Covid-19 Response Minster Dr Ayesha Verrall says there's no doubt this winter is one of the toughest seasons New Zealand's health sector has ever faced.
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Hospitalisations of people with Covid-19 and case numbers have been soaring, alongside seasonal illnesses and compounding stress on the health system.
"Covid-19 cases have been steadily trending upwards with flu and other respiratory illnesses also placing significant pressure on the health system," Dr Verrall says.
Director-General of Health Dr Ashley Bloomfield says the number of new weekly cases has increased week on week over the last month after previously declining since March, and the number of cases detected at the border has been steadily increasing too.
"It's quite clear this has been driven by these new BA.4 and particularly BA.5 subvariants of Omicron and we're seeing a very similar pattern to what we're experiencing here in a number of Australian states - particularly New South Wales."
He says case rates across all four regions around New Zealand have trended upwards in recent weeks - a 32 percent increase in the week ending 10 July compared to the week prior.
This has been driving an increase in hospitalisations, he says, which "has been quite rapid".
"Among people 65 years and older they have increased by 33 percent in the weekend to 10 July."
He says test results from border workers and wastewater suggests a significant increase in case rates across all regions in recent weeks, and the ministry believes only about half of cases are being found from testing.
"Some of those will be people that are asymptomatic, and some may be testing but not uploading their results and there may be some people that are simply not testing."
He says the proportion of BA.5 cases has rapidly increased with 47 percent of cases sequenced being that variant compared to 41 percent in the previous dominant variant BA.2.
He says three doses of the Pfizer vaccine still seem to be having the same effect on reducing infection and serious illness with BA.5 compared to BA.2, but it is clear BA.5 is better at evading immunity.
"This is important for people who have been infected previously. It does not mean you are immune to being reinfected and we are seeing a steady number of reinfections ... still around two to three percent of our total infections but we are expecting it to increase."
Photo: Ministry of Health / Modelling Aotearoa
He says if nothing is done, hospitalisations are expected to peak at 1200 beds occupied per day - higher than the occupancy from the March peak.
Rates of community infection are expected to peak around 21,000 cases a day.
However, he says if steps are taken the peak can be reduced to under 1000 hospital beds per day.
"The public health measures in place and the actions of us all are what will make the difference here."
Anyone out there who are not wearing masks because it is inconvenient or uncomfortable, he says if health and disability workers can do it, so can they.
"If everyone does their bit, we will get through winter."
Te Whatu Ora chief executive Margie Apa, appearing via video link, says Te Whatu Ora is monitoring the data and working to support health workers.
"All of this increased demand does mean it can be harder, at different points in time to get an appointment with your preferred health provider."
She says work is being done regionally to manage demand, and hospitals are coordinating planning on a daily basis.
She says there are initiatives that can be turned on at any point to help with demands at hospitals and emergency departments, and Health NZ is working on national platforms to make it easier for making direct referrals to radiology.
She says local pharmacists can be useful in providing advice, and Healthline is also available to offer advice before people leave home, all of which would help reduce demand at clinics and hospitals.
Verrall says the government has weighed up the possibility of moving to the red setting but the main difference it offers is in gathering limits, and the most effective measures are masks, vaccines, and isolation are most effective at stopping the spread of Covid-19.
"We need to balance restrictions with practicality and effectiveness. These measures also help prevent the likelihood of catching flu and other winter illnesses - so that is why we are remaining at orange."
Photo: Ministry of Health / Modelling Aotearoa
She says now is not the time to stop wearing a mask, and rapidly rising rates of reinfection show having had the virus is not an excuse.
The government is removing eligibility criteria for getting access to free rapid antigen tests. People will no longer be required to say they have symptoms to get access to free RATs through the request a RAT website.
She says businesses will be provided with public health advice, and the message to businesses is simple: following this advice will mean they are more likely to be able to remain open during winter.
She says the government is also launching a new campaign to help encourage people to get booster shots.
"Health officials are calling and texting those who are eligible. If it's been six months since your first booster and three months since you've had the virus, please go get your second booster. Do it for our health sector and to keep yourself out of hospital."
She says it's important if people are feeling sick to stay home.
Pharmac will also today be announcing wider eligibility criteria for antivirals like paxlovid, molnupiravir, and the infusion veklury.
"Anyone over 75 years of age will be eligible and there will be improved access for Māori and Pacific peoples as well as people with other risk factors."
She says yesterday more than half the people admitted to hospital was over the age of 70, and the antivirals are extremely effective at reducing the risk of severe illness.
GPs will be encouraged to write prescriptions for high-risk people in advance of them becoming sick if they are eligible, in a "just in case" approach.
The drugs will also be made available at pharmacies as pharmacy-only medications, though this will require legislative change over the next fortnight.
On the red setting
Verrall says the red setting is not redundant, and the response system needs to be flexible.
"We need to be able to continue to have a response that we can flex, but for the reasons I've outlined we believe we can get through focusing on the basics of masks, vaccination, ventilation and staying home when you're sick."
She says the virus can mutate and the government needs the option of being able to increase the restrictions as required.
She says earlier in the pandemic there was a lot more concern about superspreading events, but at the moment people are catching Covid-19 in their homes and workplaces, "and that's why we need to focus on that".
She says we need to make sure there are no barriers to mask use, and the government will continue to work to ensure they are more and more available including N95s to vulnerable people.
"Masks are just critical right now for making sure we take the pressure off our hospitals."
She says at every level of the traffic light framework, masks are recommended in schools.
"What we mean when we recommend mask use, is that you should do it."
Unlike in some other settings however, masks are not required at schools for children.
She says the decision to increase access to RATs and masks has been worked on for a couple of weeks.
A campaign to promote greater mask use is being rolled out, she says, and an advertising campaign promoting that "masks matter" will be hitting screens soon.
Apa says the shift from DHBs to Te Whatu Ora on 1 July means there is now much greater regional coordination and collaboration, "looking at escalation models within individual hospitals and where regions are able to support each other, so all those operational rhythms are part of how we will manage the system and support our workforce".
On boosters
On the possibility of offering the second booster vaccine to younger age groups, Verrall says there are risks to take into consideration.
"There are rare side effects that become more frequent at the younger age group, and that's why we have a lower age limit at the moment and we continue to track whether or not it's safe to widen access there."
She says the health system is working closely with Māori groups including increasingly at a township-by-township level.
Bloomfield says a good rule of thumb is to wear a mask in any indoor place outside the home.
He says in the current environment with an Omicron resurgence, mask wearing should be like wearing a seatbelt.
He says some people have legitimate mask exemptions however, and they should be respected.
"It is up to all of us and we have it within our reach to actually level off that peak - either this current level or not much higher - and that is what will make the biggest difference to our number of hospitalisations."
He says modelling at the moment is suggesting the peak will be sometime in the latter half of this month.
He says he thinks the orange setting is good for now, but the ministry has been asked to look at the current red settings to see whether they would actually make a difference and what else could be done.
"Am I confident people will listen and will follow through on the message? I am, because we've seen that New Zealand's successful response in the pandemic to date has relied on people doing the right thing.
"There is no way we could police our way through a lockdown, it relied on people actually doing the right thing - and they did it. And our message here today is it's important that people again recommit."
He says RAT and mask stocks are very good at the moment, which is one of the reasons officials feel widening access is doable, "and we'd rather have these things being used than sitting on the shelves".
The free RATs are not a replacement for businesses doing the right thing, he says, they are for individuals and whānau.
Earlier this week, Prime Minister Jacinda Ardern said a return to the red traffic light setting was not likely to significantly reduce infection rates, but there would be more focus on existing measures like mask wearing and vaccinations.
University of Otago immunologist Dianne Sika-Paotonu earlier told Morning Report that while people might want the pandemic to be over, it isn't going anywhere, and wider spread of the new more transmissible variants means more people getting sick, and more people dying.
