COVID-19 update 30 August 4pm

>> Good afternoon everyone.

Cabinet met this afternoon to discuss our alert level settings before I move on to those decisions, I thought it would be helpful for Dr Bloomfield to give a quick update on today's cases and a bit more detail and reflection on yesterday's. In case everyone missed the press statement earlier today. Thanks Dr Bloomfield.

>> So as you will know, there are 53 new cases of COVID-19 in the community today. They are all in Auckland.

While that is 30 fewer cases than yesterday and the lowest number of cases in five days, it is just one data point. However, it is an encouraging sign and there are. Of note, 52% of new cases reported yesterday, that is the 83 cases from yesterday, are household contacts of an existing case indicating an confirming the high rates of household transmission as we expect with the Delta variant.

 An of yesterday's 83 cases, 72% did not create any new exposure events implying that they have been isolating since lockdown started and thus reducing the potential for new chains of transmission.

So of those cases reported yesterday, on the converse only 28% are considered to have been infectious in the community which may simply have been a visit to a supermarket as is allowed under alert level four, or a health care provider, or they may be an essential worker.

We actually have a total of 101 essential workers now amongst our cases. However, many of those are from early on in the outbreak and we have just four essential workers who have been infectious in their work place and seven essential workers who have been infected in the work place.

Furthermore, based on the modelling, the R value of the virus, the R effective value in this outbreak, now looks like it is under one. We need to keep that coming down.

But it's good when it is under one as this means cases will continue to decline. The lower that R value gets, the more rapidly the case numbers will decline.

So these are all encouraging signs that our lockdown is working as intended. Breaking chains of transmission and gradually drawing the net around the outbreak. Also visual to us are the harms that we can see from COVID-19 in this outbreak.

We have 37 people in hospital, including five in intensive care and three of those are ventilated.

Yesterday there were 16,370 tests processed and our seven day rolling average is 34,620. This high rate of testing is giving us increasing confidence that we are finding any cases of COVID-19 out there. We need to keep doing so

so if you have been at a location of interest, or you have any symptoms of any respiratory symptoms or symptoms that could be COVID-19, wherever you are in the country, please do get a test.

 Hank you prime minister.

>> Thank you Dr Bloomfield.

Looking at our overall cases today, I know we all feel encouraged that our number is lower than what we've seen in the last few days. And I know that we are all willing for that trend to remain. But while it would be too premature to say we have a trend yet, what we can say is level four is making a difference. We are seeing a decrease in cases outside of house holds. A decreasing number of locations of interest. And the reproduction rate reducing. Ow, all of that helps but the job is not yet done. And we do need to keep going.

On Friday, cabinet agreed to move all regions south of the Auckland boundary to alert level three at 11:59 p.m. Tomorrow, Tuesday, August 31.

That was on the condition that all the evidence that might emerge in the following days continued to be positive. Here is nothing to suggest we need to change that plan. So cabinet today has confirmed that alert level change will take place.

Like last time, business owners and operators are now able to access their premise in order to prepare for contactless opening, including to meet the public health requirements. Ust to confirm why we are comfortable with that alert level shift from Tuesday midnight.

Waste water test anything Christchurch has not shown up any further positive results meaning the positive results last week, we believe, can be most likely attributed to cases in managed isolation facilities in the city. Additional testing across the country has only thrown up one additional positive case in Wellington. A household contact of an existing case who was already in isolation and not in the community.

Level three for the country's south of Auckland will remain in place for a week. And we will review these settings at cabinet on 6 September.

Our hope will, of course, be that we can keep lowering restrictions when it is safe to do so. So just to repeat. For the rest of the country, south of the Auckland border, it will be level three for a week with a review at cabinet next week.

His afternoon cabinet also assessed how long Northam will need to remain in level four. A decision here has been a cautious one. And that is because, unfortunately, the cases and work sites in and around emerged late in the lockdown.

 Now, that was not the case for Wellington for instance. We have had well over a week to monitor contacts and cases and ensure we didn't have spread. We just haven't had that level of time for the cases we are concerned about in Walkworth and with possible contacts beyond. Once we have that same level of reassurance for Northland, we feel confident to move alert levels.

Now, additional waste water testing at over 20 sites in Northland are due on Thursday. An addition further testing from contacts across Northland and we had our number of contacts across Auckland who have been at locations of interest, and some that relate to some more recent work sites, some of those further tests will be available in that time frame as well. F these are all clear, the director general and cabinet has agreed to lower Northland to alert level three at 11:59 p.m. This Thursday.

So again, just an indication of our intention here if all of those tests come back clear. Know many in the north will be interested in what this means for transport corridors at that point. A reminder that at level three there is still no interregional travel. The only movements into a, for instance, level four environment such as Auckland would be for essential work that is already occurring now and for that to occur, you will need a travel exemption. If it is for a wider issue, you will need an exemption in order to pass through that border. So very little movement is expected until a level three environment.

That then brings me to Auckland. We indicated on Friday what we believed was the most likely scenario for Auckland. Based on the size of the current outbreak, based on the number of daily cases, we are seeing and based on the need to see a sustained reduction in cases before moving alert levels, Auckland will remain at alert four for another two weeks.

Cabinet will meet again on Monday, 13 September to look at our next steps for Auckland. Ow, to move Auckland down a level, which is our absolute goal, we need to be confident we don't have Delta circulating undetected in the community. And we need to be confident that any cases we may have are contained and isolated. As we saw from this outbreak, it only took a week for one case to spread across the city. And that is why we are working so hard to get this right. I know everyone in Auckland knows we are just not there yet.

We are making progress though. And that is one message I want to leave today. The sacrifice everyone is making is incredibly important and it is making a difference.

Yesterday I received this graph. The red line shows what would have happened if we hadn't moved hard and fast into level four. Ow, it is a little difficult for you to see perhaps the numbers on the side. But it tells us that daily case numbers are literally off the charts. That without level four some modellers estimate that the number of new cases today could have been around 550. The lines underneath tell us the different paths we could still follow. The moment we are tracking roughly in about the middle of those options. Where we finally will land and when we will land there is not yet clear. But that doesn't mean we are powerless. The more we do to limit our contact, the faster we accept these restrictions. And more importantly, still the more lives we save.

Ou will have heard today Dr Bloomfield messenger the number of people in hospital. It is the number that each day is reported to me reminds me of how serious this illness is. The same way I'm reminded when I read the figures out of the United States with the daily average hospitalisations for COVID-19 are more than 100,000 people. Similar to where they were in their last winter peak. We may not see it in our headlines as often, but the world over countries and their people continue to battle this vicious virus.

And now we have hundreds of people battling this virus in our country as we speak. Our job is to limit how many people have to face that as much as we can.

My final message is really for all of those outside of Auckland. Please remember that level three does not mean freedom. It means caution. It means staying in your bubble. It means distance. It means contactless transactions. And I will spend a bit more time going over that tomorrow.

But while you're here, and while you're moving preparing to move into level three, Auckland is doing a huge service for all of us. And not just now. But throughout this pandemic. It’s Auckland that has maintained our gateway to the world. That has done a lot of heavy lifting in welcoming Kiwis home safely, that have worked hard to keep the rest of New Zealand safe when there has been an outbreak. Auckland has done it tough and they have done it tough for all of us. I know we are all grateful and that we are, as a team of 5 million, willing for their hard work to pay off.

Before I conclude today, a quick word on vaccines and then I will conclude. Another big day yesterday. Especially for a Sunday. That has, of course, raised questions on how our supply is looking. We currently have roughly 840,000 doses of the Pfizer vaccine in the country. And we will continue receiving weekly deliveries from Pfizer. You will recall in recent times we have been receiving more than 300,000 in each of these deliveries. Our planning has been for the program to administer 350,000 doses per week. We have the supply and infrastructure to do this sustainably over a long period of time. There has been a surge in demand. Our vaccination program has risen to the challenge. We're doing much bigger numbers. Last week we administered well over 500,000 doses. We are working on a strategy to meet that demand with more vaccine in the country

If we are unable to do this, then the worst-case scenarios that we pull back to our planned volumes which as I said would still mean 350,000 doses being delivered a week. Contrary to the reporting we are not running out of vaccine but we are seeking to meet the high demands that we have right now because, of course, we want as many people vaccinated as possible. Will happily give you an update on our work to meet that demand in the next couple of days.

Happy to take questions.

>> Have we peaked?  

>> In terms of?

>> In terms of the case numbers, we have gone to 53 today, do you feel that that was our peak yesterday?

>> I think it is too soon to say. Of course we want to see those numbers come down and with that sustained effort at level four, there is no question it is making a difference. Some modelling suggests without that level four, with those restrictions and without everyone's efforts, we could have been at 550 cases today alone. So it is making a difference. Whether or not we have now plateaued and moving down, we do need a bit more time I think to feel reassured of that.

>> What is your message around the woman who died following the Pfizer vaccine? What do you think is important to point out to people with that?

>> Two or three key things. The first is this is a known very rare side effect with the Pfizer vaccines and we had an alert around this  

>> And they this recently been vaccinated and they should look into that. That is part of the reason we have been very open about this case and also it's of great interest internationally as well because it is one of the few cases where we have got the full range of evidence around the side effects and then able to explain this death. I do want to of course give my condolences to the family that have been fabulous in supporting us to investigate this case an get this information out so that it can be useful for the wider public.  

>> And clinicians especially. They were focussed on.

>> Yesterday you indicated there could be further level four restrictions. What further restrictions are you considering and when? And Dr Bloomfield, how concerned are you by transmission among essential workers?

>> What we indicated is that we are looking in those cases where we have for instance seen a small number of instances with transmission between workers at work sites. We are talking, though, roughly four. So very small. But what we want to do is see whether or not there is anything that could be done and the guidance we give particularly to employers who are operating in level four on how they can do that safely and prevent that from occurring. Now, already they use PPE, they use social distancing, they are cautious because it is a privilege to be open at level four. But we are seeing if there is more that we could add in that guidance and, of course, continuing to check whether or not those work places that are open indeed should be. To date I haven't seen examples that of places where we've had COVID appear or workers with COVID that are in work places that shouldn't be operating. They are predominantly been in food services or distribution where we as a country really are reliant on them continuing. But let's see if we can do more to keep people safe while they are there.

>> Am I concerned? I'm concerned in that we want to see no essential workers getting infected in the first place and potentially being infectious out there. So one of the things we're turning our efforts to over this next two or three days is to have a really deep dive on each of those cases to see exactly what happened there. And that will support any further advice and we've been asked for that, any further advice to employers who have essential workers out there just to see if there is anything we can do to strengthen the measures in place and reduce any residual risk there be.

>> It is not just the work practices when someone is, for instance, on the effected floor or out in the work place itself, but what kind of practices people are engaging with even in the way into their work place or in a cafeteria or while they are dining and taking off their PPE. So right down to that level of detail because that's what Delta requires us to do.

>> Drop back to 350,000 vaccines a week, how...

>> You see my point was that our worse case scenario is defaulting to our plan, yep.

>> How much time can we keep going at the current rates before we have to start...  

>> We will need to take those decisions this week. But we have not changed any messaging at this stage to DHB. But we will look to make some decisions on what we need to do going forward over the course of this week. So at this stage we are doing that so that, of course, we can make sure that we have decent amount of heads up for those if we do. But, of course, our goal will be to actually minimise any disruption as well. So maintain bookings, keep that high flow coming through, basically run to the plan that we previously had before we added in some of those extra surge sites across the country but we also want to keep those numbers rolling in Auckland in particular. So those are some of the things we have in mind.

>> How concerned are you about vaccine hesitancy in light of today's news of a potential vaccine related death?

>> Is that for me or to Dr Bloomfield? Dr Bloomfield obviously can give the clinicians view.

>> Look, I'm not so worried about - well, I recognise that it will be a worry for some people. I do want to reassure people that there is very clear evidence that the vaccine is a lot safer than being infected with COVID- 19. This is a very rare side effect. It is one that we were alert to already and we have now put out good information to health professionals to make sure that they are alert for that. We collect very good information on any adverse effects and we are not seeing anything out of the ordinary with this vaccine compared with what the experiences in other countries. So I can reassure people that the safety profile of this Pfizer vaccine is very, very good.

>> The most common cause of it is a viral infection, so I remember even just would have been maybe a month or so ago, reading an article about the number of children and young people in hospitals in India with myocarditis because they had COVID- 19. So we are still safely offering this vaccine to protect people from that very thing. Covered and therefore the effects of COVID.

>> What is your response to reports that specific families in the Bay of Plenty are being forced to present passports.

>> I understand Dr Bloomfield has particular detail in that particular scenario he might wish to share.

>> No-one is required to show a passport or any other form of identification to be vaccinated. However, if someone doesn't have an NHI number, the process of giving someone - allocating someone an NHI number can be expedited by someone having identification. And my understanding in this case this is what was being sought. It was certainly no intention in my understanding to single out any particular group. But I just do want to reiterate no- one is required to show a passport or any other form of identification and every person in New Zealand is eligible to be vaccinated. Whatever their immigration status. I think you've seen the DHB apologise very clearly that the incident happened and for any concern or concern that may have been caused there.

>> It was a logistical hiccup, was it?

>> It was. I think everybody in the program is very acare and will be reminding them that no-one is required to show identification or passport or anything else before they are vaccinated. So this was just an attempt to try and I think smooth or expedite an administrative process rather than anything to do with eligibility.

>> The only thing you need to be eligible for a COVID vaccine in New Zealand is to just physically be in New Zealand. That is it. You don't need to present any identification. You don't even need to present any documents to show whether or not you're in New Zealand legally or not. We are not interested. We just want you to be vaccinated. So being physically here is enough. Nothing more.

>> No ID or anything?

>> No. As Dr Bloomfield has said, if you don't have an NHI number, we want to know that we are giving you your second dose and we are logging everything and so health professionals will go through a bit of a process to try to do that. But there are ways we can do that without any ID.

>> Are you aware of it happening before?

>> No, no. As I understand this has been because we've got a specific group of individuals in that region that we are vaccinating at the moment who are not in New Zealand long-term. I will let you finish that question.  

>> On Northland, why have they been included again? There will be a lot of people in Northland saying we're not part of Auckland, it's really annoying we have to be cut off, why do they have to wait until Thursday?

>> We have some sites in Warkworth that we have been concerned that if we have cases that emerge from some of those larger work sites, which we have a small group of workers who do live outside of that area, and what we might define as Northland, if we have any outbreak from that work site, we are concerned if we move too quickly then we will see the effects of that potentially in the northland region. So that's the reason. It's got nothing to do with anyone from Auckland's movements. It's really about what we discovered in Warkworth. Had we not discovered that, we would have been moving to alert level three with everyone else. The other important note is with waste water testing, some of the remaining testing coming through, that will give us extra confidence as well, but given it is - we are actually people are transiting through those areas and may have had contact with those cases, potentially, we just wanted to be really conscious.

>> Are you satisfied with the level of testing in the community at the moment? Is that why the case numbers have come down?

>> There were times of course where 10,000 we would think was a fairly solid number. Sunday has always been a bit lower. But I do want to see really solid ongoing testing numbers. And there will be days where we will have a large number of close contacts, and I think actually that has been over the last few days, where they will be coming up to day 12 testing which will lead to those numbers coming up again. But I don't think it is fair to say we've got those numbers because we didn't have enough people necessarily tested. But again, I'm not making any judgment from today's numbers. I will look at tomorrow's. I will look at the next day's and we will see what trend emerges.

>> Can we get an update too on quarantine capacity? There is still dozens of people with COVID-19 still at home.

>> The advice I had this morning was that that backlog is generally been cleared. But, of course, every day when you have a new lot reported, then you will use the course of the day to move people in and we're very careful in the way that we do move people. So my understanding is that that is clear. We have people today moving in to one of the two additional facilities that we've bought on since this outbreak. It is fair to say, though, that we do have tight capacity for quarantine and we are looking at other options to be able to manage that.

>> (Inaudible) is that the plan?  

>> No, not at this stage. My understanding is that everyone is moving into quarantine still.  

>> Just a couple for Dr Bloomfield primarily. Can you describe to us in detail what happens when COVID is discovered in an essential worker work place? And then just also after that, of those 840,000 vaccines in the country, are they sort of dispersed all around like GP clinics and wherever they are going to go or more centralised storage?

>> Bit of both.

>> I will respond to the first question there. The process is the same as it is for any case but there's a very strong focus on anyone who is an essential worker. Those cases are prioritised for follow-up. So if it is in a work place as it would be even if we weren't in alert level four and they were just essential workers, we work with the employer to identify all of the people associated with that work place. Usually they are very good records of who has been in there and, of course, because we're in alert level four, it is generally just employees. Usually the work place, the staff who are potential contacts are stood down. There is an assessment made of what risk there might be. Whether depending on whether the worker was and they will all have been using PPE but who they may have been in contact with. What the circumstances might be. So there's a thorough sort of assessment of the risk at the work place. And it may well be that work place stops producing or doing what it is doing for a period of time. Or in the case of, say, a health care setting an we have had a few of those, staff are stood down so replacement staff are brought in until those staff are cleared to return to work.

>> On vaccines, it is both. So of course as you can imagine we do have distribution across the network particularly with GPs and pharmacies coming on line. They are distributed across our network. But still we also have some that are centrally held as well.

>> (Inaudible) is there any sense whether you might manage to bump that up a bit over the next few weeks?

>> Our goal is to be able to move beyond what we had planned by...  

>> Sorry, the amount that is coming in each week.

>> As I've said we have had over 300,000 has been the weekly deliveries that we've been receiving from Pfizer. What we are working on at the moment is whether or not we can move beyond that.

>> You spoke before about the Auckland were having to bear for us, has there been any thought for prioritising Auckland for the vaccination to allow and taking vaccinations from other regions and funneling them to Auckland now and if not, why not?

>> So there hasn't been a need to take from any one at this stage. We've been essentially just meeting the demand and as you can imagine there's been good demand in Auckland but also elsewhere. And we've been able to meet that and we've been wanting to meet that. What we are working on now is whether or not we can continue that approach. What we're asking, though, our health officials to do is as we do a better planning for if we are unable to secure additional supply for those surges, how can we do two things. Maintain people's bookings but also maintain the surge in Auckland because you can see why it should continue to be a priority. So we haven't - it's all still a bit hypothetical at this stage. No decisions need to be made today. Working on those this week. But those are some of the things we want to keep achieving with our rollout.

>> Just following on from vaccinations. What work has been done around both risk homes and situations where immobile people are at home being cared for by in home care and can't get to a vaccination appointment. Have you got mobile vaccinations out and about for things around that?  

>> Yeah, there has been some thought and invasion in this space. So for rest homes we have been going into facilities in order to provide vaccinations. That's been organised through the BHBs. A variety of approaches -- DHBs. A variety of approaches for those with disabilities in some cases where there has been residential care, we have been trying to pry it in the most convenient way possible. And in other cases we've seen some vaccination centres even working to try to provide a space as low and stimulus and appropriate for those, for instance, with autism. So some real thought going into how we can meet the needs of a range of communities. In terms of some of the more specifics, Dr Bloomfield, you might have some more on the idea of at home visits where it is a smaller number but for residential care, yes, we have been visiting.

>> Yes, so all the DHBs have got a range of options, including if people are - essentially, not able to get out of their house or their place that they live. Then they can get a mobile vaccinator there to get them.  

>> (Inaudible) point of the contact, should they be trying to do this because I would have thought people in rest homes should have been vaccinated.

>> Yes, offered vaccine, of course, because residents make that decision as to whether or not they take that up. And so you will have heard us talk yesterday or the day before about the up take rate in different parts of the country. It's been high. But then there's a question of what do we do if we've got new residents coming in or residents who may have changed their mind and DHB is doing a mop up there.

>> Contact then for the in home people, should they be contacting them at the rest home and asking them to jump on as part of their service or should they be contacting their DHB?

>> If they use Book My Vaccine, will contact the vaccine health phone number through Healthline, they would be able to provide them with advice on that. But no, the people who are receiving in-home care, home and community support services or who may be in supported living arrangements, separate from age residential care, no, they shouldn't be trying to organise it through the age residential care facilities because most of that was done in fact, we are still DHBs to have all of those residents at least have their first dose before the end of June and so that will now be completed but if they use book my vaccine.

>> I will just finish on Joe's question. I've seen some recent updates on some of the strategy around reaching those across the country with differing needs, where they intensive care residential care or whether or not it's your in-home support or otherwise. So I wouldn't mind if we just go back to our vaccine team and give you an update on how that's being rolled out across different DHBs.

>> In terms of the 350,000, if you have to peel back to that, are you concerned that people who perhaps have only recently got up the courage to get vaccinated because of what happened with Delta and they have seen the ramp up and seen people be confident in it then get to a point that that is way down the track because appointments will become staggered if you drop back to 350,000, are you worried about the message that might send to people that have only got up the courage to do it.

>> That is a hypothetical that I'm not confronting. We are working out the ways that we can meet the fantastic demand that we have.  

>> I heard rest homes who have tried to get mobile vaccinators to come and haven't been able to do that and elderly residents who are having to drive hours.

>> I would be very interested to know where because we, of course, got continual reporting across the DHBs as to what percentage of their residential facilities and their region had been reached, had been vaccinated because you can imagine why it was a very big focus for us right at the beginning of the campaign. And they provided details that basically everyone would be offered the opportunity by - it was around the June, July mark if I can recall. So happy to go back and check a specific facility if they have had issues. I wonder if it is the issue of returning a second or third time perhaps. I'm not sure.

>> When do you expect to be able to open up fresh MIQ spots listed beyond the emergency? Because it is closed (inaudible)

>> Yes, no, it hasn't. So this is - most people actually probably assume that what we do is roll out all of the numbers through to the end of the year and once they are fill, they are fill. That is not the case. As you have indicated, we do continue to release vouchers. We have put a bit of a hold on that for now on releasing some of those new vouchers in the near future because, of course, as you've seen with an outbreak of over 500 people, we are using the facilities for those individuals. That is the right thing to do. New Zealanders wanting to come home want to come home to a country that's free of restrictions and the best way we can do that is by dealing with this outbreak as efficiently as possible. I don't yet have a timeline for when we will be opening those vouchers up again.

>> Now that we know Delta is...

>> Keep in mind the Crown Plaza is also off line at the moment too and that is one of our biggest facilities.

>> Given what we know about Delta, is it possible to go back to that 4,000 per fortnight coming in through MIQ or will we have to reduce the numbers to reduce the risk?

>> What we've done to reduce the risk has been to change up the way we are operating in those facilities. Cohorting for instance as much as possible, bringing people in on similar dates an releasing on similar dates, of course vaccination of our workforce, the testing regime we use, in this point of time we're looking at whether or not there are more things that we should do, more invasions we should try to again just add extra layers of protection so we're getting advice on some of those for MIQ. At the moment, it has not included reducing down the numbers. Because actually it only takes one. And people may have thought for instance at Sydney, at the time that we were putting people into quarantine, they may have considered it low risk. So it's actually about being vigilant regardless of the number you have coming in. What is clear, though, is our ability to expand that number is very limited. We just don't have the workforce to do it.

>> But the Australians did halve their number coming in after their...  

>> They did. But as I say, it takes one case. So for it is actually about the protocols that you have across the system. Having said that, many people before this outbreak were putting pressure on us to extend our facilities and our capacity. The focus we have at the moment is making sure that when we are doing it, we are doing it well with the numbers that we do have.

>> We've been hear from several organisations about a massive increase in the need of food relief during this lockdown. Auckland is facing two weeks of this, for some people that is pretty scary.

>> Facing what?

>> Two more weeks at least. That is quite a scary thought in terms of insecurity. Is the government considering doing anything to help people in those situations or help Foodbank?

>> Immediately we put $2.8 million for food, essential items support for existing providers and then a further $7 million has also now gone in as well for those who work across those food security networks. We estimate that can provide up to 60,000 parcels for those who may need it. Also 10,000 well being packs as well. I would also encourage people to access MSD. They are for these exact moments and have the flexibility to provide additional grants to people to meet any food related needs that they have at this time. Because we absolutely acknowledge that this is our very tough time for everyone and that is why that support is available.

>> Just on yesterday's questions asked about how many people are hospital were vaccinated, we now know...

>> Just the one thing I will caution is that person cover been vaccinated a week ago. You know. Four days ago. Of course the ability for that to have an effect is rather limited with those time frames.

>> So I was going to ask for your reflections on that, what you take from that and also that other key stat to say that 30 of the 34 people in hospital are Pacificer, is that bad luck or is that a failure of public health?

>> That is COVID-19. That is Delta. I mean, the rates of hospitalisation that we're seeing are high. It is undoubtedly hitting our Pacific community very, very hard. Which is why we as a country have taken this approach on COVID-19 and our elimination strategy because we knew that if COVID did manage to get into our communities, it would have that devastating effect. So the job we all have upon us now is to do everything that we can to get rid of it. And that's why we're in this position right now with these level four restrictions is to keep one another safe. While of course we are thinking about, unfortunately, the people who are already affected by it.

>> Judith Collins says the reason she's come to Wellington is because she couldn't get a grant on the epidemic response committee coming back. Why (inaudible)

>> Well, actually, we actually worked really hard on a solution to allow a virtual version of the house with the National Party. Then when that agreement, that option, was presented to the business committee, it was then not agreed to. So the epidemic response committee, you will remember, was created because the house was suspended and parliament couldn't meet and there was no question time for instance. What we've been working to is to reinstate that. What was presented was an option that allowed the opposition to access any minister, it awed them to make statements, to ask questions -- allowed them. Some would say a greater accountability than even a general question time offers. But unfortunately that was rejected by the opposition. So that is where that fell over. My preference would be to opt for a virtual option because it does the same if not more than an in-person version of the debating chamber. Select committees can still meet. So that is still happening. All of the other business of parliament can continue. The only thing we're missing is question time and my view is we could do that safely virtually. It's a shame that the opposition did not agree.

>> (Inaudible) you're allowing it to go ahead (inaudible)

>> That is totally incorrect. My view was I was willing to suspend for a week whilst we tried to find solutions. Unfortunately, the opposition and the party were unwilling to agree and I was unwilling to suspend parliament for a second week. My much bigger preference was that we get consensus. But it's one of those situations where unfortunately given there's no consensus, I feel I have no choice but I will absolutely be limiting the number of ministers that we have in this building so that we don't put other staff at risk. No-one will be travelling from Auckland to participate. There will be a small handful of ministers answering all of the questions. So in many wastes, I think it is an inferior option than what was on the table.

>> On Monday, you said you would be reviewing level three next week, you for the rest of the country, is there a scenario under which there could continue to be level four in Auckland but level two everywhere else? Is that, from a public health perspective, is that a workable option?

>> We've had split boundaries many times before.

>> Before level two?

>> We haven't. We've had three in level two. So we have had a situation before where you've got one area that has got no interregional travel alongside an area where there is. So we have had that principle before. So that is possible. But I'm not pre-empting any decisions because cabinet has not made any.

>> There is no hard and fast - it is just that it hasn't happened before.

>> It hasn't happened before. But I think probably the bigger principle is that we have had areas alongside each other where there's been one that isn't meant to be travelling an one is able to travel. That is probably the example we have to work through. So it demonstrates how important it is to get your borders right.

>> Anything you want to add on that?

>> Just to say that there is no public health reason why it couldn't happen. And, of course, one of the things we're going to be doing this week as we did last week around alert level three is see are there any enhancements to our current level two settings that we might advise, be brought in as and when other parts of the country or parts of the country move down to alert level two. So alert level two might be as we have known it with some additional things in place.

>> (Inaudible) we have spoken to are hoping for a seven day extension of level four until a bigger picture could be sought. Is waste water testing the only results that you're waiting for or will your decision be - will the decision be based on other information as well?

>> Two things. We will have similar results from additional testing in the region. Not just surveillance test from those who might have cold and flu symptoms. But there are some contacts in the region as well that we expect further results from. And that alongside the waste water testing gives us confidence that for now, we can say if they are clear, we believe it will be safe to move on midnight Thursday. The other really important point is level three is still restrictive. It is still limited in terms of stay in your bubble, you still don't have large gatherings, schools are still not convened. So that does give us confidence that it is still a cautious approach and it allows us to continue to monitor what's happening across the country.  

>> This week we've seen a notable push in terms of vaccinating, we have got drive-throughs, even social media marketing, you can see that it is ramped up. Why is that only happening now and it hasn't been in the...

>> Actually, all of our vaccination campaign was built around ramping up at a time when supply started ramping up as well. And we have entered into a period where we have more people eligible to be vaccinated. And we have more doses in the country. And so that's why the campaign you will see is ramping up at the same time.

>> Why has the Crown Plaza not yet reopened when it was supposed to open last Thursday?

>> Yeah, so what we said was that we wanted to - you will know that we wanted once it was - we had people exiting, we weren't bringing new people in, and part of that was because we were undertaking source investigation to try to identify what exactly had happened. At this stage, it is still not clear to us so all of the theories that we've had, whether or not it was as has been offered up by some of you, whether or not it was anyone passing by, we reviewed krv footage, found those individuals, tested them all, all negative. -- krv footage. There was a question over whether or not there was a link between someone from within the facility and one of our earlier locations of interest. That proved to be incorrect. So one of the things that enables us to do while the facilities is just really look into every other possibility. It already had a ventilation review. But what I would like is just a bit of a look from a Delta perspective to see if there are other things we need to do to make sure that we've covered all of our bases, even if we don't know exactly what happened here.

>> On a different topic. When you're looking at sort of the past couple of days the numbers of cases that have been infectious while in the community, 23 from yesterday's cases, 25 from the day before. How - how low would you like to see those numbers go before you're more comfortable with where we're at, I suppose?

>> Yeah, so the issue, of course, is that at level four there are people who are still keeping the country running. And keeping people fed. And moving key freight around the country to keep people fed and with essential services even at level four. So that's why we're doing two things. It is just getting that little bit of extra deep diver into those places where people have been to check that actually it is good compliance, but also at the same time, those places that are open really are necessary. At the moment there is nothing to suggest that they are not. But it does show why infection controls and really careful operations at level four are so important. He idea that you would get it down to zero, even at level four, that is hard. When we look just at our supermarket chains, 55,000 people, so it's not hard to see how you could hit people from different walks of life in an outbreak like this. And by default, we have a large number of people in this outbreak.

>> Can I just clarify. Because it wasn't to open until Thursday (inaudible) and it was being done in preparation for last week. So have you specifically asked for it to be...

>> Look, it is my understanding that they have not yet put anyone back into it. That is my understanding. But yes, they have done all of those alterations but that is my understanding. I will go back and verify whether or not it is remained the case. But all of those things that have been raised that could be instituted in order to make it safer still, keeping in mind that, of course, those barriers now are up to the ceiling, so essentially a wall, to see whether or not there is anything else that needed to be done or whether or not it has been deemed to be complete now. But that's my understanding. But I will double-check.

>> Question for Dr Bloomfield. Elective surgery in Auckland is mounting an obviously will continue to grow for the next two weeks. Can any be moved to other DHBs or can anything be done for people waiting, like for a hip replacement or things like that?

>> Well, the first thing is that any acute or urgent surgery is being done of course in Auckland and elsewhere in the country. Secondly, we started to work with our district health boards outside of Auckland on their plans for catching up on elective services that may have had to have been postponed during the alert level four for Auckland. One of the things we will look at is if there are not necessarily acute, but semi acute operations that need to happen that they can't do, whether those can be done elsewhere in the country. That's one of the things we will look at.

>> It could be any where depending on the nature of the surgery. Obviously the DHBs that are violent would be the main one. So saying all DHBs are going to have a backlog an so as happened last year, there will be specific plans in place and we will work with district health boards to make sure they are both able to provide that surgery and, of course, they will prioritise people whose need is most urgent.

>> Okay, I'm going to take the last couple of questions. Down here and then come back to you here.  

>> Did chemist agree with the Ministry of Health advice about the protocols that businesses (inaudible)

>> Oh, so the mask use issues around mask use were agreed some time ago. And as was mandatory record keeping. You will recall we made those decisions before we had an outbreak. We are working through all of the implementation and then announce them afterwards.

>> (Inaudible) given advice around businesses operating under level three physical distancing mask use indoors.

>> Yes, my - I don't believe there's been a point where we've ever been divergent on those matters.

>> But Cabinet has agreed with that?

>> But my point is those decisions were taken some time ago and my rex is that we've always followed the advice that we've received. Weeks ago.

>> I think the additional advice we gave - I will just have to clarify and we will be able to outline this time - it was for anyone who may be having any public - who isn't currently an essential worker but is going into their work place, that they need to wear masks there and even in the case of any transfer of goods or services as contactless anyway, but we are just added in there additional measure to reiterate the importance of mask use.

>> The important thing for me is I don't believe we have received any advice that we have rejected. So it might be that it is still in a process but we've tended to stay pretty closely to what we're advise odd these things.

>> Can you just go through again whether vaccination clinics are asking people for ID because I have had a few messages from people who went to a centre in Auckland who have said that they were asked for ID when they went.

>> So if you go to a vaccination clinic and you don't have identification, you will be vaccinated. No-one should be asking for ID as a way to access a vaccine. Some places, people may be asking ID to establish an NHI number, to hasten the administrative process, but it is not a prerequisite for you to be eligible for a vaccination.

>> At some point when vaccination status becomes relevant for things like passports and travel, how will people be able to prove that they have had a vaccine...

>> So we do, of course, register the fact that you've had a vaccine. We've got a case that was being raised with us where someone didn't have an NHI number and so that is where someone has used ID to try to establish an NHI number for that very purpose. So later they can go back and find a record that they have been vaccinated.

>> If they haven't shown ID to prove it is them.  

>> So they can search through your records, ask who you are, ask for things like your date of birth.

>> So every person who is getting vaccinated, a link is made to their existing NHI number if they have it based on name and date of birth. If they don't have an NHI number, one is created and that allows the COVID immunisation register to link with other health databases and at the moment, if anyone needs proof that they have been vaccinated, for example, to travel overseas, the ministry of health provides a letter signed by the director of the vaccination program to confirm that they have been vaccinated and it has their name, date of birth and NHI number.

>> Was anyone here asked for their ID when they were vaccinated?

>> We had two bookings today.

>> No, I mean the people who have been vaccinated?

>> I wasn't.

>> I wasn't. It might just be me.

>> People who are making the bookings told us that they were told to ask for ID or told the person to bring ID on the day. So is that conflicting messaging?

>> So I think there is two separate issues here. There seems to be a question here of whether or not you have to prove eligibility. Everyone is eligible. Everyone in this room and in New Zealand is eligible. It's a very different question around whether or not you bring ID just to make the administrative process a bit quicker. But if you don't, there are work arounds.

>> Are we just able to please get an update on the...

>> I will make you my last.

>> The staff isolating in the Devon Port Navy base?

>> Yes, just to say a very precautionary approach was taken there to a waste water positive waste water result which the defence had commissioned themselves, the testing and the waste water. All the subsequent testing has come back negative and the staff who had isolated and been tested, last I heard, all of those who had been tested returned negative results. There are a few results outstanding. So we're not quite sure why they had that initial positive result. But all the right things were done and so far there doesn't seem to be any evidence of any COVID there.  

>> Dr Bloomfield, before you mentioned a number of cases that were household contacts, are you able to just clarify how many there were and I guess the remaining cases, whereabouts have they been infected?

>> So, of the cases yesterday, 52 - I've got the proportion, 52% an some will have to get their calculator out later and work that out for me. But it is over half of yesterday's cases, probably 41, maybe 42, were household contacts. And what was the second part?

>> Remaining 48%?  

>> Some of them were contacts already as well.

>> Were known contacts. I think the other thing was over 70% didn't generate any new exposure events. And the other thing we were going to do and in the next day or two provide clarify kakets of this, is work out how many household contacts there are and for the likely range of additional cases we would expects, especially with Delta which has got high affectivity in the household settings. So given the number of cases we've got and household contacts, it it will help us give an indication of additional cases we might expect over coming days.

>> Just with the I guess, this outbreak, are you able to describe some of the symptoms and experiences you are seeing in some of the cases and obviously with it being Delta, is there any differences you're seeing to previous outbreaks an also more people vaccinated this time around, are you seeing any differences at this stage?

>> So I was just looking at this today. There is no evidence of any different symptom pattern with the Delta. So it is fever, runny nose, sore throat, cough, loss of sense of smell and taste is again still there. So it is the usual symptoms that we've seen with earlier variants of the virus. What I don't know is anything yet about whether people who are vaccinated and comect infected are experiencing either milder symptoms or not.

>> One thing that we are seeing is that of course some of our positives are asymptomatic. And so we do know, of course, that when you're asymptomatic, you still can be infectious when is why we want everyone just be careful at all times. Never assume because you feel well, that you won't become unwell and that we then won't have your friends and family affected. Thanks everyone.