COVID-19 update, 8 March 2022 1pm

News article

08 March 2022

The Director of Public Health Dr Caroline McElnay will today lead a briefing for media organisations to provide updates on the response to the Omicron outbreak.

Dr McElnay will be joined by the Ministry’s group manager of data and digital, Michael Dreyer.

>> Thanks for coming today's update at the Ministry of Health.

 I'm Michael Dreyer the ministry's chief technology officer. Today I will give you an update on the new IT systems developed and rolled out specifically for our Omicron response. I'm joined remotely by Dr Caroline McElnay, who's the ministry's Director of Public Health and she will start today's briefing with an update on today's COVID-19 numbers.

Over to you, Caroline.

>> Thanks, Michael. Apologies that I can't be with you in person. I'm Zooming in there sunny Napier

. Today I will give you an update on the case numbers, hospitalisation numbers and also just outline some recent research from Otago University.

 Firstly today, we are reporting 23,894 new cases across the country, with 9,881 of those in Auckland and we'll have further breakdowns of those figures in our statement.

 Auckland yesterday recorded their highest number of Rapid Antigen Test results ever, 43,735. That's 25% higher than the previous highest day, which was last Monday. So a big thank you to everyone that's been putting their results into MyCOVIDRecord.

You will be aware of commentators like Auckland University's Rod Jackson who says whilst we're tracking the daily case numbers, there are only a minimum, given the uncertainty there is around recording of results and the actual number of cases in the community is likely to be considerably higher.

That's one of the reasons why we're focusing on our hospitalisation numbers. And today there are 756 people with COVID-19 in hospital, 16 of those are in ICU or a high den pendency ward.

The largest proportion of cases in hospital continues to be in the three Auckland metropolitan District Health Boards. Information provided by those DHBs today is that case hospitalised numbers in Auckland are around the same as yesterday, in one county slightly down, the actual numbers, we can provide for you in the statement.

Now, the ICU numbers are similar to yesterday. The DHBs report continued pressure on staffing, particularly providing cover through the night, though today, I'm pleased to report that the DHB say they are managing and that occupancy levels remain manageable.

People will be concerned about the number of people in hospital and, unfortunately, we do know that this number will grow. However, when compared to the Delta outbreak, the people being seen in hospital with Omicron have less severe illness. The lesser severity is strongly related to New Zealand's high vaccination rate, and many experts rightly warn that the illness can be very severe for those who are unvaccinated.

While still early in our Omicron outbreak, our figures show that based on the data available, unvaccinated people are four times overrepresented in the current hospitalisation data. Just 3% of eligible people aged 12 and over in New Zealand have had no doses of the vaccine. However, of the eligible people hospitalised since community transmission of Omicron was detected, 17% have had no doses of the vaccine.

 During last year's Delta outbreak, the highest number of cases in ICU at one time was 11. That was reported on the 10th of November, when there were 81 cases in hospital. Of those, 13.6% are in ICU, whereas for comparison with this outbreak, on Sunday the 6th of March, there were 618 cases in hospital with 10 in ICU, just 1.6%. So a much lower proportion of cases being admitted to ICU.

Now, as you are all aware, ice lating infectious cases has been a key strategy for preventing the spread of COVID. However, as our case numbers increase, our health services are stretched trying to operate services with large numbers of staff numbers being required to self-isolate.

One measure that's been put in place to address this is an arrangement which (inaudible) with COVID to return to work earlier than usual, if their absence would mean that a critical Health Service would have to stop functioning. Now, this can only occur if the case meets strict criteria, and all steps are taken to protect the safety and wellbeing of the case themselves, their patients and other staff. The staff member's wellbeing will be checked daily and if they develop symptoms or their symptoms worsen, they would stand down from work.

There are two pathways currently available for critical healthcare workers who are cases to return to work. The first pathway allows healthcare workers with two negative RATs to return to work on day 6, after they've had their negative RAT, and the second allows COVID-positive staff to return to work on wards where all the patients are also COVID positive, without any stand- down period. Now, this second pathway can on be used if all other options have been exhausted, but it's an extra tool that enables our health system to keep running and keep functioning. Whilst at work, the healthcare worker must use a well-fitted N95 medical mask, follow infection control procedures, take share in any break or meeting areas, avoid public transport where possible, and follow our standard advice for community cases outside of work.

Before they can return to work, there's a number of conditions that those healthcare workers need to have met. They need to be fully vaccinated and boosted, be asymptomatic or have mild symptoms, they must agree to return and staff should not feel pressured to return to work.

They must work in a situation where their absence actually puts an essential service at risk, and as I've said before, they can return to work on day 6 if they've had those two negative tests. We're very mindful of the very special situations for staff who may have to return to work at day 0 and the support that's in place to allow that. In that situation, they will only be working with COVID-19 patients. This is a pragmatic approach to ensure we continue to have staff available to treat individuals with COVID but it also balances the significant risk to patients from hospital services not being able to operate against the small risk to patients from staff who have COVID in light of all the protections in place. We can provide the details of this criteria further to you.

Lastly, I'd just like to say a big thank you to the health staff across the (inaudible) for being flexible, and we're seeing this all across the country, but particularly it in Auckland, because of the bulk of cases, staff are working together to keep our health system running.

 A bit about the Otago University research, you may have seen a recent analysis by Jennifer Summers and (inaudible) of the university's public Health Department. They've just released an analysis of excess mortality and they find that New Zealand's COVID-19 response had saved 2,750 lives from excess winter mortality.

That's a common public health way of comparing the number of deaths during winter compared with those in a non-winter period. And while we've known for some time that personal hygiene, social distancing and lockdowns have suppressed all other respiratory viruses, this is the first time that we're seeing that impact across-the- board being measured.

 Secondly, the researchers also used our (inaudible) figures to calculate New Zealand's mortality experience compared to those other countries on a per capita basis over the first two years of the pandemic.

And in summary, compared to overseas experiences, New Zealand has seen a very low number of deaths due to COVID.

Whilst Omicron has seen proportionately few year cases admitted into hospitals overseas, what we're seeing overseas is the sheer number of cases mean that hospitals abroad are likely to continue to come under pressure. For example, Germany last week reported its highest total number of daily cases at 161,040, followed by South Korea at 147,429, and because of the differences in testing reporting times, these figures are expected to be lower than the true number of infections.

So finally, please remember that we can all play our part to slow the spread of the virus, to help protect our most vulnerable and make sure our health system is able to cope with extra demand. Please keep doing the basics well. Wear a mask to protect yourself and others, physically distance, practise good hand hygiene, and please, get tested if you develop symptoms, stay home if you're unwell, and we encourage everyone to continue to promptly report their test results.

 I will now hand back to Michael. Thank you.

>> Thanks, Caroline.

So in recent weeks, the Ministry of Health has released a large amount of new technology to support the Omicron response.

You can now self-report a RAT online via MyCOVIDRecord, you can order a RAT via the same channel, you can record where you've been, and vis ate one- stop shop called the Health Hub to find relevant information to-to-your situation.

These systems were designed, developed and delivered...tested and delivered at pace.

However, with all new IT systems there are initial bugs and process flows to sort out. So I wanted today to outline some of the improvements that have been made since they were first released.

 Like the rest of our COVID-19 response, we are constantly refining our systems, taking on board feedback from our health workers and our health consumers. The COVID clinical care module is technology which joins up health information about each case for our healthcare workers. So they can ensure those with COVID-19 they are caring for have access to the clinical care and welfare support that they might need.

When this system first went live in mid February, around 4,000 cases an hour could be processed through these systems. During busy mid- morning periods we could see that this peak caused delays.

Further capacity has now been built into the system over the past two weeks which means it can now handle around 20,000 cases an hour and we continue to work through and enhance these processes.

The RATs requester site went live last week.

Despite an initial intermittent bug which was fixed within the first few house, it's now fully operational and being used nationwide.

Yesterday, 55,000 total orders were placed, all but a thousand of these were through the web form rather than the call channel and around 220,000 total test kits were orders.

Please remember to report your result on MyCOVIDRecord even if it's neg tifrd and please make sure everyone in your household has also submitted or reported theirs.

Later this week we will enable you to report a RAT result on behalf of someone else, particularly for children under 12. Don't forget there's also an 0800 number for this, if you prefer, or if you don't have Internet access.

You can also do this via your GP. The self-reporting of RATs provides the health provider a clearer picture of how the pandemic is progressing both at a national and regional level. It is essential we have as much information as possible to help inform the public health decision making we have also improved the online contact tracing form after we heard from the public it was taking too long to fill out.

With public health advice, we have streamline ed it to focus on high-risk events or exposures, and welfare needs. This has reduced the average time it takes to complete the form from 30 minutes down to 8 minutes.

We also heard that people wanted a single source of information about what happens when they or someone else close to them gets COVID.

So last month, we launched the COVID-19 Health Hub. It's a simple, easy-to-navigate one-stop shop with all this information. There is also plenty of this information available as always via the United Against COVID website.

From 10 March we will be going live with text messages that notify people that their isolation period is complete, and we're also considering reminders for those people that have ordered and received RATs but have not yet submitted a result one way or another.

As with all of our systems we have 0800 numbers for those who cannot access information online or simply wish to speak to someone for advice. Where possible, we encourage to please use the online services. They are quick to use. I like to think they're easy and they take pressure off our call centres and our frontline staff. So we do appreciate the public's engagement with these already. It's great.

So we'll now stop to take questions.

>> Can you, Dr McElnay, tell us how many hospital staff are currently off work because they are infected with COVID-19?

>> I don't have the exact numbers. We will see if we can get those numbers for you, but I don't have those to hand.

>> Is that a figure the Ministry of Health collates? A colleague of mine (inaudible) through DHBs and hasn't had much luck but it seems like a pretty critical figure to have.

>> I'm not sure that the Ministry of Health collates those numbers, because the management of the absenteeism and illness among staff is managed at the DHB level. So the DHB will have those figures and they are the ones who have been managing and balancing staffing issues to be ability to move staff around within the DHB to make sure that the services are running or adjusting some of running to services to free up people in other places. I'm aware of quite a bit of movement of some staff, you know, doing alternative duties in order to cover the essential areas, so the DHBs will have those figures. I'm not aware that we at the ministry collate those but we can look into that for you. Certainly at a DHB level, it should be available.

>> Dr McElnay are you able to explain, please, how the Queenstown vaccine temperature botch-up was able to happen?

>> Thank you. Yes, I've spoken to some of the staff in Southern District kal health Board and I don't know the details of what actually happened there, but I am aware that this was a cold-chain issue that came to light, and cold chain is one of the critical areas for all vaccine distribution. It's something that we've had...we've had systems in place for any vaccination provider regardless of the vaccine to make sure that the cold chain is maintained throughout its whole distribution, right up until it's arrived at the health provider and given to the individual. So I've been advised that the DHB is obviously managing that situation and that they will be doing an investigation into...an event review into what exactly happened in this situation. I don't have those details at this moment.

>> Giventh fact there was a number of frontline workers that have been affected by this, they haven't been fully protected, is that good enough from your perspective?

>> I think it's very unfortunate that it has happened, and we really apologise to those individuals who went along to get vaccinated and then found that, because of this issue, that their vaccine may not have been as effective as they thought it was going to be. I am aware that all of those people who were affected by the issue have received a letter from the DHB with individualised details about what they need to do, so that they can go and get re- vaccinated and I just want to reiterate that our apologies and our sympathies for the people concerned with this.

>> Dr McElnay, what public health advice was considered when making the decision to send COVID-positive workers back to work?

>> So we did a very thorough review of the likely risks and benefits for enabling this to occur. As you're aware, there is pressure with the large number of cases and household contacts that we're seeing at the moment amongst our healthcare staff, but particularly for cases who are well and there are some very specialised areas where it can be quite challenging to continue to operate those services. So we looked at how this could be enabled with a very...in a very safe way, we're very mindful of the health and safety of the staff member, as well as the health and safety of their co-workers and clearly their patients. As I said in my initial talking points, there are two different paths. The first path is where the case is at day 5, if they're well, they've been off work, they have to stand down for those five days but they do a RAT, if that's negative, they do a repeat RAT the next day and if that's negative, then they can go back to work. So we've got a high degree of confidence that those workers are no longer infectious because of knows two negative RATs, and are near the end of their isolation period. What we have said for the other pathway is that that is something that should only be used in extreme circumstances, and I'm not aware that it is actually being used at the moment, but we put it in place in case it is necessary for some of the highly specialised services that we know do operate in Auckland, and that's the situation where the case would be asymptomatic, so no symptoms, or even just very mildly symptomatic. It allows for them to return to work from their day zero, from their first positive RAT, but with very strict criteria around when they can work and of course they can only work then in COVID wards, so those are working in places where there are people who've already been exposed to COVID, there are already cases of COVID, and so the risk that the worker, that the healthcare worker poses to them, actually there isn't a risk from a COVID point of view. So we've been very thorough to make sure that we are minimising the risk at all levels with putting forward that or enabling that approach.

>> Dr McElnay, with the Chatham Islands cases, what links have been establishd with the mainland, for example, what links have been established between those cases and the Wellington protest group?

>> I'm not aware of any links with Wellington protest group. The health services for the Chathams are provided by quantity Bree District Health Board and they are looking - by Canterbury disc Health Board and they are looking after knows two individuals but that's all I'm wear of at this stage.

>> Going back to the new system, when did you make this decision? Was it always the plan to implement this system or is it simply because you're facing shortages.

>> Was that the question back to the healthcare worker issue?

>> Yes, back to this new system.

>> Yes. So we had...we've previously had a system in place that would allow healthcare workers in some situations to be able to return to work. So certainly that had been envisaged but that was the situation where healthcare workers could go back early. So that's the...with a negative RAT at day 5 and day 6, so essentially for those healthcare workers, shortening their period of isolation, but only to allow them to go to work. So that had always been something that we...we knew that we would probably need to be able to implement, and then we were specifically asked to provide advice and a pathway for the very...for the situation where you may have a lot of COVID cases on a ward, and you've got staff that you need to care for them and that those staff are well, but have tested positive for COVID, and so we...we knew that it was likely to be needed, but in terms of when it was implemented, it was last week, end of last week that it was implemented, and we were able to advise our health services over the weekend that that was now a pathway that was available for them.

>> Do you know how many staff may take up this option to come back to work and I guess what protections have been put in place to ensure that they don't spread COVID to other staff and patients who don't have COVID?

>> Mmm. I don't have the numbers, and it may be that, you know, that's why we've put it in place to enable and we will ask the District Health Boards how many staff they are actually using on that pathway. I'm not aware of any staff currently using the pathway which allows them to go back to work immediately but only in a COVID ward, but we can check on the details for you. In both situations, we put a lot of wrap-around in terms of use of PPE, the staff being vaccinated, advice about how they interact with co-workers during staff and meal breaks, and so we've put a lot of guidance around that. There's quite a lengthy guidance document that's been developed with DMBs so that staff at all times were minimising any risk to others from those staff.

>> Do you know how many patients have miss out on planned operations because of the Omicron outbreak?

>> Sorry, I don't have...I don't have a number available for you. Most of our health services are reporting that they are continuing to be able to keep business going as much as possible. It's primarily in Auckland, some of the hospitals there have had to do some reduction in health services. I'm not aware of how many patients have actually been affected, but again, we can get those figures and come back to you with them.

>> Of the current cases, what percentage are believed to be Delta and what percentage are thought to be Omicron

>> Our assumption at the moment is that they're all Omicron but that is an assumption, because we did see at the beginning of the Omicron outbreak that there were still some Delta cases circulating. Our whole genome sequencing is the only way we can really distinguish between the Dell and a the Omicron and at the moment, because of the sheer number of cases, we're not able to hold genome sequence all of those cases so there is a Pryor fization process in place nor that whole genome sequencing. That is very much focused on our hospitalised cases. The last report that I saw suggested that the...what we're seeing is red - predominantly Omicron.

>> How many cases are subject to whole genome sequencing. You say "predominantly". What percentage roughly?

>> We can get you the actual percentage from the last report from ESR, but they report to us frequently on the whole genome sequencing. They certainly were saying that Delta, they were seeing the occasional Delta but it had actually been some days since they'd seen the last case that was whole genome sequenced as Delta. I will just get the date of that for you. I just want to caution that because we're not whole genome sequencing all of our cases, we actually cannot say whether there is potentially still some Delta out there, but our assumption and the most recent whole genome sequencing, I understand, has confirmed that it's Omicron that we're saying. Our assumption is that this outbreak is primarily Omicron. But there may still be a few Delta in the community that we're not...we haven't been able to pick up and whole genome sequence.

>> How many cases are being whole genome squenlsed? Thousands, hundreds, dozens?

>> It will be in the hundreds. We've had to prioritise the samples that are referred to ESR, and so the prime me - primary focus at the moment is hospitalised cases, so it's in the understand.

>> (Inaudible) but it's not going to arrive near until at least April, after the Omicron spike. How likely is is it that we will be able to speed up that delivery?

>> I'm not aware of any particular issues there with that delivery. Obviously, we would always try to do what we can to increase or speed up delivery if it's about distribution issues, we can take that away and look to see if there is any particular issue that we can speed up.

>> We've got some pretty strong capabilities around distribution that we developed during the vaccine program and obviously more recently for RATs.

>> Dr McElnay, there's still only 11 approved Rapid Antigen Test types in New Zealand. Australia has approved more than 30. How satisfied are you with that situation, with us lagging so far behind Australia in terms of the numbers?

>> We have a process in place for approval of the Rapid Antigen Tests. My understanding is that our approval process has been recently reviewed to look at the criteria for approvals, that we...on the basis of that review, the ministry has gone back to a number of Rapid Antigen Test distributors and asked them to submit more information, which I understand we're waiting for that information to be received, and if that information is acceptable, then likely that we will be approving more. I mean, we are...we have a system and a process in place to make sure that the RAT s do what they say on the packet, literally, and so we're just very mindful that...since we're relying so much on on RATs at the moment, we do need to make sure that we've got as accurate a test as possible. So I'm confident that we will see an increase in the number of RATs that we approve going forward. You have to bear in mind that we do have different systems and processes from Australia.

>> Why are our systems and processes so much slower than Australia's then, and why products that have been approved in Australia...

>> I'm not sure...

>> (Inaudible).

>> Sorry. Sorry, could you repeat that last bit?

>> Why are our systems and processes so much slower than Australia's, and why is it that products already approved in Australia which has standards comparable to or higher than our standards not been approved here?

>> I don't think it's an issue of us having slower processes. It's just that our processes are different and so that does mean that even when something is approved in Australia that doesn't mean it's automatically approved in New Zealand. That applies to a wide range of medicines. That's not just specific to RATs. So this is something that New Zealand, we have our own process the and criteria and manufacturers have to meet our criteria in order to be approved. So that's what we're working through, and I'm hopeful and confident that yes we will see some more RATs approved, once the manufacturers have completed their process, which is to provide us with the information that we've asked for.

>> Could I just go back again to the new system. What considerations have been made for the health workers that have to go back to work, given that stress, for example, is a factor in long COVID?

>> We've been very clear in our guidance that staff should not feel pressurised to go back to work at all, and the Auckland District Health Boards have been discussing with staff unions to make sure that this is very...this is understood, that this is the case, that staff should not feel pressurised to go back, and we've also requested that there is a daily staff check-in, which is not just about COVID, but is actually about the overall wellbeing and if at any point in time, staff do feel stressed or concerned, that they're back at work, then our recommendation back to the DHBs is that those staff should be stood down, and that the DHBs look at alternative ways of staffing those facilities.

>> Also, is there any particular reason you're in Napier today? (Inaudible)

>> I'm not isolating from COVID, but I do have some symptoms, and I'm following my own advice, which is if you're symptomatic, stay home and Napier is my home. So I'm working from Napier.

>> Just in relation to the Nature journal finding that possibly a mild Omicron infection may be bad for the brain, particularly still and memory, have ministry officials taken this new is it study into account yet and will they do so when providing future health advice?

>> Sorry, was that question about long COVID? I missed the beginning of it.

>> It's about a Nature study of similar to 800 participants and they found significant deleterious long-term effects from the virus.

>> Mmm. Yes, we are looking at the effects of the...the broader effects of COVID and the longer-term effects of COVID. It is our...our office of chief clinical officers at the ministerier are heading up the work in that area. We have been actively looking at the evidence, ever since COVID and the long-term effects of COVID...we became aware of it. So that particular piece that you're referring to, I haven't read it myself, but I'm aware that our chief clinical officers have, and we're also working with...we also are working with the University of Wellington to establish studies into what we're seeing in New Zealand in terms of long-term effects of COVID.

>> I will add, there's some content changes comeing on the ministry website around long COVID in the coming days and weeks.

>> You mentioned a number of technological improvements or changes. What capacity was there, I suppose, in the earlier part of the pandemic for this, or has this been quite a massive shift that the Ministry of Health has had to pivot in implementing these things?

>> Right so I guess over the last couple of years we've built quite a broad ecosystem of technologies to cover COVID, probably began with contact tracing, testing, isolation, quarantine, vaccine and now care in the community. The care in the community case which is where we're looking to I guess better enable the health sector and welfare to support people isolating at home does bring together a number of those technologies we've developed over the last couple of years. It does also bring into play some of I guess the older in the health system, a little the mix of the old and new and there are a number of I guess as there's integration between lots of the IT systems and data flows that don't always work in absolute real-time. So that's I guess a constant challenge or for to us make things happen in real-time but we continue working on that.

>> Any other questions today for either Dr McElnay or myself? OK. Well, thank you very much for coming along. I think we have another media stand-up on Thursday, so we'll probably see some of you there. Alright. Thanks very much.

>> Thank you. Goodbye.

 

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