COVID-19 update, 22 March 2022 1pm

>> (Speaks Te Reo Maori) and nice to see you all back here for today's update,

thank you very much for coming up for a quick update on our Omicron including some keyed numbers from today, an assessment of where we are in the outbreak and what we can expect the next

then I will hand over to my colleague here, our care in the community lead, Doctor Joe Bourne who will give an update on that aspect of the response was to

first of all just some of the headline numbers from today, the detail will be in our standard 1 o'clock release, there are 20,907 new cases today in the community . and a seven day average of cases is 17,020 and a seven day average of cases is 17,024

unfortunately we are reporting 15 new deaths today and the seven-day rolling average of death is now the highest it has been, we have the people around and of those 25 summary and intensive care or high dependency unit .

last Friday Doctor Anthony Jordan from the northern region health coordination Centre described that up there they were increasingly optimistic that they had seen the peak in Auckland full our latest analysis confirms that COVID case numbers have indeed passed their peak in Metro Auckland and are on their way down in all three District Health Boards, -- wards case numbers across Auckland today totalled 4291 so about one third of what they were on March 4, just two weeks ago.

Our analysis also shows that the increase in case numbers across the rest of the country has also slowed.

So in the seven days to 20 March case numbers nationally and we have taken Auckland out of this increased by just one percent compared to a 44% increase in the seven days up to March 13 so much a lot -- slower rate outside of Auckland in the country . this does differ by District Health Boards and there is encouraging signs of case numbers peaking in the region we call (Speaks Te Reo Maori) which is the Midlands region and the Wellington region, at case numbers are still very much increasing in the South Island.

I do have a few slides to walk you through today to just provide a bit of a picture of key features of the outbreak in Auckland and across.

First of all this is an updated slide on the case numbers in the northern region which includes the three Auckland Metro areas in Auckland, you will see today that it is very much following that high scenario transmission scenario, it looks like it is in medium to low now but actually just following the trajectory of the blue high transmission curve behind the other two, the peak did go higher in the original model we showed and it is not clear exactly why that is, it may well be because most of our cases in New Zealand have been from this variant, not the sub variant that the modelling had been based on.

Alongside this we can also see hospitalisations in the region are levelling off and are now sort of passed the peak that they were in the Omicron surge. Hospital admissions to fluctuate but we are watching carefully and our expectation is that they will start to drop as we progress -- week progresses.

The average length of stay for those have been discharged is now 3.2 days compared to just over two days last month. And every stay in intensive care is five days, this increase in average length of stay shows that we are now showing people needing longer care, they may even be over the infection but they have got residual symptoms that need to be managed often from underlying conditions.

Earlier in the outbreak we saw young people going into hospital, often treated and discharged just overnight.

The third slide is also hospital admissions in the northern region hospitals and what you can see here is even though those case numbers in hospitals in the northern region and are staying higher, the number of new admissions each day is dropping so you can see the blue bars almost following that blue high scenario, behind me, high transmission scenario.

The number of new admissions each day is dropping away quite quickly big -- but because those people in hospital are sick and require care in hospital the total number in hospital remains quite steady.

There has also been a drop in the positivity rates of people presenting to emergency departments across the Auckland region, so they remain highest at the middle or emergency department but have fallen from 40% last month down to 28% now.

Likewise at Auckland Hospital over that period they peaked at about 30% and are now down to 22% . positivity rate of people presenting to ED, all of who are tested, that is at about 18%, and it is up at 16% and still on the way up.

Pleasingly the positivity rate at the Children's Hospital has gone from 35% down to 21% now and on the way down.

The final slide I have got is just showing hospitalisation numbers across the Motu and this is active numbers total, the blue bar is those, you can see early on most of them were there, that is where it started, that the proportion of total admissions in the Auckland region hospitals has dropped away over this last few days or week or two.

So, the admissions in the rest of the country are growing and we will continue to see growth, so I don't think we have picked out in terms of our total hospitalisation and it would generally be one to two weeks after the case kick. And just inking about hospitalisation rates, if we think back to the Delta outbreak in Auckland, over the period of that outbreak the hospitalisation rate was around 8% where as in this Omicron outbreak it has been about .9%, under 1%.

This confirms Omicron is less severe in terms of symptoms but of course much bigger impact on hospital and community services just because of the sheer number of cases.

That hospitalisation rate will appear to increase over the coming weeks because of cases drop people remain in hospital, we will see the do nominated decline much quicker than the numerator. We fully expect that to increase up to one or 2% and hospitalisations will decline but more slowly.

Likewise it is important to remember the number of deaths each day is also likely to increase and will take longer to decline, there is a delay between case numbers of course and hospitalisations and deaths . ongoing reporting will continue to indicate when we know a split because of COVID and those that are able who happen to have COVID.

A final comment just on our hospital and health system, I know that staffing shortages due to our selection requirements are major pressure on the health system on top of the number who are being looked after in the community, including in aged residential care will be a scene that will pressure on hospitals and they do want to pass my huge thanks to my colleagues working so hard to ensure everyone gets the care they need under considerable pressure and often with up to 15 or 20% of their fellows away because they have COVID or isolating themselves or caring for family members.

What might be expected further out? International experience with Omicron suggest that in New Zealand we can expect to see cases will likely remain in the low thousands each day for some time. Hospitalisation numbers as I said earlier are likely to peak within the next two weeks also and then trended downwards during April.

But likely relatively so and we will continue to see regional variation there. Overseas experience with hospitalisations is variable, at some rate the decline was at the same rate as the rise, while fathers it was more slow.

We can expect ongoing waves of COVID with elevated levels of case numbers and hospitalisations looking across the Tasman here is quite instructive, the number of people hospitalised with COVID in New South Wales never dropped below 950 after their first Omicron wave even as the peak of cases waned. It is now back over 1000 as case numbers start to increase again, the seven day average in New South Wales is around 18,000 cases per day, in contrast in Victoria the number of hospitalisations decline down to around 200 and remain steady there, they are not going up again even though their seven-day number of cases is about 7800. , they are not going up again even though their seven-day number of cases is about 7802 quite different pictures but they may be some definitional differences, but what choices we can expect to have the residual cases in the community and people in hospital. You will be aware that case numbers globally have started to rise recently and there are increased case numbers across the UK, with Scotland hit the hardest by a search of the Omicron EA to some variant. Case numbers there are just under the previous peak and hospitalisations of the highest they have been since 2020.

Globally it is likely there will continue to be further waves of Omicron and likewise they will be new variants of concern, with unknown severity, and we will face those as other countries will. All this shows that while our current Omicron wave is receding be clearly need to keep our wits about us and COVID is not done with the world just yet.

However, we do continue to have some advantages here in Aotearoa, countries experience another surgeon cases from Omicron appear to be more affected by this sub variant and in New Zealand that is the vast majority of our cases at the moment, so we may not see quite the same search that other cases are seeing at this point and time again. We also know other infectious diseases, respiratory diseases, particularly the flu and in children RSP, could generate additional demand from the health system overwinter as our...

We are looking at what has happened with these two viruses during the northern hemisphere winter to try to gauge what the potential impact could be here, but meanwhile we are not taking any chances. O

ur influenza vaccination program starts in early April and we have ordered extra vaccine and wide at the criteria for eligibility for free vaccination, we also looking at the role of the possible fourth voice of the Pfizer vaccine for vulnerable groups including older people, and I'm expecting advice on that this week.

Our most significant advantage continues to be a high vaccination rack -- rate, this is at the heart of our efforts through the ongoing pandemic, particularly for our most vulnerable population groups. I continue to encourage everyone to get a booster dose when it is due, there is no doubt vaccination saves lives.

In summary we can be cautiously optimistic, we are passed to the peak of this outbreak, particularly in the Auckland region. We don't know exactly how fast cases and hospitalisations will fall and with a colder winter months ahead need to remain vigilant to COVID and other respiratory viruses, so once I encourage everyone to be up- to-date with their boosters.

And get the flu booster as well.

I will now hand over to Dr Bourne who will update you and then we will take questions.

Thank you.

>> (SPEAKS TE REO MAORI)And thank you for the opportunity to talk about COVID care in the community and how we are supporting our communities to be safely looked after. When they are able to do so.

As Dr Bloomfield has just indicated, while we may have been reaching a peak of COVID cases in the community, we are still seeing extremely high levels of engagement with people with general practices that are very much at the forefront of providing care. Compared with last year, general practices are having 15% more encounters with people each day compared with 2021. Those encounters may be face- to-face visits or telephone encounters.

General practice and other Primary Care providers are constantly adapting how they are working to be able to deal with the number of cases they are seeing.

Those increases in activity for general practice are not the same across the whole country. And so we are seeing like we see the case numbers changing, that being mirrored in the number of encounters we see in general practice. So the numbers in Auckland are now starting to return to their normal levels. In an area like the Hawke's Bay is seeing 33% more people than they were at this time last year.

And then every go to the South Island, Canterbury is now sitting at 30% more encounters. Each week. Compared with last year. And we would expect over coming weeks for that trend to continue across the South Island.

The increase in demand is being accommodated by general practice, urgent care providers, and community pharmacies.

They are managing to do that despite their workforces also having to isolate and isolating when they contract COVID themselves. Within those environments, they have a smaller pool of staff so that can be very challenging. W

hat I want to do is reinsure New Zealand that those vital services remain open. They do not have an option to close. They are remaining open.

To support that, Ministry of Health is opening up a database that we have a people who have made themselves available for clinical and nonclinical work to help with the response. That is being utilised through the vaccine program to date.

So we are notifying primary care providers that that is another resource that they can tap into if they think they need more additional staff. Which I think is going to be really appreciated as people are understandably getting tired, having been living with this for the last two years.

I just want to further remind you that not all illnesses are being dealt with in the community. As COVID. The rest of the clinical services that we have in our communities are still available. Excellent healthcare continues to be delivered by Primary Care providers every day.

I was working last Friday and I had to do a home visit to somebody who was unfortunately at the end of life. Nothing to do with COVID. She has advanced cancer. And what she needed was care provided in her home.

Despite the restrictions we have around COVID and that necessary infection prevention and control measures that are in place, she had already been visited by a hospice nurse, I visited her at lunchtime and while I was there, another person came in to deliver the hospital bed that she required and before the end of the afternoon, she was receiving medication that she needed to keep her comfortable at that time.

Reassuring you again that those services remain available and we need to keep providing them to people who have other conditions apart from COVID.

I just wanted to update around the self-assessment form that we have that is available for people to complete when they test positive to COVID. People receive a text message and a link to a self-assessment form. That form is vital for allowing our care coordination hubs to understand any needs those people may have in the community while isolating.

We have now introduced a place where people can declare a disability they are living with, so that can be flagged and made visible and a care coordination hub. They can be prioritised for contact by the coordination hub to find out exactly what it needs they will have during their isolation. Another part of that form that has been added is the ability for people to flag if they have a problem with where they are isolating.

An example of a case we had recently is a woman who had recently moved from one part of the country to another. She did not have secure accommodation. She tested positive to COVID. And while she was being assessed, it was identified that she would be isolating in a car.

The clinicians in that case were able to contact the local care coordination hub, who can identify a campervan which she was given access to and that she was unable to park that honour friend's property so she could isolate safely.

In addition, a local provider made sure that she had all the food and other supplies that you needed for her isolation period.

I just want to reinforce how important it is that we do continue to isolate when we have either got COVID or we are a household contact. That remains a vital part of us being able to protect those people who are more vulnerable within our communities so that where possible we can prevent the spread or at least slow the spread of COVID-19. I just wanted to take an opportunity just to reinforce what the guidelines are around isolation.

Both people who have COVID and the household contacts. A person that has COVID needs to isolate for seven days even from the day they developed any symptoms at all or if they have had no symptoms, from the day they test positive.

Household contacts need to isolate for exactly that same period and they are encouraged to get a swab at today three and at day seven.

And at any other time during the isolation period if they develop symptoms. If a household contact becomes positive during that isolation period, their isolation begins with the same rules as the person who was the first case in the household. Either when the symptoms started or when they test positive.

At the end of the isolation period, a person who has had COVID then does not have to isolate again if they become a household contact for 90 days. They do not have to test again for the first 28 days. But if they do get symptoms during that time, then they do need to test, and that should be by RAT test not PCR.

A person who has been an household contact and has never been positive at all has a 10- day period if they do not develop symptoms and not as positive themselves, if they become a household contact again, they do not need to isolate. That is 10 days from that point.

These rules may feel incredibly complicated. When we are going through them. That is because isolation remains an important part of our response and the ability to brew -- the ability to protect the most vulnerable in our communities. We asked people to continue to follow that guidance during this period.

Once again I just want to take a moment to thank all of the people who are working in our communities, supporting people, working under considerable pressure, but we see them rising to the challenge. On a daily basis.

Thank you.

>> Dr Bloomfield you were talking about a fourth shot for the vulnerable and at this stage is your thinking just for people who have underlying conditions or could that be extended to the wider New Zealand population?

>> Thank you. I have asked for advice specifically for vulnerable populations. Especially looking at what other jurisdictions are doing. All the people. People with pre-existing condition. In particular. I'm most interested in especially as we go into into. I have also asked whether the offer should be extended to other groups and in particular I'm thinking of the health workforce who would be at a higher risk as we go into the winter period. They were one of the first groups to be opened up to get the booster. Back in December. We are seeing overseas that the effectiveness of the third shot does start to Wayne. And thinking of those groups that got the shots first those with older people in the vulnerable people and the health workforce.

>> Taking the next logical leap after all that has been completed and the vulnerable and the frontline workers with the rest of the population be gearing up for the fourth shot after that?

>> Not necessarily. At the moment, I do not think there is any country perhaps Israel that is offering it more widely to the population but even then I am not sure. At this stage we are going with the emerging evidence which is those higher risk and vulnerable people.

>> When will be no that will be the industry's advice?

>> I will get the advice this week and when -- we will discuss it with ministers and then of course the decision will be theirs. And you can expect an announcement after they have made a decision. One of the aims we have is to look at whether we can vaccinate those groups alongside the flu vaccination.

>> (INAUDIBLE)

>> Ahead of winter. Alongside the flu vaccination. If the decision is taken our aim would be to do that in April and May before we get into winter.

>> I just wonder... Primary Care staff... Can you give us an indication of how much... ?

>> There is no doubt that in addition to the people in hospital and the additional people being seen in general practice that Joe covered probably the biggest pressure is the staffing one because of people who are unable to work. This is what we have planned for. There are a number of actions in place to deal with it including redeploying staff within hospitals and across the community. I know that this is happened in some district health boards redeploying DHB staff in aged residential care. As well as those critical worker exemption schemes for people who are contacts. And even although it has been used only on one or two occasions the opportunity for staff who are absolutely critical who have tested positive but a symptomatically to go back and work not only with COVID positive people anyway. There are a number of actions in place to help deal with that.

>> (INAUDIBLE)

>> The general figure we have had and it does very but up to around 15 or 20% and it varies by professional group. We know that at some hospitals like Middlemore Hospital early on they had even higher proportions of the nurses off in single days so that it really put a lot of pressure on.

>> We need to keep our wits about us. There have been significant changes to home predictions being announced. I'll be ready for that? -- are we ready for that?

>> I do not want to pre-empt the announcement of the PM tomorrow. We will make the point. I do not think there is anything that I will say that conflicts with what the issues that cabinet has been considering. This reflects also the comments made by Doctor Michael Ryan from the WHO on March 16. We are still in the middle of a global pandemic. This virus is still very fit. It has thrown us curveballs before and will continue to do so. We have throughout the pandemic adjusted our setting. As we come down off the peak of the omicron outbreak. It is appropriate that we look at and adjust the settings. But we need to make sure we are ready for whatever comes next. And that may be winter. Even just winter with Omicron and other diseases thrown in, but it also could be a new variant. We need to be prepared to redeploy the measures that we have already in place or that we have used in the past. If the indications are right and we will keep a close eye on the.

>> Is it appropriate for the government to be using restrictions that were to keep COVID-19 and its variants out of the community and to keep other illnesses like the cold and the flu out of the community as well?

>> These are exactly the things the government has been considering because there is this balance between making sure we are protecting the population and vulnerable group. And making sure that we are only using restrictions to the extent in the time period they have indicated to be used and again this is what the PM will be announcing tomorrow.

>> The assumptions you have made today and the modelling is that based on current settings as in just as the COVID settings art today?

>> Yes. The modelling was based on what the settings were that we anticipated or in place ahead of the outbreak. And of course we have overlaid what is happening with the actual cases. I do want to emphasise that we are not expecting case numbers to go back to 0. There will still be a reasonable number of cases. 3-5000 would be the estimate that we have got each day for some weeks. That may well maintain that level right through until winter.

>> Would you expect increasing cases once restrictions are eased? You must've done some modelling looking at that.

>> That is something we will watch but again I think you will see that the government's decisions have been fully informed by the current situation and the public health advice. even if we look at the framework, the next step would be go down and that has still quite significant restrictions in it, and/or public health measures, and the key public health measures that I talked about doing the basics well, masks, distancing, including staying home if you are unwell full

>> Are you going to offer the government any briefings on the legal aspect of using COVID meetings that are coming with the flu season, is there a legal issue there of using measures that are designed and legally designed for one virus against another? Is that something someone else... ?

>> We have not been asked for advice on that and it has not been part of the discussions I have been part of. What I would say though is that as we get into winter people won't be presenting with COVID they will be presenting with influenza -like illness symptoms and part of the preparation is thinking about how we look after all those people, we have got at the moment a set of arrangements in place, our care in the community, testing and so on that is specifically for COVID. Now we are thinking about what that testing and care looks like where people may well have flu or covert or respiratory illness or for children it could be RSV .

>> Just going back to COVID, has anyone (inaudible) from one hospital to another?

>> Know, that is not something I have heard any reports of, although hospitals have dedicated COVID wards and/or have reduced provision for example of planned care and they needed to to ensure they were beds available for people. I should say that in addition to people being looked after with hospital level care with hospital, there is also a program particularly in the northern regions of hospital in the home, so quite intensive support for people ensuring they can remain in their own home.

>> How many ICU patients (inaudible) COVID?

>> Think we have traversed the number of ICU beds quite a bit but I would say at the moment our total ICU and H DU beds are about 60% and that has been quite consistent. We have got today 25 of those, around 300 beds, 25 have got COVID, people with COVID in them. And of course it is one thing to have a bed but you need the staff of course for those beds, so every day the hospitals are looking at what is the projected number of people they might need their staffing those beds.

>> Just confirming they are not the ones that accounted in (inaudible)?

>> We are now reporting deaths that have come through in the last 24-hour is, a couple of times in the last two to three weeks there has been a bit of a backlog as you will be aware last week we reported deaths and 16 of those had come through over the preceding two or three weeks. We feel we are up-to-date now with the reporting so the figure each day is pretty much the number of deaths from the preceding 24 hours.

>> Over the weekend in New South Wales child aged two died, what does that tell you about the virus? For those around the country who might be taking the virus so seriously?

>> Some people, including people who with previously feeling well, the young child in New South Wales, they can get seriously ill and sometimes die. So this is not a trivial infection and if we think about the number of flu -related deaths per year, around five or 600 in a typical season, we have seen that in the couple of years that the board has been shut, we don't expect it necessarily to go on and on through to the end of the abutted as well of a 3000 deaths per year so this is clearly, even though Omicron is more mild than earlier variants, this is clearly significantly more deadly virus then flew and part of that is because it is way more transmissible, the biggest rather of hospitalisations and deaths other number of cases out there, so I want to encourage everybody to do everything they can reduce the risk to themselves and others, vaccination is the most important thing there.

>> Did you brief cabinet on Monday with the Ministry of health perspectives, the ones that the Prime Minister is currently considering?

>> I did not myself but we have put advice to cabinet, we have provided that advice of the last two weeks, number of discussions with colleagues and ministers across cabinet.

>> Was there a representative, and was that a bit unusual that there wasn't?

>> You have been to more than any other in history, so why would you not there?

>> Especially through the first couple of years we were in our elimination strategy and things are evolving so rapidly and very often I was breathing cabinet with the latest data on the day to inform decisions that were quite significant, usually around alert level changes. We are in a different phase now so I have not been involved in breathing cabinet directly but clearly health input is very important as a part of those briefings that cabinet gets to the Cabinet paper.

>> Just on the other variants, you said we are still in a pandemic and there are different variants, does that mean that lockdowns are not off the table?

>> That is a decision for government and is not something we have discussed. But to be clear the Omicron variant, it is the first of these new variants that has been both more transmissible but are less very lent -- virulent. The others have been more deadly you have got to say, so there is no reason to believe that the next variant is going to follow that pattern and this is something the WHO and others are pointed out. We need to remain prepared and realise we are still in the middle of a global pandemic. Not specifically, I think it is very emergent but at the moment it is the Omicron variant that is the one causing the most problems globally final question?

>> Mental health, the mental health and has suggested a $2 million mental health and budget will make little difference to services, (inaudible) more tangibly in New Zealand?

>> Well, the $1.9 billion that came through in budget 2019 and around two thirds of that was for the health system, the critical investment there and the mental health being commissioned know and supported this, was for primary and community-based mental health services. And there has been a big investment in that area, and there is a range of services available now to general practice, Maori and specific and use providers that were simply not there three years ago and that is where the focus has been. Part of the reason for that investment was to avoid the need for people to then require more specialist care. So saying, District Health Boards have continued to invest in specialist services year on year, but the big challenge there and this is one minister little point about this morning, is workforce and there is a number of initiatives underway to expand and grow the workforce, the specialist workforce to help support that increased demand there is for specialist services. It is not a short-term solution but the $1.9 billion and the health part of that was specifically aimed at growing primary mental health services, and it is great to see that there is a range of services now available that simply were not there three years ago.

>> Just following on with that question, it could take about seven to 10 years to (inaudible) New Zealanders potentially, another seven to 10 years on the mental health crisis?

>> There are many ways one can grow the workforce and part of that is of course the borders are going to be open again so that gives opportunity to strengthen that workforce. But in particular and this is the basis of the primary care for this is to grow new workforces and that essentially, those services are now being provided to thousands of people every month, it is a workforce that was not there previously. We will continue to look at ways to do that and at the same time grow the specialist workforce, which would say it is a global challenge, the mental health workforce, particularly psychiatrists and psychologists.

>> Would you characterise it like that, do you think we have a mental-health class is in New Zealand?

>> You are probably aware I'm not a huge fan of the word crisis, but there is no doubt we have significant mental health issues and challenges in the country and the health system is one part of the response to that. And they are big workforce challenges there and that is why the government has made this big investment there. But I would also say is I am very thoughtful about the mental health and well-being impact of this experience to the pandemic, and I think that is something we need to be really alert to and thinking about how we support individuals, Whanau, and people to maintain their well-being as we come to the third year of the pandemic. That is a fall of us, not just mental health services .

>> Sat in the future we will have in the low thousands cases going forward, is COVID something that we in New Zealand and indeed the rest of the world have to live with for the rest of our lives?

>> I think COVID will be around for good, just as the first reported, I think the first reported or known reference to influenza was about the 11th century, it is something that has been with us. COVID like other corona viruses will be here to stay, the question is just what sort of impact it will have on individual countries, communities and globally. We are only two years into this virus having appeared, and so but what the future holds none of us know but we need to be prepared. Good, thanks very much.

>> Just on the vaccination rollout, someone said the government has missed an opportunity to roll out the vaccines at the same time and is claiming around $8 million worth of vaccine are going to waste, is it possible to rollout both at the same time and any providers doing this?

>> So, this is something we have looked at because in particular for that age group, about 15 or 16 up to just over 30 where we know they are under vaccinated, that is where we have been doing our campaign and we have been looking at it for some months. Logistically just did not roof possible to do partly because any of our vaccinations are being given out, the COVID vaccinations do those drive- through centres and that the nation clinics and the vaccinated is there a train just to give the COVID that the nation. Logistically did not prove possible, however we have got some very advanced work on this and within the next couple of weeks we have got, we are planning to ramp up the campaign to increase our vaccination rates at the 12 and 15 month vaccination, but also catch up for those 15 to 30- year-olds. And are looking to see if we can do that alongside the COVID booster, so that is a work in progress.

Thank you very much, everybody, see you again.