tests.

There has been a significant investment in labs.

I think the loud society will be also wanting to make sure that the workforce they represent is adequately paid.

And that is an important part of making sure that the people are trained in the first place and be retained in the workforce.

>> You said there were difficulties moving tests around the country.

Is that something that will change now and how quickly will that be established?

The ability to do that.

>> There was some ability, particularly from our major lab provider which has labs across country, that is Asia Pacific Health Ltd.

The key is that our lives had different Information Systems and one of the areas that we will have in our new contracts with the labs is that we will make sure they can interface their Information Systems with a national database so that will improve our ability to move samples around in the future.

Seven is that you have said that one of the responses is that there will be a new funding model.

You are looking at a new funding model.

LW McEwen vision that people will eventually pay for covert tests as an individual.

>> There is no intention to introduce charges for covert testing.

Laboratory testing is largely free in New Zealand.

Most tests are freely available.

There are two aspects, to key aspects to the contract that we want to put in place from 1 July.

First of all, our labs set themselves up with a large capacity.

Now, there is some debate, it is in the report about just what that capacity might have been.

But they were doing at the height of the Omicron outbreak tens of thousands of tests a day.

Once we shifted to rapid antigen tests, that volume dropped away and it is much more than that.

What we want to do is contract them to continue delivering that, but have that waiting capacity to be able to scale up if needs be.

The second aspect of it" you, Sam, is, we are expecting more of them with the tests they are doing.

There is more complexity.

We are testing everybody who is coming across the border.

We are then asking people who return a positive test to get a PCR test.

We are asking our labs to identify all those people and send all those samples to ESR for whole Genomic sequencing.

We are wanting to recognise the extra effort and what is happening there.

The contract will be about ensuring that we can recognise the current costs of delivering PCR testing, but that there is that capacity in the labs to scale up if and when that is needed over coming months.

>> At a high level, do you think provision of testing services and these lads is the way to go?

There seems to be quite some tension between certainly the unions and workers about the conditions and a tribute that in part to privatisation.

Using a public model would be Historically most of the testing has been private and hospital testing has been public.

It has been fundamentally successful, the ability to ramp up PCR testing capacity and their willingness to work together, and their willingness to discuss age -- engage in discussion.

That's a longer term question, it applies to areas like radiology and provision of surgical services.

>> Could this have been avoided if we had enough RAT s in place if we needed them?

>> At the time of the omicron Mac rate in New Zealand there was a shortage of rats tests, and we switched across to RAT testing.

I don't think it was material in terms of timing of the shift, it was a matter of a few days.

We didn't quite get it right.

It's clear now we have a good supply of RAT tests into the outbreak the extent to which New Zealanders are testing and uploading results to a greater degree than I think it's happening in any other country.

We have a better picture of the outbreak in New Zealand and other countries do.

>> You said before that you knew on February 20 labs were at capacity, you failed to tell the public, politicians told on February 25 that everything was going well, why didn't you set the record straight early academic -- earlier?

>> They were making statements based on information we had the time and the information was that we were confident we had capacity to 30,000 and our testing volumes were two thirds of that.

We were working with the labs to do the things I've talked about, moving test around the country to use full capacity and it was over those days it became apparent that it wasn't possible to move them to the extent we needed to.

>> The review talks about a new operating model, does this mean the ministry will be overhauling the way it works currently?

>> That refers to the re-contracting we will do with the labs from July to September recognising the extra work they are doing now and maintaining capacity in case there is another surge.

>> A question for Dr Ian Town, if someone has tested positive for COVID on day seven days are up and symptoms are gone and then they have a positive test is that men they are still infectious?

>> I've had this experience myself I'd be interested what the Chief Science Advisor says.

>> This is a matter of considerable interest because there's been potential confusion, we are looking to update that advice in the coming days.

We have prepared advice which has gone to the Director-General and will be discussed by ministers in the coming days.

You're right, because there is free access, it is inevitable they will retest if they have symptoms.

We have the difference between the 28 days and the days that follow.

We need to align that advice and provide that to our colleagues general practice and Healthline and so on and bring it back to future announcements hopefully on Friday.

>> If someone is essentially, would they be infectious after seven days and their symptoms have gone away but they are testing positive for a man RAT, independent experts say they are infectious but the ministry says they can go to work.

Lots of people are saying their employers are making them go to work even though they are infectious.

>> If the RAT is still positive it means viral material has been detected.

We know from the PCR test, that test can be positive for weeks or longer.

We need to line up that advice to make sure the public health protection is in place around isolation is clarified.

>> If someone's employer tomorrow says you should come in because your seven days are up, you don't have symptoms, I don't care you are testing positive, should they wait until they test negative?

's I might need a bit of help there.

>> The first comment I would make is there is nothing special about seven days, the rule previously was 10 days prior to that 14 days.

After seven days some people will still be infectious and some of those people will return a positive RAT and some will return negative.

I think the important thing is that people don't have acute symptoms they are much less likely to be spreading the virus.

The second is we don't require people to do an exit test from their seven-day isolation and the reason for that is because of this, there will be some people who are positive but they may not be shedding virus and able to infect others.

Some people will return a negative test that may be infectious.

Here is my advice even after your seven days be careful.

You are not required to isolate, in which case, yes, if you are not symptomatic it is within your employer's rights to go back to work.

Keep wearing a mask and avoids places like aged residential care and people who are immunocompromised for a few days.

Everyone should do that, some people will should continue to shed the virus.

>> Some people will get a positive result but they are not infectious, do you have a sense of how many people that is?

Is it 50-50 or one in 100?

>> We shifted from 10 to 7 days and we did some modelling, it is a few percent of people will be infectious after seven days just as even after 10 days it will be a smaller percentage but some people will be infectious.

It is a relatively small proportion of people still infectious after seven days.

A good rule of thumb with COVID and also flu, if you are acutely symptomatic with a runny nose or a cough or sore throat, or a fever, assume you are still infectious and could be infectious and stay home.

Plasma out of the people who have tested positive after seven days, how many of them are likely to be infectious?

Do you have a sense of that?

>> I'm happy to come back with that.

>> (Inaudible) >> I had a very mild Swiss version of the virus and got to know the inside of my hotel room well, but thankfully mild symptoms and back to 100% today.

That is not everybody's experience, some of you may have had COVID and many people who are fully vaccinated and otherwise well experience ongoing fatigue for some time and also brain fog, which is a real thing.

Thankfully for me, mild illness and I got back to New Zealand.

>> You alluded to testing positive for quite some time, >> I returned a negative predeparture test in Switzerland which is how I got back in a few days later with a more, following the instructions around the swab, returned a positive test here and I wasn't back at work then.

I was at home.

I have had this expressed by others, in other countries when you are getting a swab, it is a fairly gentle swabbing.

What we are seeing here is people are following instructions which is why we are getting a good positivity rate from our RAT test.

>> We are hearing it is overloaded, GPs have three-week waits to see people.

How is the health system not already overwhelmed?

>> The health system is under a lot of pressure.

It waxes and wanes a little bit.

On Friday I was in Dunedin visiting the DHB and on the COVID ward and the ICU, they had had a lot of pressure in that weight that it eased off later in the weekend was more manageable.

This is normal as Doctor Ian Town said we get these waves.

It is early this year and a lot of that is because of the influenza that's come into the country with the borders opening and that is creating Professional -- pressure on the system.

The system has to adapt and one of the ways hospitals adapt is by reducing planned care.

They focus on doing acute surgery that might be needed so they can redeploy staff and use beds that otherwise would be used for planned care.

They use that for a shorter period of time as possible.

>> Doctor Ian Town, can you give us an update on the variant planning you are doing for the government and did you identify areas that needed to be improved in preparation for future variants?

>> We made a report through the Director-General to ministers and understand that is being discussed this week in terms of the planning.

We had a good opportunity to talk to colleagues in Canada this morning about their planning and it was interesting to discover the issues they were worried about where exactly the same issues we are worrying about full firstly BC of aliens, -- surveillance, if there is a new variants we can be aware of that and they are doing random testing at the borders in Canada.

Secondly to make sure the planning, it comes back to surge capacity and contact tracing and laboratory preparedness and public health issues are there in reserve.

We would expect the ministers will make further announcements about the variant planning scenarios.

You might recall there were five we put up, we are expecting them to provide further advice to the wider public later this week.

>> Would you like to see closer testing at the border?

>> I think we are doing pretty well, we are improving the number of samples we can process, we are getting good cooperation to people returning to New Zealand asked to do a PCR test.

It's not necessary to test everyone to get a good handle on the risk.

We have identified in community testing through hospitals there are cases of the PA for five variant tested in New Zealand that supports a good surveillance network at present.

>> Any of the scenarios are looked at, would they see New Zealand having to go back to strict COVID lasers -- measures, lockdowns?

>> Those are responses we have described as being in reserve and decisions would be taken by ministers at the time based on the public health risk assessment.

>> On predeparture testing, what is the epidemiology: medical basis for not being able to remove the requirement now?

The Prime Minister has spoken about potentially needing a process to identify variants of concern, could that be happening through requiring positive test from arrivals to undergoing PCR testing?

>> Cabinet discussed this yesterday and I can't report what their discussion was.

The Prime Minister has already said it will be removed by the end of July.

If the timing changes ministers will announce that.

I want to go to the point you made about the role of predeparture Tom the key role of predeparture testing is it prevents picture -- people getting on a plane.

What we are seeing and to build on what Doctor Ian Town said, our provision of RAT test for people coming across the border, about 90% of people are doing the test and uploading the result which is a fantastic response.

2-3% are returning a positive test with predeparture testing.

That is very important.

We have in place our ability of people return a positive RAT we can see if they do a PCR test if it appears in the lab database and if not we can follow them up and asked them to get a PCR test.

At the moment we are seeing one third of the Meg Dalling that and those are going through to ESR for sequencing, we are getting several hundred samples per week and we are seeing the VA to, 12 one variants and detecting them in the community in very low proportions, most of our virus in the community is still the BA to variant.

final comment.

Over 85% of ours through the Omicron outbreak have been CO2.

Hopefully that puts us in a better position so the new sub variants coming through, rather than being big, additional waves, are likely to just slowly take over or overtake the PHU sub variant.

>> (Inaudible) >> What I would say is it is a decision for ministers.

>> Just on ministers, we saw today, (inaudible) no longer has the COVID 19 portfolio do you have any reflections on your time working with him in that space now that it has been handed over to someone else?

>> You know, I have worked closely with Minister Hipkins in that role over the last 18 months or so.

I enjoyed working with him.

Likewise, Mr Beryl has been an associate Minister for the COVID 19 response and has become increasingly involved in the work and she is now picking that up and of course, she brings to that role her background as an infectious disease specialist as well.

So, I look forward to working closely with her through this next phase.

>> Of all hospitals closed to visitors because of the influence outbreak?

How is the Minister supporting (inaudible)?

>> I wasn't aware of that, but this would be something that you might do not just in a small hospital, but if you had an influenza outbreak for example on a ward of the hospital, you would close the board as well to visitors.

That is not unusual.

I do know again, having been down in the DHB in Dunedin, they were working closely with their rural hospitals as well to support them if they have outbreaks.

As you point out, it is at the moment more likely to be flu rather than COVID.

Any final questions?

If not, we have had a great session, thank you very much to everyone for coming out today.

Kia ora.