COVID-19 update, 15 March 2022 1pm

>> Kia ora koutou katoa (SPEAKS TE REO MAORI), welcome back. Nice to see you again.

This is for our update on the outbreak, and I have Dr Ian Town with me today who is going to speak specifically to Long COVID, some of the research and service responses we have got in place here.

Before I start on our update, I want to acknowledge today being 15 March - three years since the terrorist attack on the two Christchurch mosques that killed 51 New Zealanders and left many more with life- threatening injuries. I want to acknowledge from here the incredible work that was done by our colleagues working in Canterbury DHB, the staff there, not just in the immediate aftermath but also following up on continuing to support and care for the victims, their whanau, and their ongoing health and well- being needs.

Today our outbreak update, there are 21,616 new cases with 960 people in hospital around the country.

 Just 22 are in the ICU or a high dependency ward. Further details and breakdown are provided in our 1 o'clock update.

 A little more detail of the hospitalisations in the Northern Region where we have very good automated data. There are 559 people, and of those 40%, 233, are aged 70 or over. The average age is 58. So we have seen a shift towards older people being in hospital. We know they are more likely to require longer care, so they may have a longer stay in hospital.

I'm aware there is a lot of interest in how many people who are in hospital are there because of COVID, versus how many are there with COVID. The reason someone is in hospital is not actually finalised until they are discharged through a very careful, internationally consistent coding process. However, we do know there will be three groups of people in hospital with COVID.

First, those who are there primarily because of COVID- related symptoms, which need to be managed in hospital and cannot be managed in the community or by individuals at home.

The second group are people who have pre-existing conditions like diabetes or heart disease, who get COVID and that may be exacerbating their underlying condition. So they are provisionally admitted for the treatment of the underlying condition rather than COVID per se but it may be that the COVID infection is what has tipped them over into requiring hospital care.

Third there is a group of people admitted for other reasons, unrelated. For example, injury, or requiring maternity care, and they also happen to have COVID.

Now we have got some data from hospitalisations at Waikato Hospital between the second and 11 March that gives insight into how many are in each category. I will walk through these but we can provide this in writing afterwards if that helps.

During that period, of around nine days, just 19% of people were admitted to be looked after in the respiratory service. The main reason they were in hospital was for treatment of COVID-related symptoms.

There was a further 36%, dust over one third, admitted for medical care. For example, heart disease or kidney disease. Some of those people it may be their underlying condition was exacerbated by becoming infected with COVID-19, what it was not the main reason for their admission.

And there were 23% of people admitted at that time who were there on surgical wards, looked after by surgical teams, so they were definitely there for reasons other than COVID.

And another 7% who were being looked after by the obstetrics and gynaecology service, and some of those would have been for maternity care.

The rest, the other 15%, where children admitted to the paediatric ward. Some of them again may have been because of COVID.

But overall, at least one third of people admitted during that time happened to have COVID but were not in hospital because of COVID. Only about 20% were there primarily to have their COVID- related symptoms treated. T

his is one hospital at one point in time but it does provide some insight and we will continue to look at this. We want to look prospectively at people who are admitted with COVID and try to create a picture in at least one or two of our hospitals.

 I would also like to share a few slides today around the picture, around the picture of the outbreak in Auckland, the Omicron outbreak. Auckland as we know has had the majority of cases and hospitalisations. So tracking what is happening there is important, and it will give us an indication of what might happen around the rest of the country.

First, we have a slide that shows for the Northern Region's four DHBs including Northland the number of cases, which is the blue line, compared with three transmission scenarios that were modelled before the outbreak. You'll see the high scenario that was modelled peaks at around 11,000 cases in the Northern Region during the second week of March. Incidentally, that's about 50 times the peak that we saw during the Delta outbreak last year.

As you can see, case numbers got higher than that higher transmission scenario that was modelled. There are a couple of reasons why that may be.

One, we introduced rapid antigen tests, and we have had remarkable levels of reporting by people of their rapid antigen test results both positive and negative.

The other reason and I will come to this is that it may be a reflection of the fact that we have got quite a high proportion of cases that are the BA.2 sub variant of Omicron. We will come back to that but you can see after that peak quite clearly in Auckland the number of cases is on the way down.

This second slide shows occupied hospital beds. Sorry, it doesn't. It shows new hospital admissions for the Northern Region. They are following the pattern that was modelled with a higher peak than was initially modelled for that scenario.

While the number of new admissions each day seems to be on the way down, we are still seeing the total number of people in hospital in the Northern Region continue to increase.

For example, it was 655 today and only 628 yesterday. However, as the number of new admissions starts to track down, we will see the total number of people in hospital in the Northern Region decline as well. Importantly, the number of people in intensive care because of COVID-19 remains well within the modelled scenarios, at very low rates.

Finally, I spoke to this last Thursday, but I did want to provide this graph. It shows how quickly during February the Omicron variant took over as the main variant overshadowing Delta.

Furthermore, you can see the BA.2 variant now makes up between around 75% and 80% of the cases that are having a PCR test and whole genome sequencing. Most of these will be people in hospital. For example the latest report from 10 March, there were 47 hospitalised people who had whole genome sequencing done in the preceding few days and of those, 25 had Omicron BA.2,, sorry, BA.1 and 22 were the BA.2.

So that's an interesting shift. Reflecting on my earlier comment about why the peak may have gone higher in Auckland and elsewhere possibly in the country higher than the high transmission scenario, it could be a reflection of the fact that we could have a predominance of the BA.2 sub variant. And you will have seen a globally the evidence emerging that this sub variant - some people think it is a separate variant that I will leave it to the scientists to debate that - but it is about 30% more transmissible than the BA.1 sub variant.

This may well help us, act in our favour, in fact, if the majority of cases through our outbreak are BA.2. Because what we are seeing in NSW and the UK - and I have just read an update from Scotland, in particular, that it has about 85% of their current cases are the BA.2 variant - you can see even those jurisdictions that had an initial quite big Omicron outbreak are getting a second one that seems to be associated with the BA.2 sub variant.

There is a possibility we will miss that second big peak again that other countries are seeing. But in Scotland at the moment, they have the highest case rate that they have seen in nearly 2 years. They have got about 1800 people in hospital there at the moment. Compared with the 960 we have got. And this is their second wave of Omicron. Anyway, I thought that would be of interest to you. I will leave it up there.

Finally, some data that I think emphasises the importance of boosters especially for Omicron as epidemiologist and colleague Professor Rod Jackson pointed out yesterday. The most important thing anyone can do is make sure they are vaxxed to the max. That means getting a booster if you are 18+. We talked about being fully vaccinated was two doses and the booster on top of that. Really what we should be talking about is being up-to- date with vaccinations. It is quite clear for Omicron, being up-to-date means having three doses period.

At the moment 73% or thereabouts are boosted, but that means there are nearly 950,000 people who are eligible and have not had their booster.

Please do that. It is incredibly important. We know that after two doses of the vaccine effectiveness against getting Omicron and/or being hospitalised does Wayne -- wane.

 I want to give some figures from a report from the Northern Region from 8 March that showed just 16% of people admitted to hospital specifically for COVID in the preceding two weeks had had their booster shot more than two weeks before being admitted. Fully 84% of those people were not fully boosted. That is 84% of the people admitted for COVID.

So even though only a small proportion of our population now has not had two vaccinations, it's really, really clear that a booster protects people from being hospitalised. And we know it also protects people, helps protect people, from dying from Omicron. And in that same period of time in the two weeks prior to 8 March in the Northern Region, just one person admitted to the ICU had had their booster at least two weeks prior to admission.

So we now very clearly understand, this emphasises, what we knew. You need three doses of the vaccine to gain protection against Omicron. That third dose could be life saving for you or a whanau member or friend. So please, if you haven't already, go and get boosted today.

I would like to now hand over to Dr Town.

>> Tena koutou katoa. Thank you.

Today I would like to talk with you about Long COVID, how you can get help and how the New Zealand health sector is working together here in New Zealand and with our international counterparts to develop guidelines for management.

The good news of course is that most people who develop COVID recover completely. However, there are a number of folk that continue to develop symptoms or to experience symptoms which go on for a number of weeks.

Once it gets to about 12 weeks, then this term 'Long COVID' starts to be used. There are a whole range of symptoms that the syndrome can include, including particularly low energy and fatigue, shortness of breath and coughing, which reflects the impact of COVID on the lungs themselves, headaches, low mood, and difficulty concentrating, or cognitive impairment often described as brain fog or something akin to that.

There may be ongoing chest pains, a racing pulse, joint pains, aches and pains, and even muscle weakness may continue. Ongoing changes to the senses of taste or smell and poor quality of sleep. And if you believe you may be suffering from any of these symptoms, the key thing to do is to chat to your doctor or your healthcare professional. We are also providing advice about Long COVID, what you may be experiencing, and practical tips on how to recover safely on the Ministry's website. There is a lot of research going on internationally about Long COVID.

Some of you may have seen a recent study which showed some impacts on the brain itself. Indeed, an MRI study showed before and after COVID there may be some shrinkage of particular areas of the brain. This yielded some fascinating images, that it probably raised as many questions as it did answers about what the causes of these changes may be. Is it something to do with the immune response, or does the virus somehow directly affect the brain itself?

 Researchers were able to show that there were changes in the brain area that is responsible for the processing of smell, so that goes along with our knowledge of the impact on taste and smell. And also in the area where the brain is involved with memory processing.

Around the world, researchers are continuing to look at ways of understanding these lingering impacts but also practical ways of treating this long-term syndrome which is not to similar in some respects to what we might otherwise call chronic fatigue syndrome.

As we get better advice from overseas peak bodies and research we are doing here in New Zealand, we will be able to provide more practical advice and a rehab program. We have a great he will chair an expert group to provide health and sub -- help and support full stop one of the things we are interested in is our experience recently, mainly with the Omicron area, and whether or not this is more or less likely to cause long COVID is something of great interest to us full stop in addition to this expert advisory group, the ministry is finding an important study called Impacts of COVID 19, which is being undertaken by colleagues based here in Wellington from Victoria University of Wellington full stop the study aims to understand the experiences in Aotearoa New Zealand of those who have had COVID 19, looking at the short and long-term impacts of contracting the illness, health, well-being, and other factors.

We will look at the experience both within families, and Pacific families, as well as people with disabilities, to give us a broad information about people's experience over time. And we are certain this research, when it is received by the expert advisory group, will be able to help us plan better for future management of those with this condition.

We have sent out about 8000 invitations from the Ministry of health I letter or text to people that have been diagnosed with COVID here in New Zealand, and we would love people to take part in the study. Very specific invitation is to call the 0800 (08) 0080 0581 to talk to the researchers about possibility of participating, it will be incredibly helpful. We do know in recovery from infections such as this, it's important to take it easy, to rest, and undertake the advice that is provided to you by your health practitioner.

Overseas we are starting to learn about how common this is in the post COVID environment, and international statistics to provide some clues. Estimates from the United Kingdom showed that about one in 5 people who tested positive for COVID-19 have continued to experience a range of some of the symptoms that are mentioned for more than 5 weeks after their initial diagnosis. And about one in 10, 10% of people who experience COVID, continue to have symptoms up to 12 weeks after the initial diagnosis. This is very similar to data we have seen from the United States, from the National Institutes of Health, where they found that 10% of people continue to complain of some of the symptoms for up to 3 months after contracting COVID 19th stop -- . This can include -- occur in people with relative COVID symptoms in the acute phase as well as those with more severe symptoms and have been admitted to hospital.

A study which followed up 110 patients who had been hospitalised in the UK found that around three quarters of these continued to experience symptoms at 12 weeks. The most common symptoms experienced and reported in the sample was breathlessness and fatigue. So well for many people the Omicron variant illness we are experiencing here in New Zealand at the moment may be relatively mild, some of these will have ongoing symptoms, some of these people.

Our plan is to provide evidence-based guidelines for our health practitioners, within NGOs, primary and secondary care, to help guide the recovery of patients with these ongoing problems. It's very important, I know the Director-General has emphasised this previously in his remarks, this is definitely not a disease to be taken trivially. Just getting it for the sake of getting it may have long-term and short-term consequences, so that is not advised and we are continuing to update our health measures to prevent the spread of COVID 19.

Thank you, back to you Dr Bloomfield.

>> We are now open for questions, and happy for most of those to be directed to Dr town.

>> When it comes to case numbers in Wellington, are they rising quicker here than in other regions?

>> There is a full on outbreak here in Wellington, and I think the rate of increase is similar to what we may have seen in Auckland, Bay of Plenty and others. The DHB region with the highest case rate per capita at the moment is Tairawhiti.

>> Do you think the peak is happening at the moment or on its way?

>> I think we are still on the way here in Wellington, that will include capital and Coast and Hutt Valley, and it will be done to people and what they do in terms of staying home and not spreading it to others, and of course using masks and physical distancing, to ensure we can turn that peak around as quickly as possible.

>> Do you have concerns about how that increase in cases is impacting the DHBs?

>> I think the DHBs have good plans in place, hospitalisation numbers are well within what they had anticipated, and putting plans into place. We are seeing in Wellington and around the country, when DHBs have got high case numbers in hospital, they do need to scale back other services, particularly plan care, for a period. But they are not doing that until they have to.

>> There are a lot of people in the community with COVID symptoms but they are testing negative on RATs. I you concerned about the accuracy of daily case numbers?

>> We are seeing the limitations of rapid antigen tests, and we have known that from the start. Using them at the point in time now where there is what we might call a high pretest probability, people are symptomatic, we know there is a lot of COVID out there, we are seeing people and households with other cases, they are returning not just one but sometimes several negative tests, and then a positive test, or some symptomatic but never return a positive test, probably work COVID positive. This emphasises rapid antigen tests are wonderful, but if people are some dramatic, if they are exposed, or a household contact and have symptoms, they should assume they do have COVID, that is one thing. The 2nd question is around what proportion of cases we are capturing. To emphasise, I have been really impressed with and fortunately surprised with the number of people we are seeing who are reporting both positive and negative results. From tomorrow we will be reporting the positivity rates for rapid antigen tests by District Health Boards. There is variation, and that will help us build a picture of what the total community burden might be in different regions around the country. But actually, I think we have quite a good picture of the number of actual cases out in the community.

>> With a gene sequencing, are we still doing it now that rapid antigen tests are the main way to go?

>> We are, we can only do gene sequencing on a PCR-based sample, from a Asia frame Jill saw. There are thousands being done each day, usually for people hospitalised, or where someone has had a rapid engine test and a PCR might be helpful. For example, in terms of determining what treatment they might require. We are still doing quite a reasonable sample of whole genome sequencing but just on PCR test.

>> 950,000 illogical people who have not been boosted yet. Do you have -- eligible. You have a breakdown of age- group, if they inevitably get COVID, what (inaudible) different regions?

>> I don't have that you have. I would say we know what our vaccination rates are by District Health Boards and booster rates, and happy to provide a follow-up table that shows what the booster rates are by region. And by ethnicity, so we can do that. For anyone who might want that. I will go over the side.

>> A follow-up, the types of COVID, from PCR testing done in hospital, those are as alarmingly BA.2. Is it possible we are seeing more severe cases by virtue of it being done in hospitals, and should be have more of a PCR surveillance program?

>> To reiterate, there is still PCR testing done out in the community, and whole genome sequencing, particularly where it is good material for determining outbreak control and slash or treatment. There is a mix of both. Ian may be able to comment, but from what I have seen, the BA.2 subarea has -- sub variant has a transmission advantage but there is no evidence around being more or less severe. This material is no delta gene sequence since mid February, and we know delta produces more serious illness than the Omicron area, but -- variant. There are still delta cases out there but it has been almost entirely superseded by Omicron, and that has (inaudible) to the BA.2 sub variant quickly in New Zealand.

>> How many ventilators do we have in our hospitals, and how many patients (inaudible) be able to take care of?

>> The first thing I would say, at the moment we have 22 people in intensive care, and as of midnight last night, almost exactly 300 intensive care and high dependency unit beds around the country. And about 60% of those are occupied. We have less than 10% of our total ICU and HD you beds occupied by COVID positive people at the moment. I don't know if any of them a ventilator, but I think, I actually look at the exact figure here, but on a daily basis generally between 10 and 20% of our ventilators are in use, so we have plenty of ventilator capacity around the country.

>> (inaudible)

>> Let me find that for you. I do have a table of that right here. So yes, the number of ventilators that are currently in service, available for use, is 425. And of those, 68 Arrhenius, that is a 16%. -- are in use.

>> How does Omicron differ in terms of other variants (inaudible) will require a ventilator that someone with delta or alpha would have done?

>> I think that is clear. We have 960 people in hospital, just 22 in ICU, and that is similar to what has been seen, I mentioned Scotland earlier on, they have about 1800 people in hospital, around Scotland at the moment, just 27 in intensive care. Very clear this emphasises that Omicron tends to be a less severe illness. I want to caveat that by a comment by the Chief Medical Officer in Scotland, almost certainly due to the effect of vaccination, boosters and treatment, and hospitals over the past 2 years have worked very hard on ensuring they are providing good and timely treatment for people hospitalised, so it is early and pre-emptive treatment.

>> All of us by now know someone who has had Omicron despite having used a shop and some of them, (inaudible) what is your message to people who hear about those cases and say "What is the point of getting boosted if I will get sick anyway?"

>> I would like to point to the figures I quoted, just 16% of people admitted to Auckland hospitals over a two-week period, several hundred less fully boosted, at least 2 weeks since their booster. Is about risk reduction, and we know just as seat belts greatly read -- reduce the rate of people being seriously injured or dying in a crash, vaccination greatly reduces the risk of getting serious and well or dying from being affected -- infected with COVID 19th

>> (inaudible) a booster, didn't make it seem unnecessary?

>> I don't think it was a mistake, that is what everyone globally was referring to it as, including the manufacturer. But of course, the outbreak is unfolding as we go, and some people may have seen Pfizer just, the Chief Executive, I'm sure for good reasons, announcing a couple of days ago that their sense is 1/4 dose may be unnecessary or ongoing shot required. We have been talking for several weeks about shifting the language from 30 dose being a booster to talking about being up-to-date with vaccinations, is clear 3 is enough now. It may well be that for is what is required, especially for people at high risk. I have asked Dr Town and the group to look at this issue over the next week, to see if there are some risks (inaudible) warrant a further dose for them to be up-to-date with vaccinations.

>> Are you planning to do anything specific to either increased doses of the general population or do you have plans in place to increase, for the 4th dose with the special group? Specifically looking at increasing the number of uptake is of the booster.

>> We continued to push for people to make sure they are up-to-date with that third dose. Including the range of initiatives we had to get that very high rate of vaccinations with the first and second doses, 97% and 95% respectively. We are going to keep pushing. We want this as high as possible. It's clear there is a big difference between 73% of people having three doses and where we want to be which is again in the mid-'90s. Not only does it protect those individuals, but you get that cumulative population immunity effect as well once you get up to those high levels. We are going to continue pushing it but I am again repeating my message to people - if you haven't had your third dose, please get it. It is never too late. One other comment I would make, I know there is quite a lot of interest in a specific issue I have been asked about over the last few days. How long should people wait if they have had COVID, how long should they wait for their booster shot if they haven't had it? That advice would be three months, is what we're saying. We have also just recently updated the period where someone doesn't need to isolate if they are a household contact or a contact if they have had COVID is now a three-month period. It used to be one month but we updated that to 3 months. Easy to remember. Three months after your infection for the booster if you haven't had it, and three months - unless you are symptomatically course - three months where you are not required to isolate as a household contact.

>> What would you, it's a bit slower with the booster rollout, what is the difference, was that a comms issue?

>> If you look at where we are now, in the mid-'70s, we started the boosters in early December. It is probably similar to what we saw. We saw high early uptake, and then it takes longer to get through that last part of the population. What I can say, one of the things I think is working very much in our favour, our DHBs have worked really hard to ensure that everyone in aged residential care had their booster before the end of January. And also a really strong focus on our older people to get them boosted, and people with pre- existing conditions. The largest group who haven't yet had that third dose is younger people. Again, just encouraging them. Some, because it may well be they didn't get the second dose until late in the year, but just encourage them that it is never too late. Go and get it.

>> Long COVID in children, COVID spreading through kindergartens, are there any specific concerns for Long COVID in children and the possible that now we have four- year-olds with chronic fatigue symptoms?

>> Yes, that's a really good question. I think there is some data emerging but it is very early days. Children obviously tend to have a milder illness. We would hope that would mean they are less likely to develop Long COVID. Some of the research projects that are underway internationally will help us with that. Obviously we are focusing on creating a safe environment in all of our schools and ECEs, and of course our 5 to 11-year- olds are also eligible for vaccination here in New Zealand which is another protection.

>> With Long COVID, you talked about practical ways of treating it. And if someone has symptoms of Long COVID, go to your doctor. And on the Ministry of Health website there will be some information - what is that information and advice?

>> It's similar to what we would do with chronic fatigue syndrome. So it's a question of recognising and accepting that these symptoms are real. There is a conversation with a health professional. There is no suggestion that these are psychological symptoms. These are a very real experience for these individuals. The key thing is to pace yourself and have a slower recovery. Not drying to rush back to work. Accept -- not trying to rush back to work, excepting you may need more rest. Especially if you have a racing pulse, or something like that, or aches and pains. It's more a rehabilitation framework and that's why we're really pleased Martin Chadwick is leading this, and he is our Chief Allied health officer because he is working in a multidisciplinary framework. The advisory group I mentioned in my remarks will be setting the tone for that and providing a framework for people to adopt.

>> Is that not more preventative? If you have COVID symptoms, to take it easy. But for people already suffering Long COVID, is there no treatment?

>> There is no specific treatment. As you are probably aware, similar to chronic fatigue syndrome, this is thought to be part of a post-viral immune response which goes on triggering the body and generating these symptoms, so it is very much a framework of rehabilitation and pacing yourself and not overdoing it. As you say, that is exactly the same during the illness itself. We want people to rest and take the time to recover after the acute phase. We don't know what impact that may have on the occurrence of Long COVID at this time. Do we know anything about the difference with Long COVID in Omicron variant is Delta?

>> No. I mentioned in my remarks, that might be something we can study in New Zealand in our follow-up study so that is of great interest. It is an important question.

>> (INAUDIBLE) earlier in the pandemic there were reports from overseas (INAUDIBLE), did you receive any reports in New Zealand from GPs?

>> I would be very surprised if that was the case because our GPs take a very holistic view of their patient's well-being. There is no suggestion this is a psychological or malingering event. We want people to feel confident about talking with their doctor, and perhaps an individualised program to return to work and get back to normal activities over weeks and sometimes months.

>> What support might be available for people with Long COVID in New Zealand, Dr Jeffries reported at this stage there is very little. We are getting reports that patients are getting left uncared for. That is pretty bad, so at what point do you think that will change?

>> The study that Dr Jeffries is doing, the study I mentioned, will help inform that. And the expert advisory group will be developing guidelines which we will distribute to all NGOs and primary care providers and doctors in New Zealand.

>> (INAUDIBLE)

>> I'm not sure. We would have to talk with Dr Chadwick and update you on that but I will be sitting on that group so we will try to proceed at pace. There are also a large number of self-help groups that have been developed, as you know, on social media, providing practical advice and support. Sometimes it is just someone to listen, rather than anything specific. There is no magic bullet in terms of recovery.

>> Dr Town, with the numbers you describe, say one in 10, that is a huge number of people that will have some form of Long COVID. Is there an analogy or somewhere you can compare it to a different type of illness that is normal and well-known so we can get a sense of what you are talking about because that is tens of thousands of people.

>> The NHS will probably have early data on this because they of course started their experience of the COVID pandemic before us. It is potentially a huge burden but the natural history of this is for a slow and steady recovery, and that is exactly what we are seeing with perhaps a slow recovery after a severe episode.

>> Dr Bloomfield, I have a question about QR codes. QR codes have dropped to the lowest point in six months, what is the value with still encouraging people to scan in?

>> First of all, there are circumstances where we may want to contact tradespeople and follow them up. -- trace people. So I think there is still merit in people scanning in. And as we come down off the peak of the Omicron outbreak we may find we want to and we are able to use our contact tracing system more widely again. And quite clearly, QR codes are helpful in that regard. So I think about it a bit like mask use. Once you are in the habit, just keep doing it. Remember it provides that record back for 14 days and you never know quite when it is you might need to know about. So I would encourage people. Businesses are still displaying them so I encourage people to keep doing it.

>> Will it become more important again after the Omicron peak is over when contact tracing isn't so overburdened with cases?

>> It could be. We are still thinking what the role of our contact tracing capacity could be as we come down from the peak. If we project forward a few weeks, there will be a baseline level of COVID cases in the community. If we look at, say, the United States, Australia, the UK or Denmark, it may be that we are seeing anywhere between 3000 and 5000 cases per day in New Zealand for some weeks or months. In that context it may be worthwhile in certain settings for us to be contact tracing, so we would want to make sure we were able to use our QR code system. The other thing, again I am quite taken with the Scottish Chief Medical Officer, but some really apposite comments from him yesterday. I should say, I should give you his name, Professor Sir Greg or Smith -- Grego Smith. "The one thing I have learned about this virus is not to become blase about it. It will continue to evolve. It is still at an unstable stage in its development. Until we have global stability of this virus, we can't say we will have domestic stability." Again, one of the other reasons we might want to really engage our contact tracing system in future is if there is another variant where it is very important we apply quite rigorous public health approaches to get on top of it quickly.

>> Have you read the letter from the five Super Rugby CEOs relating to increasing crowd capacity and will you consider allowing Super Rugby teams to increase their crowd capacity?

>> I don't know if I have seen a recent letter from the five Super Rugby CEOs. I had one from a range of sporting codes a few weeks ago and responded quickly to that through Sport NZ. We have been supporting bigger crowds for the Women's Cricket World Cup which is on at the moment. And of course we will be looking very quickly at the opportunities to look at bigger crowds for the Super Rugby and other outdoor sporting events, again based on the information that we know that outdoors is a much lower risk setting than indoors.

>> (INAUDIBLE)

>> We have been specifically asked earlier on about the Women's Cricket World Cup matches. Particularly the opportunity to increase the crowd sizes from being pods of 100 to being 10% of the overall capacity of the stadium. And I recall for the game at Basin Reserve on the weekend was 20% of capacity. The Women's Cricket World Cup is a significant sporting event as well. But there are other sporting codes, including the rugby, which I'm sure we want to do the same. We just have a few more minutes for questions.

>> On RAT tests, experts have been citing studies indicating that people should be swabbing the back of the throat as well as their nose to pick up Omicron, do you have any advice on that?

>> There is interest in and speculation on this. No harm in doing the throat, but do the throat first and then the nose. That's what I understand is the best way to do it. The important thing is when you swab in the nose, it is not up, it is back. You have got to go in a little way so it is a bit uncomfortable. If it is uncomfortable, that's not a bad thing and give it a good twirl around. That certainly helps with the accuracy of the result of the test.

>> I understand the Prime Minister is going to make an announcement tomorrow about border reopenings, possibly bringing it forward, some of those dates. What advice have you given the government about whether or not to bring those forward?

>> Far be it from me to do anything that might steal the Prime Minister's thunder on that. And she will reflect not only on our advice but from other agencies.

>> Did you advise her not to bring it forward?

>> You can ask but I am not answering.

>> You have about 2 million on hand right now, the program has slowed down significantly. Are we looking at a point where some expiry dates may be coming soon?

>> Not at the moment. The Pfizer vaccine we have got still has a long period before it expires. That includes both paediatric and adult doses so it is not an issue for us at the moment.

>> A man died in Pekapeka, up the Kapiti Coast, and they were apparently connected to the Parliament protests, can you tell us anything about that?

>> I have no information on the case. Because it was in a neck speed case, it will be with the -- unexpected case, it will be with the coroner to investigate. Thank you for coming. Live Captioning by Ai-Media ai-media.tv