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MINUTES: COVID-19 Technical Advisory Group
Date:
Friday 12 November 2021
Time:
10.30 am – 12:00 pm
S9(2)(k)
Location:
Chair:
Ian Town
Anja Werno, Bryan Betty, Michael Baker, Nigel French, Nigel Raymond, Sally
Members:
Roberts, Shanika Perera, Virginia Hope
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Ministry of Health Attendees:
Andi Shirtcliffe, Daniel Bernal, Jeremy Tuohy, Sarah Mitchel
Guests:
Steve Waldegrave
Collin Tukuitonga, Erasmus Smit, Matire Harwood, Caroline McElnay, Emma
Apologies:
Hickson
INFORMATION
Welcome and Previous Minutes
1.0
Dr Ian Town welcomed all members attendees, and guests in his capacity as Chair of the COVID-
19 Technical Advisory Group.
Minutes of the last meeting (22 October 2021) were approved.
Ministry of Health Update on COVID-19 Response
2.0
• The Chair presented some slides using data and model ing for Auckland and Northland
• Shows pattern of continued increase in cases at 150-200 daily. Includes assumptions
about protective vaccine effects as vaccine numbers increase by about 6000 per day
• With opening of retail, we may see cases climb further
• With this outbreak, less cases have been progressing to ICU, possibly due to the younger
cohort and increased vaccination levels. The occupancy is stil relatively low in Auckland
metro ICUs
• The model ing includes some raw predictions around beds and ICUs
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• Noted that testing and contract tracing capacity are at breaking point, and a more risk-
based approach for these is needed
• Community based care programmes and protocols are being developed using complex
algorithms and risk assessment.
TAG feedback included
• In Auckland and Waikato, Public Health are stretched, with flow on effects to GPs.
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•
There is an issue with lack of clarity regarding the risk vaccinated vs unvaccinated
patients pose to staff and other patients in primary care, and how masking affects this.
-
The Chair noted that a protocol on this topic for secondary care has just been
finished, and that this would be followed up for primary care
ACTION: confirm with the Chief Clinical Officer for Primary Care and COG that work is underway
to support this request for primary care.
•
Raised concern about the vaccine exemptions and how it was announced - an
announcement was made, and then 3-4 weeks passed before there was a process in
place.
-
The Chair noted that the vaccine order has been re-written and the exemption
process posted. The new order is to be Gazetted on Monday.
•
With regard to the PowerPoint slide shown, the projections look quite encouraging in
terms of the number of cases level ing off over time. However, it was questioned whether
some factors had been considered, such as relaxation of restrictions around social
mixing, waning of immunity post-vaccination, and the impact of boosters.
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-
The Chair noted these are complex interactions, and further input from TAG would be
welcome. Also noted that NZ data has informed some contract tracing decisions.
•
There was a comment that it would now be a good time to socialise what endemicity
would mean for New Zealand. Even some health professionals are surprised to learn that
literally every person wil have to encounter the virus at some point. This message needs
to be familiarised. We need awareness that this is something our immune systems wil
need to see on a fairly regular basis.
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-
The Chair noted that this should be a key topic for the next TAG meeting to allow
time for more in-depth discussion.
•
It was noted that other areas may be able to learn from Auckland’s experience. Several
anecdotes given in example of this.
Science Updates
3.0
Not discussed due to time constraints. Future science topic priorities for the Science and Technical
Advisory wil be discussed at a later meeting.
4.0
Protection Framework Processes
•
An overview was given of the developing strategic thinking about how we take account of
the proposed traffic light system to make sure this works in the context of broader public
health measures.
•
Key questions proposed and TAG input sought: when exactly the shift wil occur (likely
early-mid December); how to protect the most vulnerable; how to keep the health system
sustainable; how boundaries should work; and how contact tracing, testing case
management and isolation should be mana
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•
A key question is how vulnerability should be defined and how vulnerable communities
should be protected as the virus spreads. The Ministry of Health suggests a composite of
indicators that balance vaccination, access to healthcare, deprivation, age profile – and to
not just rely on the traffic light system.
TAG Feedback included:
•
The benefits of limiting infection should not be underestimated. For example, the impact of
long COVID is a big unknown that could profoundly alter the risk equation
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• Some were very concerned about the prospect of opening Auckland soon and emphasised
the benefits of delaying the spread of SARS-CoV-2, especial y to more vulnerable areas.
- The Ministry of Health is also concerned about Aucklanders travelling, and is advising
strongly on the need to protect more vulnerable communities.
• The need to retain the ability to enact measures above and beyond the red level, such as
lockdowns, was emphasised
- The group was reassured that the Ministry of Health is putting forward strong advice
about the importance of being able to move to lockdowns if necessary.
• The new system should take account of likely future events, such as flu season next
winter, as wel as a legacy point of view
• Therapeutics in hospital appear moderately good at preventing people needing ICU. In the
community however, therapeutics are likely to have a more modest effect at least in the
short term (due to factors such as price, likely smal deliveries, and difficulties getting the
treatment to people).
• There was a recommendation to make the need to minimise harm across the system
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central to the strategy (more than just reducing hospitalisations associated with COVID-
19), and the community sector should be better represented.
• One option to alleviate the pressure on primary care could be to have COVID-19 specific
treatment centres available in the community, where people who don't require
hospitalisation, but may only require 24-48 hours of close observation, can be looked after.
• There was feedback that when strategy is being developed, it needs to be better
connected to operational planning and the reality of services on the
INFORMATION ground. Before a
change to a whole new system and opening of borders, there is a need to lock in some of
this operational planning.
- The Ministry of Health is unable to influence the decision to open before Christmas,
so the focus is on trying to prepare to minimise potential harm. It was acknowledged
that strategy in isolation from operations is not meaningful. Guidance is needed from
the government on targets, definition of vulnerability, etc, and then it wil be essential
to ensure that connections with key people locally are being made to enable
community level planning
• There is some evidence that vaccination rates pick up as COVID-19 becomes a more
tangible threat to communities
- There is some complexity around this, for example in Northland there was a jump in
vaccinations original y but this dropped off second time around. This may particularly
occur in communities that have a deep distrust of government
• There would need to be thought about how geographically adjacent areas would work
together when at different colours (e.g. with workforces across areas)
• Managing demand of testing wil be critical
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and should think about focusing on real y important areas that give best value for money
and allow the system to operate speedily
- It was agreed that there is a need to focus resources tightly and this work is
underway
• It was noted that there is a lag between the number of cases and the impact on
hospitalisations and deaths. It would not be wise to just wait until we are at crisis point
before moving to lockdowns – has thought been given to the triggers that should be used
to determine moving to stronger measures?
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before publishing on Ministry
website.
confirm with the Chief
Ministry of Health
Clinical Officer for Primary
77 Update on COVID-19
Care and COG that work is
STA
12/11 – Action raised
Response
underway to support this
request for primary care.
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