COVID-19 media update, 4 May

News article

04 May 2020

The All of Government COVID-19 National Response provided an update at 1.00 pm today.

Speakers:

  • Dr Ashley Bloomfield, Director-General of Health.

View the video of the media briefing below.

Summary

Dr Bloomfield said that there were no new cases to report. 

One probable case has been reclassified as a confirmed case. 

There are no additional deaths. 

Our total number of cases remains at 1,487.

2,473 test completed on Sunday.

152,695 have been completed to date. 

1,276 cases are reported as recovered.

Dr Bloomfield discussed the shift from level 4 to level 3, and complacency and discipline throughout the lockdown. 

Dr Bloomfield discussed testing at the Marist college. 

Dr Bloomfield discussed flu vaccinations. An additional 400,000 flu vaccines were acquired by Pharmac this year. 

Over 451,000 people over 65 have been vaccinated this year. Nearly 1.4 million vaccines have been distributed across New Zealand. 

Dr Bloomfield reminded people to make sure their contact details are up to date with their local GP. 

Questions from journalists

  • Dr Bloomfield was asked about a potential trans-Tasman bubble. 
  • Dr Bloomfield was asked about why we are still in Level 3, even with 0 new cases. 
  • Dr Bloomfield was asked about the long tail of COVID-19 as seen at Marist. 
  • How real is the risk that people may breach the guidelines now?
  • Is the current situation cause for celebration?
  • How many cases are still being investigated?
  • What work is being done to implement new, faster tests?
  • Would Dr Bloomfield permit nurses to work on a COVID ward one day and another ward another day?
  • Dr Bloomfield was asked about testing in Auckland around the Marist Cluster and whether that kind of testing would continue across the country. 
  • Dr Bloomfield was asked about wider testing around clusters. 
  • Dr Bloomfield was asked about regional bubbles. 
  • Dr Bloomfield was asked about a contacting tracing app and if we need it to go into Alert Level 2.
  • Is there a certain threshold that stops us moving to Level 2?
  • Dr Bloomfield was asked about coping with any backlog associated with elective surgeries. 
  • Dr Bloomfield was asked about ongoing breaches. 
  • Dr Bloomfield was asked about the 57 staff who were stood down at an Auckland hospital.
  • Dr Bloomfield was asked about staffing and immigration. 
  • There were questions around contact tracing and compliance with 14-day isolation. 
  • Questions were asked about whether the police had the legal power to enforce the lockdown.
  • Dr Bloomfield was asked further questions about a trans-Tasman bubble. 
  • There were further questions around isolation and whether that may lead to further infections in the coming weeks. 
  • Dr Bloomfield was asked about reopening domestic travel and if there were any concerns about opening shops etc. 
  • Dr Bloomfield was asked a question around a case connected to the Cook Islands and where that case may have come from. 
  • Dr Bloomfield was asked about the pandemic plan and whether it will involve influenzas in the future. 

Subsequent to today’s media conference, the Ministry has provided updated information that four people are currently in hospital with COVID-19.

Dr Bloomfield: Welcome to this afternoon's briefing.

Today we have no new cases of COVID-19 to report.

One probable case already known to us has been reclassified as confirmed following a positive test in the last few days, so that is a probable case that has now become a confirmed case. It means there is no change to the overall total of confirmed and probable cases which remains at one thousand 487.

I am pleased to say there are no additional deaths to report.

So our total number of confirmed cases rises by one and is now 1,137 and this is the number that we continue to report to the World Health Organization.

Yesterday, being a Sunday, there were a lower number of test, 2,473 tests completed. Our total combined to date, completed.

Of our cases, 1276 are now reported as recovered, an increase of 10 on yesterday and now 86% of our total confirmed and probable cases are considered recovered.

Today, there are seven people in hospital and none in ICU.

We still have 16 significant clusters and three of these are now considered closed as there is no longer transmission of the virus within the cluster, and it is a period of two incubation periods, so a total of 28 days since those clusters had a case.

Clearly, these are encouraging figures today. But it is just one moment in time. The real test is later this week when we factor in the incubation period for the virus and the time it takes for people to display symptoms, which is generally five to six days after exposure.

So that is when we will have an indication if there are any new cases coming through that might be emerging in the community as a result of our shift from level four to level three. We cannot afford to squander all the hard work and effort of the past weeks.

We did see at the weekend that it can be easy to start slackening off and we need to maintain discipline and keep pushing on and sustain the advantage that we have fought so hard for.

I want to commend the work on an initiative involving students and staff at Auckland public Marist College. The staff and student will be offered the opportunity to undergo free COVID-19 testing this week and a joint initiative between the public health unit and GHB and the school. While only half of the 94 cases associated with the Marist cluster were directly associated with the college, the others were a result of transmission within families or to others in the community, it is important that the wider school community is given the opportunity to be tested. The testing has been agreed in a discussion for the school board, the Ministry of Education, the Auckland Metro District health Board and the Auckland regional public health service. I would strongly support this initiative and look forward to following the progress of it during the week.

I also want to address the topic of flu vaccination. This is something we have been plugging hard this year. Not because the flu vaccine gives any protection whatsoever against COVID-19, but because by vaccinating as many New Zealanders as possible, in particular our older people and vulnerable New Zealanders, that reduces the likelihood that they will get flu and then suffer the sorts of illness that might put them in hospital.

It has been a record year for flu vaccines with more than 1.3 5 million vaccines already distributed out to general practices, pharmacies, workplaces and other providers, and this is more than has ever been distributed in an entire season in New Zealand previously. We have talked about it, an additional 400,000 doses of vaccine were procured this year before the COVID-19 pandemic had even appeared on our horizon. It has been important for us to prioritise those vulnerable groups early on, hence we started the vaccination campaign two weeks early, and we continued to just prioritise and make it available for those groups who are publicly funded for a full month. I can reassure those of us who are relatively healthy that there is a very low level of influenza circulating in our community, and I pointed this out before, that our flu tracker and our monitoring of influenza -like illness is very, very low, a direct result of the period of lockdown we have been under, which has stopped all sorts of respiratory viruses circulating in the community.

So the current travel restrictions and restrictions under alert level three will be continuing. I am pleased to say that over 451,000 people over 65 have been vaccinated already this year, exceeding the total number vaccinated in the whole campaign last year, in this age group, and likewise more Maori over 65 have been vaccinated in the past five weeks than in the entire year of vaccination last year.

Nearly 1.4 million doses of vaccine have been distributed to providers, and as of 30 April, around 700,000 of those were recorded on our national immunisation register is administered. So there are still approximately 700,000 doses of flu vaccine out in the community, some will have been administered but not yet entered on the national immunisation register, and others are waiting to be administered, around 1000 or so general practices, several hundred pharmacies that have accredited vaccinated and a range of other providers.

And of course there have been challenges around distribution of stock, but any GP or pharmacy that has run out of stock at this point and still has at risk people requiring the nation should get in touch with their local immunisation coordinator who have been coordinating the process of redistribution and prioritising access to the next shipment of vaccines when it arrives, and putting them in context, remember there is only 1% of the preCOVID-19 number of international flights being undertaken, so we have worked hard to get priority for the next two shipments of further vaccine, which are arriving this week and next week.

To conclude with three important items.

First of all, if anyone has cold or flu like symptoms, however mild, please do seek advice and ask about getting a test as quickly as possible. This is a point in time when we want to find any residual infection that could be COVID-19 out in the community.

Please also check that your phone details are up-to-date with your GP practice and that will help if there is any need for us to be able to contact you as part of contact tracing.

And I guess my final important message is to thank all of you, as I have before, and the media, for the important role you have played over the last three months in supporting our collective efforts to keep the public informed, to ask the important questions and the hard questions and to ensure that we are being held to account for answering those.

Thank you very much. I am open now to further questions.

Media: Have you talk to your counterpart in Australia around their processes and how you can match their processes?

Dr Bloomfield: Yes, we are in constant dialogue with our Australian counterparts, and it seems to be one of the things that will be very important, if there is an agreement at the highest level, to have a trans-Tasman bubble that we are working very closely with our Australian counterpart on what those key public health pillars would need to be around how we are testing for identifying and isolating cases and contracts, and also our position around contact tracing and our ability to exchange information smoothly to ensure that any con to -- contact or potential contacts to be followed up if they have travelled in either direction.

Media: Did have the system that will reach that standard?

Dr Bloomfield: We would need to be confident in each other's capabilities in that regard and my senses, if I reflect how closely we have worked together over the last three months right from the early days and trying to go very much in tandem with the range of what we have made around the border, case definitions and sharing of information, I am confident we could continue that to support a trans-Tasman bubble arrangement if that is what the governments agree.

Media: Now that we have reached zero new cases, can you explain why we need to still stay at level three for two weeks?

Dr Bloomfield: Yes, and the important thing here of course is that we are still wanting to be sure that there is no undetected community transmission in our communities. We have had a week of testing out in the community to identify, testing a cinematic people in a range of settings, and it continues this week, and our public health units have some public -- made very clear detailed advice about a sort of environment they should be testing and the numbers of people, for example, to the level of detail around which aged residential care facilities, how many people they should be sampling in each supermarket workers, they should be sampling which people they should be sampling in healthcare settings as well. So reflecting on the incubation period of this virus, and it is really later this week that we will be confident if we are or are not seeing new cases popping up in the community, so that is why it is very important we maintain the current posture.

Media: The long tail like we saw at Marist, for example?

Dr Bloomfield: It is clear from looking at other countries in a similar position or have been in a similar position, there is a very long tail, and what we are trying to do now of course is make sure we are in effect finding any potential additional cases that are associated with current cases or clusters, and what I can say having just had an update on some of the cases that we had in the last week or so, where it wasn't immediately clear what the exposure was, there has been wide testing around them of their work and family contacts and even more widely, none of that testing has shown up as any further, with any further cases, which is reassuring, but we want to just make sure we are covering off that long tail. It has been very interesting to see what we have had in New Zealand mirrors what other countries are found as well.

Media: People look at the fact there are no new cases, people celebrate the news and we are out of the woods and breached the guidelines.

Dr Bloomfield: That is a risk and I have emphasised that this is a point in time and it remains very important, very important for us to maintain the discipline around this and be vigilant. We know are a week away from making a decision about a move to level two, and I think by the Prime Minister and I have been clear that it is not just the number of cases or pattern, but the level to which people are seriously taking, taking seriously the expectations particularly around physical distancing, hygiene measures and not really squandering the advantage we have created for ourselves.

Media: Likewise, this is causing celebration, isn't it?

Dr Bloomfield: It is cause for celebration. It is important we reflect that it is symbolic of the effort that everybody has put in, so I don't want to downplay that. But once again, we need to be continuing vigilance. Yes, it is important we all collectively acknowledge this is the first day when we have had no new cases and we want to keep it that way.

Media: How many cases are you still investigating? How many do you think I still possible?

Dr Bloomfield: So, there are still two, and just to describe a couple of those cases we had last week, one which was in Nelson and one which had been found through our surveillance testing of the workforce at Auckland airport, and in both instances there was an explanation related to overseas travel sometime ago. And it is likely that this late case, the late positive test reflects the fact that these people had been infected and there were fragments of the virus showing up on the test but that does not necessarily mean they were ineffective and more importantly, there are no further positive tests and the people around them. That is what looking for in those cases where we cannot fully explain where the infection may have occurred.

Media: What is the government's thoughts in terms of tests being carried out on location in a matter of minutes or hours? Is it something you see any promise in? That is a development we are watching carefully.

Dr Bloomfield: We are most interested in, at the moment, in having the most accurate testing and the point of care testing is still a bit like the antibody testing, there are still questions about reliability and it is one to watch where it may be useful if we can get some reliable point of care testing could be, for example, in more remote locations where it would speed up the turnaround time or, secondly, it may play a role in supporting us at the border and in particular with people who are flying out and need to go, are going to a country on business, for example, where they are required to have a test. It could play a role that but at this stage it is not sufficiently reliable and we will stick with the fact we have good testing capacity across the country and continue to work hard to make sure that turnaround times are quick.

Media: Would you commit nurses to work on a COVID-19 Ward one day and then with high risk patients the next day?

Dr Bloomfield: I know there has been concern about this and there has been a response. I would rely on the advice of clinicians, remembering that staff insider hospitals day in and day out, particularly in intensive care unit are working and caring for people with a range of infections. So the practice that clinicians and clinical experts advise on is based on experience and on the very best advice so I defer to those specialists for their advice.

Media: [Inaudible]

Dr Bloomfield: I would be looking to the clinicians who are working in those settings. They are experts and would provide advice and I imagine that, like me, they would consider what would be paramount is ensuring that both staff and other patients in the hospital were kept safe and I know they will have very detailed around the use of PPE, washing their uniforms and so on, that would support safe practice.

Media: Does it not defy common sense when it is such a virulent thing to deal with, to have people moving between wards.

Dr Bloomfield: A point to the fact that, like us, I know the leading the response of their rely on and put a lot of stock on getting the best possible clinical advice and that is based on experience, of course, and people working in all sorts of healthcare settings are dealing with infected people, people with infections, a range of infections in the usual daily practice and that is what they base their advice on. My expertise is public health I would not second-guess the advice that infectious disease specialist give.

Media: The approach that Auckland has taken around testing everyone who had any involvement with the Marist cluster, would you like to see other clusters experienced the same level of testing?

Dr Bloomfield: A specific approach is being taken with the Marist cluster and in particular the decision around reopening the school helps inform the school, the students and the school community more widely. In each of the clusters, in particular those in aged care residential facilities, there has been wide testing of non- symptomatic residents and staff and family members to help support and control those clusters over the last few weeks as we have learned more about the transmission of this virus we have moved much more towards walking that make working with the DHP in regards to testing. And even in regards to individual cases, some we have seen where we have tested, for example, there was a resident at a campground and testing has been offered and conducted and most of the people who were wanting to be tested there, everyone offered a test has been tested to.

Media: Has been substantial testing already in areas with clusters, based on aged care homes for example,?

Dr Bloomfield: For the last two or three weeks we have been working closely with public health units about widespread testing of asymptomatic people, putting a wide ring-fence around these clusters and in particular in the aged care residential settings but also in some other clusters as well.

Media: But experiences like that on the West Coast where they have had no new cases in two weeks and have done a lot of community testing, would areas like that have a good argument for a regional bubble as we discussed?

Dr Bloomfield: In the future they may do to get the moment our advice, and the position we maintain is that we maintain a single national approach and the advantage for those regional bubbles would be, regional travel in particular but it may allow some wider commerce retail and so on. We are into the second week of level three and as we say we will not know until later this week whether that loosening of the restrictions from level 4-2 level three anywhere, even if they have or have not had cases recently, we will not know if there are other cases out there that may spring up. So it is the right position, currently, to keep everybody under level three. The regional differentiation may play a role in the future but not at this point.

Media: How far away as a decision on a contact tracing app and do we need one here in New Zealand to move to level two?

Dr Bloomfield: On the first question we are finalising advice for Cabinet and it will be a Cabinet decision around both the functionality of and the timing of the use of an app whenever that is made available. Do we needed to go to level two? No. It is clear from our experience here and even if we look at other countries, that the mainstay of being able to support a move to ease restrictions is having that really good core contact tracing system in place which we have been working hard to strengthen. The app may play a role in supporting that but it will be additional to what the core capacity there is. Not having an app in place will not be a constraint towards moving towards level two

Media: In terms of teachers, is there a pressure on us not being able to move there?

Dr Bloomfield:  I don't think there is a level but I think that it is very important for all New Zealanders to maintain the current expectations and we did quite well in level four. We are nearly there. But let us not slacken off now. We're not putting a number on it it will be clear if there is widespread behaviour that could be creating risk and I think that will definitely factor into advice in the decision that cabinet will make next week.

Media: 30,000 elective surgeries were postponed. How are we going to be able to cope with that backlog and what is being planned at the moment to do that?

Dr Bloomfield: There is a great deal of planning and action on the way because we are already one week into level three. That work is happening with the private hospitals because they will clearly be an important part of catching up on surgery and other procedures that were postponed. This is a big challenge for the system did it is to do as much of that work as possible while still dealing with any acute care needs that come through the door and, of course, maintain vigilance in keeping things safe from a COVID-19 perspective. There is a challenge ahead but everyone is focused on looking ahead and working with the private sector's.

Media: How long will we take to catch up was to make.

Media: Some months.

Dr Bloomfield: We would be aiming for months because remembering that what we aim to do in a non- COVID-19 environment is to provide people with the first specialist assessment within a four month period and then if they are dissing to need a procedure, to do that within four months. So the aspiration is to return to those timeframes as quickly as possible.

Media: Can you tell us about restrictions on surgery?

Dr Bloomfield: The description around an alert level three, of course, when we are still in a situation where there may be risk to older people and those with preexisting conditions, if this surgery can be deferred, then the advice is to defer it to avoid exposing them to any potential risk of COVID-19. Once we move down alert levels, there is clearly a much lower risk and that stands would not continue.

Media: In regards moving between covert wards and other wards, -- COVID-19 wards, why are there no guidelines?

Dr Bloomfield: There are ministry guidelines on this practice for many things including the use of PPE. But also recall that each hospital is different in terms of the staffing, the sorts of services they provide, the way their wards are configured, the number of staff on a shift, the seriousness of the illness that they may deal with. So it is absolutely appropriate that each hospital works out what is the best way to ensure that they are keeping staff patients safe while being able to run rosters, and provide cannot just for those with COVID-19 but all the other patients who are in the hospital as well.

Media: Standing down staff is not the best approach is it?

Dr Bloomfield: Approach to head off risk of further transmission is the right approach and this is what we have done where we have had other cases like this. Again, I defer to the fact that the clinicians were actively leading the process of providing advice and they will continue to. And in saying, as we have done in other settings, we have learnt more in aged residential care about the nature of these infections and how they transmit and we have constantly reviewed and updated guidance.

Media: Looking at what the rules will be at level two, do you have any advice about that and what sort of suggestions have you made?

Dr Bloomfield: I can say that we have provided advice as to the issues around alert level two that cabinet is considering today and the Prime Minister will have you on what the consideration was later today but I cannot second-guess nor preempt that.

Media: In terms of your own advice, given that down to zero, given that you have been quite clear that people are not doing what has been asked at level three, what is the advice for level two?

Dr Bloomfield: That advice will be the advice we will provide an input for Cabinet for the decision next week. What they consider today is what alert level two looks like in more detail. That is not a decision about whether to move, the balance of whether cases are coming from and a pattern, whether we see new emerging cases and the compliance with level three will be something they consider next week.

Media: To verify you don't get specific advice about what level two may or may not look like? You just give the numbers?

Dr Bloomfield: We have given clear advice that is being considered by Cabinet today about what level two looks like along with all our agencies across government. That is what is being considered today did it next week is the question about whether it is appropriate to move to level two. It is the decision considered next week.

Media: On those staff stood down, has created starfish resource shortages?

Dr Bloomfield: Not as far as I know when I spoke to the chief executive over the weekend so obviously having to move stuff around to accommodate that and indeed move some patients, but that is something that they will manage there. It is appropriate they have taken a precautionary approach and I know that they will be doing some wide testing to ensure there has been no further transmission.

Media: Given the current order closures and the plight of migrants, does the Minister worry about the long-term implications of staff in the health system? If the borders remain closed for a long time?

Dr Bloomfield: One of the things we have been doing from the start is, you know, we have been canvassing people who may have been out of the workforce for a range of reasons and over 9000 people have registered to be available to support the health system if required. So my sense is we are able to manage with what we have got here onshore for some time, however we will also be looking at if there are emerging needs including in the home and community support sector or aged residential care where we have quite a number of workers from overseas, we would be working with our wider sector and colleagues to find out what their needs are and providing advice in case we needed to change the immigration settings to bring people into dig.

Media: A question from the newsroom, is a government tracking to see close contacts comply with self isolation rules?

Dr Bloomfield: Or at the moment although people are followed up daily with a phone call to check what they are doing and their health, if they are having symptoms or welfare needs. It is one of the areas we are looking at as to whether they need to be strengthened as we go into level two. Perhaps shifting from phone calls to actual physical checks of people were close contacts.

Media: Sometimes the phone doesn't get picked up are concerns...

Dr Bloomfield: The feedback I have is there a very high levels of compliance, and in fact if someone isn't compliant, of course that is that opportunity for the medical officer of health to assure a notice and require them to go into supervised self isolation.

Media: (INAUDIBLE) they did not have the legal power to enforce the lockdown? Did police give concern that they did not have the legal powers to enforce lockdown?

Dr Bloomfield: Both ourselves and the Police and Crown Law were very thoughtful about making sure that section 70 notices that have been issued sequentially did provide a sound legal basis for the full range of expectations that we were putting on people, including the police powers to enforce those expectations.

Media: (INAUDIBLE) wasn't until partway through the lockdown, so were they not covered?

Dr Bloomfield: Our sense was they were, however we felt that issuing a very detailed section 70 notice was the best way to provide that assurance that there was the legal basis for them to exercise those powers.

Media: (INAUDIBLE) decision made to use the health app whether -- rather than a civil defence at...

Dr Bloomfield: Actually, recalling also that there was a national emergency declared, and that is still actually in place, the fundamental reason we have put these very significant restrictions in place is because of a public health threat, the threat of a pandemic from an infectious agent, and so it is very appropriate that we use these powers that are there under the Health Act 1956 and it was felt that was the best basis for providing a legal framework for the lockdown measures to be implemented.

Media: Was there a point where please do not have that power to enforce the lockdown?

Dr Bloomfield: Not that I am aware of, and we were in close discussion with Crown Law and the police right through the lockdown and then as we move into a Level three as well.

Media: It has just been revealed in Australia that Scott Morrison has invited Jacinda Ardern to dissipate in a National Cabinet meeting tomorrow. What aspects of New Zealand public response would you be keen to share with Australian leaders?

Dr Bloomfield: I can't preempt what the PM will discuss with her counterpart. I am aware, and we have been providing advice for the Prime Minister for the discussion and she may well reveal later today or tomorrow after the discussion exactly which issues were discussed. As you can imagine, of great interest is of course the idea of a trans-Tasman bubble which has been well canvassed already.

Media: Is two weeks one incubation period and just that really enough time to figure out whether the level three restrictions and perhaps people breaching those and in terms of how relaxed they are getting would lead to more transmission? If someone was at one of these parties over the weekend, we might not see that until Tuesday or Wednesday next week.

Dr Bloomfield: Yes, that is correct, and later this week we will know if there are new infections emerging, but we also of course will look over the preceding four weeks, remembering that there wasn't a bright line when we entered alert level three, so we will be looking back, look and see what is the pattern of cases over that full four week period, so to incubation period and any new cases emerging. It may well be even if the decision is made to go into alert level two, that progresses, that we may still see cases emerging, that is why we maintain a really strong posture around wide testing, surveillance testing, rapid contact tracing and isolation of contacts if we do see those cases emerging.

Media: To the people that partied over the weekend, do they document our chances of moving to level two? Segment I hope not. ! If we were to open up domestic travel again, would that make you nervous?

Media: If we were to open domestic travel to all New Zealanders, would that make you nervous?

Dr Bloomfield: I am not sure it would make me nervous. What I think applies to whether it is domestic travel or other elements of what we want to do under alert level two, which is open up more retail settings, there is a whole raft of things that would come into play. What would make me nervous as if we were not maintaining those course of a public health behaviours that we will need to maintain around particular physical distancing, hygiene and not going out, if people have any symptoms. So those other things not specific settings, routinely making sure those being observed in whatever setting, including whether it is domestic travel.

Media: What do you think is the concern opening up domestic airlines or people to move around or more retail been opened and people congregating, restaurants and those sort of things? What is the concern for you?

Dr Bloomfield: No concern per se, perhaps I would just go back to my previous response that the concern would be if we were relaxing the sorts of things we have now started to do more routinely around physical distancing, and around not going out, either to work or to visit others if we have symptoms of respiratory infection.

Media: (INAUDIBLE).

Dr Bloomfield: Not specifically. Again, the risk lies in the way we go about those activities, and what we have seen in retail settings that have already opened up is that they can, for the most part, and there was some learning along the way, they can undertake activities in a way that actually does support the core public health principles that apply, and also those... Support behaviour for people to level two.

Media: Just on a case where it says the travel was from the Cook Islands, are you contact tracing that case in Nelson, and obviously trying to mitigate a bit of panic in the Cook Islands where they had zero cases?

Dr Bloomfield: Two things. First of all, we were communicating on the day that this was found on the local public health officer was communicating with my counterpart, the secretary, the director-general in the cooks about that case. What is not clear is that infection might have happened as part of the travel back from the Cook Islands. They haven't had any cases, but whether it happened in another setting during the period after that person arrived back. And so that is more likely. So I don't think it puts in jeopardy anything that might have happened in the Cook Islands there.

Media: The influenza pandemic plan... (INAUDIBLE). Is there a case after this crisis preparing for a wider range of pandemic, not just coronavirus or emerging...

Dr Bloomfield: I think there is, yes. One of the things we have had to do and I think we have done effectively is adapt our overall approach in influenza pandemic plan because with all this was a different virus behaving in different ways in terms of its infectivity, in terms of the seriousness of infection and in terms of the mortality rate. Yes, I think one of the things we will want to do will be to look at our pandemic plan so that it has more flexibility depending on the nature of the agent that it is responding to.

Media: Is the plan not as selectable as you wanted to be in retrospect?

Dr Bloomfield: The plan is good in that it provides a framework and it is still, I think, been a very good basis for our preparation and our initial response. The key differences that we made that early decision not to move into a management typeface and that was the key decision. Our actions under keep it out and stamp it out I really still very consistent with what is in the pandemic influenza planet that we have taken them a lot further than perhaps had been 10 years ago with the swine flu pandemic of course, because a much stronger response at the border, and we have upped our capacity capability around contact tracing. In response to the differences between the two viruses.

Media: (INAUDIBLE) is there an argument for a case-by-case basis relaxing of the rules for things that we talked about before, like visiting people in hospital after surgery is on compassionate grounds under level three?

Dr Bloomfield: Not at this point. I think it is important, as I said, we may see steel cases emerging later this week and there is no guarantee they won't emerge in those reasons that don't currently have a case. Now is a time for us to just maintain that Midlands right across the country, and as we move into alert level two, that is where there may be a case in the future, there may be a case for some differentiation.

Media: (INAUDIBLE) you are looking at, what case numbers should people be looking at that suggest we may move into two or not?

Dr Bloomfield: Again, I'm not going to pre-empt Cabinet decision, but what we will be looking for is located numbers and knowing where all those cases are coming from. Being able to link them to our existing cases, that is what is critical.

Thank you very much.