Members · Web view1 day ago · BridgesGood morning. I think, hopefully, everyone is unmuted....

Hansard transcriptInquiry into Government response to COVID-19Epidemic Response Committee31 March 2020MembersHon Simon Bridges (Chairperson)Kiritapu AllanMarama DavidsonHon Ruth DysonHon Paul GoldsmithKieran McAnultyDr Shane RetiDavid SeymourFletcher TabuteauHon Louise UpstonMichael WoodHon Michael Woodhouse WitnessesJohn Ombler, All of Government ControllerSir David Skegg, epidemiologistHon Dr David Clark, Minister of HealthDr Ashley Bloomfield, Director-General of Health

1

HANSARD TRANSCRIPT: INQUIRY INTO GOVERNMENT RESPONSE TO COVID-19

Bridges Good morning. I think, hopefully, everyone is unmuted. Can I just welcome members to the committee and also the [Inaudible] This will be the COVID-19 select committee that sits in our Parliament, and our role, I think, is very simple: it is, simply, to provide constructive scrutiny of the Government’s response to COVID-19, and doing that to improve the national response over the next month, as we meet every week.The way I intend to run this, as chair of the committee, members—and for you at home who are watching—is like a parliamentary review; that is, with brief introductory remarks by our participants and then questioning. Everyone will get a chance on the committee to ask the questions that they want to. There will be a preference for Opposition members because the committee has been set up with an Opposition majority and, of course, Government members have much greater access to their ministerial colleagues and Government decision making.Today is very much about health and has a real focus on that, but we are starting with John Ombler, who is the All of Government Controller. Can I just, Mr Clerk, note there’s papers to be tabled, and we’ll formally do that, but I think we’re very—or unless anyone has any issues as members, we’re happy to proceed to John Ombler, controller of the Government’s response. I can see you, John; can you see and hear us all—or me, at least?

Ombler Yes, Mr Chairman, I can see you fine. Can you hear me? If you can, then I might have a few introductory remarks and then take questions.

Bridges Well, look, thank you very much for making yourself available. Thank you for your written notes, which we really appreciate, and we’d love to just hear from you briefly to set the scene for us.

Ombler Thank you. I’ll start with the big picture if I may. It was at the start of this year—or the very, very last day of last year—that China notified the World Health Organization of 44 cases of the new respiratory disease, and since COVID-19 was identified, it’s spread far and wide, reaching over 200 countries. There’ve been over 638,000 medically confirmed cases internationally and over 30,000 deaths. The real number is likely to be somewhat higher, and the economic and social impact overly is profound. New Zealand currently has 589 confirmed and probable cases and 63 recovered cases, and this week the nation experienced its first death.

2


New Zealand stood up the national security system in response to the COVID-19 threat on 27 January. Since that time, there have been eight meetings of the Officials Committee for Domestic and External Security Coordination, known as ODESC, and seven watch groups to support that. In terms of the Government response itself, the Ministry of Health first set up a monitoring team on 24 January, and health staff began meeting flights from China on 27 January. Health then set up the national health crisis centre on 28 January, and the Ministry of Health was supported in its lead agency role with all of Government strategy and policy input from early February.On Tuesday, 10 March, the National Crisis Management Centre was activated, and the chair of ODESC appointed me to lead the national response. That’s three weeks ago today. I’m supported in my leadership by a team that consists of Dr Ashley Bloomfield, with his statutory powers as the Director-General of Health; Sarah Stuart-Black, with her statutory powers as the Director of Civil Defence and Emergency Management; Police Commissioner Mike Bush, who has been and will continue to provide coordination of the operational response; and Dr Peter Crabtree from MBIE, who is providing oversight and coordination of all of Government’s strategy and policy.COVID-19 does truly present an unprecedented challenge to New Zealand, certainly in my lifetime. The scale and fast-moving nature of the threat has required us to continue to adapt our way of working and our operating models. This is not only an all of Government response, it’s truly a national response, and I’d like to acknowledge the extraordinary efforts and commitments on public servants, the generosity and tenacity of the private sector, and all New Zealanders who are doing the right thing to unite against COVID. Our mission is simple: it’s to keep New Zealand and New Zealanders well and safe.The strategy under Alert Level 4, which we’re now in, is to eliminate the virus by going hard and going early to avoid our health system being overwhelmed in the way it has been in other countries. And I expect within the coming month we’ll have a strong indication about the efficacy of our strategy. Ultimately, though, it depends on New Zealanders’ collective cooperation and commitment. With that, Mr Chairman, I think that’s enough said for me to start, and I’m happy to answer any questions.

3


Bridges Thank you very much. Can I just join you, and I’m sure all of the committee from all of the parties would, in your thanks for all of the public servants’ work—those around you, your work, also those who are [Inaudible] services—and I think you’re right to also mention the private sector, who are helping to gear up our response as a country.Can I just start with a framing question, really, John, before we go to committee members? And it’s this: could you describe for us, in a sense, we know we’re in war like conditions—you’ve said “unprecedented circumstances”. You and your leadership team have truly significant powers. Could you run us through that and how you intend to go through the process of using those remarkable powers, really?

Ombler The powers are held by the Director-General of Health—and I know you’ll be talking with him soon—under the Health Act and in the Epidemic Preparedness Act, and by the Director of Civil Defence and Emergency Management under the Civil Defence Emergency Management Act. So that is where the powers lie. Also, of course, Police Commissioner Mike Bush has powers under various statutes, and that will continue with the police after he finishes there later this week. That is where the powers lie, and it is those individuals that will exercise them [Inaudible] under the delegation from the chair of the Officials Committee for Domestic and External Security Coordination is to coordinate across Government, which is not an exercise of extreme power; it’s about leadership and coordination.

Bridges Sure. I see David Seymour has a question. David?Seymour Yes, thank you, Simon. And John, thank you for that

answer. I wonder if you saw an opinion piece on Stuff this morning by Professor John Hopkins at the University of Canterbury; he’s a law professor who specialises in the law around crises and he makes the point that when Government officials—particularly frontline ones—have such extraordinary powers, it’s important that the Government puts in place guidelines for their use. So what exactly does it mean for police to be able to direct people to comply with COVID-19 regulations? Do you intend that the Government will start producing the kind of guidelines that Professor Hopkins called for?

4


Ombler I haven’t read the piece, I’m sorry, and I certainly will after this, now that you’ve brought it to my attention. I think the very process we’re involved in right now is part of the regulation on the way that Government and officials use powers in a situation like this; that’s what this select committee is about. I think we have been progressively looking at—you know, this has been happening at an extreme pace, and we’ve been looking at the sort of powers that might be necessary, but also the way that we might exercise those, be it through the police in the frontline, or other things. That is a moving feast. We’re learning as we go. I have to say that, by and large, the public of New Zealand are responding magnificently to the challenge in front of them, and so the exercise of extreme powers is not something that’s been dominant to now.

Seymour So could we summarise that, in your view, there’s no need to produce the kind of guidelines that Professor Hopkins calls for?

Ombler Well, as I said, I haven’t read what Professor Hopkins called for, but I certainly will after this. I think it is necessary to be quite careful and measured in the way extreme powers are exercised, and there’s—so, enough said.

Bridges We’ve got Paul Goldsmith with a question.Goldsmith Good morning and thank you for all the work that you’re

doing. As I understand, the broad strategy is to lock down the country and do our very best to get on top of the virus so that we can get back to our normal lives as quickly as possible. So the critical issue, or one of the critical issues, is the quality of the lockdown and your efforts to stop any leakage—you know, lockdown leakage—over the next little while, and so I’d be very interested in your assessment of how successful we are being if we start off at the border and—well, I just want to get some clarification.

5


For example, in my neighbourhood at Ellerslie there has been a hotel where people have come from the border. They’ve arrived. Everybody understands that, if you arrive in New Zealand from overseas, you’re meant to have two weeks in isolation. But there’s been a lot of confusion about what that actually means, and some of these recent arrivals have been going off to the supermarket, and that’s the advice that’s been received from the National Crisis Management Centre, and that advice has changed again last night: that they’re not allowed to go. I just want to get your sense of just how tight the lockdown is for international arrivals and what the rules are, so people can have a clear sense of what they are.

Ombler For international arrivals since the—oh, I can’t remember the exact date. For international arrivals, it is quarantine for 14 days. So that does not mean going out to the supermarket; it means being serviced by others helping you, delivering stuff and so forth. For people who have not arrived from overseas, it is entirely different. It is about isolating at home but being able to go out to do essential tasks. So there are different rules for different people.

Goldsmith So how confident are you that that simple message is getting through? Because my understanding in my neighbourhood was that message wasn’t coming through for international arrivals; they were being sent off to the supermarket to get food up until yesterday. So are you absolutely confident that everybody is singing from the same song sheet and everybody knows what they’re doing?

Ombler Well, I think “absolute” would be too strong a statement. My understanding is that everybody who arrives internationally—and this has been for some time—has received instructions about what they are required to do when they go home after international arrival. We have followed that up. The police, on our behalf, have been checking on a number of people—not all by any means, but a sample—to ensure that there’s a level of understanding and compliance. The feedback I’ve had is that—I don’t have the exact numbers with me right now—but, generally, that’s been pretty good and people have been pleased that the police have gone to say hello to them and see how they’re getting along. “Absolute” is too strong a statement.

6


Bridges Who is the appropriate person in your leadership team, or other person if you think, that we should be putting detailed questions about border control and quarantining to? Is that, in fact, the Director-General of Health or is it another person?

Ombler For the rationale for how we’ve set the settings at the border and for post-border movement of people, that’s driven very strongly by public health guidance about what is appropriate and how best to manage the risk we have, and certainly questions to Dr Bloomfield on that would be appropriate. For some of the operational side of it, Police Commissioner Mike Bush, who I think you’re talking to later this week, I think could also provide further comment.

Bridges Great, Kiri Allan.Allan Mr Ombler, colleagues, thank you for your time and,

reiterating the words of our chair, thank you for the service that you have given to our country over this very tiring time.My question is a supplementary, really, off Mr Seymour’s question following on from the comments. I know you haven’t read the article that Professor Hopkins put out this morning—and it is a good one. One of the mentions that he makes is that our civil defence management Act is revered around the world as being one of the best and exemplary for enabling the powers to be divvied down to the relevant stakeholders but also the checks and balances there are in place—comparatively, for example, with the UK. Our powers under the state of emergency last for three months; in comparison with them, it lasts for six months. I was wondering if you could give some comments on what you think the extraordinary powers that both the Director-General of Health and, of course, the Director-General of Civil Defence—do you think that there are the requisite checks and balances there that can assure New Zealanders that the powers that are being exerted at the moment are, in fact, being done in the right way?

7


Ombler I think the detail of the question is best put to those two individuals. What I’d have to say is that, as each of those two individuals are considering and exercising their powers, we talk about that as a team. So there’s a certain level of discussion and analysis about the necessity and the nature of the exercise of those powers, which I think is of considerable assistance. And, of course, at times that discussion happens with Ministers as well. But I think the detailed question about the powers and the way they’re exercised is best dealt with those two individuals.

Bridges I mean, to date, do you have any concerns when it comes to—and I’m not suggesting this is necessarily my view, John, but, you know, some commentary online about overreach. We see, this morning, talk about dobbing in one’s neighbours. Have you a view on any of those things?

Ombler Well, I think it’s regretful that it’s even remotely necessary, to be honest. The strategy we’ve adopted really depends on stopping person-to-person and location-to-location spread of the disease. So the sort of constraints that were placed on people are just absolutely vital for us to succeed in beating COVID.As to people “dobbing in” people, as you say, my strong preference is that as far as possible, one, people do the right thing; two, people talk to one another, not in an aggressive way but in an explanatory way, to talk about why it is important that we get a strong level of compliance with this. Of course, if there are people who simply don’t want to play that game, they’re putting all other New Zealanders’ lives at risk by their actions. To that extent, if it does require the “dobbing in”, as you put it, then I guess that’s the last resort that’s extremely unfortunate.

Bridges Thank you. David Seymour—you’re on mute there, David.

8


Seymour Apologies—hopefully that’s coming through now. I just wanted to follow back to Paul Goldsmith’s question about the Novotel in Ellerslie. Also nearby, at Alexandra Park, I understand there is a place for people who have been travelling in campervans, particularly tourists, to remain. There’s been some concern from locals who have, basically, asked the question: is it wise, if you’re going to quarantine people who have been travelling, to do it in the geographical centre of the nation’s largest city? I don’t know if you’re in a position to answer such a local and specific question, but what reassurance can you give about the decision to have those campervans there; the status, in relation to COVID, of the people who are staying there; and the precautions that are being put in place to prevent community spread to nearby neighbourhoods?

Ombler What I can say is that, at one level, it doesn’t matter where people are as long as they don’t get within a couple of metres of others and that they maintain exceptional personal hygiene. If you go for a walk and you put your hand down on something and you happen to have COVID, and the next person comes along and puts their hand down on the same place, that can transmit the disease. So really good personal hygiene is important; staying two metres distance. Apart from that, the fact that people are in Auckland or in Taumarunui I don’t think particularly matters. But that’s a question that Dr Bloomfield may want to comment on from a public health point of view—he’s the expert. It’s his department who provide us guidance about how to create the settings and administer things in time.

Bridges Then, John, we’ll clearly put them to him. I suppose, to go to Paul’s and David’s sort of ultimate point, though, isn’t the issue that with quarantining at the moment you’re, effectively, for international people, doing it in the private sector whereas there is a case for the Government to directly intervene and do it in set places so there is, effectively, more control and it’s not just self-isolation, it’s quarantining?

9


Ombler With the incoming tourists—oh, sorry, it’s mainly incoming New Zealanders now, not tourists—incoming people going into quarantine, either they must have a satisfactory plan to then go and self-isolate and quarantine themselves, which we tick off, or they go to a site where—typically, a hotel—we have purchased a number of rooms for people to quarantine at. So I think there is a strong level of centralised management and control over that.

Davidson Mōrena, Mr Ombler. I hope you’re also all looking after each other. Thank you for everything you’re doing at your front line for all of us. I’m looking at the strategic communications section in the briefing that you’ve provided, and I wondered if you wanted to talk about an acknowledgment that there is no one form of comms that is going to be able to reach to every single corner of our community, and pick up on paragraph 19 in particular, which talks about a significant focus for the whole comms approach continues to be on providing advice to Māori and Pacific communities as well as to at-risk and vulnerable communities, and I wondered if you wanted to provide us with some examples of that part of the strategy.

Ombler Thank you for the question—a couple of things. Perhaps at a high level before going right down into that, I just note that the website that’s been set up, the COVID-19 website, since 11 March, has had 3.2 million individual visitors, with 14 million page views. So it’s been a very, very significant part of our communications to the public. On the day that the Prime Minister announced our move to level 3—that day alone—we had 800,000 individual people visiting. Also, with Facebook, which, of course, many, many people across New Zealand have access to and use, 80 percent of New Zealanders have visited the Unite Against COVID-19 site, and you may have seen the TV ad that was running with—it starts off with Ardie Savea and has a whole lot of other people afterwards. That’s reached 2.8 million people on Facebook. So that’s a very, very important set of channels for us.

10


With the specific part of your question about Māori and Pacific, both Te Puni Kōkiri and the Whānau Ora commissioning agencies have been very active with the Māori community and also as part of the Whānau Ora Pasifika Futures, and also the Ministry for Pacific Peoples have been active, and also [Inaudible] At the moment, there have been significant communications and help from Te Puni Kōkiri to Māori communities and to Whānau Ora. There is a national iwi chair to the Crown engagement process daily at 4.30 to discuss COVID-related matters, trying to find out what the issues are and to get on to them early before they escalate.There’s been a lot of work done to provide support packs to certain vulnerable people in the community. For example, Whānau Ora managed to distribute—I don’t have the exact number, but a very large number of—support packs of cleaning equipment to houses to help with the hygiene around the house and for people, which I think is a fantastic thing to do, very early on. So we’re doing what we can through those organisations to try to ensure that we’re well connected and understanding what the issues are and how we can respond to them as quickly as we can.

Wood Thank you, Mr Chair, and good morning, Mr Ombler. It seems to me that one of the more significant things which has happened—and this is referenced in paragraph 9 of your briefing memo—has been the shift from mitigation to “stamp it out”, and a lot of the significant measures which have come in place have stemmed from that. Given the significance of that strategic shift, can you talk through for the committee some of the assessments and judgments which went into leading us to the point of making that shift, and could you offer some comment on how that affects both the severity of restrictions that people are likely to face and also the potential length, the duration, and the frequency of restrictions, bearing in mind that I know we can’t read the future—but how might that decision shape decisions that we make going forward?

Bridges And, just to add on to that, John, practically speaking, what is the difference between mitigation and elimination?

11


Ombler For the technical part of that answer, I’ll probably rely on my colleague Dr Bloomfield. I’ll have a bit of a crack at parts of it. I think, in that last question, the comment was made that we can’t read the future. One of the benefits of being after many other countries in this journey is that, to an extent, by what’s happened there, we have been able to read the future. We’ve been able to look at their experiences and learn from them in real time so that we can act with the benefit of that knowledge. Some of the work we did with the border measures and ramping up testing and contact tracing was well ahead of what others did. Our border measures were unprecedented in an international sense.Also, some of the strong restriction measures at Alert Level 4—we did them in New Zealand when there were only 200 cases recorded and zero deaths. As a comparison, California went into lockdown at 24 deaths, China at 30, Spain and France at around 200, and Italy at 800. So we have been able to learn from what they have done in order to move more quickly. The whole deal with trying to eliminate it is to stop this person-to-person spread. Can I do my bushman’s epidemiology for you: if there’s 10 people and we all have COVID and we pass it on to nine, we might win; if there’s 10 people who pass it on to 11, we won’t.

Bridges Are you satisfied, though, in relation to that, that we’re doing what the likes of the WHO talk about, which is “test, test, test”—and, dare I paraphrase as well, “trace, trace, trace”—in sufficient numbers and quality to meet that strategy?

Ombler I think that’s a question that Dr Bloomfield is better equipped to answer for you. We’re relying on advice from [Inaudible] That’s a discussion we have frequently. I think that the way that our testing is running and our contact tracing is running, you could step up and you grow the capacity and alter the way that we’re doing it in real time. I am not unnerved by where we’re at, and I’m aware that we may need to change and enhance the way we do it over time.

12


Goldsmith Thank you, Mr Chair. Look, just coming back to that sort of issue of leakage of the lockdown—I mean, obviously, many New Zealanders out there are under immense pressure because of the lockdown in terms of their work, their livelihoods, their businesses, and so they’re very focused on an effective lockdown so we can get back to our normal lives as quickly as possible. So I think a lot of people are puzzled when we see so many of the cases that we’ve got are linked with international arrivals—so a lot of people are puzzled as to why we’re not being even more vigorous at the border. You’ve said you arrive from overseas and there’s not huge numbers—I’d be interested in the exact numbers for the last week, per day—and you’re saying if they’ve got somewhere to go, they go and self-isolate or they go to a hotel. That’s, basically, still a very high-trust model that we’re operating, and I suppose the question that I’m sure a lot of people are saying is: well, we’re turning our lives upside down for an unknown period of time and this is the most effective thing we can do to keep the virus under control—why are we taking a relatively high-trust, relaxed approach to quarantining or making sure that those new arrivals to the country are not spreading the disease?

Ombler I understand exactly what you’re saying—I agree with you that it’s imperative that people actually do what is required. We’re looking at the way that we can get a real-time measure of how effective that has been. Earlier in the discussion, there was talk about the need for care around the exercise of some of the Draconian powers that—my word, not yours—exist. I think there needs to be a balance between the way that we seek cooperation and the way that we enforce cooperation. In the first instance, at least, it would be my strong desire that we seek cooperation and only if that is being shown to be ineffective would we go to our stronger powers. But we’re looking at ways of getting a measure of that and the effectiveness of that, and we’ll respond before then.

Goldsmith I’d be interested in any data that you’ve got on the effectiveness of it so far. I note other countries, such as in South-East Asia, have used technology apps, for example, to help track where people are. Have you considered any of those sorts of opportunities?

13


Ombler There’s been discussion about those sorts of things. We have not settled on some of those technological answers at this point. But, as I was saying earlier, there have been checks on a number of people, especially around the quarantine rather than the nationwide “please stay at home” message, and the level of compliance with that has been reasonably good. I haven’t got any exact figures, sorry.

Bridges Do you know—and I appreciate I’m putting it on you; off the top of your head—but can you tell us how many are still coming in through the border, and the split of those between international visitors and returning New Zealanders, whether residents or citizens?

Ombler I can’t do it right now, but I can make sure that the committee is given that data. I can tell you, in general terms, that the number is generally diminishing. Certainly, year on year there’s a lot fewer people coming across the border, and that at the moment the majority are New Zealanders, but we’ll get some specific figures to you.

Seymour I wanted to ask a bit about what the Government’s approach to procurement of materials and technologies needed to fight COVID is, starting with PPE. We’ve got widespread complaints from GPs, some from within hospitals—although they seem to be better—from people in front-line positions such as supermarkets, and particularly people who are carers for the elderly. One carer may visit 50 different people in a week, according to their schedule, and they are saying they do not have PPE. And we’re not just talking about face masks but facial shields, booties, gowns, hoods—the kinds of things that we see being used elsewhere. I wonder what the Government’s approach is to procurement. Can it be open about where it has shortages—the same goes for testing—and then, perhaps, have some sort of portal for people who are able to supply such goods?And then it comes to new technologies. There are a lot of people going around saying that this treatment or that treatment—you know, hydroxychloroquine—might be the thing that works. I don’t want to get into speculating that any particular solution is what the Government should be using, but following on from Paul Goldsmith’s question about the tracing app, what approach is the Government taking to procurement of things we already know that we need, and new technologies and medicines that might be helpful?

14


Ombler When it comes to questions about procurement in the health sector, I’ll leave that to Dr Bloomfield to answer. What I would like to do, though, with regard to PPE, is to just draw the committee’s attention to some—I don’t know how well you can see this on screen, but on the COVID-19 website and on the Ministry of Health website, there are these factsheets which show a range of circumstances for people. In this case, it’s community care providers; in this case, it’s requirement for essential workers, non-health sector—the sort of PPE equipment that is appropriate in each circumstance.Now, this was prepared by the Ministry of Health to assist people across the community to understand what is the requirement, from a public health point of view, to manage the risk of transmission of this disease. I think that’s particularly helpful and starts to, I think, help people have a level of confidence about the equipment they have, but also can manage some of the supply line issues. You don’t want to send a whole lot of stuff out to somebody who doesn’t need it, and you want to send the stuff in the right place. I’ll let Dr Bloomfield answer the medical question.

Seymour So, just to be clear, what you’ve just shown us is a document that says people might not need it. With the greatest of respect, I’ve got people who are health professionals who know what they need, they know they need it, and they’re concerned that they’re not getting it. And you’re saying that, from a whole-of-Government perspective, there’s no initiative with procurement to try and get more equipment faster to the right people?

Ombler No, that’s not the case at all. There is a lot of work going on in the health sector, and across the non-health essential services, to get the right gear to the right people, and at the right time. There’s a lot of stuff even happening today. I know there are millions of masks, for example, other protective equipment, being sent around the country at the moment, and there’s stuff on order, there’s stuff being manufactured [Inaudible] plant.

15


Bridges Do you accept, though, John, there does seem to be—based on the feedback that every member of Parliament will be getting—a fundamental disconnect between what you, the Prime Minister, and others are saying, and what we are hearing on the ground, in two ways. Firstly, in that those pharmacists and midwives and the like are saying, “Well, that’s fine. That’s what they say we need, but we actually need more.” I can think of a physician who has contacted me and said, “Well, they’re saying masks, but we actually need gloves and gowns for our people as well.” And then there’s a disconnect at another level, and that is that, more broadly even—forgetting the debate about what they should and shouldn’t have—they’re simply saying, “Well, actually, we’re not getting anything.” Like a grandfather who said to me his daughter and granddaughter are both midwives and he despairs that they simply cannot get any PPE whatsoever. So there does seem to be this disconnect between what officialdom says and what is being said on the ground. Do you accept that?

Ombler I’ve heard some of those same stories. It shouldn’t be happening; we know that. If there’s somebody who requires equipment and doesn’t have it, then clearly, out and around the country, the district health boards and so forth will be working on that. But I think, when it comes to PPE across the health system, I’m far better to leave the discussion with the committee for Dr Bloomfield.

Bridges Well, look, John, thank you very much for your attendance. I would like to tell you it will be your last but, regrettably, I don’t know that that’s true. We really thank you for your service and your time with us today. We’re going to now move to our special adviser, David Skegg, an eminent professor in public health and epidemiology, to, effectively, give us a few pointers on what to expect in areas he would be asking questions on as we shortly hear from the Minister of Health, David Clark, and the Director-General of Health. David, are you there? Can you hear me?

Skegg Kia ora tātou katoa. Thank you, Mr Chairman, for the privilege of addressing the committee. I’m delighted that members of Parliament will be scrutinising our response to COVID-19. We need transparency and a readiness to change tactics if we’re to have any hope of defeating this virus. So I’m going to speak for about five or 10 minutes, if that’s all right, and then I’m happy to answer questions, and I’m sure the Minister and Dr Bloomfield can address these as well.

16


I don’t need to expand on the threat we face—we only have to watch television to see what is happening elsewhere—but the rapid spread of this virus, especially where Governments have been indecisive, is sobering. The first case of COVID-19 in the United States was diagnosed on 20 January, two months ago; now, they’ve had over 140,000 cases. Yet there are a few other nations, such as Singapore, which have been very successful in controlling this virus, even without a lockdown. We need to learn from them.As we started to face this challenge, New Zealand had both strengths and weaknesses. We have no centre for disease control or public health commission. Our Ministry of Health employed almost no epidemiologists. Recent epidemics of campylobacter infection and measles, on a scale that was shocking for a developed country, underlined the fragility of our public health function. On the other hand, we are a small country with high social cohesion. Our politicians and public servants are responsive, and there has been cross-party support for bold action. New Zealanders are good at rising to a challenge, and the great majority of people are committed to overcoming this threat.Early border restrictions gave us a little more time to learn from other countries, but the number of cases of COVID-19 kept rising, and it was clear that community transmission was occurring. I’m afraid that only complacency can have allowed our authorities to imply that the virus would behave differently here than everywhere else. Testing has been heavily skewed towards people who have returned from overseas or their contacts; so it’s no surprise that most of the cases detected have links to overseas travel. The actual number of people who have been infected will be far higher than the 589 notified, and we really have no idea of the extent of community spread.Fortunately, the Government was bold enough to take us to Alert Level 4, a national lockdown. So, what could that achieve? Well, there is no document that sets out the Government’s overall strategy. Some statements have implied a goal of eliminating the virus, while others imply suppression or even mitigation. One would have thought that, by the start of a lockdown, there would be a clear goal, with a time line for achieving that goal, and a series of options if it is not achieved. When will that document be developed?

17


I assume, and certainly hope, that the current goal is elimination. We should no longer be talking about the influenza pandemic plan, as COVID-19 is different from influenza. Because of the longer incubation period of this new virus, New Zealand still has a fair chance to eliminate it. In infectious disease control, elimination refers to the reduction to zero or to a very low, defined target rate of new cases.Just imagine if we could largely eliminate the COVID-19 virus from New Zealand so that any small local outbreaks could be controlled by testing, rapid case contact tracing, and isolation. We could all be out of the lockdown, with its huge costs to the economy and to social, cultural, and sporting life. Some, but not all, border restrictions would need to continue until a vaccine becomes available, and that’s at least a year away, but we could be one of the very few countries on earth to be functioning normally.China showed what can be achieved by a rigorous lockdown. As you know, many other countries have now imposed lockdowns, but they’re almost all too late—a case of shutting the stable door after the horse has bolted. Because our Government acted at an earlier stage, we still have a window of opportunity, but only if we lift our game quickly.There are at least four requirements to have a good chance of achieving elimination. First, the lockdown must be as comprehensive as possible to minimise person-to-person spread. Are all those essential industries really essential?Secondly, every effort must be made to prevent spread from New Zealanders returning from overseas. As each day goes by, the probability of such people carrying the virus increases because of the rising prevalence of infection in the countries they return from. And Australia has taken a different approach, of quarantining everyone in that category, but the matter has already been raised by members of the committee.Thirdly, we need to do far more testing. The ministry’s criteria for testing have been loosened, but this has not got through to many of the clinicians in the field. I keep hearing about patients who should have been tested but were not because they haven’t been overseas recently. Testing should also be part of planned surveillance studies, which I’ll mention in a moment.

18


And, fourthly, the capacity for rapid case contact tracing must be greatly expanded as a matter of urgency. Contacts need to be located, isolated, and tested before they start infecting other people. This is a huge logistical exercise and a challenge which I don’t underestimate.A number of people have suggested we should learn from the success of places like South Korea and Taiwan, where cellphone technology is used to augment contact tracing. Special legislation was passed to enable that. The approach raises privacy issues, but at least it should be evaluated quickly to decide whether or not it’s acceptable. Who is doing that?A lockdown on its own is not enough. Can I repeat that: a lockdown on its own is not enough. It’s like pressing the pause button on your device. As the head of health emergencies at WHO has said, once we’ve suppressed transmission, we have to go after the virus. We all know how costly this national lockdown will be in human and economic terms. It will be a terrible waste if we don’t pull out all the stops now to maximise our chance of eliminating COVID-19. But it worries me that the Government doesn’t seem to be talking clearly about elimination. So has it already given up on that goal? Plan B: if elimination cannot be achieved, when and how will we know that, and what will be the next goal? Those are the kinds of things I would expect to see in a strategy document.There’s a limited role for mathematical modelling, but I’m worried that some are dazzled by the maths and don’t realise how uncertain the estimates are. It’s no surprise that groups produce such different estimates, because many assumptions have to be made and there’s debate about the appropriate model. One of the values of modelling is to identify gaps in knowledge and hence needs for data collection and research. We have far too little information about the occurrence of COVID-19 in New Zealand today. That needs to be obtained by planned epidemiological studies immediately. I heard that general practices and other sites used for sentinel surveillance of influenza would be asked to test systematically for COVID-19. Did that work start? When will the first results be available?

19


Finally, changing tack, epidemics are often not fully understood until they’ve nearly run their course. That is especially true when we are dealing with a novel disease. More information about COVID-19 pours out every day. The advent of new rapid tests for both the virus and the antibodies it stimulates might lead to a major change in approach. The Ministry of Health is overstretched, as shown by delays in providing sufficient guidance for personal protective equipment, or PPE. It has a Technical Advisory Group, but I think the Government also needs an independent public health advisory group to review all the evidence and to recommend appropriate strategies.I heard a WHO official say that New Zealanders should not be worried, because the country has some of the best public health scientists in the world. I think it’s time that we started to make more use of those public health scientists. Kia ora tātou.

Bridges Sir David, thank you very much for that very incisive critique. Can I just say to members: we will have David back at the end of our discussion with the Director-General and the Minister. We can do some questions at this stage; I just ask they be very brief and for clarification, so that we can move from the entrée to the main, if you like—I’m sorry to say that, David, because that was excellent. Could I just ask you very briefly this, on one of your points about testing, which is your, I think it was, third point, really, of the four things we need to do for elimination: is there such a thing as over-testing in relation to this pandemic, and what is your view at the moment about the criteria we are using?

Skegg Well, I find the criteria still quite confusing, and perhaps Dr Bloomfield will expand on that, but what I hear from the centre and what I then learn about from what’s going on in hospitals and general practices is quite often different. We can’t do too much testing. The WHO keeps saying, “Test, test, test.” The countries that have been most successful in controlling this epidemic do far more testing than us. But there is a problem, and that is a shortage of test kits, and in some countries there’s been a lot of use made of university facilities—because many of our universities have a lot of laboratory capability. I heard just yesterday that, in Singapore, they’ve even been raiding the universities for reagents to keep up the testing. But I think this is just so urgent. Every day counts at the moment. We’ve seen how rapidly this virus spreads in other countries—

20


Bridges Sorry—but, very briefly, what’s the basis on which you say that there is a shortage of testing kits? Are you talking internationally or New Zealand?

Skegg No, I’m talking internationally, and I can’t comment on what the constraints are here, but I’m really just addressing your question. Obviously, there is going to be some limit on the amount of test kits available. So we do have to be strategic in the way we use them.

Bridges Thank you. Look, let’s very briefly go through the clarification points from members, if you will. Fletcher Tabuteau.

Tabuteau Thank you, Mr Chair, and thank you, Professor Skegg. I appreciate your giving us your time and expertise. I just wanted to clarify your observation around the lockdown and the sufficiency, or lack thereof, in regards to the actual elimination of the virus. Can I get you to expand on that so I can understand, because, in your introduction, you said New Zealand has responded well and we are likely to come out—well, we are one of the few countries that may come out the other side of this in a positive frame, but then you spoke about the lockdown not being sufficient in terms of an elimination strategy. Could you please explain that for us, please?

Skegg Well, the fact is that transmission will continue during the lockdown. There are many people still going to work—I’ve got no idea of the number, but, you know, our cities are not dead; there’s still a lot going on, and there are some industries that are continuing where one wonders whether they need to. But, obviously, there are many essential industries, and so transmission will occur—the virus will keep spreading at a low level—so once we stop the lockdown, it’ll take off again. That’s why I say it’s like pressing the pause button. So what we need to be doing while we’re in lockdown—not afterwards; right now—we need to be chasing the virus, testing, isolating, and that’s the only way we’ll stamp this thing out. I think a lot of people think, “It’s great we’ve got this lockdown; let’s just relax for a while.” But this is the very time we need to pull out all the stops.

Bridges Thank you. Michael Wood.Wood No, my question’s been answered, thank you, Mr Chair.Davidson Thank you, Sir David. What would you like to see before

Alert Level 4 goes back to Alert Level 3?

21


Skegg Well, I would like to see a lot more testing. I think we need to have epidemiological information about the extent of community transmission, but these are the kind of things which I’d really want to see a whole group of experts get together quite quickly and to hammer out some objectives as to what should be achieved before that big decision is made.

Allan Professor Skegg, thank you for your time this morning. You will be aware that there is the independently commissioned report that was released by the Ministry of Health today, setting out the modelling that they’ve used to track the trajectory of COVID. Does that satisfy some of your concerns around independence—those were scientists from the University of Otago and Germany?

Skegg No, that’s a different matter. Of course, I know Professor Wilson and Professor Baker very well and have a lot of respect for them, but those models are not about what we need to do now to control the virus. What they show, I think, very explicitly is what will happen if we don’t eliminate it now. But that wasn’t the point I was making. As I say, the models tell us this is going to be a huge problem, and I don’t mind whether it’s 10,000 deaths or 20,000; we obviously need to prevent them. What we need now, I think, is a real clarity in purpose in the way that we now stamp this thing out, and the modelling won’t help us with that at all.

Bridges You would [Inaudible] specific strategic purposes document, and you say there isn’t one at this time. Is that what you’re fundamentally saying on that one?

Skegg Yes, I don’t believe there is a document that sets out clearly the goals and how they’re going to be measured.

WoodhouseThank you, Mr Chair, and thank you, Professor Skegg, for what you’re doing. There seemed to be an inconsistency between what Mr Ombler said in regards to border controls and what you have said. John Ombler said our border measures were unprecedented in an international sense and he wasn’t unnerved by what was going on. You told the committee early border restrictions gave us time but that complacency exists that we would somehow be different. You mentioned quarantining as the second point of your four-point plan. Are you saying that the Government should formally quarantine all arriving passengers from now?

22


Skegg Yes. Well, there are two parts in your question. First of all, earlier on, I don’t think we were unprecedented in our border restrictions. We pretty much followed what Australia did and the United States and a few other countries, but we were certainly much earlier than most, and I think that gave us a great advantage. What’s happening now—I am concerned that self-isolation may not be enough, because we all know that people may flout the requests that are made to them. So, personally, I would much prefer that we do what Australia is doing and to quarantine all people arriving here now, and not to self-quarantine but that they should be quarantined. But I think the only way of answering that is to very rapidly assess the effectiveness of the self-quarantine.Now, for example, in Singapore, if someone is infected, they’re sent about three text messages every day, which they have to reply to immediately, to check where they are, and if they leave their phone with someone else while they pop out to the supermarket, the police also call occasionally as well. But I just don’t think we have that level of checking going on.

Seymour Look, thank you very much, Professor Skegg. I really want to thank you because you are treating New Zealanders like adults who deserve to know what the data is, know what the plan is, and know how decisions will be made in future. I’m really looking forward to moving on to the Minister of Health and the Director-General of Health so we can ask them what is the plan for more testing, what is the plan for testing through doctors surgeries routinely, where is the plan, and how do we make decisions about lifting the current level of restrictions. So, thank you, Professor Skegg.

Bridges Thank you. David, thank you very much. You will stay on the line, of course, and hear what the Minister and the Director-General say, and we’ll come back to you at the end. So let’s now move to the Minister, Dr David Clark. I think you’re there, David. We thank you very much for attending virtually—and, of course, Director-General Ashley Bloomfield. Ashley, I think we would all as a country thank you so much for what you are doing for New Zealand—the outstanding job that you are doing. Have I got you both?

Bloomfield Yes.Clark Yes, here.

23


Bridges Could we just welcome you and ask you, just briefly, please, if you would, for any introductory remarks you would like to make?

Clark I have some introductory comments that do cover many of the areas the committee’s covered already, and I’ve had the good fortune to listen in, and also follow up on some of the questions the Opposition has been asking and raising in the media that I think need to be addressed. So I do have a statement at the beginning, but, obviously, we’ve got lots of time for questions. I have no limit on my time availability.So far, New Zealand has seen 589 cases of COVID-19. The vast majority of those cases have been linked to overseas travel or to a known case. Just 2 percent of the 455 cases where we have sufficient information so far are currently believed to be a result of community transmission. I mention this not to try to minimise the challenge we’re facing but to highlight the fact that we remain well placed—and I think Professor Skegg highlighted the importance of continuing to be active in our response—but we’re well placed to contain the spread if we take those active steps.Part of the reason we are well placed is because we’re an island nation, and part of it is because we’ve taken those early and decisive steps at our borders, as Professor Skegg mentioned. The action has given us that time to improve our preparedness. I listened to Dr Skegg’s comments about the next steps in that, and I can assure members—but I’m sure we’ll have questions—that we are looking at those next steps in the context of the fact that it’s about 90 days since this disease, then without even a name, was notified to the WHO.

24


We’ve seen the virus spread in the likes of China, Italy, and Spain, and we’ve seen hospitals overloaded there. We’ve seen in other countries and territories like Singapore and Taiwan how they’ve managed to contain it, and so, based on that international evidence, we know that our health system would be stretched well beyond capacity by an uncontrolled and widespread outbreak of COVID-19. That’s why our plan has been built around these four Alert Levels, designed to avoid a single large surge of cases. If we can spread the cases over several smaller waves, our hospitals and health workforce will be better able to manage the demand and better able to treat people and save lives. So that’s why we’re asking New Zealanders—and this is the messaging you will have seen publicly—to stay home, to stay safe, so that we can help break that chain of transmission.A word on modelling: this morning, the Director-General of Health released the modelling work that has informed, along with a range of other information, our decisions over recent weeks—and Dr Bloomfield will speak himself to that shortly. I wanted to start here, though, with a note of caution. Modelling work is not a prediction; it is based on available evidence, which is still emerging and, naturally, includes a range of assumptions. But it does show how serious the threat of COVID-19 is, both checked and unchecked. As the Prime Minister has acknowledged earlier, early modelling based on data from other countries suggests that New Zealand could expect tens of thousands of deaths without significant action, and that would be—I think we would all agree—totally unacceptable.The detailed modelling that has helped inform the bold decisions we’ve taken—including, effectively, closing our borders to all but returning New Zealanders, permanent residents, and their families, and the extraordinary steps we’ve taken to require people to stay home during Alert Level 4. The truth is that, based on the modelling and what we’ve seen in other countries and territories, including those that have taken very significant measures, we continue to face a major challenge to avoid tens of thousands of deaths. If we assume that each person who contracts COVID-19 passes it on to an average of 2.5 people and we manage to reduce contact within the population by just 25 percent for six months, we could still see more than 1.1 million cases and 12,700 deaths.

25


That’s one scenario, and we’re determined to avoid that scenario. By way of comparison, if we assume the same level of infectiousness—so, an R0 of 2.5—but we manage general contact reduction of 50 percent for nine months, the number of cases drops by a quarter of a million and the number of deaths might fall by 4,000. Those are pretty confronting numbers, but, again, they’re not predictions; they’re not set in stone. The modelling isn’t directly linked to the actions we’ve undertaken in each of the levels in our alert systems. So it doesn’t reflect what happens at each level, but it does show that the stronger the actions, the more lives that will be saved.It also shows that some restrictions could need to be in place for some time if we are to suppress the impact of COVID-19 on our health system and the health of New Zealanders. It doesn’t automatically mean staying at Alert Level 4 for longer, but it could mean retaining strong border measures until we can guarantee those coming in are not able to spread the infection in our communities, and we can all influence the course of this pandemic by staying home, washing our hands, coughing into our elbows, and, most importantly, self-isolating when we’re sick. We can limit the spread of COVID-19, and as the Prime Minister has said, you may not be at work, but we all have a job, and that is: saving lives.In terms of the health response and preparedness, the decision to impose travel restrictions and, more recently, to go to Alert Level 4 has affected every part of our life as a nation. Around the country, people are adapting to a very different way of living and, where possible, working, but these measures are a key part of the decisive action to protect New Zealanders and give our health system more time to scale up its response. I want to speak to some of that response and capacity, starting with the lab capacity.

26


In January, we acted quickly to establish our testing capacity. In the last week, our labs processed an average of more than 1,700 tests per day, and we have the capacity to do more. Currently, our labs have the capacity to process up to 3,300 tests per day, and that is expected to grow even further in coming days. On a per capita basis, we are testing at a similar rate to Germany, and we have nearly twice the level of testing capacity that the UK is targeting to be at in three weeks’ time. South Korea is considered the gold standard for testing at this stage, and our rate of testing compares more than favourably at the comparable point in its COVID-19 outbreak. The Director-General can speak more to the detail of that.But I do want to be upfront with the committee—and this has been raised already—that there is strong international demand for the reagents and other consumables used in the testing process, and that’s why a lot of our focus and the focus of health officials has been in that area, but we have every reason to be confident in our testing capacity. Our labs have surge capacity and are working hard to maximise the use of our reagent.The major laboratory equipment companies are using an allocation model which ensures that each country continues to receive supplies but no one country can stockpile. So we’ve seen that from overseas, and deliveries of reagent from all three major suppliers are expected in the next week, and we will continue to source more. At the same time, officials are looking at alternative testing methods, and we’re exploring every avenue and offer being made, including working closely with the private sector. I can expect our testing to continue to ramp up. We have to be careful to make sure that we’re using our health professionals, of whom there are only a limited number, to focus their effort on testing where we know that we will have the most benefit. But, again, I’m sure we’ll answer questions on that—that will come.

27


In terms of contact tracing, of course, when we get a positive test result, one of the most important things that we can do—and the Director-General of Health at the WHO has reinforced this—is contact trace. It continues to be a real strength of our health response to COVID-19, and I want to thank the public health experts who have done this year in and year out with infectious diseases. Although a very small team, it has been scaled up. As part of the $500 million health package announced earlier this month, more than $40 million was made immediately available for public health, with a strong emphasis on contact tracing, allowing that capacity to ramp up.The National Close Contact Service has been established to support local public health units. It’s proactively making contact with individuals and advising them that they’ve been in contact with a person who has tested positive for COVID-19. The NCCS—the National Close Contact Service—will be moving on to a digital platform over the next week, which will link with all public health units so we have a streamlined process for public health contact tracing across the country. If more is required, as I expect it will be, more funding will be found. It has been made very clear to me from the start of this outbreak, from both the Prime Minister and the Minister of Finance, that funding will not be a constraining factor.Our public health units are doing remarkable work, and I do want to thank them, along with the other health workers who are working so hard to protect and care for New Zealanders. Their work has been particularly important, as we’ve seen—work to stamp out isolated clusters. There’s been the Hereford conference, the Marist College in Auckland, the Assisi rest home in Hamilton, a private wedding in Wellington, and the Redoubt Bar in Matamata, and a related group that travelled to the US. All of those are clusters that have been in our communities, and there’s important contact tracing work going on there. There are other smaller clusters, which are being actively managed by public health staff.

28


As you’d expect, I just want to speak about Healthline. The demand for health advice has hugely increased in response to public health concerns about COVID-19, and that’s led to longer than usual wait times, although this has now been stabilised as more and more staff have been added, along with other ways of providing information and advice to people. Healthline has more than doubled its workforce since the end of January and currently has 426 people taking calls, with another 128 people via third-party contracts. That’s expected to expand even further in coming weeks.In terms of waiting times, on Sunday the average time it took for clinical triage calls was 17 minutes and 55 seconds. Six out of 10 calls to Healthline are seeking self-care advice or information. Just 13 percent of calls are for people who are experiencing cold or flu-like symptoms, and 25 percent are from people who have returned from overseas in the last four weeks. We are looking at ways to relieve some of that call pressure by further developing online capacity to help people who are seeking basic advice or information, thus freeing up Healthline for those who need it most.Primary care—in primary care, we’ve already established 45 community-based assessment centres, where people who have symptoms of COVID-19 can safely be seen and have samples collected for testing. There are plans to expand this approach, with another 61 CBACs—community-based assessment centres—in the works. Fifty-two general practices have been designated to respond to COVID-19, with 10 more to come, and four more mobile clinics are proposed to be deployed. We’ve also seen general practices embrace digital and telehealth services, with an increased use of video consultations to support people staying at home and to limit the chances of transmission of COVID-19.Financial support packages have been developed to support general practice and community pharmacies. This payment, yet to be announced in full detail, will recognise the additional workload and how the work has changed as we’ve moved into Alert Level 4, and I’m expecting to announce detail of a package that will be coming from the money that the Government has set aside for primary care in the Budget—the small Budget announcement that the Minister of Finance made with the $12 billion allocation—and that is aimed to support general practices with the additional workload and also the costs incurred with moving to virtual consultations.

29


Community pharmacy will also receive additional funding as a support payment for all community pharma service providers, to recognise the increased workload and to recognise the way they’re moving to a virtual working environment alongside general practice. On top of that, there will be an additional payment to DHBs to support the set-up, implementation, and running costs of the CBACs. Funding will be available to general practices who have agreed with DHBs to form part of that CBAC network. Further funding may be required, as both general practices and pharmacies have reported significant revenue reduction over the past week. As a Government, we will continue to support GPs, community pharmacists, and other primary care providers.In terms of PPE, all GP clinics have been supplied personal protective equipment to help protect our GPs, nurses, and other staff. It’s important that PPE is available to those that need it and that it’s used appropriately. Just last week, a total of 640,000 face masks were sent to DHBs from the national reserve supply to ensure that hospital staff have continued access to masks. Today, another three million masks will be arriving in Christchurch and four million in Auckland. These masks are specifically earmarked for DHBs to deliver to front-line workers in the community, including those in aged residential care, home and community support services, pharmacies, NGOs, family planning, disability support providers, and Māori and Pacific providers.At this point, I should stress we have good stocks of PPE in our national reserve. When I discussed this yesterday, the numbers were that we’ve got 18 million face masks. DHBs have a further 5.1 million. We’ve got 1.8 million gowns and aprons, 2.4 million pairs of gloves, 21,000 bottles of surgical hand wash, and 60,000 items of eye and face protection. Of course, you will all know that there is huge global demand for PPE. We are fortunate in that regard to have a local supplier for face masks, and I’m sure the Director-General can update the committee about our ongoing work to secure continuous supplies beyond that. All the work we’re doing is designed to limit the transmission of COVID-19 and ensure our health system can continue to deliver.

30


So just a few words about hospital capacity: as part of the move to Level 4, DHBs have postponed a range of elective procedures, freeing up large amounts of capacity in the system for acute care. Currently, occupancy rates at our hospitals are around 50 percent, which is well below the usual average level, which is routinely 80 or 90 percent, sometimes more. Of course, a big part of the equation is the level of demand, and that is where we all have a part to play. By staying home and staying safe, we can reduce the spread of COVID-19 and reduce pressure on our health services, and that’s why it’s so important that we stay in our bubbles. If we don’t, then the risk of the widespread outbreak we’ve seen have such devastating consequences overseas, where even the most well-prepared health systems have been overwhelmed, is a risk that we would run here.Make no mistake: if we cannot bend the curve and reduce transmissions, our hospitals will come under unprecedented pressure. We must do, collectively, all that we can do to avoid that. That said, in terms of hospital preparation, a considerable progress has been made in preparation for a surge in cases. Under normal circumstances, New Zealand DHBs have around 150 dedicated ICU—intensive care unit—beds, with ventilators, with a further 240 beds outside of ICU that are capable of looking after ventilated patients, and we know that won’t be enough if we experience significant COVID-19 outbreaks here.In recent weeks, a huge amount of work has been done to determine how we can scale up that ICU capacity. I’m advised that DHBs are now confident they can support 533 ventilated beds. More ventilators are being sourced, using a range of public and private sector channels, and there are also 218 ventilators, including anaesthetic machine ventilators, in private hospitals around the country. Work is also being done to explore capacity in teaching universities, emergency services, and the Defence Force. Of course, all of this equipment needs appropriately trained staff, and we currently have around 2,500 trained ICU critical care nurses. We know there are a lot more nurses that have had relevant experience, and DHBs are already running refresher courses and training new staff to care for ventilated patients should that be necessary.

31


Workforce—final topic before summing up. I know members of the committee will agree we are fortunate to have a dedicated and professional workforce of doctors, nurses, midwives, laboratory scientists, mental health workers, and allied health workers. These people provide outstanding care for New Zealanders day in and day out, and we’re asking so much of them as we combat COVID-19. I do want to thank them once again for all of the work that they are doing. It’s worth noting we’ve already had more than 6,500 healthcare workers indicate they’re ready and willing to return to work, either from retirement or from overseas or from working in other fields within New Zealand, if we need to expand our healthcare workforce in coming months. It’s an incredible response which reinforces the commitment and quality of our healthcare professionals here in New Zealand.There is much more I could say, but I know you’ll have many questions. Before I finish, let me stress once again that, as a country, we have acted early and decisively. That has bought us the time, but there is no room for complacency. We’ve used the comprehensive pandemic plan as a guide and rapidly refined our response based on the emerging research, evidence, and the experience overseas. We’ve made COVID-19 a notifiable disease and then a quarantinable disease. It was just six weeks from 3 February, when we introduced our first border restrictions, until 19 March, when we, effectively, closed our borders to anyone other than New Zealand citizens, permanent residents, and their families.We’ve gone into Level 4 and all that entails well before other countries that have seen far more cases have acted. That will save lives. We’ve taken strong action based on scientific and medical advice and put the public’s health and safety as our number one priority. It is a global pandemic. As has been clear with our first death from COVID-19 on Sunday, we are not immune to the terrible impacts of this disease. But we are prepared. We will continue to work to our plan and continue to do all that we can to keep our people safe and well and ensure that our country bounces back as quickly as possible. Happy to take questions.

Bridges Thank you, Dr Clark. It’s very important material. I will ask your ministerial colleagues to be somewhat briefer when they speak, but I appreciate and let you off because you’ve made quite clear that you’ve got all the time we need, and I appreciate that.

32


I think what we’ll do, members, is we’ll do this somewhat topic by topic. It seems to be quite clear, from earlier questioning of John Ombler and what Professor Skegg has said, there are some, I think, fairly clear topics that we’ll want to run through. The way I see this, Doctor and Director-General, is, really, it’s for either of you to jump in and make your answers known. Perhaps if we can start with what Paul Goldsmith has called the “lockdown leakage” and the issue of borders? I wonder if you are able to tell us how many are coming in through our borders, say on average over the last few days—or if you want to do it on a daily basis. And if you’re able to give us a sense of how many of those are international visitors and how many are New Zealanders, whether residents or citizens.

Clark Yeah, if I can respond to that in the first instance; the Director-General might wish to add to it. I recall one of the recent days there being, I think it was, 389 people arriving. The numbers now are relatively small. They are restricted to being New Zealanders—citizens, permanent residents, or Australians resident here, or their families. So the numbers now are small. However, as Professor Skegg and others have highlighted, this represents one of our biggest risks, because these people are frequently coming from hot spots where the incidence rate is high, and that’s why we are requiring them to go into a different kind of self-isolation to others. We are expecting them to be in self-isolation in the same way as close contacts would be, where they don’t go out, where they are looked out for by others, but maintain a distance even from those others if they’re with their families who might be in self-isolation. Director-General?

Bloomfield Thanks, Minister, and kia ora koutou. So, just to clarify, as the Minister has said, to back him up there, we provided the clarification that, actually, anyone coming back from overseas is, effectively, treated as a close contact. Those who are assessed at the airport—and everybody is assessed and asked questions about symptoms—anyone who has any symptoms is health assessed and then quarantined and tested. Those who have no plan that is clearly well developed to go into strict self-isolation are also put into hotel accommodation at this point, until they can develop that plan, and any movement of those people outside of those hotels is, essentially, segregated from other travellers.

33


So, even if there are flights put on, they will be—and we’re just working this up—they will be dedicated just for people who’ve come from overseas with, effectively, similar precautions to when we flew people back from Wuhan. And, finally, at this stage, we are still allowing people to go home and self-isolate as if they are close contacts, just as we are allowing close contacts of other cases onshore to self-isolate at home. We are not quarantining them in a dedicated facility. So that’s the current posture, and I know Australia has changed their approach to this over the last couple of days. So we’re looking constantly at that.

Bridges And no issue for you if you can’t—although if you could provide them to us, say, by Thursday, that would be helpful—are you able to tell us the daily numbers and the proportion that are New Zealanders and non - New Zealanders?

Bloomfield Well, what I can say is, as the Minister said, the numbers have dropped, and, in fact, there are no non - New Zealanders coming in—no one on a visitors visa is allowed to come in. Actually, there will be non - New Zealanders if they have a working visa—it’s my understanding—but those would be people who would be normally resident here and have a place they can go and stay.

Bridges So can you be quite clear today we don’t have non - New Zealanders coming into New Zealand at our border?

Bloomfield We don’t have anyone on a visitors visa. There are some non - New Zealanders if they are family of New Zealand citizens or residents or if they have a working visa, and then they are under the same expectations as everybody else coming in.

Bridges And just on your commentary that you were making then around the issue of testing at the border, I suppose a question that many New Zealanders would ask: we’re in lockdown—lockdown must mean lockdown; the modelling, which aren’t predictions but show 14,000 fatalities potentially—given that they’re small numbers, why don’t we test all of them?

34


Bloomfield The simple reason is that the virus may be incubating in people who are asymptomatic, and they may have a negative test. So the key thing here is—and this has been our approach right from the start, and it is the approach of the vast majority of countries—that the key intervention here is to identify close contacts, and we’re treating everyone coming in from offshore as a close contact, isolate them, and monitor them daily for symptoms. And if they develop symptoms, then they are tested.

Bridges Surely, on that basis, we wouldn’t test anyone, because there’ll be false negatives. I mean, surely, as I say, given the extreme measures we’re taking as a country, we should simply test everyone at the border, given it’s a small number of hundreds each day?

Bloomfield So we are testing anyone who is symptomatic, and those people are placed in strict quarantine until the test result is back. Of course, if they test positive, then they have to remain in that quarantine for the full 14-day period—actually longer, a period of 14 days from after their symptoms diminish, or go away. So, again, it’s just getting this balance right between using testing where we know that, if someone is symptomatic, we want to rule out or rule in COVID-19. The important part of the response is to make sure they are isolated and that we find all those close contacts.

Bridges I can see my colleagues brimming with questions, but can I just push my luck one further time, Director-General? You talk about balance; isn’t the reality, though, that we have no balance here—we’re in lockdown as a country, Parliament isn’t sitting, there’s a modelling of 14,000 fatalities—and so, rather than be balanced, we should over test at the border so that we are able to move on stronger and sooner?

Bloomfield So just a final comment there. I think the key point I’m making here is that a negative test of an asymptomatic person coming across the border does not rule them out for having COVID-19 infection, and their response would be the same: they would go into self-isolation at the moment, if they’ve got appropriate plans, or into supervised accommodation, if they don’t.

35


WoodhouseThank you, Mr Chair, and Minister and Dr Bloomfield. Can I just add my thanks to you and your team, Ashley, for the very hard work that you’ve done We are going to probe some of the things that you have said, simply to, I think, give the public the confidence that we are on top of this, because I do think there’s high levels of uncertainty about whether this is going to work, and I want to start at the border as well.You have said that the self-isolation is a high trust process and that there is a need for them to register with Healthline. Even with the diminishing numbers of people coming in between, say, 1 and 14 March, I was staggered, frankly, at a reply to a written parliamentary question from the Minister that said that, on 16 March, there were just 954 people currently registered for self-isolation. Now, that would have been a fraction of the numbers of people coming into the country in the preceding 14 days.What level of confidence do you have that the people registering with Healthline as self-isolating was an accurate and close proportion to the number of people returning from overseas?

Clark Can I just step in there, because nine hundred and something does not sound like the correct total number for that. It may have been on that day, and I just want to be clear. If there’s a misunderstanding, I’m happy to go back and clarify that.

WoodhouseNo, no; that is correct, Minister. It was the number of people registered on that day—not who did register on that day; who were currently registered. So you’re quite right, and Dr Bloomfield, you have said that there have been several thousand coming and going through that register, but my question relates to the confidence that we can have that the self-isolation and contacting by the Healthline staff is actually working, because, if we didn’t know where they were, how would we know what they were doing?

36


Bloomfield So, look, a couple of comments there. First of all, at that point, we had shifted to a process whereby everybody coming in through the border was required to complete an arrival card and to register there and were handing in the cards at the border, and so the registration was being done at the border and uploaded to the Healthline database at that point. So I would have to go back and check the numbers. It doesn’t sound right that there were only 900 people in toto. I suspect that may have been the total number registering that day. But, again, I don’t have the numbers in front of me.

WoodhouseWell, through you, Mr Chair, can I perhaps ask that the committee is provided with daily data on both the number of people presently registered with Healthline as self-isolating, and co-relate that with the number of people coming across the border—say, for the month of March; say, from 1 to 31 March. It would be quite helpful, I think, to be reassured that that self-isolation process was working.

Bloomfield Can I just make a comment on that, please, Mr Chair? Effectively, we’re in a very different situation from what we were before we went into Alert Level 4, where we were registering people coming across the border who were going into self-isolation, and the only other people in self-isolation at that point in time were close contacts of cases who had been contact-traced and advised, and they were on daily checking from the public health unit or, subsequently, from our national contact centre.We’re now in a different situation, clearly, where the whole country is self-isolating and the expectations on people coming across the border is, again, some are quarantined if they’re symptomatic and they’re tested; others are in accommodation that’s provided if they don’t have arrangements, or they’re self-isolating at home. In the latter case, they are checked on; there are checks done on them by the police within three days of their arriving and self-isolating. So we know who they are, and we know where they are.

37


WoodhouseYeah, look, I understand that, but with respect, up until the lockdown, and even for a period after it, there have been significant anecdotes of people—Commissioner Bush talked about it the other day: that the Desert Road looked like a campervan carpark. Now, the number of people who came in before the lockdown, which Professor Skegg has said is so important to make sure it’s a proper lockdown, and then were not self-isolating or being monitored through the Healthline process is, I think, a significant barometer of how effective this Level 4 lockdown is going to be. So I do think, through you, Mr Chair, that it would be helpful to know what those registration numbers were against the number of people arriving in the two weeks prior and the one week after Level 4 was implemented.

Bridges Yes, thank you. Now, can I just make clear to members: at this point, we only want questions on this issue of the border, please, so we can finish that as a matter. Was there anything else, Michael, you had on that?

WoodhouseYeah, just one last one, Dr Bloomfield. Can you just explain to the committee what the screening process is at the border now, after the lockdown, and what it was prior to going to level 4? And then I’ll have a supplementary question on that; just a quick one.

Bloomfield Sure. Well, in fact, the screening process is similar now as to what it was prior to going into Level 4. That is that the first contact people have coming off the plane is with health staff, who go through their questionnaire, their declaration they have made—so it’s now a combined visitor entry form with very specific questions about possible symptoms of COVID-19. Each of those cards is gone through with the passenger. If they have any symptoms, then they are referred for an assessment by a nurse, which includes checking their temperature, further inquiry about their travel, possible exposure, and possible symptoms. In cases, both before and after Alert Level 4, if they had symptoms and they were tested, they were required to go into self-isolation, or now quarantine. So that system is the same; effectively, all passengers are asked about symptoms and—

38


WoodhouseOK. So, look, that’s helpful. I’m not sure if this is a question or a comment, but are you telling the committee that every single arriving passenger prior to the Level 4 lockdown was being stopped, questioned, screened for being unwell, and taken aside if they were, because that’s certainly not the lived experience of the many thousands – well - hundreds of people who have corresponded to colleagues to say, “Our arrival processes were significantly less than”—weaker than, in their view, the other airports that they had flown through to get home. I wasn’t aware that every single person was being stopped and interviewed prior to the Level 4 lockdown. Can you clarify that?

Bloomfield Yes, so that posture at the airport did strengthen as we went through the weeks preceding the move to Alert Level 4, but certainly in the period before we went to Alert Level 4, that was exactly what was happening—people were being stopped and questioned, and they had to fill out a very clear declaration about any symptoms, just as they do around anything they might be bringing into the country like fruit or vegetables—

WoodhouseEvery single person—is that what you’re saying?Bloomfield [Inaudible]Bridges Director-General, well, just on that issue of screening,

then, if we look at the successful countries in their battle against COVID-19, they have thermal screening. And I appreciate your answer is probably going to be a little like the one we’ve already had in our questions around the false negatives, but, of course, there are many more positives, if I can put it that way, and I just don’t for the life of me see why we wouldn’t, unless it was a resourcing issue, do the thermal screening. And while I’m on a roll, can I say to you, frankly, when we reopen the trans-Tasman border, as we will inevitably want to do, we’re going to have to do it in any event to satisfy our trans-Tasman partners about what they’ll want to get that cross-border flow happening again.

39


Bloomfield Sure, and yes there’s plenty of interest in thermal screening—no doubt about that—and there are some countries that do use that at the border. The screening that we’re using at the border, and I think it’s an appropriate first screening test, is to ask people to fill out a questionnaire about what symptoms they have. So, in a sense, that’s the primary screening test. Then, if they have any of those symptoms, then they have a health assessment, which includes taking their temperature. So that is the sequence of how we use temperature checking. So, in effect, we’ve gone for the questions, which are quite broad—some people with COVID-19 will have just some symptoms, not the full sweep, and indeed at least 10 percent won’t have fever even if they have actual infection. So that’s why the questions are quite broad and designed to be inclusive rather than exclusive.

Seymour Thank you very much for the work you’re doing, Drs Bloomfield and Clark. I want to follow up on a question that I asked of John Ombler earlier. I asked: do we have adequate PPE and, more generally, what is the Government strategy for procurement in this time? Now, I acknowledge the Minister of Health has given us some reassuring numbers about the amount of PPE. Can I follow up what he said with a simple question: is he satisfied that the Government has adequate supplies so that nobody will go without adequate PPE for the job that they have to do at this time? If he is, and people still feel that they don’t have it, what’s the best thing for them to do? Who should they contact? And if there is still a need, will the Government consider setting up some sort of portal or contact, because there’s a lot of people out there who have trade networks who have the ability to supply things, and they’re saying, “Look, we could help but we don’t know who to talk to with providing PPE and the like.”The second part of that question that John Ombler said to put to you guys is: when it comes to new technology, and I don’t want to get hooked on any particular—you know, hydroxychloroquine or any particular treatment, but there is certainly technologies out there, whether it be apps or new faster testing, that we could benefit from and surely should be getting ahead of the curve on. I just wonder: what is the Government strategy for assessing and adopting new technologies? Would it consider a portal or a place that people can go, because, ultimately, the best ideas may come from outside Government?

40


Clark OK, I’ll have a go at the first four of those and then hand over to the Director-General to add comments. In terms of PPE, this is something that we have very early on tried to ensure we have the adequate flows coming in. Of course, the reserve stock that’s in place is a part of the pandemic plan; that was written under the previous Government and then tested under our Government in its early days. It requires the central holding of a good deal of PPE. And that, you know, includes the 18 million masks that are there and the 5.1 million that are around the DHBs, the 1.8 million gowns and aprons, the 2.4 million gloves, and the 60,000 face shields, eye protection.In terms of, though, ensuring an ongoing supply chain, that has been the focus early on. We are fortunate to have that mask factory in Whanganui that makes the highest-level surgical masks—has the ability to do that. It’s currently turning out about 80,000 masks a day and is looking at the ability to ramp up from there.The private sector has reached out to make offers, and those have been coming through to me and been passed on. And, yes, we have looked at the idea of a portal. It’s a sensible and sound one, having a means for people to channel those offers through. Of course, it takes a lot of people at the other side of that portal to work out where the credible ones are coming from and what the scale is and whether they’re the right type of offers, because there’s some technical specifications around PPE that are really important in discerning which ones to supply.And I do want to thank the officials that have been working in the central command team who have been looking at how best to refine that process over time. I also want to thank MP colleagues who have passed on offers, and I have had them from across the House. I’ve had a number of offers—

Bridges We need this more succinct, with respect, Minister.Clark OK, well, I’ll—these are good questions, I have to say,

and they deserve full answers.Bridges Can we just—look, we’ll come back to PPE. Can we

[Inaudible] the issue of borders before we move on from that?

41


WoodhouseI’d like to come back to the issue of borders, and probably for Dr Bloomfield. The key question for the self-isolation process is, really, how strictly it’s being enforced, and I’m worried that we’re seeing far too many stories of people who have recently arrived who are breaking self-isolation. Now, if they are the biggest risk to the spread of the virus through the country, surely it behoves us to be much more aggressive in our monitoring of self-isolation. We’ve seen this overseas with electronic and app-based efforts. Are you satisfied that we know that those people who are saying they’re self-isolating are doing it? And I’ll finish with this one anecdote, and Mr Seymour mentioned it before in the Novotel Ellerslie. The guidelines the Ministry have released have said that those people, even though they are well, are not to be going to supermarkets and out and about, and yet we know, even with a nurse being placed at the hotel, that’s exactly what’s happening. So I don’t have that confidence; can you tell me why I should?

Bloomfield Well, look, a couple of comments here. First of all, and this is an issue that’s been really important right from the start of our efforts to address COVID-19, and you’ve quoted my words back to me: it’s a high-trust environment. The vast majority of people—the vast majority of people—understand their role and comply and do everything they can and should to support our nationwide effort. I have a lot of confidence in that. And we must -we rely on them to do that, because we can’t police every single person.The second thing here is, of course, if people are not complying, there is a mechanism for that to be notified to the police, and you’ve heard Commissioner Bush talk about that in the last day or two. There’s a special website that’s been set up, and people are using it. So we rely on other New Zealanders to support our efforts to ensure we are all doing our bit.I guess third is that, if people are not complying, again, the Police have shown that they are willing to take them to task, and to actually help ensure that they know what their obligations are and exactly what is required of them.

42


WoodhouseCan I just interrupt there? I think you said we can’t police every single person. My simple question is: why not? These are the single-biggest risk factors to the community transmission—the widespread community transmission—that we’re all fearing. Surely, with the several hundred people—maybe a few thousand—that are in isolation, you know, why can’t we monitor every single person a lot more assertively than we presently are?

Bloomfield So they are being monitored by police, as I said earlier on; they all are required to be visited within three days, and the expectation is they will be where they say they are going to be. That is the same with all our close contacts. Our onshore close contacts of confirmed cases are expected to be in self-isolation at home. They are contacted each day by the contact-tracing centre or by Healthline.

Goldsmith Could I have a quick question?Bridges Yes.Goldsmith So you’ve said that people may be incubating the virus

without showing symptoms. So we can have people arriving at the border today not showing any symptoms, and they will be sent home if they’ve got a plan—presumably in a taxi, or I don’t know what the arrangements are to get home—and they self-isolate. And you say they get visited by a police person in three days. So I think the simple question we’re asking if you’re talking about a few hundred people in that category: how confident are you that everybody is complying with self-isolation? What tests have you done to determine how many are complying, or are you just relying on trust and one visit by the police every three days, or three days after they’ve arrived? I’m not really so much interested in what you hope people will do; I’m interested in what you know people are doing and how confident you are that they are actually doing it.

43


Bloomfield Well, I think this is a similar question to the one I’ve just answered—in fact, you asked Mr Ombler the same question—but the enforcement of the self-isolation is not a health responsibility; actually, that’s a responsibility of the Police and other officials in our all-of-Government effort. I don’t have the details in front of me about what their latest data are on levels of compliance, but, again, I would just point to the fact that most people, most New Zealanders, understand what their obligations are, remembering that everyone coming through the border now are Kiwis or their families. They know their obligations, they are complying with those, or, if they are not, there are clear mechanisms for others to notify the Police and for the Police to follow up.

Bridges What about, as an alternative or in conjunction with more considerable “policing” of the matter, what I understand a number of other countries are doing in terms of these GPS apps and the like?

Bloomfield Yes, well the Minister talked earlier on about the offers we’ve had from across the private sector, and I did want to say there is actually — I think this answers one of the earlier questions — a dedicated email address; I think off the top of my head it’s [email protected]. So all offers of support from public or private can be funded through that email address, and we’ve had a myriad of offers. A number of those offers have been in the area of the use of digital technologies to monitor people, and this is something that other countries do use, and we’re actively exploring a range of options there.

Bridges Thank you. Is there anyone else?Clark Mr Chair, if I can add to that, just to agree with the

Director-General: we are actively exploring some of these areas, and of course weighing up the efforts to make sure that human rights and privacy is protected, but acknowledging that these are extraordinary times. The private sector has stepped up with offers in that regard, and we are very actively exploring some of these things right now.

Bridges Thank you. Anyone else on borders, briefly—any other members?

44


Seymour Ah, yeah, sure. Can I just circle back to a question that I asked of John Ombler earlier? And he didn’t seem to have a specific answer. Just regarding the campervan park in Alexandra Park, I asked why it was logical to have such a quarantine station at the geographical centre of our largest city, and what reassurance might be given to people that live around that area of the status of people there in relation to COVID-19, the precautions that are being taken for people that are there, and what sort of procedures or protocols there might be if someone tested positive there.

Bloomfield Well, I’ll step in to provide a few thoughts. First of all, it’s my understanding that the people in those campervans are not people who are symptomatic, and have been tested. So those people are in a very specific facility out near the airport, and are being looked after, obviously, if they’re unwell, but also awaiting test results. So those folk in the campervans are people who don’t have other satisfactory arrangements to self-isolate at home, and that’s a supervised setting; so they can’t just come and go when and where they would like. And if they become symptomatic—and the whole idea of keeping them there for the 14 days is to observe them for symptoms—then we would use a very standard sort of protocol to ensure that we were taken to be assessed and, of course, tested if that was indicated.

Bridges Thank you very much. Director-General, can we move, then, to the crucial issue of course, of testing. I could refer you to many cases that have been brought to my attention, but in the weekend I corresponded with a young mother who has all of the symptoms, including an inability to smell and taste, and the like. Her GP has told her that she probably has COVID-19, and she should be tested, but, of course, at the testing—whatever it’s called—station, they will not test her. Can you clear up for us what the clear criteria are here for people in New Zealand being tested for COVID-19?

Bloomfield Sure. So the current case definition, which dates from 14 March, includes what we call epidemiological criteria; so a history of travel or a history of exposure, close contact—either confirmed or probable, or probable or suspected case—and symptoms. And, early on, the symptom cluster was quite restrictive; so it required fever and cough or shortness of breath. Now it’s much broader: it includes fever or cough or shortness of breath or sore throat.

45


But what we also did in revising that case definition on 14 March was made it very clear—and it’s in bold in the case definition—that even if someone doesn’t fit those criteria but there is a clinical suspicion, then they can be tested, and we’ve clearly seen, by the number of tests that have been done—over 21,000 already to date—under that case definition, that many people are being tested who don’t necessarily fit closely with the epidemiological and travel criteria, but there is that, of course, important ability of the clinician to apply their judgment.That doesn’t mean that they will get it right every time, just in the diagnosis of any illness, whether it’s an infectious disease or a non-infectious disease. So, of course, what we’re interested in is, in a sense, over-testing to make sure we’re finding the cases. Our current positive test rate is about 3 percent of the tests being done are positive.

Bridges Isn’t it—Clark Sorry, Mr Chair. The testing capacity that we have has

trebled in the last 10 days. There is not a capacity constraint there, and it’s really important that clinicians understand that their clinical judgment is to be used where they think it is appropriate. The Director-General has said that, but I can’t underscore that enough.

Bridges But isn’t the problem, Doctor, that that’s still not happening. I mean, we had the case of, is it, Tom Kitchin, the journalist, today on stuff.co.nz, whose doctor wanted him tested. And he wasn’t. Now, he was, actually, but he wasn’t originally. The mother I’m telling you about whose doctor wanted him tested but he wasn’t, and I have absolutely no doubt whatsoever that today in New Zealand there will be doctors recommending testing and those patients will not be tested.

Clark Well, I want to push back there. I think that, you know, the case definition has been revised at various points, and my expectation and understanding is that the vast majority of clinicians understand that where that’s not happening, then that is a concern that should be raised, and that can go right through to the Director-General.

Bridges In the Bay of Plenty, my understanding is—whether it’s the PHO or the DHB, but I think it’s the PHO, I am told, again is applying a different judgment to the GP. Would you give us, I suppose, the clear position, that if the GP wants it, it should happen?

46


Clark That’s my expectation, and the case definition allows for that. Look, the advisory group on that case definition is meeting again today, and in light of the community outbreaks that we are seeing. I would be very surprised if they didn’t further clarify that, because I think, where we’ve had anecdotes of misunderstanding, it’s really important that the message is out there that if clinicians have suspicion, that they are doing the testing.

WoodhouseThank you, Mr Chair. I just want to expand on that issue of the case definition and I’m going to make a couple of comments before the questions. On the Ministry of Health website, Dr Bloomfield, the case definition is still dated 14 March, as at last night, which doesn’t appear to suggest there has been a widening of the case definition criteria. You yourself said in your media briefing on 22 March, after describing that case definition, “We can’t be testing everybody who has symptoms that are respiratory or lower respiratory tract infections.” My question is: given the anecdotes that the chair has described, why not? Would it not be a much more prudent approach, given that we are spending $52 billion and shutting down this country to prevent the spread, to take a much more broad approach to the testing process for people who are displaying lower respiratory tract sequelae? Surely they should be tested without question.

Bloomfield Thank you. One of the comments I’ve also made, actually from early on, is also that we want to find these cases, and we will find them if we test. So we’ve been encouraging testing. As the Minister mentioned, the Technical Advisory Group is meeting again today, and I’ve asked them — and Professor Ian Town, our Chief Science Advisor, actually a respiratory physician, is chairing that meeting today. And I’ve said that I’m particularly interested in us widening the case definition to include any lower respiratory tract infection in the community, and that’s his view as well. So we’ll be getting that advice later today. But, as the Minister said, I fully expect that case definition to now expand as well.

WoodhouseA couple of quick follow-ups on that. The first one is this: do you think it’s appropriate or acceptable for the clinical judgment of a medical practitioner to be overruled by people at assessment centres and testing centres if it is the medical practitioner’s judgement that a test should take place? That’s the first question.

47


The second question is this: the Minister mentioned, in his preamble, the honest reality that there is a global shortage of reagents. The second question is: how many tests do we have, and is that influencing clinical decision-making by not testing more than we otherwise would want to?

Bloomfield Sure. I can answer the second one first. No, it’s not influencing clinical decision-making, and as the Minister has said, we have been ramping up our testing capacity and adding new laboratories to that on almost a weekly basis, and there is further capacity coming online later this week. One of the advantages we have, and I will agree, and it was Professor Skegg that raised it: there is a global challenge around the suppliers of reagents, particularly for the proprietorial [Inaudible]To give you an example, several of our labs use a Roche platform. And one of the key reagents there, which we are now getting a good supply of coming through — I spoke to the regional director in Singapore, who is actually a Kiwi — their demand has gone up seventyfold for that reagent, globally, in the last three weeks. So it is a tight market out there. One of the advantages that we have is that our labs all use a range of different platforms so we’re not reliant on one platform, which is good. We also have several labs and others that we are going to stand up that use a more generic platform that can use reagent that we can make locally.So testing capacity is not currently a constraint, and we are ensuring that it will not be a constraint in the future, including so that we can, as Professor Skegg said, do some surveillance—so do some testing to see what is the prevalence of infection out in the community to see what the extent of community spread might be.

WoodhouseCan you answer the first question? Do you think it’s acceptable for the clinical judgment of the medical practitioner, who determines on the basis of the symptoms that a test is necessary and appropriate, to be overruled at a testing centre or by some other authority?

48


Bloomfield So what I can say is that the people at the testing centre are also health professionals, and they’re the ones who are seeing the people. And the ones at the testing centres will be only doing this; so they will be seeing every referral for possible COVID-19 presentation and determining, based on the symptoms and on the epidemiology and also clinical judgment, whether the person needs testing. I wouldn’t want to second-guess their clinical judgment, either.

Bridges Doesn’t that entirely cast in doubt the assurances of the Prime Minister and Minister Clark—that I was very assured by—[Inaudible]

Bloomfield Sorry, there’s just a bit of feedback there.Bridges I’m just making the point there does seem to be a very

subtle but, in fact, clear difference between what you were saying and Minister Clark is saying, when Minister Clark has told us that it is his expectation that, where GPs think there should be a test, there will be a test, and you are making clear to us that in fact, no, those clinicians at the testing stations may well overrule that.

Bloomfield Well, I don’t think it’s a matter of overruling. The testing stations are specifically established in each community to be a place where people can go and be assessed for their symptoms and where the testing, where the swabbing, can take place and they can be sent for testing. I would imagine, if there is a difference of clinical opinion, that a conversation would happen between the clinicians. I do think that — and we’re happy to send out a message to clinicians that they should [Inaudible]

Bridges Why don’t we just over-test? Why don’t we just over-test? We’re in lockdown. There are 14,000 modelled fatalities that aren’t — I totally acknowledge a projection. If the GP wants it, why don’t we over-test?

Bloomfield Well, I think the key point here is we have the lab capacity to test. So it’s not that there’s a constraint at the community-based assessment centre. They’re not saying, “We won’t test you, because we can’t get the test done.” And I think all of the CBACs and all GPs know that and they will certainly know that now after this.

Bridges How many testing kits do we have?Bloomfield [Inaudible] Minister.

49


Clark Yeah, so we’ve got—well, Director-General, you might have the—I think we’ve got 35,000 test kits currently that are complete on hand, which is about 20 days’ supply at current rates. And I’m just checking the notes — another 30,000 arriving by the end of this week, and then more again next week, quite significantly more. So there is no constraint there, but I do want to acknowledge and thank those health professionals that have been working on that, in what, as several people have noted is a very constrained environment. We have secured a lot of complete test kits. So that is not a constraint for us.

Bridges Have you considered resourcing with the fingerprint test that, I effectively understand, is sort of new technology in a way that South Korea has — I understand from an article I was reading, Australia has purchased half a million of those. Is that under consideration?

Clark Director-General, do you want to speak to the different technologies that we are looking at, because I know that we have also been looking at the rapid test kits and so on. There are a range of different methods; some are more reliable than others. But, Director-General, I think you’re better to speak to the technical detail on that.

Bloomfield So, just at a high level, there are two types of testing. The one we’re using now, that every country is using, is the PCR test for the actual virus itself, and that’s to diagnose. The other testing that’s being looked at, and some of the more rapid testing that’s being talked about in the media, relates to testing for the antibodies after someone might have had an infection. So that’s a sort of post-infection test. We’re looking at all the options, including rapid testing, but they are all still evolutionary, really. The important thing is we’ve got enough testing on our current platforms and have sourced and are continuing to source enough test kits to ensure that we can continue to increase our testing capacity.Finally, the Prime Minister’s Chief Science Advisor, Juliet Gerrard, did just commission a piece of work by some scientists to have a look around the world at what the current state of different testing options is, so we’ve got a very clear picture of where they currently are at and what role they might play over the coming weeks and months.

Bridges Thank you. Look, I’m sure we’d love to see that also. Dr Reti.

50


Reti Thank you, Mr Chair. If the Technical Advisory Group is meeting today, we’d like them to review their criteria for asymptomatic testing. We think this a hole in our defences, and a hole that we can shut. I draw your attention to the very good brochure that the Ministry of Health put out two weeks ago where it states: “a case is considered as potentially infectious 48 hours prior to developing symptoms”. I think that’s absolutely correct, and I’d pose it to you as two questions which I’d like you to address if you can.The first is: how many asymptomatic cases have been tested to date and how many have been positive? The second is: it’s reasonable to say that the more cases we get the greater the chance of asymptomatic transmission. So what total number of cases will be required in New Zealand before we make asymptomatic testing the default? Is it a thousand cases? Is it 1,500 cases? What is the number before that criterion will change, please?

Clark Can I just briefly say, Dr Reti and Mr Bridges, when both of your microphones are open we get an echoing effect. I don’t know whether they’re connected but just for that—but I think I got the gist of the question. The advice is being constantly updated by the Technical Advisory Group, and I’ll hand over to Dr Bloomfield to answer that question.

Bloomfield So, yes, the current criteria mean we don’t test asymptomatic people. The evidence is that people may be infectious and shedding the virus, not because they’re sneezing or coughing, as you would know, but because they may have it in their nasopharynx and be putting hands to face, touching mouth or nose, and then transferring it to surfaces. I guess that may well play a role, and it’s something we keep under constant review as to whether we do test asymptomatic close contacts. In particular, where we have got close contacts—for example, in a healthcare setting—I think that would be important that we are able to test people before they become symptomatic there. But, of course, that doesn’t then rule out that they may not develop the infection, and they still need to stay in isolation for that full 14 days.

Dyson Can I just ask a supplementary on that, Mr Chair? So what I’m interested in is, given how strong and clear the messaging is about “stay home, save lives”, what happens to the psychology of a person who’s tested and produces a false negative? I’m really thinking about the—what happens to their health? What happens to their behaviour? What happens to the clarity of message?

51


Clark If I can speak to that first, I mean, that is a risk—that if people get a false negative test because they’re pre-symptomatic, that they relax the way in which they go about their actions in the community. Part of the thinking around this is thinking about how we focus the efforts of our health workforce and our lab workforce, but also thinking about making sure that we are focused on testing at the right time and in the right place. But, Dr Bloomfield, if you want to add to that?

Bloomfield Yes, this is one of the concerns about getting false negatives in people who may be asymptomatic and not shedding the virus but still be infected and developing the infection. I think, in the situation we’re in, where we’re expecting these people, even if they have a negative test, to be in self-isolation if they are a close contact and knowing that they could still develop symptoms, it’s less of an issue. But the key point here—and Professor Skegg emphasised this and the WHO has been very strong on this, and it’s a key platform for our work—is identifying close contacts, self-isolating them, and monitoring them daily for symptoms and testing them if they become symptomatic. It’s just fundamental to the public health and is part of the response to this sort of communicable disease.

Reti Thank you. Just one very brief comment: can we review Parliamentary Question 4503, where you state that false negatives have zero percent as of 23 March? That would seem not to be consistent with the discussion we’re having here. I wonder if you could review that question, please.

Bloomfield Sure. Bridges Michael, Marama, or Kiri, do any of you have anything on

testing you’d like to ask? Wood I have a new line of questioning, rather than on testing. Goldsmith Can I just ask about testing? Bridges Well, we’ll come back to you then, Michael, and Paul, you

finish us off on testing. Thank you.Goldsmith Just two questions: are you planning to do random testing

of the broader community on a regular basis to try and get a sense of the state of play? And, secondly, are you doing routine testing of healthcare workers in a routine manner, and if not, why not?

Clark I’m aware that surveillance activities are being planned. Dr Bloomfield, can you provide the detail on that?

52


Bloomfield Sure. Just on the second part of the question, we’re not routinely testing every worker who might, for example, be in contact with someone or treating someone with COVID-19. We’ve had a small number of people in hospital — particularly if they’ve been wearing PPE. If they may have been exposed, as we’ve seen in a couple of situations, then of course, they are self-isolated and tested if they develop symptoms. We will look at whether we test them just first up while they’re asymptomatic, but again, it doesn’t rule out them developing the infection.I do just want to comment on the other question, which is a good one, around the testing in the community. And this responds to one of the points Professor Skegg raised around surveillance. We had a very good surveillance plan developed, which we were all ready to go with, which included ramping up from 100 to over 300 general practices who code influenza-like illness, and that information is extracted each day to inform just the prevalence of—or, actually, the incidence of—influenza-like illness across our communities. Likewise, we were intending to do—well, we have a group of about 90 general practices that we call “sentinel” practices that do swabs of the first three people every week that they see with an influenza-like illness. They do a throat swab, and that’s sent to ESR. And that’s our sentinel practice testing.However, we’re having to revise that plan because that was developed before we put the country into the situation that it’s in. And, in particular, we’ve seen general practice move from doing face-to-face to virtual consults. So most of the people with influenza-like illnesses are either not being seen face to face or they are going to be seen through our CBACs. So I’ve asked the team to just revise that plan to say, well, what might that look like in a situation where we’re in an Alert Level 4-type arrangement, which we are.And one of the things—and you’ve raised the question, and Professor Skegg did as well—is that it may require us to actually do more, sort of, population-wide surveys of both symptomatic and asymptomatic people, just to look at what the level of infection is. So that’s one of the things that will be considered as part of that updated surveillance approach.

53


WoodhouseCan I just reinforce what Paul Goldsmith has pointed out: the two cases that you refer to, Dr Bloomfield—at North Shore Hospital and Grey Base Hospital—took out around 74 health workers for a fortnight. Surely there is a way to, firstly, prevent that happening—and we’ll go on to PPE in a minute—but, secondly, to test and clear them in order that our workforce, which could become very, very busy, is actually tested more rigorously than, perhaps, the general population because of their exposure to risk?I want to point out one last thing in relation to testing. Dr Bloomfield, on 21 March, you talked about New Zealand’s testing rates being at a level similar to South Korea, and on the 24th the Prime Minister said our rates are at rates comparable—for example, South Korea, that is being held up as the gold standard. Now, I tested that against the tests that have been undertaken by South Korea on that day, and on a per capita basis, in fact, they were testing at a rate nearly 400 percent greater than New Zealand was. So my question—and you may have been referring to testing capacity. I’d just like you to clarify how it is that you and the Prime Minister could say that when South Korea’s actual tests, on a per capita basis, were—well, I could tell you, 388 percent higher than New Zealand’s? How do we reconcile that?

Bloomfield So the information we have on testing capacity is quite hard to get online. But what we have had the benefit of, is our Foreign Affairs missions around the world providing us with daily updates based on briefings they get from the health officials in the countries where they are posted. And the data from South Korea, which admittedly are about 10 days ago now, their testing capacity there was about 10,000 tests a day. Ours, comparatively, at the time was about 1,000, but it’s now clearly much higher.

54


Likewise, in one of the reports of the Australian Health Protection Principal Committee from about a week ago, they looked at Australia’s positivity rate compared with other countries. And one of the countries they compared themselves with was South Korea’s test positivity rate, which was 3 percent at that time, which is about where we’re running as well. So I guess, in terms of capacity and in terms of positivity rate, we’re on a par with South Korea. And likewise, we’ve had information from our missions in other places—from Berlin, as well, about the number of tests that Germany is doing or had done in the preceding week. So that’s the best data we’ve got to benchmark ourselves around—not just our capacity but also the rate of testing we’re doing.The other point is, of course, we are two or three weeks behind South Korea in terms of where we are in terms of the infection, but we’re continuing to ramp up our capacity and our testing, and broaden the criteria for testing.

Clark Can I clarify—I mean, there’s different ways of cutting it, and it’s not an exact science, because we’re all at different points on our epidemiological curve, across different countries. The data I have in front of me says that, in another two weeks, when we’re 35 days from hitting one person per million infected, we will have easily overtaken South Korea’s per capita testing number at the same point. So, whilst they’re not directly comparable now, when we’re at the same point in our epidemiological curve, we will be testing at a higher rate, comfortably, even if we test at the same level we’re testing now, as South Korea.Now, I don’t think that takes away from the message that I heard Professor Skegg give—that we need to continue to expand our testing. That is what we accept, and I’ve heard from plenty of epidemiologists, who have been generous, really—and the Chief Science Advisor, I know, has been consulting with epidemiologists as well—saying that that is a really important part of our response: is to keep growing our testing capacity.

55


Wood Thank you Mr Chair, Drs Clark and Bloomfield. I want to go to the first point that Dr Skegg raised in his contribution earlier, and that was around the importance of the lockdown being, I think he said, as comprehensive as possible. And I’m keen to hear from you the public health analysis that you have that determines how exactly we set the lockdown conditions. Dr Skegg, in his comments, questioned whether some of the current essential services perhaps should be looked at again. On the other hand, we sometimes have community and political pressure to, for example, increase the number of food outlets that might be operating. So can you talk to us, in general terms, in response to Dr Skegg’s comments about the lockdown being as comprehensive as possible to meet the public health need, and also specifically address that question of how we use public health information to make a good public health decision about how many outlets we do keep open, to keep them to the bare minimum?

Clark Can I speak first, just to talk about the conversation Ministers have been having, which has been a first principles one. We want as few outlets open as possible, practicably. And that involves making sure that we have outlets open where there is an availability of that social distancing. And so for dairies, for example, we’ve put a one in, one out policy. We prefer that people are accessing supermarkets but recognise that, in some parts of our community, that’s not possible because they don’t have supermarkets close by, and we don’t want people travelling across town unnecessarily. We want people to stay local. That’s part of the idea of the “stay home and stay safe” message; we reduce movement as much as possible. So that’s the principle we’re working to.Then we work through the [Inaudible] from the public health experts at the Ministry, who then have come back to us and said, “Here is how we think we can minimise that public exposure, that public travel, and how we can best observe social distance in those essential services that are still available.” But Dr Bloomfield, I’ll leave over to you for the specifics.

56


Bloomfield Just two additional comments: one is I think, as the Minister said, the starting point is making sure that it’s “as essential as possible”, because if we’re asking everybody in the country to go into this sort of Alert Level 4 type arrangement, it’s a huge imposition. There’s a huge economic and social impact, and we want to make sure we get the maximum value from it; so that’s a very key thing.The second thing is I’ve been really struck by the extent to which my colleagues across Government have been assiduous in seeking our input into their arrangements in their own sectors, to not only help define what might be essential services but then what sort of measures can be put in place, even if that service has to remain open, to try and ensure that there is as low a risk as possible of any transmission, either between the workers or between people who may be accessing something like a supermarket.

Seymour Well, Mr Chair, can I just come back and ask a question about the principle that the Minister of Health has given? He said the principle is as few stores open as possible. Surely the principle is minimising the spread of COVID-19? And I’d be really interested to hear, particularly from the Director-General, about the logic of closing local stores such as butchers, bakers, and fresh fruit and veg stores, because the practical effect of that, in many parts of the country, is that people travel further to other neighbourhoods to go to bigger and busier stores, and it actually seems apparent that the public health danger of that kind of activity is greater than if those stores were allowed to be opened and they could shop more locally, in smaller stores that are better controlled.

Bridges And can I add to that very good question, Director-General, with I think what is related and, in a sense, sums up the questions we’ve had so far: why are we, in a sense, if listening to Dr Clark is correct, so stringent on these issues for New Zealanders whilst, it seems to me, relatively more relaxed when it comes to issues of the border, such as testing everyone in relatively small numbers and stringent quarantining?

57


Clark I’ll hand over to Dr Bloomfield to talk about the detail of those decisions, but suffice to say we, in terms of the debate between which local stores should stay open, and the quality control we know we can have over big supply chains—that was a vigorous debate, because we wanted to take the advice of the public health experts and fully understand it. So the kinds of questions the committee are asking are indeed the same ones that we asked ourselves as we worked through the policy, but—Dr Bloomfield.

Bloomfield Well, just a general comment, really, and that is that of course we can provide public health advice, and advise on the science, but there’s also a very large element of judgment in these things. And for example, the specific question that Mr Seymour has raised — supermarkets tend to be larger, they tend to be able to have staff to control flow in and out, they have security, they can provide hand sanitiser for people; so arguably there is a lower risk than having a larger number of outlets open which are smaller, where there is more potential for people to be inside that 1 to 2 metre physical distancing. And I know that that may vary by neighbourhood but, again, if the first principle is “Let’s start with as few things as possible open, and extend it outwards.”—and you will see the advice changing, because it’s being reconsidered on a daily basis—then I think the idea was to start at least, as tight as we could, and then review as we go. So I think it was a reasonable starting point, and the public health input was clearly a major consideration, but not necessarily the only one.

Seymour OK. Can I ask a slightly cheeky and related question? I see in front of you you have a copy of a daily newspaper. From a public health point of view, how is that different from a weekly newspaper, or a monthly publication, such as North & South?

Bloomfield Me personally, I don’t subscribe to any monthly publications, but I do have [Inaudible] So, look, I mean, you know, again, these things are assessed. One of the things I would say is that, of course, the daily media plays a fundamental role in supporting our societal effort here, and they have right from the start. And that is why we have been studious in ensuring that we are briefing the media, and they’ve played a really significant role in getting information out to the public, and I just want to acknowledge that. So I suspect that’s the main difference between the two.

58


Seymour I put it to the Minister that the Government being able to selectively shut down some publications is a terrible precedent, and we should be thinking a lot more carefully about it.

Clark Can I speak to that because there’s been a suggestion made in the media that Ministers took a decision to shut community newspapers. That is simply not true. There was advice—some newspapers had already decided they were going to shut down. We are very concerned that, in this time, we do have good information sources, and our community newspapers are trusted sources alongside the dailies. So I’m aware that there are conversations going about whether it’s practical for some of those community publications to start again, and I just want to be absolutely clear: there was no central government thing there. We’re very concerned that there is, in these extraordinary times, appropriate scrutiny both through the press and through things like this committee, and I didn’t acknowledge that up front, but I want to thank this committee for the work that they are doing in asking the questions that need to be asked in a democracy. So I just—

Seymour Well, can I—I don’t mean to hog this, but can I just say, this morning I received an email from a theatre nurses journal, which has been refused delivery by New Zealand Post due to COVID-19 restrictions put in place by your Government. Can you tell people today that New Zealand Post are able to deliver a periodical for theatre nurses at the current time?

Clark What I want to be clear on is that the conversations are happening to make sure that the appropriate hygiene procedures are in place around the publication and so on. So it’s not my area, but I just thought important to bring this to the committee. I think you’ll have the responsible Minister in front of you later in the week.

Bridges Well, can I just say, gentlemen, there will be many topics that we haven’t canvassed, and that’s the way these things go. I don’t want to turn this into a marathon. We appreciate your time in a difficult situation. Can we simply canvass one final topic, which I think we sort of couldn’t go past, and that is the issue of the gearing up of our hospitals and the PPE and the staffing—just for 10 minutes or so? And can I just start with, I suppose, the opening one for you to address us on, and that is: how ready are we for significantly increased hospitalisations, should that regrettable set of circumstances occur?

59


Clark Well, that is something that a lot of focus has been on, and, again, offers of assistance from the private sector, both in terms of looking at alternative manufacturing but also importing of machines. We’ve gone from a situation where we had 150, roughly, dedicated ICU beds with ventilators, through to one where we have 533 in our public health system that are ready to be deployed. We’ve also got 247 in the private sector that we know of.On top of that, really, the big issue has been, and continues to be, having the staff trained to use that machinery. That’s what we’ve seen overseas is the critical point, because these things can be staffed around the clock and need to be staffed around the clock. We have 2,500 ICU nurses trained up, but we know that there are more with experience who are being re-trained by our DHBs now, and we’re wanting to make sure that we train workforces ongoing so that we can ramp up the people power.

Bridges Are you considering things—like, I understand they’re considering offshore medical students, retirees, immigrants that we know have overseas experience and qualifications. I mean, on those three, are they things that are actively being considered?

Clark Absolutely. We’ve got 6,500 people—just a little over that now—who have put up their hand to come back in. Either they’ve returned from overseas, they’ve been retired, or they’ve been working in other now deemed non-essential workforces who have—and I want to thank them for putting their hands up. And also to the professional bodies that have expeditiously worked on recertifying these people. There’s a portal set up for DHBs and others to look to source these workforces to bring them on stream. But, you know, of course we’ll also look at other workforces, the likes of the ones that you mention, Mr Chair, as we work our way through this.

Bridges Do you have, on the PPE and the equipment such as ventilators, a comprehensive document stocktake, if you like?

60


Clark Yeah, well, we have done the stocktake—the numbers that I’ve read out to you. We’ve got—I guess the more interesting thing now is making sure that we have the continuing supply chain in a global environment where there’s a lot of competition for these items. On the face masks, of course, with that factory ramping up to produce 80,000 top quality ones and being able to ramp up further, that will be really important, but also continuing to source ventilators—and there are a number on their way. One estimate is that we might get about a hundred a month that we can continue to see coming in. Many are on order already. So those are the questions that the whole-of-Government is very focused on: how do we make sure those supply chains are intact and that we’re getting the things that we’re expecting to get?

Bridges Do you think you could provide us with both the stocktake of where we are and also that comprehensive sense of what you’ve got coming? I think that would be incredibly helpful.

Clark Happy to provide to the committee what we’ve got. Quite a bit of it went out yesterday via press release, but I think all in one place and the forward-looking picture of where we’re hoping to get stuff—I’m happy to provide some of that to the committee.

Bridges And can I just sort of—and then I’ll open it up—return to the point, I think, David Seymour was making, which is that we’ve heard your numbers and on the face of it they sound impressive. Of course, what we also see is a disconnect with what we’re hearing on the ground. I mean, I’d give you many examples—but of a Tauranga pharmacist who has made quite clear to me that he simply doesn’t have the PPE required for himself and his staff across his three pharmacies. I think his words were, literally, it brought him to tears.What are you doing to get that—I take it you’re saying there is no shortage in fact. So what are you doing to get it to the people who—and I don’t want to say “need it”, because I think actually it should be those who want it. Because, fundamentally, if they’re in healthcare provision, whether it’s midwives, whether it’s pharmacists, they should be getting it. Do you agree with that, and what are you doing to get it to them?

61


Clark Yeah, and it is going out. I think you’re absolutely right. We need to make sure that it’s in the right places, and that’s where the effort is very much focused at the moment — to make sure that it is with our community midwives, with those in the care sector. The stuff—you heard the Director-General speak about it. There are about 7 million masks being sent out now.Now, traditionally, of course, these are private businesses that would source their own PPE and they would also have health and safety plans in place. They deal with infectious diseases day in, day out, year in, year out. However, these are extraordinary circumstances, and that’s why the Government has stepped in, when normally this would be done through private supply channels to assist these businesses, because we are asking them to be at the front line. And that’s why these anecdotes we hear of are of concern and why we as a government are moving to make sure that everyone has some PPE. We expect them to follow the clinical guidelines on when it’s needed because they’re health professionals and they understand that, but to make sure that we are making sure that that is spread around the country.Dr Bloomfield might like to talk to the clinical side of that, because the Ministry provides the guidance on when and where it should be used. But as a government, we are concerned to make sure that those masks in the first instance are getting out so that people, if they feel at risk, and they’ll use their own judgment — the midwives and the aged-care workers. Let’s not forget, and I don’t want to minimise this, they are working with elderly folk and they do that day in, day out, year in, year out, and the flu has been with us a long time — other diseases. They are very careful. They understand public hygiene, washing their hands, and keeping the people they work with safe. But, in this circumstance, we want to make sure that they’ve got some additional gear if they need it.

62


WoodhouseThank you, Mr Chair. It’s that very point I’d like to elaborate on. Dr Bloomfield, you heard the Minister just say there that there was reassurance that gear would be available, but “we expect them to follow the clinical guidelines.” And I’d like you to clear up some confusion about what that is. It’ll take me a little bit just to set the scene. On Sunday, you said at the moment the guidance for home and community support workers is that they don’t need masks. Then, in yesterday’s briefing, you were then saying you’d make a particular effort to ensure that our home and community support workers have got, through their organisations, access to masks: if they need them, we’ve got them. But your guidelines, that’s these that are on the Ministry of Health website, remain very clear that people who are not suspected or have COVID-19 should not be treated by homecare workers with surgical masks, eye protection, or even gloves in most cases.Can you clear up some confusion that clearly exists, and apprehension amongst the thousands of homecare and support workers who are caring for our vulnerable, elderly, our injured and our disabled? What is the current position in respect of their hope and your expectation for the use of PPE?

Bloomfield Thank you. Yes, I’d be happy to provide some clarifying comments. My team’s been working on this over the weekend and engaging regularly with the unions for workers.So, the fundamental principle is we want our front-line workers, including those working in homes, our care workers, to be safe. What we have got in the advice, and you’ve just shown it,is I think very good advice about the situations where all our front-line workers do and don’t necessarily need to use different types of PPE, whether it’s masks or gloves or gowns. So I think the advice is good. It’s from experts in infection and prevention and control.However, I’m also conscious that it’s one thing to tell people, “here’s what you might need in this situation”, but people also want to feel safe, hence my comments in the last day or two. So, what I’ve asked my team—and PPE, or appropriate PPE, particularly masks, are an important part of people feeling safe. And I think it’s hard for front-line health workers to hear “well, you don’t need a mask in this situation” and to not feel they have access to masks, if they then go to the supermarket and see the checkout operators wearing masks.

63


So, what I’ve asked the team to work on is ensuring that we are getting, in the first instance, masks out through our DHBs to all those front-line workers who we would normally not be providing masks to. And the DHBs would not necessarily even have a contract with, but they are getting those supplies and they have got a very clear message to get them out over the coming days to all those organisations that those people work for—pharmacies and so on—and, therefore, that they are able to access the mask and use the mask appropriately. Because we don’t want to just use them all up, and part of this is also ensuring that they know what appropriate use is, how to use PPE safely—and, of course, it’s only an adjunct to all the other measures they need to be taking to keep themselves and the people they are caring for safe, including meticulous handwashing, distancing where possible, and so on. So that, I hope, summarises the position.

WoodhouseYeah, it does, and I was nodding assertively in agreement until you got to the point where you said, “but we want them to use it appropriately”, and then you said, “we don’t want to use them all up”. I got an email from a support worker that I think sums it up when she said, “We feed them, we shower them, we toilet them, we blow their noses, we cover their coughs, we give medications, we test their bloods, we drain the catheter bags, and so much more.” And they do want to feel safe, but I’m afraid the last comment you made kind of adds to the confusion I have that the guidance isn’t going to change. Your goal appears to be to say, “Well, if you don’t feel safe, it’s because you don’t understand the risk.” Actually, I think they do understand the risk, and I want your assurance that, if a homecare worker wants gloves and a mask or other protective equipment for a vulnerable person they’re caring for—and bear in mind, they could be going into the homes of 10 different people—that that equipment will be available to them.

64


Bloomfield So what we’re aiming to do is ensure that the equipment is with them, or that the PPE is available to them, but I don’t resile from my comment, and the comment is less about that there’s a supply problem; it’s just there is no need, for example, to use a different mask and change a mask every time you see someone. I’m not thinking necessarily about a home and community support worker here but someone, for example, working in a CBAC who’s seeing and swabbing people. They only need to change their mask every three or four hours or if it becomes moist, and it’s the same with a mask in another setting. So the appropriateness is making sure that they know, first of all, how to use the PPE safely, because you’ve got to put and take off gloves safely to protect yourself—and so making sure they know how to use it and how to make sure they are minimising the risk both for themselves and also for the clients they’re looking after.

Unidentified Excuse me, Director. Can you please excuse yourself?

Bloomfield Sorry, Mr Chairman. I just need to take leave of the committee to brief ahead of my media briefing.

Bridges Thank you very much for your time, Director-General. We really appreciate it. While we’ve still got you, Dr Clark—because I feel terrible—Louise Upston has been waiting patiently for a question. Let me give Louise Upston a chance to ask you something.

Upston Thanks, Minister. The question is similar to Michael Woodhouse’s around PPE, and I think the Director-General covered it, but it’s really related to the important care for midwives and new mums. So, I’m taking it from the Director-General’s answer, that midwives will be provided with gear and that the directives will be changed, which currently state that midwives are only required to wear PPE if the mother is not suspected of having COVID-19. So confirmation of that would be good.The second question is around any changes that have been made by the Ministry of Health in directives for what occurs during birth and the 48 hours of postnatal care. We’ve been fielding a large number of queries from concerned mums and from midwives, and they’re both interested in their safety.

65


Clark Yeah. So, as the Director-General has said, that PPE—the masks—is being sent out currently; so that will be with the midwives shortly. In terms of the clinical directives around what practices are deemed to be the best ones, that is not something I can speak to, because that is a clinical judgment, but what I would say is that part of what we’re wanting to see here is that they have the material and the equipment on hand should they feel that they’re in a position where they’re vulnerable or they’re uncomfortable. We want to make sure that they have the confidence to carry on. These are our front-line health workers, who we depend upon—all of us as New Zealanders—and we want to keep them safe, because they’re keeping us safe.Of course, the overriding thing here, even with the PPE and the other things, that remains to say is that all New Zealanders have a role here. All New Zealanders can stay home when they’re unwell. All New Zealanders can make sure that they’re washing their hands regularly and observing that social distance when they go out. All of those things will reduce the risk to our health workers in the health system, because we break the chain of transmission. That’s the very best thing we can do to keep those health workforces safe.

Upston Yes, and to be fair, in this instance, if a mum is in labour, she’s in labour; so she can’t choose to not go out. So I’d appreciate an answer to the second part of the question, which is around any directives around birth, delivery, and the 48 hours’ postnatal care.

Clark Look, I can’t and won’t make clinical judgments on that. I’m not qualified to do that. That is something that the Ministry of Health is best placed to advise on.

Davidson Thank you, Mr Chair Minister Clark—and I would have loved the opportunity to put this supp’ to Dr Bloomfield—we know that stopping the spread involves taking a look at the different health profiles of different sectors and communities, and this is concerning both rural and Māori communities. For example, Dr Bloomfield presented to the ongoing Waitangi Tribunal kaupapa inquiry into the healthcare system inequities for Māori. I wondered: how is the public health response to COVID-19 especially protecting vulnerable Māori communities? I think we can look to rural communities in that as well, for example, many of whom have pre-existing conditions.

66


Clark This is something that we have specifically looked at as a Government and put together a package for iwi providers to ensure that we have a Māori response. There’s some additional Whānau Ora money that has gone into that, recognising that historically pandemics have disproportionately affected Māori and Pacific Islanders. So, as a Government, we have put that money specifically aside to address that, and Minister Henare has been leading on that work to make sure we have a Māori response, and Minister Salesa for the Pacific response. We’ve also got teams set up that are specifically looking with an equity lens at our response to make sure those communities have the messaging—and you’ll see that all of our messaging is available in different languages—but also that the treatments and available options are there, because different people will choose to access health in different ways, and we want to make sure those ways are accessible to everybody and that a Māori person or a person in a rural environment equally has access to healthcare as anyone else.

Bridges Minister, thank you very much for your time. We greatly appreciate it. Now if we can move to Professor Skegg to give us some brief comments on his feedback on what we’ve heard.

Skegg Thank you, Mr Chairman—a very interesting discussion. Someone said that everything you do before a pandemic is alarmist and everything you do after it arrives is inadequate, and I don’t think anyone would accuse our Government of being alarmist in the early stages. I think they’ve done some great things. But I think we will accuse them if they’re not sufficiently ambitious now. I thought the Minister Dr David Clark said some really good things about the huge amount of work going on, but I was disappointed: I don’t think he once mentioned the word “eliminate”. He talked about containing the spread, suppressing it, reducing transmission, but if that’s our goal, we’re going to end up just the same as Britain, or the United States eventually.

67


We’ve got this opportunity now to eliminate the virus, and I think we need some real clarity of purpose. I said before: there is no strategy document. I checked on that with the Ministry yesterday. We shouldn’t be talking about the old pandemic plan, because that was designed for influenza. You can’t eliminate influenza any winter. This virus is different, and every day counts. If we don’t eliminate it in the next few weeks, the shutdown will continue for many months or we will have a series of shutdowns, which will paralyse our society for a year or 18 months, and it’ll never be the same again. But if we now can eliminate the virus, we can return to normal within a few weeks, or certainly a month or so.I think it’s great that committee members probed the really important issues of introduction of the virus at the border and the adequacy of testing. I think the one thing that hasn’t been covered in detail is the rapid case contact tracing. Now, I don’t have a good idea myself of how it’s working. I don’t know if anyone does. I’d love to ask, for example, the sad case of the woman on the West Coast who died a few days ago: have all her contacts been traced? It would be really nice to have a report just on that one little biopsy to find out what happened after that person was diagnosed—how many people were traced, have they been effectively isolated, have they been tested? We know about a few clusters around the country. There could be many more that we don’t know about. So I think it would be really helpful, because that’s the other key ingredient.But I’ll just say again: I think New Zealand has got a fantastic opportunity. We’re a lot better off than most of the countries we compare ourselves with, but we do need, I think, to have a very clear purpose. Kia ora.

Bridges I think you’re right about the tracing point. That was a glaring omission, but simply in the interests of time—and we will come back to that, I know, and am grateful that the Minister and the Director-General will give us more time. One thing I’m curious on, and I don’t know the answer, but the Director-General seems to place great emphasis, both at the borders when I asked him about screening, and when he was asked about testing, on the issue of false negatives. What do you make of that?

68


Skegg Well, false negatives are always a problem with a test like this. But, of course, there are very few false positives. So a positive test is extremely useful. But, as a number of people—I think the Minister himself—said, we’ve got to be careful that people don’t get false reassurance if the test was done on the wrong day. So that’s why we have to be particularly careful with people who’ve been exposed.

Bridges Any other questions, briefly, for Professor Skegg?Wood Yes, if I may, Mr Chair. Dr Skegg, I inferred from the

comments that you just made, and I want to test this and clarify it, that you believe that it would be possible to eliminate the virus over the next few weeks.

Skegg Yes.Wood I’m correct in understanding that’s your view?Skegg Yes, I do.Wood OK. And can you point us to—great respect for your view,

but—analysis or supporting evidence to suggest that this is an achievable outcome?

Skegg Yes; a number of epidemiologists have been saying this for weeks—Professor Michael Baker, Professor Nick Wilson. I did define “elimination”—it’s a bit like, you know, we’re going to have smoke-free New Zealand by 2025. That doesn’t mean every single smoker will have stopped smoking, but—we won’t eradicate the virus in the way that smallpox was eradicated from the globe over 40 years ago, but we could—the sense in which the term “elimination” is used in infectious disease control is to get it down to a defined minimum number of cases which can be handled at a local level. So that’s what I would like to see in a strategic plan.I don’t imagine that we will ever eliminate every single virus particle in New Zealand, but we could effectively eliminate it so that there would be no need for another lockdown. People could travel around New Zealand, have holidays, and, what’s more, in the coming months we could very likely let tourists come in, because there are new antibody tests becoming available which will be able to tell us who has had this infection and who is immune. So it may be that, in a matter of months, we will be able to open the country up, to an extent, so long as people can prove that they’ve had a test that shows they’re not carrying the virus. It could be just like when I first went overseas; everyone had to have a smallpox vaccination certificate.

69


So I think, you know, the prize is great. We’ve got such a great opportunity, but it’s no use waiting a few weeks to ramp up these things. We have to act now. Otherwise this is going to get out of control, because, as Dr Bloomfield said, we need surveillance to get an idea. Have we got 500 undiagnosed cases out there, or have we got several thousand? At the moment, we don’t know.

Seymour Can I just ask, is there another country that has produced a template of what a good strategic plan looks like? Who’s doing it best—being open with the people and showing what the plan is?

Skegg Yeah, I’m sorry, I wouldn’t be a good person to answer that question. My impression is the country I would really look to is Singapore. Singapore have got a fantastic public health system and a great hospital system. So I think it’d be well worth finding out what their plan is. We can certainly see a lot of countries that haven’t had good plans, the United States and the UK being two good examples.

Wood Can I follow up, Mr Chair, just by asking very specifically, Dr Skegg, what you see as the difference between what you have just described and the strategy of “stamp it out”, which, as I read it, is about getting the incidences down to an extremely low level whereby we might only have minor flare-ups occurring in the future, which can be managed? I hear your point about saying you wish either way that there was a more detailed, strategic, publicly available plan sitting in behind it, but is that fundamental strategy all that dissimilar to what you are describing?

Skegg No. What you have just said—but, you see, it’s not what the Minister said. The Minister didn’t say that once. He talked about containing the spread, suppressing it, reducing transmission. We need to stamp it out. And I’m worried. I wonder whether the Government doesn’t really want to be explicit about the goal because they’re worried that we might fail, and that you Opposition people are going to say, “Ah, well, you failed.” I think we need to have a cross-party—in fact, a national—commitment to do our best. We might fail, but we’ve got a really good chance of success, and I think that I would like to see the Government be very explicit about this, because then I think the people will realise that all this hassle we’re in is worthwhile.

Wood OK. I’ll just note that Mr Ombler’s briefing notes and presentation did in black and white spell that out, so.

70


Upston Can I just add something in this discussion, because the words the Minister used was that the aim was to reduce it to smaller waves. Can you clarify that?

Skegg Well, I think that would be an admission of defeat. That may happen, but I think it doesn’t need to happen. I don’t think that people should be talking about waves. I don’t think people should be talking about flattening the curve. We want to flat-line the curve. I’m sick of seeing in the media these curves, which they get from overseas, showing, you know, the peak being brought down. We don’t need to have those curves.

Bridges Thank you very much. Paul, did you have something, very briefly?

Goldsmith Oh, yeah, look, I just—we had the question around community testing and random sort of testing. I mean, I’d be interested, just finally—you’re obviously keen to see more of that—what community testing would look like, and, I mean, do you have a sense that the 2 percent figure that’s being used at the moment is in any way accurate or could be sustained in the absence of that community testing?

Skegg No, the 2 percent is very misleading. Not deliberately, but every time the public are told only 2 percent of the cases appear to involve community spread, it’s meaningless, because, as we’ve heard several times this morning, you only get tested if you’ve come from overseas or where there are epidemiological reasons why the person might be expected to be infected. So that must be an underestimate of the true number of people who are infected. So, yeah, we do need carefully planned surveys, and they should be started immediately. I thought that Ashley Bloomfield explained very well why using the influenza surveillance practices isn’t working: because people don’t get to see their doctor; so they’re not there to have a swab. But I think the Ministry needs to get advice very quickly as to how to get a good gauge on the extent of infection out there in the community.

Chair David, thank you very much. We will see you again on Thursday. For people watching, tomorrow—it’s very similar, save that it will be a very economic focus, with Minister Robertson; the Treasury secretary; Phil Twyford, Minister of Economic Development; and one or two of his senior officials. It’s been a very productive meeting, I think. If members can simply stay on the line so that we can cover some procedural matters; otherwise, we’re ending the public aspect of this now. Thank you.

71


Seymour Well, Simon, just before we go off, can I suggest that we actually acknowledge and publicly table the letter we received from Tony Ellis in relation to the cessation of prisoner visits by lawyers? Now, I recognise that probably the welfare of prisoners is far from front of mind for a lot of people, but there is a principle that the Government should be following the law. We’ve got a very prominent lawyer providing good evidence that the Government has acted illegally by saying that should you end up in prison—and, you know, being a politician, you never know what might happen—that, you know, you don’t actually have the right to call a lawyer or for your MP to come and inspect the prison. It’s quite serious, and I wonder if there’s any objection from members of the committee from us tabling that letter that we’ve all received from Tony Ellis.

Chair I’m happy to do that. Look, we will of course, I think, inevitably—and Thursday will be the start of that—be having some focus on the issues of civil liberties, rights, and legality; so I don’t think anyone watching at home, or, indeed, members, should be under any illusion about that. So we can do that.

Seymour Thank you.Chair I think now, as I say, that’s the end of today’s hearing—

publicly, at least.conclusion of evidence

72

Members · Web view1 day ago · BridgesGood morning. I think, hopefully, everyone is unmuted....

Documents

Transcript of Members · Web view1 day ago · BridgesGood morning. I think, hopefully, everyone is unmuted....