COVID-19 update - February 16 2022 12pm

Live Transcript – 1200 NZDT Wednesday 16 February 2022

Ministry of Health Media Briefing – COVID-19

Speakers

+ Dr Ashley Bloomfield, Director General of Health

+ Dr Joe Bourne, Ministry of Health Primary Care Lead

+ Viv Rickard , MSD Deputy Chief Executive.

>> Kia ora Tena koutou katoa.

Nice to see you here masked up and suitably spaced.

It's a good opportunity for me to thank our colleagues in the media for your role over the last two years and supporting us in getting information out to communities and asking good questions to make sure the information is clear and people are getting what they need. It's been a challenging time in the role you have played has been critical and we appreciate your efforts in this regard.

Today's format, I will run through the main features of the shift to phase 2 and a couple of colleagues, due Dr Joe Bourne who leads the care and community program in the Ministry of health and every card, the deputy chief executive of MSD, and we have Michael Dreyer, our days are -- data and digital whiz and is responsible for the team that has developed the digital tools over the last two years for the COVID response and the vaccination program, he will talk to you later on about the digital tools coming on time to support the move to phase 2.

Phase II and phase 3, should we get there, are all about flattening the curve. We want to reduce the number of cases and the spread of cases to the greatest extent possible. The aim is to keep people well, out of the health system, out of our hospitals, and making sure the country keeps functioning to the greatest and possible.

Key features of phase II have been announced in the last few days.

Foremost among those, the reduction and isolation period down to 10 days for cases and contacts down to 7 days.

The use of rapid antigen tests, there is a lot of interest to support the critical worker exemption scheme to allow people to be back at work if they are identified as a contact, if them being at work is critical to a service continuing to run with the use of daily rapid antigen test and the greater use of digital tools.

We will go into how those will come on stream and how they will deliver during the discussion today.

Starting with cases and contact tracing, digital technology has and will continue to help us identify new cases and contacts more quickly. Most cases will be notified by text message if they have returned a positive result and the message will provide a link to information around self isolation, how to inform others that you have COVID-19 and whether they are a contact, how to look after yourself and what help is available. Cases will be available -- invited to fill out a web based form to make sure they receive any support they may need to isolate safely and successfully.

For example, if a person is immunocompromised or has an underlying illness that has impacted themselves or a member of their household, they will be able to have a discussion with our teams in order to determine the support they need.

As part of filling out that registration online they will identify who their close contacts might be for contact tracing purposes. We would imagine most people will identify their close contacts, particularly family and household members and people they work with and that will enable us to get a speedy response and get both cases and contacts isolating straight away.

Most people and we know with Omicron will have mild illness and won't require support. They won't require any phone interviews. But there will still be that option for people who either prefer that or don't have ready access to digital tools through a cell phone or computer.

And our public health unit teams will be focusing on those cases and outbreaks and setting at high risk like aged residential care, corrections facilities and those sorts of places or where it might be a super spreader event.

To emphasise again, just as it is now, there will be phone opportunities for people, remembering most of our cases now are notified they are a case by phone. The majority of people won't be receiving that outbound call but it will be there for those who need it. I have talked about the isolation periods of cases and contacts in particular for household contacts, they will now only need to isolate for 10 days and the 10 days starts at the same time as the case in their household returns a positive test. They will be asked to get a test on days 3 and 8 and if it is negative on both occasions they get released on day 10 along with the initial case in the household.

We know households with delta, Omicron other places where we see the highest conversion rate. Anywhere between 30-50% of household contacts with Omicron are becoming cases themselves. We expect to see that still.

Likewise, as with cases, contacts will be notified by text message and will receive links to information they need. I should say we will continue to use QR codes, Bluetooth, and other locations of interest will be put up to identify places where we need people to isolate. If they are high risk settings.

We have done some analysis of Bluetooth notifications over the month from early January to early February and interestingly, here are some numbers, of 2258 community cases interviewed, around 20% of those, 462, were provided with a Bluetooth token that allows them to anonymously generate a notification to others who may have been in close contact because they swapped a Bluetooth signal with their phone.

About 20% of people who are contacts in that time received a Bluetooth token.

Of those, around 90% successfully used token to send the message out anonymously.

It doesn't identify the sender or the recipient. 1500 devices received a Bluetooth notification during that month.

And about one third of those resulted in people calling a helpline, 538 calls, in that month, people who identified as having been notified by Bluetooth.

And overall, it was less than 1% of our contacts who were identified through Bluetooth notifications. It is still an important technology and will become increasingly important in phase 2 and we will use it until it reaches a point where it is potentially resulting what has been called overseas a ping dammit, we don't want people to be notified if they are not a contact.

There has also been a lot of discussion around what a closed contact is, we have a clear definition, I won't read it through but it is clear on the website. Those who live in the same household are clearly the most important and others with whom you have spent quite a bit of time.

The general rule of thumb is if you have been close, that is within 1.5 m, of someone who is positive for more than 15 minutes and they were not wearing a mask, that is close contact.

And direct contact through kissing or sharing a cigarette, not much of that happens nowadays which is good, may be a vaped or a drink bottle, you would be a close contact or if someone has coughed or sneeze directly on you.

And spending time in a confined space with activities like singing, shouting, exercising or dancing going on, these things create a high risk and that means someone will be a close contact, the definition is clear on the website.

With regards to testing, PCR testing remains the mainstay of how we identify and diagnose our COVID-19 cases, particularly early in phase 2. We will move during phase 22 using rapid antigen tests in some cases for diagnosis but there has to be a point where we know there is a decent prevalence of cases in the community.

We have some data from yesterday from Middlemore Hospital where you would imagine people turning up at hospital would be more likely because they are turning up with symptoms to have COVID- 19.

Yesterday it Middlemore Hospital, just under 10% of people presenting to the emergency department and everyone received a rapid antigen test, 10% were positive.

The reason it is useful to use rapid antigen tests there because there is a high pretest probability, unwell people turning up seeking care. But out in the community where you have people, even in Auckland at the moment with three quarters of our cases, rapid antigen tests are not accurate enough. The press Gallery had an example of this early in the week where someone returned a false positive rapid antigen test.

As case numbers increase rapid antigen tests will start to play a role in helping us identify and diagnose cases.

From today rapid antigen tests are playing a role to support our critical worker exemption scheme and I have checked online, you can look on Healthpoint and find out where the closest places you can collect rapid antigen tests if you are part of that scheme and you've been notified as being a potential contact and you are required to go to work as part of that critical worker scheme to ensure that business can continue.

We will also be using rapid antigen tests once we open up to Australia from 27 February, people coming across the border who are going home to self isolate will be provided with a pack of ransom -- rapid antigen tests and our COVID response worker is currently undergoing surveillance testing using PCR will transition to rapid antigen tests are we free up the PCR capacity for diagnosis deaf and testing in the community.

There's been an increase in testing, particularly in Auckland in the last couple of days.

I want to emphasise the point, people who need to be tested are people with symptoms or those who are known and notified as being close contacts.

It is not helpful and not necessary for people who don't have symptoms or who are not close contacts to seek testing, just because they would like to be reassured. And it's important we make sure our testing is used for the right things at the moment.

I am going to hand over now to Dr Joe Bourne who will hand -- walk you through the caring community process, what it looks like for someone who can look after themselves and what it looks like for someone who need support from the health system or social support services. And after Joe I will invite Viv Rickard to make some comments about how a social support services link with the health ones. And then our technology team will walk you through some of the new tools as well.

Over to you, Joe.

>> Kia ora Tena koutou katoa.

I am here to talk to the detail that Ashley Bloomfield has touched upon when it comes to supporting people in isolation.

This is a big shift psychologically for the population in the healthcare sector because to date, we have been providing fairly intensive support even for people who have been relatively well in the community in terms of the number of phone calls they receive from nurses and doctors and nurse practitioners.

Now as we move to a situation where we expect larger number of cases and with the variant that causes less severe disease, we have an opportunity for us to use greater self-management as people would be used to doing when they get respiratory infections at other times.

So, the whole principle of this is that people can continue to receive good quality and appropriate care, clinical care, while preserving the resources in the health system and those other welfare support is to be available for those who have greatest need. By enabling people to look after themselves, people looking after not only themselves but their whanau and communities, we can preserve healthcare resources and other resources for those with the greatest need. What I will do is just walk through the different stages of the pathway that is there for people to self-manage.

As Ashley Bloomfield touched along, the beginning of the pathway comes with a positive notification and we know that positive test that tells you you are COVID positive is currently through a PCR test but in time will move to other types of testing, and Michael will touch upon those methods we will have in place that people can upload their results in the future.

But for now people receive a text message and we will show you what it looks like because we are aware that when people receive a text message that says click on this link, follow this link, there can be some concern it is part of a phishing scam. We want people to be reassured this is what the text message helps like it will be helpful if they can click on the link and take themselves through to self- service form. we have system set up where people will have a phone number so anyone who doesn't have an ability to click on a link can be reassured we have telephone capacity to provide you with the support you need through a telephone instead.

Behind all of that we have local care coordination hubs who have a responsibility to make sure nobody slips through the net, so they will be monitoring when each person's test comes through, flagged to them at their local hub level, monitoring that list and will be able to see as and when people have that first contact and that first assessment. For those that are not seen to have that assessment, they will follow that up by any means necessary and we already have those local coordination hubs who are working very closely, particularly with iwi and Maori And pacific providers and they can reach out into those communities if they cannot see evidence they have been able to interact with us. Just coming through to that self-management pathway, when people click on the link they will be taken to a self- assessment form and that form will collect data we have previously been collecting over the phone and that will involve an assessment that considers people's clinical needs, any requirement... Constraints difficulty around them self isolating and also what they welfare needs are. That then... All that information gets pushed down to the appropriate providers so they can then take the actions needed in order to provide the care required and this is a real example of where we are having to work across multiple agencies so we can benefit from all of the skills that they bring to be able to support people. We anticipate most people will be able to self manage and we will identify that through the information we have gathered and if somebody is then on the self-management pathway, they can really expect very little contact from the health system or any of the other agencies but they will have extremely clear advice as to as and when they should escalate their care because we don't want people sitting at home wondering what should I do? I feel more unwell. Again reassuring people all of that support is available but it will be down to people and they whanau to activate where it is necessary so that could be a phone call that you make to your general practice or through a tele-health provider if that is needed. The care is there. When you are reassessed, that care provider will say, "This is somebody who needs additional support," And they will be contacted regularly like other cases are that are under active management or they will make the decision that actually those symptoms are OK, they can provide reassurance and that person continues to self manage. Finally, at the end of the self-management... The isolation period, people will be automatically notified again through a text message where they are able to receive text messages that the period of isolation is complete and they can then return to what they normally do. We will be working with employers to ensure they understand the initial text messages that people receive at the beginning of the isolation period and at the end of the isolation period can be used as evidence of the fact they have been unwell and have not been able to be at work. Again, we look to see how we can preserve the capacity of the health system and in particular general practice so that Enactus and time providing medical certificates when going back into work. -- they do not have stop that can really pressure on the health system. That is essentially how we are looking to run things. I think that again we are imposing -- reinforcing the message and people from our priority populations, Maori And Pacifica, that will not work for all groups and the self-management pathway is what we have to create the capacity in the health system in order to be able to provide that higher level of care. People from this priority populations may need that. And a local care coordination hubs of the safety net that ensure we cannot design a pathway that will be appropriate for every single individual person, so what we do is empower our communities and our local providers with the ability to design the appropriate pathway that will support people with higher needs through their period of isolation. So, we have got Viv, stepping up an inner second and a video that will demonstrate an example of the resources available online for people. -- in a. Then Michael will talk through some of the specifics of those digital labellers that people will be able to access when diagnosed with COVID-19. Thank you.

>> (Speaks Te Reo Maori) Ladies and gentlemen, I will try and make sure we keep comments short. I want to highlight a few things. Firstly, in late November ministers made a decision that actually heading into Delta and Omicron which we didn't know exactly what was going to happen in the future that we needed to put more support in to help our busy health colleagues, so as a result they have asked a misty to coordinate a health response with nine agencies and that's what we intend to do to help health colleagues and the message that Ashley and Joe go. Our model mirrors the model in health so they have an online form as Joe has talked about and that self-assessment piece. We have a better touch of that form outlining the welfare needs. We have put up things at a regional and local level to support the health response and the welfare needs, we have funded 150 providers throughout the country. Out of those providers around 70 are (inaudible) whanau providers and Pacifica providers. I think the key for us is to ensure people are able to isolate and with the help support when required and also with the welfare support but I want to highlight that really for us the key things now are really for New Zealanders as a whole to get prepared because generally, prepared is not just about buying stuff, prepared as not having a plan, contacting the right people, knowing who you will go to, knowing who your neighbours are and if you have to isolate who will bring things to your place. However response will be for those that cannot afford to or are not able to access help while they are isolating, so it is for the period of isolation. I think initially I would say that we have been going for a while and it seems that the biggest immediate need has been food and as a result we have funded 205 food organisations throughout the country as well to support the welfare response. The key for us, I believe, is that we keep talking about coming together as one to help. There are some people that are going to need support and others will be OK. And I think the mechanism, both through Health and through the welfare coordination agencies, is to pivot our emphasis on those people and then with that, we will be able to do really well. Ladies and gentlemen, I will wait until later to see if there are any questions. We might hold it for today and see what comes about. (Speaks Te Reo Maori)$$JOIN.

>> I am Michael Dreyer from the digital team. I have Miriam McLeod, one of our project managers. We will do a bit of a quick demonstration, show and tell of some of the technology and as we go through, we will talk you through some of that and afterwards I will take questions around.

>> -- it.

>> Starting from today we will start texting positive case notifications. Those will come from the text message number 2328, which is also the same number that the vaccine messages are sent from and that will contain two links and a number of phone numbers. The first link will be to the contact tracing form that has been described that also has some elements of wellness and welfare requirements, so this will be... This is a form through which you can share your information, share the information from your COVID tracer application including your diary and Bluetooth tracing, any other high risk exposures and information for your close contacts so they can be notified as well as linking through to the welfare support systems that MSD set up. Initially, this will link through, so today this will link through to the Ministry of Health website. For further information about what people need to do as a case or as a contact... And starting from tomorrow, this will come through to the COVID- 19 help help, which has been designed to make information relevant and easy to understand so that people in the stressful situation of testing positive for COVID can easily understand what they need to do and what help they can access. -- hub. I will also give a quick demonstration of the feature that has just been added to my COVID record, which allows people to self-report the results of a rapid antigen test, the RATs result. This has been deployed this morning, so this is available now.

>> (Inaudible)

>> Yes. So, this will help people understand not just to report through the result of the rapid antigen test but also to understand how to interpret it, so if both the control and the test one of visible, then that indicates it has been detected. -- line. We are being careful about the wording here because at the moment there is... It is detected and the advice is still to get a follow-up PCR test.

>> That may change over time (inaudible) higher numbers of cases.

>> That is using My COVID Record, which millions of New Zealanders have signed up for two access vaccine passes.

>> What we saw during the vaccine program with things like My COVID Record and Book My Vaccine is 80% of New Zealanders were up to (inaudible) working digitally through those channels and were able to provide technology to those who did not (inaudible) so we could support them to use them well and with the other 20% we could push them through (inaudible) channels. It worked really well and this is what we are going after again here.

>> I think that is all.

>> We will open up for any questions.

>> Yes, the video. (Captioned video plays)

>> Thanks very much for the demo. Some interesting new symptoms on demonstration in the video. We will do some juggling at the top but Michael, if there is a question on technology for Michael?

>> With all this technology do you require data and what about whanau in rural areas with no access to data?

>> The way we have designed the service, it allows for 80-90% of New Zealanders who can self- serve digitally. For those services provided online, wherever possible we provide funded data channel so it doesn't rely on you having data on your plan. It doesn't always work like that but wherever possible we work with the big telcos to make that happen. If the technology is not going to work or you don't have access to et al... In remote areas and that's where the local care hubs, the GPs and the local providers step in and can provide more direct services on the ground. We saw that during the vaccine program as well.

>> It seems like in the locations of interest have become less important, with the new definition of close contacts and self reporting. Can you explain, will they be updated and regularly published?

>> Locations of interest will still be a thing but there are two new aspects. First of all, there will be so many of them that not all would be able to be followed up by contact tracers. We want our contact tracers to focus on exposure events at the highest risk and that brings me to the second point. We know already from what has happened in the last month which are higher risk exposure settings, and they are not for example public transport or supermarkets and those sorts of places. We don't need to identify people in those places as contacts. This will rely on everybody doing what we have required through the last two years, even if you are not notified as a contact, if you have symptoms, go and get a test. That has not changed. We will focus our exposure events and notifications about locations of interest on places that are the highest risk.

>> Very important to keep scanning in, people will want to know when need to know if they've been at one of those higher risk locations of interest. Exposure locations, first of all. And secondly, Bluetooth is still playing an important and useful role, we want people to keep their Bluetooth turned on.

>> People may worry about being caught up in a self-contained and having to self isolate, and they may not scan or turn Bluetooth phone. What would you say to them?

>> It will be a much narrower group who will be identified as close contacts, so if you continue to scan and are identified, that is because you are at higher risk. It's even more important and useful to scan in during phase 2 because if you get a notification through your app you are in a high resetting it's even more important to isolate.

>> Will schools be part of those high risk locations? Or will it be up to the families to notify the school about their child?

>> On your second point, it's important families notify schools and likewise that people notify their employer if they test positive. That allowed schools, who have good guidance with support around the Ministry of education, to assess the risk. Those are the sorts of settings where public health units can provide advice. We have already had quite a number of schools where they have had cases, particularly in Auckland, and they are responding very well, they have good guidance and support from the Ministry of Education but it's important for families and guardians to notify schools about positive tests.

>> How many people (inaudible)?

>> We have many thousands in the country and we have another 50,000 on order, most people will not need a pulse oximeter. To date, especially in Auckland the vast majority have received a pulse oximeter, that will not be the case could, partly because Omicron is a less severe illness. Those who are on the self-management pathway will not need a pulse oximeter. They will be provided to those who need them because of, for example, pre-existing conditions, they are likely to deteriorate and we need to monitor their oxygen saturation.

>> Rapid antigen test available from today for that specific group, are things running smoothly?

>> I haven't heard to the contrary and I would have if they were not running smoothly. Early days yet. We have been working with businesses already and someplace is already over the past week and even in phase 1 where there were specific needs, Air New Zealand would have had crews who had to stand down but we work with them to get supplies of RATs. We will continue to work with businesses who may have a large number of workers with potentially contacts, an example in the Nelson Marlborough region with King Salmon., 250 potential places person cases amongst their staff.

>> Today being the first day of phase 2, how would you describe where this current outbreak is? Have we reached a peak or is that yet to come?

>> We are definitely still on the way up. Over the past few days we see high hundreds of cases, you can expect the case number today to be over 1000, on the first day of phase 2 when we said 1000 was the time we would move to phase 2. If we look at the expense of other countries, there is no doubt that case numbers will keep going up. We have cases in all regions of New Zealand, so it is all the more important that people do the basics well. Get tested if you have symptoms, if you haven't had your booster, please do that, it's important and helpful.

>> On the RAT testing, well that self identification be included in our daily case numbers or if not, when do you expect it to be?

>> That's a good point, we are going to start including the results of positive RAT tests when we reach the point they are being used for diagnostic purposes. At the moment they are being used as a screen, if someone returns a positive, what was the right terminology? A detected result. They still have to have a PCR test. At the moment our case numbers will be confirmed by a PCR test, whether a first test or a follow-up to RAT. It may still be in phase 2, it will depend very much on whether our PCR capacity is able to keep up. But we will signal that shift. Likewise, as we move to higher case numbers we also know that our case numbers won't be an indicator of all the cases out there, even now we know there are some cases that are not necessarily been tested. We are not capturing everybody. We will provide the confirmed cases through PCR testing, we will include rapid antigen test results when we get to that point, and we will also include an estimate of what we think the way to case numbers might be, based on some modelling, including the results of wastewater testing because ASR can give an indication not just of yes or no but an estimate of the number of cases from a region where the wastewater detection might be happening.

>> What would it take to move to phase 3, what would the setting be?

>> Similar to those that been laid out already, it is about our capacity and testing system, what is happening with our hospital and primary care capacity, and the caseload is clearly important. Indicative Lee it would be around 5000 cases per day. It's not inevitable we moved to a phase 3 at this point in time.

>> Will schools be one of those high risk locations that the Ministry of Health be notified or not?

>> Not necessarily. In the first instance parents will be notifying the schools and they have a good protocol and dozens of them have been developing that protocol. Following that protocol. If they need support from the local public health unit, it will be there but in and of themselves schools are not a high risk setting.

>> You have talked about people who need care, people who are not compliant, what practical capacity under this system is there to monitor compliance and has consideration been given to the use of geolocation?

>> The geolocation technology in what way?

>> In Taiwan and some other places where it helps.

>> You mean compliance with the requirement to self isolate. It is not something we have used and not something we are planning on. Our response has relied across all domains on people doing the right thing, and in large part that's what New Zealanders have done and that's why we've been successful.

>> You are relying on the likelihood that people will be compliant rather than forcing compliance?

>> That is clearly not something that is possible to do with such large numbers of cases. I have a high level of confidence people will want to do the right thing to protect themselves and their whanau and the wider community.

>> How close is the current PCR testing to capacity at how soon will that be reached?

>> Our seven day average test is 22 or 23,000 per day. Our total capacity at the moment, we could surge to 60-70,000 per day, but there is a rider on that and this is important in Auckland where the current capacity is 20,000 per day. Once you get a reasonable number of cases, the positivity rate goes up, they are less able to pull tests. With low rates of infection in the community, you can do up to 8 samples at once, and mostly they would come back negative. If you get a positive result you pull them out and do them individually. With positivity rates in Auckland, between 3-5%, they can't do the pooling, that reduces capacity. At the moment our non-pulled capacity nationwide would be 30,000. Most places around the country are still able to do some pooling.

>> How concerned are you that that event in Parliament was a super spreader event?

>> It could be an event where there are infected people, there is probably a lower vaccination rate than there might be in the general population and because people are clearly in close contact and not wearing masks, that increases the risk. Again, the rules are there for everybody. They are there to protect not just individuals but to protect others. It's an important thing about Omicron, it may not be as severe an illness for most people, if you are young and healthy, but it sure is and can be deadly for people with pre- existing conditions, or are immunocompromised or are older. Those are the people whether measures like use of masks and physical distancing are designed to protect. The same as ever, do it for others if you are not prepared to do it for yourself.

>> How do you know the strategy will work for Maori given the Maori providers are overstretched and lacking skilled workers, one example of a clinic had to close, how do you know it's working for us?

>> I was looking this morning and the doctor suggested we should have gone to phase 2 last week and a reason we have designed this phased approach is because it allows us to absolutely focus our resources and the response on those communities and those whanau and individuals who have the highest needs.

>> (Inaudible) rather than the clinics go to our whanau. As an example, (unknown term) is 2.5 hours to go to Rotorua. Very difficult for those farmers so you are asking them to come to you.

>> Not necessarily. Joe might want to comment on the range of options available.

>> Kia ora. Thanks for the question. My own general practice is based in (unknown term) and I guess I can speak from personal experience about how we are engaging, not in a really remote location but in one way we do see significant high need among our (Speaks Te Reo Maori) Population. -- Maori. We should not put (inaudible) take for granted the effort put in by our (Speaks Te Reo Maori) And the community in the last two years have stepped up and supported each other and that is what we have done on a daily basis when we have had new places -- cases come to them. When people do not have the ability to come to us we go to them. One example is having Khan conversations with people in (unknown term) and their approach is tailored on the meeting are not just engaging with iwi around the coast where those people know who those most vulnerable people are in those areas that have the least access to Wi-Fi, etc. And they are going to use those people and those whanau and connections to reach into those communities and ensure where travel is not possible they can still get access to the care they need. And the example was given around pulse oximeters and you can measure your oxygen level. What we have done there is we have had a person whilst maintaining appropriate social distancing go out and demonstrate the use of the tool, which is quite unfamiliar for people and then they can go back and they can support the recording of those readings and interpretation and where, necessary, come back to the clinicians part of the team and help understand whether that person is a particular risk and ultimately if what we need to do to preserve that person's healthcare we can arrange for transport to take them through to hospital level care. We think that will be a small number of people but those safety nets are still there so I wouldn't underplay the challenge and I recognise this challenge actually exists outside of COVID as well but we do have lots of mobile teams who are doing their best to reach into those services and I think this is work the ministry of health's role is to support local communities to deliver the care they know is needed within their areas. -- way.

>> Can I ask (inaudible). (Speaks Te Reo Maori). A couple of things. The first one is the Prime Minister - and it is about care of the community - and (inaudible) acknowledge there were some of our whanau who are isolating in (inaudible) so... However, they passed it on to the Minister of Housing to get them to get care. So, are we saying they that our whanau who are having to isolating cars, sheds and garages will not get the care and protection, the care in the community they require because they are not in houses? That is not what they are saying, are they?

>> No. (Speaks Te Reo Maori). People should not isolating cars during COVID. We know we have housing and accommodation challenge in our country pre-COVID and that exist today and in some ways has been exacerbated but what - - by what has occurred. Equally we know that under pressure they are sometimes within some regions around the country and Auckland has significant issues that Auckland -- we have to use measures to help the whanau. That should be driven by the clinical piece, they have to isolate because of the clinical welfare these costs, might be because the way the (unknown term) is set up. To reiterate - I don't want to see people and they should not be isolating in cars. There is no need for that. We can find places for people to isolate.

>> What role, if any, this MSD play with providing emergency accommodation like hotels people can safely isolate?

>> We provide emergency accommodation today for 5000 households. They are in emergency accommodation. That is what we are doing today and we will continue to do that during COVID and find other options for people but the sense is mainly that if you have to isolate as a result of Omicron, generally you will be isolating in situ, where you are at the moment unless there is a need (inaudible) and that is difficult for large households sometimes and I understand issues in relation to that but generally we will ask you to isolate where you are.

>> There is an issue around trust, though, and Maori... (Speaks Te Reo Maori) We are not hearing those messages from us and we having to go through the minefield of all this technology and technical staff. We aren't having those messages sent to us, so again we are sceptical about whether or not the strategy will be successful for us. -- stuff.

>> (Speaks Te Reo Maori)$$JOIN. I think you are right. I understand the challenges and issues around remote and our people but I think and it was lovely to hear about (unknown term), Waikato and the coast and my relations will be ecstatic that you have mentioned them but I think the issue is actually this is not around just ethnicity, HARRY ZAC:, New Zealand. We recognise within the health and welfare system we have to do better for Maori and to ensure what has occurred before that we don't exacerbate issues that have gone on previously and I think you heard me talk about the way we have funded and in our model, if you think about the amount of TAHNI FROUDIST: providers, they are the largest number and can I take the opportunity to acknowledge these providers out there? They are on the sharp end and have been for 18 months and they have helped in the community for the health and welfare response and that has been fantastic. A shout out to them.

>> Dr Bloomfield, we have 125 (inaudible) vulnerable people isolating. It is the best solution for isolating households?

>> It is one part of the solution. We have found camper vans have been really helpful in some instances, partly because they are mobile and you can take them out to different places including remote places, but they are just a part of the solution. As Viv said an impact all out DHBs already have had local accommodation arrangements, those are still there and we still have rooms available if we need to in our large centres and managed isolation facilities to support people to isolate safely if they need to there and every day there are some people going to those facilities still.

>> Could you explain what the threshold is for being able to access an MiQ room or get a campervan?

>> The threshold is based on the people doing the assessment, talking to these individuals and whanau to find out what the needs are and then discussing with them what the options are and it is a joint decision about what is the best thing for that particular person.

>> You mentioned the arrivals at (inaudible) 10% testing positive.

>> I don't know the actual number. Off the top of my head it was around 250 presentations on that day, so around 25 tested positive. Many of these people would have been seeking healthcare because they were symptomatic. Routinely there because if you look at our case numbers over the last couple of weeks, South Auckland, Manukau has been where the highest number of infections are so that is the situation where routinely screening people with rapid antigen tests is useful to help of course identify if they are cases. They may not be symptomatic but also to protect the staff and others.

>> (Inaudible)

>> Not at the moment but it makes sense when you know you have a higher pretest probability that somebody might be infected and that is a good example of where it is useful. Any final questions?

>> Do you have an idea of when (inaudible) can expect to move to phase 3? I know it is very dependent but is it weeks, is it a we?

>> I don't have any idea but rest assured, we will keep updating people on a daily basis. -- week. People will be looking at the numbers and also we will keep people updated on what is happening with testing and so on so if there is a move decided to phase 3 that will be signal well ahead.

>> Pasifika providers (inaudible) outside MiQ are needed and authorities have been too slow on that. Have you got a response to that?

>> I guess my response would be I don't think we have ever been better placed to have a range of accommodation options including for whanau where there are large households and of course these options were developed in response to the Delta outbreak and very successfully and were a key part... Along with the hard work put on by the Pacific community, keep part of our ability to almost get rid of the Delta outbreak, so I think we have a range of options available in all regions, regional coordination hubs and local coordination hubs will be making sure that proper assessments are done and if people need accommodation, to support them to isolate safely and support their needs and that will be available.

>> One last one about mental hospital staff. Where you along the 10% of the people that presented at Middlemore tested positive by that statistic? Speaker not alarmed but pleased to know they were testing because right through the whole response to the pandemic, we don't know about cases unless we test people for them and once we know we can respond and do the right thing to protect those people and whanau so it is an important part of our response. Thank you much -- very much for your attendance. We appreciate it.