Post-Cabinet Press Conference: Tuesday, 14 April 2020

Ashley Bloomfield

Director-General of Health

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Tēnā koutou katoa. Welcome to today’s briefing. Today I’m very, very sad to report four additional deaths linked to COVID-19 infection. One of those was in Wellington and three are additional deaths from the Rosewood cluster in Christchurch. This brings the total number of deaths in New Zealand to nine, six of which involve Rosewood residents being cared for at Burwood Hospital. So the deaths I’m updating you on today are of a man in his 90s at Burwood Hospital, a man in his 80s at Burwood, another man in his 90s at Burwood, and the fourth death was of a man in his 70s in Wellington Hospital, and that latter death was associated with overseas travel.

We’ve previously signalled the underlying vulnerabilities of the Rosewood residents and that this group would continue to be at risk. That does make today’s news any less sad. This is the largest number of deaths we have reported on any day in New Zealand from COVID-19, and it is a sobering reminder of what is at stake here.

I do want to acknowledge the families associated with these people who have passed and offer my sympathy and those, I think, of all New Zealanders and our support. Whether husbands, partners, fathers, grandfathers, brothers, uncles, cousins or friends, wherever they fit in their wider whānau, we are thinking of them and of you. I do ask that the privacy of families and friends associated with these deaths continues to be respected. And what I can say is that of the folk who died in Rosewood yesterday, they all had underlying conditions to some degree and were all confirmed cases of COVID-19. The man in Wellington was admitted to hospital on 22 March and has been quite unwell in ICU for some time. The district health board and staff have been working very closely with the man and his family over the time and will continue, of course, to provide support to the family. As I’ve said earlier on previous briefings, the Rosewood group was transferred from a high-level psychogeriatric or dementia unit. The care they have been receiving is very consistent with the high level of care they were receiving at Rosewood and would have been provided there, and that does include end of life and palliative care.

And just before I make some more general remarks about what we are doing and how we’re working closely with the aged residential care sector, I just wanted to pass on some feedback we’ve had today from the family of a Rosewood resident at Burwood who could not speak highly enough of the nursing staff: “They’re just amazing, doing an incredible job. The communication with us was superb. We had lots of calls, including Facetime calls with Dad. We are so grateful.” And from another of the families: “We couldn’t speak more highly of the staff and care dad received both at Burwood and Rosewood. I skyped with dad and the nurse caring for him arranged for him to see a video the family had put together, and there were lots of phone calls.” So we know that aged residential care settings and facilities are very vulnerable—the populations there are very vulnerable if we get COVID-19 infection in those facilities. And so we have been particularly vigilant from early on in the presentation of this infection globally to work closely with aged residential care and act very quickly and pre-emptively. And what I would say is that we’ve had cases to date, or have cases, in six aged residential care facilities around the country, and this is out of a total of over 650 facilities nationwide. I mentioned yesterday and on the preceding day the excellent care and preparation that is in place across that sector, and the fact that we have had relatively few of our facilities affected by this virus, in quite stark contrast to many other countries, I think, is testament to the work they have been doing. And again, to emphasise, we’ve been working with them very closely from early on in this outbreak. We early on provided advice around ensuring nobody came to their facilities who had any respiratory symptoms at all. They put in place visitor policies—no-visiting policies—much sooner than we went into alert level 4.

So I’d just like to outline some of the other measures we’re working with them on, just so people understand. Every new arrival into an aged residential care facility goes into isolation for 14 days. There are no shared meals happening in the facilities. As I said earlier on, and for some time, no visiting allowed at the moment. I’ve asked all our DHBs to work with each of the facilities in their region to ensure they have good policies, procedures; that they have access to PPE that they need and good supply lines; and to identify what other support those facilities may need to help ensure we keep that high level of care and of preventing COVID-19 getting into those facilities. There is a low threshold for testing of any residents who might be symptomatic; and, of any new arrivals, if they have any symptoms whatever, a precautionary approach is taken—they are tested and they are not allowed into the facility unless they have tested negative—and also a low threshold for testing staff. And, obviously, staff who are sick have to stay home, and there’s very careful observation of any symptoms of staff.

In addition, we’re doing a number of other things, and last night I was on a video conference with the head of the Aged Care Association—both the chair and the chief executive—to talk about what else we are doing and can be doing with them. There will be announcements later in the week about funding for aged residential care to help offset some of the additional costs they are incurring to both prepare and look after people who may have or who do have COVID-19, for extra security and so on. We continue to work with them on making sure we are maximising the value of testing of both residents, of incoming admissions, and of staff.

And I have also decided to commission a review of the rest home facilities—or the aged residential care facilities—where we have had cases, because in some of those instances the cases have been able to be bounded very quickly with no further transmission, and others we’ve seen just how tricky this virus is and that it can spread quite rapidly. So we think it’s a very good point in time to undertake a review of both the facilities where we have had cases—to learn about what’s worked well and where we could improve—but also to look at some facilities that might be similar where they haven’t had cases. And my hope is to do this in conjunction with the Aged Care Association so we can use those things to inform both what the facilities are doing and also what ourselves as a ministry and the district health boards can continue to do to support them.

I’ll just move on now to the cases for the day. I’m just finding the right piece of paper here. So today, the total number of COVID-19 cases increases by 17. This comprises eight new confirmed cases and nine new probable cases. There are now 628 cases of COVID-19 infection that we can confirm have recovered—an increase of 82 on yesterday’s number— and our recovered clearly now firmly dominate the cases overall. The new total combined number of confirmed and probable cases, therefore, today is 1,366. Today, there are 15 people in hospital—no change from yesterday. That includes three people in ICU—one each in Middlemore, Dunedin, and North Shore hospitals. The person in Dunedin hospital remains in a critical condition. Forty-eight percent of cases involve contact with confirmed case in New Zealand, including those in our clusters, while 39 percent have a link with overseas travel. Those that can be prescribed to community transmission are still just at 2 percent.

Yesterday, 1,572 tests were processed which is, again, a low number. So the rolling seven day average is just over 3,000—3,039—and, in total, 64,399 tests have been undertaken. Just to comment on that, at this morning’s select committee hearing—the CBD select committee—the committee heard from Professor Brendan Murphy, who’s the chief medical officer in Australia. And, as part of his comments, he also commented on the quite big reduction in testing that has been happening in Australia over the last few days, and, like me, he ascribed this to the fact that because they’ve got quite physical distancing measures and people staying at home, there are just less respiratory viruses circulating in the community of all sorts.

So it’s interesting to see that Australia is seeing a similar pattern to us and a big reduction, also, in testing there. So in saying that, I sent a message out to all our DHBs today, and we now have 70 community-based assessment centres, and I’ve suggested that they have a low threshold for testing anyone with respiratory symptoms over this coming week so that we can be sure that anyone with respiratory symptoms is not due to COVID-19. Our expectation is that cases will continue to remain low, but we want to be doubly sure, of course, that we are finding any cases that could be out there. You may well also have seen the reports that a number of DHBs are now using mobile testing, as well, to get out to communities who may not have direct access to those CBACs.

So I think I’ll just leave my opening comments there, and I’m happy to open it up to questions.

Ashley Bloomfield

Director-General of Health

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So end-of-life and palliative care is a very important part of the care that is provided in aged residential care facilities. Just to put this in context: about a third of our deaths in each year, annually, in New Zealand happen in aged residential care facilities, and the staff in those facilities are very well-trained in end-of-life and palliative care, and the residents who have been moved there would have been receiving that sort of care in this situation at Rosewood, and they are receiving very good quality care in Burwood.

Ashley Bloomfield

Director-General of Health

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So two comments there. First of all, of course, the deaths that are occurring now are a result of infections that happened at least a week—mostly one, two, even three weeks ago. Secondly, it’s simply because this is a population where people are older—as I have mentioned today: two people in their 90s, one in their 80s—they’re already frail, they have very low reserves to be able to fight off these sorts of infections, so that’s why we are seeing them highly represented in the fatalities.

Ashley Bloomfield

Director-General of Health

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It was because the infection was in the group that was in that psychogeriatric care unit that is part of a bigger facility. So there were no people—which is effectively closed off from the rest of the facility—and because of their high needs, and also because there were infections among staff members, it wasn’t possible for them to keep staffing it and provide the level of care and support that was needed for those people who were probable or confirmed cases. So that was the reason for shifting that group to Burwood.

Ashley Bloomfield

Director-General of Health

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More specifically it’s to look at—again, just put this in context, we’ve had a relatively small number of aged residential care facilities affected, and that’s testament, I think, to the work that has gone on right across the sector to prevent infections getting in in the first place. I think it’s just good practice, and now’s a good time to do it, as we’re informing what we need to be doing as we move out of alert level 4 down to alert level 3. And I think there will be things we can learn from what has happened, both in the facilities where there have been cases and also comparing those with some facilities where they haven’t, just to help strengthen and improve our efforts.

Ashley Bloomfield

Director-General of Health

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So I can’t really talk about that specific example, but I’d be happy to look into that. The PPE that’s generally required doesn’t always include hair cover or foot covers, so I’d have to check as to what the situation was that that nurse was working in as to whether those were indicated. What I am confident is that the staff there will have access to the PPE they need depending on the role they play.

Ashley Bloomfield

Director-General of Health

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Yes, thanks for that. Well, I’m concerned about any case in a healthcare worker, particularly where it happens in the workplace. And a couple of comments: one is we’ve got some information about the cases that are healthcare workers, and what I’ve asked the team for particular analysis of is, of the cases that have happened in the workplace, how was it that they were infected? So was that through being part of caring for someone or involved in the care of someone with COVID-19 or was it because they are part of a cluster where they may be a close contact of another staff member? I think that’s the important thing. And then, by understanding that, we can get a better understanding of what else we may need to do to help ensure that our staff are protected in whatever setting.

Ashley Bloomfield

Director-General of Health

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I think it’s clear that we are past the peak under this alert level. The key information we’re looking for now is for each of those new cases, we want to know very quickly where have they come from? And if we can’t immediately link them to an extant case or cluster, then we need to do a pretty forensic analysis and find out very quickly where they’ve come from and have a very quick and close look at all the possible contacts there and put a ring-fence around it. So yes, we’ve passed the peak; that seems to be clear now. We will be more confident once we know about each of those new cases that has been appearing really from the last week and as we go into this week, and, also, if we continue to get reasonable testing rates of people with any symptoms and we’re still not finding additional cases, that will provide us with an even greater level of assurance.

Ashley Bloomfield

Director-General of Health

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Well, as soon as possible, obviously, is what I would be looking for. And once we get down to that, not just the low number of cases, but are confident that through our testing we’re not identifying further cases that seem to be popping up out of nowhere rather than being linked to existing cases. That’s what we’re really looking for.

Ashley Bloomfield

Director-General of Health

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Yes, so the lab testing analysis we published last week, I’ve asked the team to get another extract today so we can update that. As of last week it was about 49,000 tests that they had analysed. Actually, it showed quite good spread across the regions with some lower testing rates in some regions, particularly around Whanganui District Health Board and Tairāwhiti District Health Board. So we’re looking to get the numbers of testing up there. And really, there’s good access to CBACs, and I know that both DHBs have been making sure that testing is widely available. What I’ve said to them and to all the DHBs is just have a really low threshold: so anyone with respiratory symptoms, whether upper respiratory symptoms—which could just be a sore throat or a runny nose—test those people anyway. They don’t necessary have to have lower respiratory tract symptoms—so a cough, or phlegm, or fever.

Ashley Bloomfield

Director-General of Health

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Well, we will make sure that we can provide really robust advice to Cabinet and that we are confident in the extent of and the pace of our contact tracing. We’ve got some analysis coming through about what the current speed is with which people who are contacts are identified and tested, and we’ve seen that time decline. I’m just waiting for the final information on that; and, likewise, I think Professor Sir David talked about the surveillance testing and making sure that we’ve been very deliberate about getting wide testing across a range of population groups, and that’s why we’re increasing the testing this week to complement the over 60,000 that we’ve already tested. So it’s about 1.1 percent of New Zealanders have been tested already, and we’re going to try and increase that further, just to get a really good picture.

Ashley Bloomfield

Director-General of Health

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That we’re able to trace now, so we’re able to trace—well, we’ve got 220 staff available to trace, so we would have the capacity to trace between 50 and 100 new cases per day. I would say the capacity now is around 100. What I can say is that, of course, our number of cases per day is now much smaller, and also the number of close contacts is, on average, around four to five, rather than what was a much higher number before the alert level 4 restrictions came in. So far, that close contact centre has traced several thousand people, but that’s over the two to three weeks since it was stood up.

Ashley Bloomfield

Director-General of Health

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Yep, just to pick up the point about trace a lot of the people, actually, it will be very much supplementary. The fundamental way to identify and trace close contacts will still be the routine process we have, which will be better, because we’ll have that electronic and be able to link it to NHI. The Bluetooth and other apps will be supplementary to that. Professor Murphy talked about this, because Australia is looking at this, and their view is they would need to have over 80 percent of people using that technology. Now, that doesn’t mean, necessarily, they need to be using a single app, but they need to be using an app which can use that Bluetooth-type technology and exchange of information, so that when a case is identified, you can pull out the data from the person’s phone to find out what other phones they may have been close to during the infectious period.

Ashley Bloomfield

Director-General of Health

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Yes, so I think this goes to the issue of the current approach under alert level 4, which is not to allow visitors to people in hospital. This is clearly a very distressing time for family members, and this is something I’ve asked my team to look at very specifically, is about the visiting policy for people who not just are dying, but others in hospital. And another example raised with me this morning in select committee, of course, is new mothers as well. So we are having another look at that and to see what are the things we could put in place to ensure that we could maintain the safety of both the person in hospital as well as the visitors and the staff there. So that’s being actively looked at.

Ashley Bloomfield

Director-General of Health

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I can’t give you a lot of detail, I’m sorry. What I can say is that there are two elements to that national distribution. There’s the distribution from a single point out to the district health boards in the health sector. From there, they distribute on to the providers in their area. And then, separately, there’s a single distribution network for non-healthcare essential worker organisations, and that is happening in parallel to ensure that essential workforces who need PPE for their work are able to get it and it’s distributed out through that mechanism.

Ashley Bloomfield

Director-General of Health

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We have all been doing things under alert level 4 that we felt were necessary to break the chain of transmission and stop, for the whole country, this sort of situation where we’ve seen in other countries that haven’t acted quickly and gone quite hard, as we have, because you end up with a much bigger problem. It’s not just access to loved ones; it’s the fact that we end up with many, many more cases and many, many more deaths. I really—you know, I genuinely, for someone who has had both parents pass away, I absolutely understand how people must be feeling, and that is why we are looking specifically at that policy.

Ashley Bloomfield

Director-General of Health

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I think the main reason for this is they simply have a lower number of cases, and that is because most of—well, actually, all of our cases have been associated with either people coming in from overseas and/or spread from those people. So all of our cases—ultimately, the index case was an import from overseas, so I think it’s just there has been less travel to those regions, particularly early on when we saw cases popping up in other places like in Auckland, like in Queenstown, or associated with events like the wedding in Bluff, where the link was to overseas travel as well. So I think that’s the reason, but we want to be assured that there are not cases out there that we’re missing, and that’s why we’re doing testing—

Ashley Bloomfield

Director-General of Health

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Ah, no, I can’t, and I don’t have the name of that rest home. What I can say, though, is that that cluster includes—half the cases are involved in a rest home and half are in the community. And what’s not clear is just yet quite the relationship between that, and whether it originated in the rest home or it just happens to involve a rest home. As soon as we think it’s appropriate, we will name the rest home facility.

Ashley Bloomfield

Director-General of Health

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Not testing kits per se. As I said, we’re having a very active discussion about appropriate use of testing, very low threshold for testing, and they wouldn’t need to have the testing kits per se. They may do the swabbing there or they may need someone to come in and do the swabbing. The testing would be done at one of our laboratories, and low threshold for testing any symptomatic resident, low threshold for testing any admission who may have symptoms, and also staff who may have symptoms suggestive of COVID.

Media

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You worked for the World Health Organization previously. To what extent do you think its post-SARS guidance around border closures, specifically that they weren’t effective in dealing with the spread of that virus, influence any nations sort of delaying border closures in response to COVID-19? And, with the benefit of hindsight, do you think it was a mistake for countries or the WHO to lean on that post-SARS advice?

Ashley Bloomfield

Director-General of Health

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That’s quite a big question. What I will say is that early on in this outbreak, even before it was declared as a pandemic, the WHO was asking countries to be thoughtful about the role of border closures but still saying it’s also up to you, and we saw many countries, in fact, implemented border closures. New Zealand was one of those, as was Australia and a number of other countries. What also became apparent—and one of the reasons our advice to the Government, and the Government moved quite quickly around the use of border restrictions and then closures, is because it became clear that this virus was quite different to the SARS virus in terms of its infectivity. And what we’ve seen, both here and overseas, is that it can spread so rapidly and it’s quite tricky as a virus. So I think what is clear is that border closures have been a really important part of countries, including our own, being able to maintain a very strong “keep it out, stamp it out” approach. So I am sure WHO will continue to review its own advice on this and also inform its future advice around managing these sorts of situations globally.

Ashley Bloomfield

Director-General of Health

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Well, what I can say is it’s very good we’ve got the capacity we need, because testing will continue to be a really important part of our ability to stay confidently in lower levels of alert—so 3 or even 2—if we are able to test rapidly and identify early any cases of COVID-19. And so that would be, again, moving to having a low threshold for testing anyone who’s got respiratory symptoms. We’ve now got capacity to do over 6,000 tests should they be needed.

Ashley Bloomfield

Director-General of Health

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Not for testing asymptomatic people. So what we now have is a situation where we’ve got capacity to test pretty much anyone who has got symptoms of a respiratory illness, so a low threshold for testing, and that is the most important—and also to have capacity to do quite wide testing where we get cases where we’re not sure what’s going on, and particularly in settings like a healthcare setting.

Ashley Bloomfield

Director-General of Health

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Well, if anyone’s got symptoms that they think may be suggestive, then there’s always a clinical assessment, but I think a low threshold—I think the clinician will always apply some judgment in these situations if it’s very, very clear there’s actually no risk of COVID-19 and the symptoms are not in the slightest bit suggestive, but at the moment we’d rather over test than under test, quite clearly.

Ashley Bloomfield

Director-General of Health

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Weren’t sent to ICU? Because they and their families—in discussions with clinicians, and, in fact, probably with the facility they were already in— would have already made a decision about whether they wanted active intervention, including ICU - type care, if they got into this situation. And, as I say, a third of people every year in New Zealand die in aged residential care facilities and the care they receive is appropriate for where they are and the decisions they’ve made about what sort of care they would like to receive.

Ashley Bloomfield

Director-General of Health

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Those people would receive all the medical interventions and care that was appropriate for them—to both relieve symptoms and, if appropriate, to treat their illness. However, they will have already had an agreement in place. And I should say also just a reminder that the medical care for those residents, while they are being looked after at Burwood, is still being overseen by the general practitioner who would look after them if they were still at Rosewood.

Ashley Bloomfield

Director-General of Health

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Well, the advice to the public is, if you have any symptoms you’re concerned about, ring Healthline, ring your GP, or you can go to the CBAC, and the locations of those are made available. That doesn’t mean you will automatically be tested, but, as I said, the message out to those running the CBACs is have a low threshold for testing for anyone with upper respiratory tract symptoms or lower respiratory tract symptoms.

Ashley Bloomfield

Director-General of Health

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I don’t have concerns; what I have asked my team to look at is specifically, now we have the very strong border restrictions in place for every person who travels in other than airline staff to going into 14 days quarantine, effectively, to make sure that our position around our airline staff—what precautions they have to take—are still appropriate. And, having looked at the advice for airline staff, which is very thorough, I think precautions are appropriate to reduce the risk of them being infected and/or introducing infection into the country. Perhaps the last couple of questions.

Ashley Bloomfield

Director-General of Health

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OK, on ethnicity, what we’ve seen from the testing to date is there’s quite good coverage across the different ethnic groups. It’s not exactly in proportion to the population, but it’s quite close. We will be looking, over this next week, for good spread of testing by both region and by ethnicity to make sure that we are not undertesting in certain populations.

And the issue of sentinel testing is an interesting one, and I’m intending to follow up with Professor Murphy from Australia about what approach they are planning to take to sentinel testing. And, at the moment, the wide testing we are doing—and especially if we, essentially, are testing most people who have respiratory symptoms, you could argue is, in a way, almost population sentinel testing. The question is still about whether there is a need to test people without symptoms, and none of the advice we’ve received from all of the experts is that we should be doing that at this point. So it’s really having that low threshold for testing anybody with even low-level symptoms.

Ashley Bloomfield

Director-General of Health

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Not at all. No. That may well play a place in the future, and it may be in two ways. It could be with the diagnostic testing, but, in particular, once we get antibody testing, that could play a role then in looking to test people who we think—or to see what level of past infection there has been in the population or to find out whether someone has been infected and therefore is over an infection.

Ashley Bloomfield

Director-General of Health

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Yeah. I don’t think I said I have no concerns about airline staff. I think what we need to do is make sure that airline staff—the measures that they are taking are protecting both them and ensuring we’re not introducing cases into the country. That’s going to be very important. In the case of the Bluff cluster, what I can say is I know that the infection there originated from overseas, but I don’t have enough information to say whether it was one or another person or what the occupation of the person was.

Ashley Bloomfield

Director-General of Health

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Yes. We’re at that capacity now. We’re at that capacity with the current number of cases, or even more. What we want to make sure is that we have that capacity to do that even if we have a much larger number of cases, and that’s why we’ve trained extra people and also why we’re looking at the digital solutions as well.

Look, thank you very much. I appreciate your ongoing interest and support.