The Ministry’s Chief Science Advisor, Dr Ian Town will host a media briefing at 1.30pm today to provide updates on the COVID-19 response – specifically, on the surveillance measures for monitoring new variants of the virus in Aotearoa.
Dr Town will be joined by the Ministry’s Chief Testing Advisor, Kirsten Beynon, and the Ministry’s Lead Science Advisor, Dr Fiona Callaghan.Transcript
Welcome to the Ministry of health.
We are going to be giving you an update on the Omicron outbreak response and specifically on our efforts to monitor for new variants of COVID-19 here in Aotearoa, New Zealand.
My name is Ian Town, the ministry’s Chief Science Advisor, and I'm delighted to be joined by 2 of our key senior colleagues, Kirsten Beynon, our chief testing advisor on my right hand, Fiona Callaghan, our Lead Science Advisor. Way to have these colleagues participate in today's discussion.
We are going to give an overview of our order and post border variance surveillance, these are key components of our monitoring for new variants, and then will have a general discussion about our tracking of COVID-19 general.
You will be aware our normal 1 PM statement has already been issued, that has all the details of case numbers for today, so we will not be going over those. Also like to draw your attention to the slides, which I hope will be helpful as we talk through the surveillance approach, and you can see there are a number of components to the surveillance strategy which my colleagues will deal with in some detail during the course of their discussion with you. If we think now about the international situation, obviously we are still seeing further waves of Omicron around the world, New Zealand of course has been experiencing exactly the same thing with additional sub- variants being detected here over recent weeks. As we know, once we detect a variant here in New Zealand, it does take some time to gain an appreciation of the severity, the outcome for individual patients, with each of these variants. There is a small chance that in the future a more aggressive area may be found in New Zealand, but in general we have seen that emergence overseas. And that is where our international intelligence plays an important part. Of course as you know we previously have been working to elimination strategy, but in December last year that change, and we are now working in the COVID-19 protection framework environment. We are currently in the orange setting, as you are aware, about protection and surveillance, and hence the emphasis today on our surveillance approach. Those are settings within the protection framework are reviewed regularly by our public health and science colleagues, who take a look around for international and local evidence to assess how appropriate these settings are at any given time. As I have said, the Director- General has assessed the current orange setting as being appropriate for the stage of the outbreak, and we have a regular program of reviews, previously they were taken, were undertaken every fortnight. At the moment they are undertaken monthly, with the next review being timetabled for next week. In the middle of June. Although we have experienced quite a peak of cases earlier this year, case numbers remain relatively high. And these factors continue to inform our disco -- decision-making and levels of protection through the settings. Of course with winter coming, already seeing the impact of this, the additional impacts of cold and flu, are likely to add to the workload experienced across our already busy health system. Overall, the work we have done up to now with our public health measures, protections and vaccination rates are continuing to provide good levels of protection and leave us well-placed for the weeks and months ahead. To introduce Kirsten Beynon, ouch Chief Testing Advisor, she has a wide range of laboratory experience over many years in the New Zealand health and disability setting. She is going to kick off with a discussion about water and post border variance surveillance approach, which is so fundamental to us detecting new variants here in New Zealand. Following that, Dr Callaghan, an epidemiologist and biostatistician brings a wealth of scientific evidence to our work, will cover aspects such as the science behind whole gene sequencing, and other key management tools we are using for tracking the prevalence of COVID-19 in our community. Surface, over to you Kirsten, thank you.
>> Kia ora the data, thank you. A commitment to science and evidence response has been critical to our success today. While we have moved away from elimination and capturing every single case, it's important we continue to identify trends in COVID case numbers, both at a local and national level, in addition we need to monitor which variants are coming into Aotearoa and in our communities, and having the greatest impact on our health and health system. We do this using surveillance techniques, which is the collecting of scientific and factual information from a range of sources, including testing different populations. We serve a Travelers intro New Zealand, individuals, wastewater is in our communities, and those who are sickest in our hospitals, and we can triangulate this to understand the collected burden of disease. The knowledge gained through surveillance informs our public health decision-making, as well as helping with the management of individual cases, it enables us to trace how COVID-19 is spreading in our communities, and where to direct our public health response. The Omicron variant in particular continue to circulate in our community and open borders will bring new variants. We need to remain vigilant at our borders and within our communities. For variants of concern our intelligence gathering and surveillance activity begins overseas. Which has assisted decision- making throughout the pandemic. Monitor daily overseas reports on changes in the virus and developments in science and public health thinking to ensure our approach to testing for COVID-19 to and the identification of new variants meets the needs of our response. How do some of this work in practice at our borders? I will excellent. As previously -- explain. We use a variety of information gathering methods and testing tools to provide information from a range of settings, which collectively provide a better understanding of the prevalence of COVID-19 in our community and to understand which variants are circulating. We deliberately avoid relying on assembling a single group of people, and one testing approach. Rather, we sample from a range of settings, of people, to give us the best possible picture for New Zealand. Many countries have stopped testing at their borders and others, like Canada, have moved to randomised assembling of vaccinated travellers. In Aotearoa we are maintaining a high level of testing at our borders. People crossing our border are tested twice, on day zero one, and 5 6 after they arrive. While this is reliant on self reporting, the numbers are encouraging. For example, of the 37,000 people who arrived in New Zealand in the week ending 5 June, 75% completed and reported the 2 RAT's. Approximately (inaudible) were positive for COVID-19 currently about 1/3 of these positive new arrivals are getting PCR yen -- and whole gene sequencing. This gives additional information on the variants are circulating over the water. It's important -- border. It's important when people arrive in New Zealand they have RAT tests and if possible, positive, CK PCR follow-up. This enables sequencing and identification of new variants. The ministry is submitting a technology solution that will support rapid follow-up of travellers who are positive to encourage them to get a PCR. We are currently travelling all travellers who have not had a PCR in person. We have seen an approved uptake as a result of this process, overall we will continue to use a high trust approach as this is currently the most feasible to managing over 30,000 people each week arriving into New Zealand. Currently we are building on our whole gene sequencing capacity and capability within New Zealand, and I like to take the opportunity to acknowledge the continued artwork and thank the New Zealand COVID testing Teams and ES are who collectively ensure information is readily available to have #2 support the public health response. COVID has spread of science, the result has been the rapid announcement of treatment, knowledge, experience and understanding. Applying that knowledge which has improved as time has gone on has helped New Zealand -- has held New Zealand in good stead. I'd like to head over to Dr Callaghan.
>> Thank you Kirsten. As we have said before, it remains true, our experience -- strategy for managing COVID 19 evils and methods adapt. The overall goal of surveillance is to give us visibility be about the different aspects of the pandemic. There are a number of components to a good strategy. Looking internationally, to begin with, globally our surveillance system as part of an international act -- effort to track the impact and spread of COVID 19. We continue to communicate with international colleagues are monitor data gathered from around the world. Within Aotearoa we need visibility at the border, the community, and within hospitals. Surveillance of each of the settings has different goals. At the border we need information primarily on new variants entering the country. In the community the goal is to estimate the number of cases. And then to characterise which variants are most common, and estimate the growth rate of the variant, potentially to anticipate if that will trigger ways of cases. For hospitals, the girls are to know which patients have COVID 19, which patients are currently infectious, so we can take appropriate action to protect those patients and the people caring for them. And also to monitor new variants that may be responsible for severe disease. We have a variety of tools, including monitoring developments overseas, we have RAT's and PCR test is a new arrivals, people in the community reporting the results, wastewater trends, holding sequencing and the communities, behavioural surveys, and each of these have their own purpose and bring a different piece of the puzzle to build an overall picture of the spread and prevalence of COVID 19 and its variants. Whole gene sequencing in particular allows us to detect and monitor the COVID 19 variants at the border and in the community. The goal for community gene sequencing is to get an accurate picture of the variants are circulating across the country. PCR samples from hospitalised patients undergo holding sequencing where possible, and the most clinically severe cases are Ira ties for sequencing when required. Currently the BA.2 variant is responsible for over 95% of reported community cases in New Zealand. With new variants such as BA.4 and BA.5 beginning to show early indications of increasing in prevalence. As we can see from the graph, the BA.1 variant was common until recently, and now BA.2 is dominant. Sampling from across the country informs the proportion of the circulating, variants in New Zealand and prioritising hospitalised cases helps us to understand which variants may be causing more severe disease in New Zealand. Of course we have other management tools, so it rapid antigen tests and whole gene sequencing I just to testing tools we use to monitor for the presence of COVID 19. For instance regulate wastewater testing across the country is another surveillance tool used to monitor the level of COVID 19 in our community. And to monitor variants. Wastewater testing proved crucial early on in our response to COVID 19 as an additional precautionary measure, helping to rule out or identify any undetected COVID 19 infection and provide the respective public health advice. Now with ongoing community transmission, wastewater is used to measure the levels of virus present in the wastewater, and therefore allows us to monitor the level of infection in the community. It also provides information on the overall trend indicating whether an outbreak may be growing or declining. Quantification surveillance wastewater is underway at over 100 sites from testing locations are all over New Zealand, which indicate the level of COVID 19 in particular areas. This information can also help us monitor if there are any undetected levels of community transmission. Furthermore there are over 20 sites were variant testing is routinely conducted on the wastewater. And these samples are tested to detect whether a particular variant is present in the wastewater, and gives us an indication of whether a new variant may be present -- presently circulating in the community. Thank you, back to Dr town.
>> Thank you for those excellent summaries. Just to wrap up, obviously COVID is not going away. It's a continual challenge for us, as it is in many other countries. Our response has been continually adapting and responding to new evidence and information to inform our response. As the virus continues to spread within New Zealand and globally, there remains a lot for us to learn. We have $9 million available, and that closes in fact this Friday, looking forward to reviewing those applications, and we expect to make an announcement about the successful projects in August As mentioned, we are already seeing increased pressure across the whole system, and this may get worse as the impact of colds and flu starts to be felt across the system. And in addition, there is always a risk of other diseases occurring, particularly measles and whooping cough which we have not seen in recent times. Are immunity, our collective immunity to some of those infections may be a little lower than usual, particularly for the flu, as we have not had significant flu in New Zealand areas for two years of. Vaccination remains at the heart of a protective framework and is the best way for us to protect us in our whanau, including vulnerable population groups for the worst effects of COVID-19. The more of us that are vaccinated, the greater protection that we have, and this is no different for other illnesses. New Zealand is well-versed in the basic public health measures and these are really clear and applicable as they are now earlier. To make sure that you are up- to-date with your vaccinations if you have not had a chance to have a vaccination or a booster where appropriate, but also the influenza vaccine is also widely available and there is a continued program of catching up with the MMR vaccine for those, for the younger folks. Secondly, we are modelling that behaviour, I can see that in the room. So when we are indoors with people that we do not know, particularly when ventilation is not good, it is still appropriate to wear a mask to cut down transmission of COVID- 19. And most importantly, if you are unwell, it is important to stay at home and not go to work or school while you are unwell with a respiratory infection. If you are concerned about whether or not you have got COVID, we have a wide availability of rapid antigen tests, we are delighted that people are continuing to upload the results of those tests, both positive and negative really helps us track case numbers around Aotearoa. Thank you those who have been diligent in uploading test results. Doing basic work has been an important part of our backbone of a response today, thank you, we are happy to take any questions about our briefing or related matters, thank you.
>> Quite high wastewater test results, and alongside the dropping of daily cases, are we likely to still be in the pandemic with those?
>> Would you like to pick that one up?
>> I think when you compare the case numbers with the wastewater, you see more similarities and differences. It shows there was a peak, and a levelling off, the rhombus -- the numbers have remained very steady.
>> Even though it is quite high and steady since March? What is the reason between that difference?
>> That resource the possibility of under ascertainment, so the number of RAT being reported, that is a lower bound for the total number of cases. We know that those other true cases, and then people for whatever reason do not get tested or do not upload the RAT results, that is why we try to triangulate with the wastewater data which does not rely on people's compliance with the testing, and the test have less ascertainment bias.
>> 's at the peak of the pandemic with some of the results that are presented
>> I don't think we are at the peak, what we are seeing is a steady plateau I think is the best word for it and that is backed up not only by the testing results in reporting, and RAT, but as Fiona said, we continue detection through the wastewater.
>> (Inaudible) what will that mean?
>> That is a really good question. As Fiona mentioned, and on the graph earlier, we have started with the BA.1 variant, and BA.2 has been by far the most dominant in the early months of 2022. We have detected the BA.4 and BA.5 area, in small numbers and small quantities, if that does have a significant advantage biologically, often because it is more transportable -- transmissible for example, we expect those numbers to slew creep up over the coming months, that is the pattern that we are seeing in the UK at the moment.
>> What are the chances of getting infected by the earlier BA variants?
>> That is a really good question. I'm not sure if we have a precise answer for that right now. Obviously the natural infection and vaccination are giving good protection against severe disease, just as a level of protection of getting new infections, we are not sure about. We are tracking that evidence. It is quite difficult to be certain the answer to that type of question.
>> Which variants seem to have the most severe?
>> We are just learning BA.4 and BA.5 at the moment, we do not have enough experience in New Zealand. There is not even that much variance worldwide, we have seen in the UK and Australia and we have seen with Omicron there is still a lot of people being admitted to hospital, and a lot of people with relatively mild illness.
>> With people being infected the second time (inaudible) that you can get COVID one twice?
>> I think it is still unknown at this point. New Zealand has caught up with the rest of the world and we are learning these things pretty much at the same time as everybody else. But that isn't area of discussion, and it is quite possible that we may be seeing over a longer time period of repeated infections, particularly of new variants emerging.
>> What is the official advice at the moment? Is it still the ninety-day is not likely to get COVID?
>> I think we have been called out by one of your eagle out -- eagle eyed collies, that the advice on our website was not what we hope to express.It advice just for the avoidance of doubt, anyone with symptoms of COVID within 90 days of infection, she took to their health profession on whether they need to have another test, so I were a virology colleagues feel that it is quite unlikely that there will be a repeat infection with that time, if it does occur, it is a good opportunity to check with your doctors and what to do.
>> Do you know much about the reinfection quiches within the ninety-day period?
>> Obviously, the rapid antigen test if it is negative, we tend to point that not being the situation, but of course the symptoms of the common cold even the early stages of flu are very similar. It is important really just to be staying at home, looking after yourself, keeping warm, and if there is a deterioration, talk to your family and talked about it.
>> Cases of flu in Australia pretty high at the moment. Have we considered giving free flu vaccinations to everyone in New Zealand?
>> We certainly have extended the X -- the eligibility for flu and bringing that age down and making it available for those under five. I'm not sure the exact reason, but I understand that there was a supply issue as well, so making it available more widely may not have been possible this year.
>> (Inaudible) have COVID?
>> That is a good question. Fiona, do you have the Intel at the moment?
>> I do not have the modelling data in front of me. But yes, they do monitor the number that have been reported and those who have been infected. And there are also estimating, they try and give an estimate of who has been infected.
>> Is that more than half a New Zealand?
>> I do not believe so at this point, but I would have to check and get back to you.
>> (Inaudible) on Doctor Bloomfield testing positive?
>> I was just talking to him a few moments ago. He is back in New Zealand and I gather is feeling fairly well.
>> (Inaudible) any issues, and may have got that wrong, is there any studies in New Zealand about the post COVID sickness?
>> It is a good question. I think there is concern amongst the medical and scientific communities, that there may be long-standing damages for some of the variants and some of the system -- symptoms that people experience, the aches, and some of the symptoms certainly represent impacts on the organ systems, we do not have any New Zealand data at the moment.
>> What have you been finding from investigations?
>> We are just getting underway on that program of work, so we at the science team will be looking at the evidence base around COVID, we have not done a systematic survey of how many people are experiencing symptoms of COVID beyond the three month phase, but we are developing guidelines, which we will be working on over the next six weeks, and we hope to release those in July, and through an expert advisory group, our head of the profession's leading that.
>> For those who are pregnant, there is an increased risk of COVID illness, (inaudible) pregnant women making inquiries about getting a fourth dose?
>> We would be making a second booster available, And it has not decided on the specific category yet. But in general, our advice is to offer those who are experiencing more severe outcomes. But not at this stage.
>> (Inaudible) so it would not include pregnant women?
>> I think there are two separate processes. One is enabling the ability for the Doctor to prescribe the vaccine, and we are going to a select committee process, I understand that it takes a little while, so we would be looking for further advice from various consumer groups, and also other medical bodies about the right target for that.
>> Is work underway to improve vaccine rates?
>> So we started with quite a surge, in the early days, and then the rates have dropped off. This is an important decision for families and their whanau to take, so there is no mandate or requirements for children to be vaccinated, it is effectively an informed consent process for the family. We have provided a lot of evidence, we believe the vaccine is safe and effective at that age group, but at the end of the day, it is still a decision for the family to take themselves.
>> (Inaudible) the momentum (inaudible)
>> We know from history that vaccination programs do lose momentum. So we have to keep up and providing feedback to people about the level of coverage, we are working with other providers across the DHB sector, and the providers are working exceptionally hard to close those gaps.
>> How worried should we be about monkey pox?
>> So monkey box has been a subject of a number of active discussions and assigns team a. We are following the international developments really closely stop as you probably know, one of the larger outbreaks have occurred in Britain, about three cases so far. We are aware that a case has been detected in Australia, and you may have recalled cabinet yesterday decided to make a notification of the disease. I think our normal case identification will be to stop the spread of it. If the number of cases stay relatively low as they have in Australia and UK, absolutely. Good, other any more questions before we finish? If not, thank you for coming. It is always a pleasure to see you here at the Ministry of Health.