COVID-19 update, 7 April 2022 1pm

>> Kia ora koutou katoa (SPEAKS TE REO MAORI) and thank you very much for joining us up here today.

Before we get going on Omicron, and other matters around COVID- 19, I wanted to today as World Health Day, the date of the founding of the World Health Organization in 1948.

New Zealand has a strong repartee shall when it comes to public health and our contribution to global public health and we have an excellent global health group here in the Ministry and I want to acknowledge the work they do on an international level, and in particular they played a critical role in supporting our vaccination support efforts for the Pacific over the last year or so.

And they have done a great job.

As we are all aware, the ongoing COVID-19 pandemic has certainly highlighted the delicate relationship between people and the planet.

And the World Health Organization, along with our other international partners, has been pivotal in guiding our global public health response.

As you can see, I am joined here today by the Director of Public Health, Doctor Caroline McElnea.

-- McElnay, and she is joining me for the last time, which I have mixed feelings about.

She will give you a review of the last years of the pandemic response here in Aotearoa.

I would like to give a quick update on the current outbreak and a bit about some new research we have into New Zealanders' willingness now to comply with ongoing COVID-19 public of measures.

First, an update on the daily numbers.

Today there are 11,634 new cases in the community.

And we are seeing our seven day rolling average of cases continue to decline.

Today the seven day rolling average is 11,791, which compares with a week ago, when it was 14,515.

T oday there are still 639 people in hospital, a small decline I've yesterday when there were 654.

29 of those people are in intensive care or high dependency units.

Sadly today we are reporting a further 13 deaths of people with COVID, taking the total number of publicly reported COVID-19 deaths to 456.

And our seven day rolling average is now 17.

My sincere condolences, as ever, to the whanau, friends and communities who have been impacted by these deaths.

Further information with all the detail is in our 1:00 update.

I have now got just a few slides to go through to provide some visual demonstration of what's happening with the outbreak.

Our weekly rate of cases fell from the previous week when it was 22.

5 cases per 1000 people, it is now down to 18.

5 cases per 1000 people.

If we look at the rates by region, you can see, and the legend may be slightly challenging to read there, but the important one, the one that Cozaar pie, the green one, -- the one that Kos up higher, the green one, is the northern region one, which peaked and has now dropped to about half the case rate to the other three regions around the country.

The other one I just want to point out is, if you look at where the rates were at on 30 March and compare those with 6 April, it's really only since the end of March that the rates have started to decline in the southern region.

When we did our last public health risk assessment, that informed our advice to keep the country in that red setting, the rates were still on the climb, actually, in the southern region.

And they were pretty much levelled off in the Midland region, so we are really only seeing that decline in all regions just in this last one or two week period.

And of course that will be part of the information that will go to the public health risk assessment that the team is doing again next Monday to inform the government's decision next week ahead of Easter on what will happen with the CPF colour, which is currently still in red.

Looking at hospitalisations across the northern region, which is Metro Auckland plus Northland.

We see they are declining, but quite slowly, still.

And there are still quite a number of people on the wards in the Auckland region.

Hospitalised cases peaked at 842 on 29 March.

And they are now down to come as I said earlier, 639.

They are on the decline but there is a long tail of hospitalisation.

Of course not all of those people are in hospital because of COVID.

We estimate 30-40% of people are there with COVID as an incidental diagnosis and not the primary cause of their reason being in hospital.

But it does still leave around 400 people or so who are in our hospitals around the country because of COVID and obviously that means those beds and the staff caring for the people in those beds are not available to do other care.

And the final slide I have, just showing the hospitalisations in the northern regions.

This is new hospitalisations each day, and we can see it tracking down.

So many people who have been in hospital have been there for some time and are staying there because they need longer care.

So it is tracking down in line with the higher transmission scenario.

But still as you can see there, around 40 people have been nearly hospitalised each day with -- newly hospitalised with COVID each day in the northern region.

Just some research that was undertaken between the 11th and 18th of March by the Department of Prime and As to an Cabinet Unite against COVID Unit, it shows that the large majority of New Zealanders are still willing to and are complying with COVID-19 public health measures.

The research showed that 76% of us stay home if we are feeling sick or unwell, which is actually up 3% since January.

The same proportion, 76% of people self-isolated if they have COVID-19 symptoms or awaiting for a test result.

And 75% - three quarters of us - are using facemasks in shops and on public transport.

The only areas where people are less willing to comply is in two areas where they no longer need to - still, though a massive 74% of people are taking and using their vaccine pass where it is asked for, even in places where it is no longer necessarily required.

While 63% of people are still using the NZ COVID tracer app, perhaps out of habit.

And as we said in the past, it may be we need to use the app again to help with our efforts, so please keep it on your phone, and staying in the habit of scanning is something you still do, that's fine.

So a huge thanks - I think these results are very encouraging, and thanks to everyone who is willing to continue to act in the interests of everybody to help minimise the impact of COVID-19 on our communities.

I will now hand over to Dr McElnay.

>> (SPEAKS TE REO MAORI).

Thank you, Dr Bloomfield.

Two years ago, New Zealanders in the early stages of a COVID response and in alert level 4 lockdown.

It was a pivotal time in our nation's history and we have all learned a lot since then.

But a lot has also changed.

COVID has changed our landscape and continues to do so.

We scanned QR codes, used vaccine passes and we wore masks.

While some of these measures are not needed for now, wearing masks has become part of our daily lives and will continue to be so for some time yet.

We know that wearing masks in indoor environments, including schools, helps to protect people from catching COVID.

That's why they are part of the COVID protection framework at both the red and orange settings, and they are a critical aspect of our public health response.

But we also access healthcare differently.

We often did this virtually during lockdown.

We set up special centres for testing and for vaccinating.

Healthcare services put many different protections in place in workplaces to protect their staff, so they could continue to provide care, and continue to protect patients so that they could continue to receive treatment.

Car parks became much more than a place to park your car, and became assessment sites and vaccination sites.

We have all changed the way we have worked.

We have A zoomed and continue to Zoom.

Like many others, I have learned to quickly find and use the mute key.

Sometimes I can't find it, to be honest.

But my team and many others continue to work from home.

COVID has also sped up signs.

science effectively shows progress through publishing scientific papers, which makes the information available to the science and health amenities.

Pre-COVID, that process often took months.

But during COVID it was clear that sharing information was key.

Information that could help understand the science behind the pandemic and assist in tackling it needed to be fast, so it could be used equally quickly.

We have seen more online papers being produced and published, and it has allowed the fast spread of important information to the science community and the public, often within days.

The end result has been the rapid advancement of science, of vaccines, of treatments, of knowledge, of experience and understanding.

Applying that knowledge, which has improved as time has gone on, has held New Zealand in good stead.

Vaccines and treatments effective at keeping people out of hospital were developed fast and advances in tracking and testing were equally quick.

New Zealand has been very fortunate that we have been able to bring the public with us through lockdowns, hand- washing, physical distancing, testing, vaccinations, isolation, quarantining and staying home when sick.

There have been frequent changes in advice and approach, as we have learned more about COVID, and we have learned more about how best to manage and prevent spread.

We have endeavoured to use the science, evidence and experience both from here and overseas to guide our advice.

I'm very aware of the impact that our advice and guidance, underpinned by regulations, has had on many, many peoples lives.

We are fortunate to have a solid foundation of trust by the public in our institutions, our health sector and our approach for the past two years.

People have listened and people have acted.

We are aware that our messages are ones that often compete with other messages.

There have been at times has felt like an overwhelming level of information produced by the pandemic.

There has also been a rising level of misinformation, often called 'the virus within'.

This hasn't spread globally as well as locally.

We have increased the level of information we have provided to the sector and to the public to help ensure there is readily available sources of information that people can trust.

Our daily 1pm statements continue, and our 1pm stand ups, of which I have been a part, including the very first stand up we streamed on 27 January 2020, when there were 2000 cases globally, and none in New Zealand.

At that time, travellers into New Zealand were being asked if they had gotten sick within a month of arriving, to provide their travel history to their treating health professional.

These stand ups and this, I'm reliably told, is our 299th stand up in two years.

Will continue.

Although they will do so now without me.

I am sadly leaving the Ministry, although it remains in good hands and good heart.

I am travelling overseas, and it will be some months before I come back to New Zealand.

It has been an honour and a privilege to have served as Director of Public Health during this time, and there are many, many people to thank for the support they have given me during this time.

I particular want to acknowledge my outstanding team of public health doctors here at the Ministry of Health, who have worked with me to provide the very best public health advice throughout the past two years.

But I want to finish by thanking you all - all New Zealanders - for getting us to where we are today, on what has been a rollercoaster of a ride.

I would also like to thank you in this room, the media, for your extensive coverage throughout the pandemic.

Helping to keep the public informed about the necessary public health measures to keep ourselves and those around us safe.

(SPEAKS TE REO MAORI) back to you, Dr Bloomfield.

>> Kia ora, Caroline.

I think the first stand up we did was a much smaller room with reporters all crowded in and none of us wearing masks, just next door to hear.

We have learned a lot in the last two years.

I think some of you are there.

There has been some speculation and perhaps concern in the last 12-24 hours about the timing of Dr McElnay's departure.

And my own.

As she has said, she has decided that now is a very good time to do so.

I am here for another four months until the end of July.

Doctor Jim Miller, a doctor of public health at the public health area that covers Bay of Plenty and Lakes District Healths has already joined us to act in a public health role while Dr McElnay's replacement is appointed and that process is well underway to Jim joins a team, as Caroline has mentioned, a very able public health positions and we have a range of very able public health physicians across the organisation to being one myself, I am always of the view you cannot have enough public health assistance.

Have very capable leadership in this organisation and across New Zealand.

People who are and will continue to advise on and help lead our ongoing response to the pandemic.

B ut just before we do cut two questions, I want to take the opportunity to save personal thank you to Dr McElnay as this is her last media stand up.

I acknowledge the COVID-19 response has involved many people across many organisations in the public sector, the private sector and the health sector.

And it has been the work of many rather than one individual, and that has meant we have all achieved what we have to date.

Having said that, Dr McElnay has been instrumental, and often the public face of the Ministry's response to the pandemic, so I would like to recognise and celebrate that.

Dr McElnay started at the Ministry in 2017.

She came from Hawke's Bay District Health where she had been there director of public health, and in the last five years, her contribution to the health and disability system has been absolutely critical, particularly in the last two years, where it has included overseeing the public health response to that initial outbreak here in this country - the Delta and Omicron outbreaks more recently, and also the crucial public health advice to inform, it seems like a long time ago now, but the alert level framework, and more recently the COVID protection framework and now the Omicron response plan.

She has developed a great team of people here in the ministry, critical relationships and a great deal of respect across the health sector.

And she has supported the Ministry to deliver often in very challenging circumstances our COVID response over the last two years.

A mammoth effort indeed.

Personally, I just want to fully acknowledge Dr McElnay's calm and supportive and solution-focused approach throughout the last five years, but in particular this last couple of years.

She has been a real rock for me, and it's always a pleasure to be able to do these sessions together.

It's a challenging role, being Director of Public Health, Caroline, and you have embraced it with grace and energy.

You have become a recognisable face to the public, and I know there was much speculation about the length of your fringe during the first lockdown, and it was sort of the marker for how long we might have been in lockdown, was the length of your fringe, and I know you greatly enjoyed that first visit to the hairdresser to stop all the speculation there.

I'm pleased you're having a break, and I know you will return to contributing to public health in New Zealand.

So (SPEAKS TE REO MAORI).

Caroline is now happy to take questions.

>> Can I ask why you have decided to resign?

>> When I took this job five years ago, I made the decision to continue to live in Napier and travel down to Wellington.

And at the time I took on the job, I said five years was a good length of time to consider doing that.

It has been tough doing that constant travelling.

It has also been tough during lockdowns when I have been here in Wellington are not able to travel home.

So for me and my family, it was just the right time to step away and spend some time.

>> The director-general yesterday mentioned some of the misogynistic abuse that senior public health figures have faced in New Zealand.

What sort of vitriol did you receive and how did you cope with it?

>> Well, I haven't received too much, as Dr Bloomfield says, I did get quite a few comments about my hair, which I'm not sure if he got quite the same criticism about his hair.

Look, I don't really engage much in social media.

And I find that the less you read the comments, the better.

I'm here to do my job and I do that in the best way that I can, and if I get the positive feedback that I want, from my bosses and the people that I'm working for.

So I just don't really engage in it.

But I have received some.

>> Where do you plan on travelling to, for how long, and do you plan on returning back to the Ministry of health when you return home?

>> I'm certainly planning to return to New Zealand.

We are going for an extended trip overseas.

We are still doing some of the detailed planning from that, as many of you know I am originally from Ireland, so I'm going to certainly catch up with family and friends over in Ireland, and in Europe.

And I've got no job planned to come back to, but I will just look to see what opportunities there might be for me when I return.

>> Was it hard to leave the role now, with the pan -- when the pandemic isn't over yet?

>> It is hard.

I don't think there's ever a perfect time to leave any role, but it has certainly been on my mind, about when is the right time to leave, when this pandemic certainly is set to continue for some time.

But I felt very much - and that was the conversation I had with Ashley - from a public health perspective I think we have achieved a lot, in terms of the approach to COVID, and we are moving on.

We are looking at how we can continue to protect the most vulnerable in our community, and make sure they don't suffer from the worst outcomes from COVID.

So from a public health perspective, I think it is about public health standing back and our health services and treatment services picking up that load.

So for me, that was then a good time for me to say I can hand the mantle over to others.

>> Dr McElnay, burnout has been discussed as a possible factor in your resignation.

Most of us I'm sure would not begrudge that, but what advice do you have for other Kiwis who after these two stressful years might be feeling burnt out, but they can't because they don't have the financial resources to take time off?

>> Firstly, burnout is a very real thing and we do need to acknowledge that.

Workplaces need to acknowledge that.

But also people themselves need to acknowledge that.

I personally do not feel burnt out, but I do feel tired.

There are things I would like to be able to do and things that I would like not to have to do.

So I do think that, people, if you are feeling tired, then that's a real feeling.

So talk to your family and friends and talk to your health professionals.

It may be that you feel you can't take some time out, but I think employers, in particular, are very aware about burnout for a number of reasons, as well as the impact we have all seen, that COVID has had.

So I would encourage people to listen to themselves and talk to people.

>> In some parts of the world they are talking about a post- pandemic mental health crisis due to lockdowns and other stressors.

Are we facing a post-pandemic mental health crisis in New Zealand?

>> Dr Bloomfield might want to speak to this, but I think we are very aware of this possibility and the need to plan to make sure we have got services in place to deal with that.

We are aware that people have been very stressed, for a number of reasons, because of the COVID response.

We have seen that overseas, as you say.

So we do need to make sure we are as prepared as we can be to support people as we continue in our journey through COVID.

>> Do you think government and the public sector is doing enough in that area?

>> Dr Bloomfield might want to speak on that, but I'm certainly aware that the planning has started to look at what is needed, and I think that's always the first critical part.

Dr Bloomfield is very aware of my love of plans - that we need to have a plan before we launch and do something.

I think that's always going to be the first step, and then implement.

>> What are some of the things you are looking forward to being able to do that he may be haven't had the time for while you have been in this role?

>> Well, what I want to do is spend a bit more time hiking, in particular, doing some more walks.

Being able to go for a very long time without your cell phone.

I'm actually really looking forward to that.

And one of the advantages of going overseas is, it makes it even harder for people to get hold of you.

>> Are you considering taking another role in Health New Zealand when he returned to the country?

>> I honestly haven't thought about what role I might take up.

I am a public health doctor, it is my passion and background and training.

I fully expect to be working in public health in some capacity when I come back.

And there will be new entities in place by the time I come back, so I will be looking for any and every opportunity that I can.

What I might be less keen to do is perhaps have a job that requires lots of travelling.

>> Dr McElnay, yesterday we ask Dr Bloomfield around his highlights in the last two years.

What about for you?

What has been your highlight and are there any regrets you have had?

>> There has been a lot of highlights.

I wouldn't describe them as regrets, but there have certainly been some challenging times.

Or not even challenging, but certainly very awe-inspiring times.

And for me, the highlight was probably right at the very beginning of our COVID response, when this building was full, back then, with the social- distancing that we required back then - full of people from across the government sector, as we all came together to build a plan for our COVID response.

And just to see the very many different people from different backgrounds and different government agencies all coming together to work together on a single problem, I think is something that I hadn't experienced, and it was good to see and I hope we see that for future events as well.

So that was a highlight.

What I will always take away with me was, the feeling that I had myself, watching the Prime Minister make her first announcement to the nation about the COVID alert level framework.

And when she announced that, the country was going into, I think it was alert level 2 in the first instance and then very quickly, later on that week we moved into alert level 4.

I had been part of the discussions and the planning sessions, and along with Dr Bloomfield providing that advice to Prime Minister and Ministers.

So having been in those meetings providing that advice, and then suddenly the next day.

Not suddenly, but the next day watching it on television made me feel how much, what we had done.

And the awe-inspiring nature of that.

And the responsibility, the weight of responsibility that comes with this job, and how you are affecting the lives of so many people.

That weight of responsibility is very real.

And has continued throughout.

But I think that was probably one of the first moments when it dawned on me exactly what was happening.

>> In terms of the overall pandemic, how could the death toll have been left?

>> I think the death toll in New Zealand is staggeringly low.

I just came off a call this morning with colleagues in the UK, the US, Canada, Australia.

And our death rates in New Zealand are an indication of the success of the response that we had in those first couple of years.

So I think certainly whilst every death is a tragedy, and sadly, for me in those early days, it felt like every time I did stand up, I was announcing deaths and I know that social media for a while trolled me as Doctor Death.

But I do think we have done such an amazing, we have had such an amazing response here in New Zealand, I would challenge anyone who says our death rates are in line.

>> The prison response has been pretty disastrous.

Why is that?

is it because they were arrogant, with a conscious of how you are responding to it?

You would have family and friends, are they conscious of the way we did it?

>> I think every country has responded differently, according to the context of that country.

I did my public health training in England, so I know that public health in England is the same as public health here in New Zealand.

We all use the same evidence and analyse it in the same way.

New Zealand does have some points of difference to the UK, which did have an impact on our outbreaks.

We were in the early days able to look and see what was happening in the rest of the country, they were much further advanced in terms of cases than we were.

And we also as an island nation were able to close our borders.

It really was the closing of the borders, as the real first step, that protected us and gave us time to have a vaccine, to get people vaccinated, and that now allows us to open up in the way we are doing.

>> Just for either of you, looking ahead at how the pandemic might play out, how well prepared are the frontline staff, such as GPs, for an influx of long COVID cases?

>> Do you want to try that one?

>> You are doing a great job.

Yes, a quick comment on that.

Just as the overall pandemic response, and Caroline articulates this really nicely, has moved from a focus on broad public health measures - a largely public health-lead response to a much more health sector and healthcare type response.

We are also needing to shift from just responding to the acute COVID illness through the healthcare system and looking after people to supporting people who have longer duration symptoms.

And of course this is not something that is unique to COVID.

There are people who have post- viral symptoms that sometimes last four years.

So we need to gear our system to have the resources and the funding to be able to look after people who have got those symptoms that go on for quite some time and that's part of our planning ahead, part of our winter planning as well, thinking about not just how we are responding to people with COVID and other influenza-like illnesses, but being able to provide the support for people with ongoing symptoms.

Are there any more questions for me?

māku?

>> On the traffic light settings, when you give advice to Cabinet, you pointed out the declining number of cases in the regions, including the southern region, and the slow decline of hospitalisations.

Do you think next week you will be recommending the move to orange?

>> I can't say, what I can say is there is a process undertaken by the public health team, and that will happen on Monday, I get the advice and then it flows through to advice to Cabinet.

I don't want to second-guess it.

>> Do you think we're moving towards a period where it is safe to be orange?

>> I will wait to get the best possible advice from my team.

>> Can you talk about the strain on health care system?

Is that also trending downwards alongside these grassy, question these graphs here, or does the health system remain strained?

>> There is ongoing pressure on the system, and the slides I've shown are just around hospitalisations, of course.

Most people who need care I looked after by general practice or in the community.

But the pressure is easing there in terms of COVID-related illnesses.

All that does allow in general practice and in hospitals is for them to gear up other care.

So in general practice, that means care that might have been deferred, like preventive care, or management of people with chronic conditions, they can start to do more of that again.

And likewise in the hospital, more planned care.

So the DHBs, through this outbreak, have been very good at just making sure it is not on or off with planned care.

If they can do any planned care, they have been doing it right throughout the outbreak.

>> The impact on the health system due to the virus has been a key concern.

Will there be a marked difference between this coming Thursday and today, do you think?

Is it improving that quickly, is what I'm asking.

>> Yes, it is improving, and you have pointed to the thing that is probably a major factor.

That is not so much that there are less people in hospital, but there are less staff off with the illness, themselves, all because they are close contacts or because they are looking after family members.

And as the case numbers continue to decline, it will mean there will be less staff off, and that will mean there is less pressure certainly on the hospital side of things but also in primary care.

That will be one of the factors that I think will be material in terms of the difference between perhaps early next week and two weeks ago when the last assessment was taken.

>> At the end of the month, the school holidays at the end of the month, how will school holidays affect case numbers?

>> Really hard to know.

I think the key thing will be, whether school is in or out, those basic public health measures are going to be important.

Arguably, and Caroline might correct me here, but I think what we've seen in the past is that school holidays have actually not resulted.

Often we have been considered they would result in an increase in infections but we have often seen the opposite.

So hopefully the weather will still be warm enough for people to be doing a lot outdoors as well still, as we are in April.

>> What sort of evidence are you seeing around the Pfizer vaccine, and are you putting plans in place for a second booster?

>> Yes, that advice is going to ministers this week so you can expect an announcement on the decision fairly soon.

Certainly we have been looking and seeing what other countries have been doing and the groups that are most likely to benefit, or need a quarter dose, are those who are most vulnerable.

-- a fourth dose.

And I have the advice and it is going to do is now.

>> Will likely be the immunocompromised and.

>> Largely older people and immunocompromised people of all ages.

>> What is the scale of the loss of planned care in this outbreak?

>> Well, I don't have them with me, but there are some numbers.

What I would say it is probably less than other outbreaks, because through this outbreak, all our district help have maintained as much -- district healths have maintained as much planned care as possible, whereas we were still previously in the strong elimination type approach, most planned care was stopped to help avoid the risk of having cases inside hospitals.

So all the DHBs have had plans right through to maintain as much planned care, both outpatient and planned care as they could.

>> How would you like to see DHBs make up for lost time?

>> They are already, they have already been working on that for some time and they had plans in place.

The key thing here is, they will be prioritising people whose care is the highest priority.

Of course that means people who require either diagnostic interventions, like radiology, or treatment for things like cancers or things that are time-critical.

But they will be working on plans to make sure everybody whose care has been deferred is delivered in time.

>> Just looking ahead, yesterday you mentioned you wanted childhood vaccinations up.

Obviously we have borders easing as well, and the likes of flu and measles for example, are you concerned about a perfect storm coming this winter?

>> Concerned enough, as my colleagues across the system, to have put in place some plans to avoid the perfect storm.

You will know the vaccination program for flu started on 1 April.

Really good early interest and uptake and pharmacists are saying they have never seen quite so much demand.

So already, by midnight last night, 56,000 doses of the flu vaccine had been given across the Motu, and even more, because we only have the general practice numbers once a week.

There is a program underway to really ramp up the catch up campaign and that is going live as well.

So these are of concern and we are actively delivering programs to avoid getting into that situation.

>> How popular has the vaccine been so far?

>> Only 2000 doses have been given so far.

I will hand back to Dr McElnay.

>> Dr McElnay can how satisfied are you with the current set of COVID rules for the country and is there anything you would change?

>> The current framework has been well worked out.

My team and I were part of that.

So it is based on public-health logic.

I think the key to the framework is moving through settings and through the different colours.

And we have had experience going up and haven't yet had the experience of going down.

It is always different coming down to going up.

So I am satisfied that the framework provides that level of protection for the community.

And the essential thing about the framework is that it relies on a highly vaccinated population.

And regardless of the framework, there are some public health interventions that are the interventions that stay in place no matter what.

So they become the fixed level of controls.

And vaccination is the number one for those.

And that's where the boosters come in as well.

That is really good evidence, you know, that you have the third booster and get really good protection.

Alongside that is how we manage cases and contacts.

And the isolation periods for those.

Because the theory is around reducing transmission.

Your cases are the people you know have infections, so you know they are the ones most likely to transmit it.

How we manage cases and contacts.

And then the rest is to ease you down through the layers of protection and that is with the orange settings, the requirements for masks, then on to green where it will be a recommendation for masks but less of a requirement.

>> You mentioned in your opening statement just about masks.

How difficult would that be?

Because as far as we can centre the future, there will be Omicron cases.

If we are moving to green and the mask requirement is lifted, is it possible you see widespread community transmission, that we could see a situation where the governments as it is OK to ditch masks?

>> I think there is a difference between requirement and recommendation.

From everything we have learned about COVID, masks are very effective.

What we have seen overseas - and actually on the call this morning, I comment was made about how other countries, as they are a little bit further ahead in their COVID journey than us, what they are doing is, allowing more regional decision-making around what is the rate of illness in your community, how is that affecting your population.

And at that point then, increasingly messaging around, this is the time to start wearing masks.

It may not be a requirement, but it is a recommendation.

So this is the time in this community you might want to think about wearing a mask when you go out to various settings.

And that may well be where we end up.

Where we have got an understanding and appreciation of the benefits that a mask brings.

There might not be a requirement to bring a mask, but the understanding.

I think that is the way forward.

That we as a community understand what we need to do, and make those choices ourselves.

I remember saying at a meeting earlier on, we will reach a stage where we all have a mask in our pocket, and then we use the mask when we need to.

>> What is the advice you are leaving for your successor?

Permanent successor?

>> Well, it's going to be interesting for the permanent successor, because the health system is going through some changes.

So the permanent successor will be working as part of the public health agency, and the public health agency will be sitting within the ministry, and the ministry itself will be a bit different.

And also Health New Zealand.

So my advice to my successor would be, you need to work out the structure first of all, who is who.

Relationships are actually really important in this job.

The ability to get on with people and find out who is responsible for what, and who the decision-makers are, and how you can best do your job.

The job of the director of public health is to promote, protect and improve the health of New Zealanders.

And there are many others who are doing that job as well, it's just that we've got a particular title, which allows you to open doors to have those conversations.

So I would advise them to work out which doors to open, and open those doors.

>> A question on daily case numbers, I'm not sure who would like to answer this - but with the southern DHB, with our case is now declining, does it mean the Omicron outbreak has peaked nationwide?

And what does it mean for daily case numbers moving forward, and where would, where do you see are settling in terms of daily case numbers, in the late thousands?

Where would that end up?

>> I think we have probably mentioned this before, that we expect to see a long tail, a bumpy tail.

Looking at what other countries have seen, that could be 2000, 3000, 4000 cases per day.

It could be different in other parts of the country.

Where have seen a steep drop off in the Auckland metro areas, but in more rural areas it's more of a gradual decline.

And we anticipate we will have a long and grumbling tail of COVID that we might see some spikes along the way.

If we look at our nearest and dearest neighbours in Australia, they are seeing it going back up.

But actually it will probably come back down again,.

>> So the outbreak has peaked?

>> I think we have increased confidence from the case numbers that the numbers have peaked.

But bear in mind that we are aware we are basing our case numbers on the self-reported results from the RAT test.

I was look at it from a pattern rather than from the actual number, but certainly when you look at the pattern, it looks like we've got a bit more confidence to be able to say we are over the peak and coming down, from the case numbers.

>> DOCTOR: On a, last week you mentioned there was a task force looking at what to do about dropping childhood immunisation rates.

Have you received any advice about that and if not, when can we receive that advice and what sort of advice i.e.Respecting from that?

>> Dr Bloomfield might want to comment on this.

I haven't received that advice.

The task force itself, I am not aware, has actually been set up.

Last week I talked about needing a task force, because we do need to look.

Childhood immunisation is something that requires a lot of different perspectives.

And guidance from the sector and communities as to how we get those rates back up.

So it is still very much a priority for the ministry.

I don't think the task force as such has actually been pulled together yet.

>> Well, thank you very much for coming up again, and Caroline, I think you have demonstrated today why you are such a treasure for this country.

Thank you again for your amazing contribution, and I know many people around the Motu will be sent to see you go and wishing you all the best.

Kia ora.