Novel coronovirus update - 27th January 2020

Novel coronavirus (2019-nCoV) update - Monday 27 January 2020

Kia ora koutou katoa. Welcome to the Ministry of Health. Thank you very much for attending this briefing this afternoon. My name is Dr. Ashley Bloomfield. I'm the Director-General of health. And with me, also, I have beside me here, Dr. Caroline McElnay, who is the Director of Public Health. And many of you will have spoken with Caroline or heard her in interviews over the last few days.

We wanted to just update you on the work that's happening to both prepare ourselves and ensure we are very ready to deal with the novel coronavirus outbreak in China, and now with some infections in countries outside of China. So as you will be aware, there is, of around midday today, there are over 2,000 confirmed cases globally-- 2,014, in fact, in the latest WHO report. Fully, 98% of those cases are in China-- largely, mainland China, with sporadic cases and a number of other countries, including four in Australia, as you will be aware. It's important to emphasize at this point that the situation in New Zealand remains unchanged and I will come back to that.

So just to reiterate our key messages here from a health perspective. All travelers coming to New Zealand who become sick within a month of their arrival are encouraged to seek medical advice and/or contact health line or a doctor, and share their travel history. This is not new. This is advice that people routinely receive on entering the country. And this messaging has been enhanced, of course, over the last few weeks. In fact, our first advisory went out on the 6 of January.

There is, of course, as you can imagine, a high level of awareness, and of course, concern about the novel coronavirus. So unsurprisingly, people are aware of it and of what they should do when they enter the country. And you will also be aware that as of this morning, at Auckland and Christchurch Airports, there are public health staff meeting people coming off flights directly arriving from China. You also may be aware that the two flights this morning, first thing this morning in Auckland, over 560 people met.

And the media reporting on that is that they were wearing masks on the plane. A high level of awareness. No one had any symptoms. And they all received information about what to do if they did become symptomatic.

The personal hygiene messages for anybody around this particular illness are the same as for any respiratory illness. Frequent washing of hands. Good cough and sneeze etiquette. Covering mouth and nose when you sneeze. And of course, very important, staying at home and isolating yourself if you are sick, and avoiding close contact with others.

So I've mentioned the enhanced border measures we have with public health staff present at the border. We have a cross-government border working group that is convened at MIT on Friday. It has representatives from a range of government agencies, as you might expect. All government agencies have been updated on the situation and on the actions that they can undertake as part of the cross government effort. The border response, as I've said, has a particular emphasis on Auckland and Christchurch Airports that have direct flights arriving from China.

Also, just having read just now through the latest situation report from the World Health Organization, effectively, their advice hasn't changed at this point. There remains some gaps in information that all countries are seeking to fill as quickly as possible. The WHO does not recommend any specific measures for travelers. And it also advises against the application of any travel or trade restrictions on China based on current information.

And I think I'd just like to finish with a comment, coming back to my point at the start. The situation in New Zealand remains unchanged. We haven't yet had a case here in New Zealand. However, our assessment is the likelihood of us getting a case is high. And it may well be, as in Australia with their first case the person, who was subsequently diagnosed had in fact traveled and was asymptomatic when they came into the country and developed symptoms a few days later.

We may well find ourselves in a similar situation at this stage. We don't have any cases. A high likelihood we will. We've also assessed that the likelihood of transmission if we do get a case, of when we get a case, to another person is probably low to moderate, because we are prepared and ready. And at this stage, based on current information, our assessment is the likelihood of a sustained community outbreak remains low. We are constantly reviewing that assessment and will continue to do so.

So in summary, we are well-prepared. We're actively working on this issue. We have been since the 6 of January. And we continue to work on it very actively over the weekend. We are well-connected with our Australian colleagues. And we will continue to work closely with them. And from tomorrow morning, we will be standing up our national health coordination center. So perhaps at a future briefing here, we'll plan to hold briefings regularly. We welcome you coming down and having a look at that in HCC, which is down in the basement of the ministry. Kia katou, and welcome to ask any questions. Myself and Dr. McElnay will answer.

When was the last time we screened for illness at our borders?

So the regular border measures are that every passenger coming into New Zealand receives information about what to do if they become unwell. The last time, in my recollection that we had, specific border screening was during the 2009 swine flu pandemic.

Do authorities have the power to quarantine passengers? And if not, why not?

There is a quarantine power available to medical officers of health for notifiable diseases. This particular condition, we have going into the process for cabinet approval to become notifiable. I do say it's very, very unusual to use quarantine powers. And effect during the flu pandemic, they didn't need to be used because people generally do self-isolate. And so we'll be relying on people to self-isolate if they are symptomatic or indeed, if or when someone is diagnosed with the illness.

You said the likelihood of getting a case here is high.

Yes.

Could you go into some details as to why that is? Why is it high?

Well, the likelihood is high because we can see a range of other countries that have had small numbers of cases of people coming in. We know that people can be asymptomatic for up to, say, 14 days with the illness. So they may be incubating it when they come into the country. And we still have people arriving in the country who have come from China, either directly or via Australia or via other countries.

Rotorua Hospital assessed three patients and then let them go when they were still within that 14 day period.

Yes.

Why was that able to happen?

That was able to happen-- so there was a group that had been on the same flight as the first person diagnosed and confirmed as a case in Australia. The information and follow up went well. That group was assessed by St. John in Rotorua yesterday. Three of that group of 19 had further assessment at the hospital and were clinically assessed to be not displaying symptoms of a viral illness. Some tests were taken, but there was no reason to isolate those people.

The whole group, as with other travelers coming into the country, have very good information about what to do. And there will be daily contact with that group.

Would you say those take awhile to show up? And is that safe practice to let them go?

Our assessment is it is quite safe practice. And I just want to emphasize-- these people who have been assessed by specialists in the hospital who are used to seeing people with viral illness and assessed as not displaying symptoms of a viral illness.

How can you just explain how the screening process worked? Were they screened on the bus or in a hospital?

So that group was in Rotorua. They stayed put once they had seen the information that had come through from Australia via email. And they were actually assessed at the place they were in Rotorua by St. John staff on initial assessment. Three were then referred on to the hospital for further assessment. And I've told you the outcome of their assessment.

Is there any indication--

So basically, after the first assessment, they see these three people have some kind of symptom or seem unwell?

That-- it was based on their assessment, on the symptoms or the people's history they gave and not on any particular clinical signs. So they felt that there was-- it was warranted to refer them for further clinical assessment, and that was done at the hospital.

How confident are you that no one on that bus was carrying coronavirus?

Well, they've been assessed, and at this stage, the clinical assessment has-- and this is the same as with anyone who is at the border, the same as those people on the bus. They're not symptomatic at the moment. They know what to do if they do get symptoms. There was a question at the back, yeah.

Is there any intention to screen the flights coming in from Australia, considering many of them will have come from China?

That's under active consideration, and in fact, people could be coming via Australia from China. But there are other ways we can ensure that people have access to the information they need, including airport announcements. There are electronic banners there, and the information is very visible and widely available. And again, I think in particular, because of wide media reporting, a high level of awareness amongst travelers.

Given that such-- given we do have a lot of flights from Australia, I mean, that would be a big operation. What's the kind of thinking going into making that decision?

So I think there are two key considerations here. The border response is important and needs to be proportionate to the other parts of our response, because having public health staff at the border is just one part of the duties that public health units and other clinical staff need to do as part of preparing for and, of course, managing if we do get a case. So the border presence needs to be proportionate.

What we do know is the most important thing we need to do at the border is ensure people have good information about what to do, and that's the second point here. You'll be aware that there's some reporting today that-- reports out of China that it's possible people are infectious before they show symptoms. And again, so it's most important at the border that people have good information. They know what to do if they do become symptomatic.

Just one correction to what has been reported there-- the WHO situation report includes information that in the case of MERS-- that's the Middle Eastern Respiratory Syndrome-- there are reports of people being infectious prior to having symptoms. So that is something that has happened in other coronaviruses. It's not unique to this novel coronavirus.

Could you walk us through what you mean by a sustained community outbreak? What does that actually look like in practice?

I think that's a good one for Dr. McElnay to respond to.

OK, thank you. So we-- if, from the information that we've got to date, if we had a case, we may expect to see another case from a close contact of that case, but it would be very limited. By sustained community transmission, we're talking about a situation where there is a rapidly increasing number of cases, a bit like what we saw with measles in Auckland where you can see a rapid increase in cases developing from that first case. Now, we don't think that that will be the situation in New Zealand, and that's for a combination of reasons, one being the information that we've got about the infectiousness of this virus, but also about our ability to respond to identify those initial cases to ensure that isolation is happening and make sure that that person is not then passing the virus onto others.

So basically--

So you guys simply--

--we're quite well prepared now, and getting ahead of it beforehand is what is going to stop from essentially being an outbreak?

I think it's really important that we get ahead and that that is the key that we do not want to see, is that sustained community outbreak. And that's been our focus with our health professionals, is really making them aware of what they need to do so that we're not in that situation.

Some of the passengers that we spoke to this morning in Auckland Airport say that the pamphlets they received in Mandarin, they weren't very helpful. Can you explain to us what's in those pamphlets and if you think that the info could be improved?

Well, I'm not certain what the "not very helpful" means. The information that's there is translated from the same information that's available in English. It's very similar to the information that's being given out in Australia. So we would need to just find out more about why that's not helpful. It's quite basic, simple information and is the advice about being aware of any symptoms and about seeking-- either ringing Healthline or seeking health care if symptoms develop.

Is it correct that the SARS vaccine can be used to prevent severe symptoms, and if so, what is the situation with New Zealand's supplies?

There is no vaccine for this virus, this coronavirus, so I'm not sure where that information has come from with regard to a SARS vaccine. There is some development already happening in terms of looking at a vaccine, but that is likely to be a few months away before there would even be a vaccine developed, and then there's-- a production of vaccine always takes time.

So the person that-- or the person or people, albeit a small amount, what's the likelihood that it's going to be a fatality?

Yeah. Well, I guess the best information we have at the moment from the Chinese authorities is that the fatality rate is around 2% to 3%. In fact, the latest information, it's around 3%. So you can work that out for yourself. I think, just to put that in context, that's a relatively low fatality rate, just as this virus has got relatively low infectiousness. So the current data suggests that every person who might have the illness will infect around two to three people. You can contrast that with measles, where every person with measles infects about 14 other people.

So it's much lower infectiousness and it's a relatively low mortality rate. I think of particular importance, though, here is that what we are seeing in China is around 15% to 20% of people have quite severe illness. So one of the things we are planning for is to ensure that our hospitals and our ICUs have capacity, should we get a number of cases, that we're able to look after those people well.

So the likelihood of it coming to New Zealand is high, but the likelihood of someone dying is low.

Yeah. So the risk of people dying in New Zealand would be similar at this stage to what their risk is from what we're seeing in China.

There are people turning up on flights who are wearing masks. International media have said that this actually doesn't do much in terms of preventing the spread of the virus. What's the Ministry of Health's official word on that?

So I think people should wear masks if they feel that that is protecting them and/or if they feel they may be harboring symptoms of any illness, whether it's a common cold, influenza, then it's appropriate to wear a mask. And that's an individual decision.

Is it effective, though?

Well, I think there's limited evidence around the effectiveness, but certainly wouldn't discourage people from wearing masks if they wish to.

Is the ministry advising cabinet on whether to make the disease notifiable, as they're meeting tomorrow?

Yes we are, and cabinet meets tomorrow morning, as you've said, and they will be discussing this very issue.

What will-- apart from a lab quarantine, what will the notifiable status allow you to do? What's the basis of that?

So the notifiable status makes it compulsory for the disease to be notified every case. Of course at the moment, we have a high level of awareness and we have regular discussions with the public health units and we have information out to professionals, so we are receiving information about any suspect cases anyway. This will just formalize that. There is a number of diseases that are already notifiable, and there are some other powers that that gives the Medical Officer of Health. Perhaps, Caroline, you could speak to that.

So it's really in case we need to use powers, that it allows Medical Officers of Health to have the powers of isolation. At the moment, for non-notifiable diseases-- and as we said earlier, most people do comply-- but there may be the occasional situation where the risk to the public is greater, and so powers have to be used in making it notifiable. Means that legally, the Medical Officer of Health is able to do that.

What sort of contact have you had--

Do you--

--with the Chinese government?

Sorry, we have someone over here with a question, then we'll come back for you.

Do you have plans to screen everyone who was on that flight with the Australian person who fell ill?

So the particular risk, and this is what Australia were working on the basis of, is they were particularly seeking the people who were seated two rows in front of and two rows behind. That's standard practice. The person who became ill, other passengers on the flight were notified. That's how the group in Rotorua were notified, and we've have acted on that and are daily following up just to check on those people.

So did the group in Rotorua contact the authorities, or did the authorities contact them?

The authorities contacted them. So the contact tracing works-- and I just want to emphasize again, we're working very closely with our Australian colleagues and are very much in step with them. They have daily teleconferences that we participate on. We've spoken with the chief medical officer. So there's constant sharing of information, and we are used to sharing information across the Tasman to support contact tracing.

Are you still seeking anyone else for screening?

Not at this point, no.

So it's voluntary.

So there's a question-- yeah, sorry, it's a question over here.

Oh no, go ahead.

All right. So it's voluntary checks at the moment at the airport. When do you envision it becoming mandatory?

So what is happening at the airport now is that people being greeted off the flights from China are receiving information, and if they have any symptoms at all, are being asked to self-identify and would then be assessed by a public health nurse. Again, remembering my reading of this is everybody coming off the flights had a mask on. There's a high level of awareness, and I don't think we're in a situation where people would be trying to hide symptoms. I think there's a very high level of awareness and consciousness of what is appropriate to do if you do have symptoms.

But if there is a bit of confusion, like a language barrier or anything like that, do you think mandatory checking might become necessary at some point if the disease gets worse in New Zealand?

It may be. All options, of course, are on the table. We believe our activities are proportionate with the current situation and they're certainly in step with what Australia is doing.

How much contact have you had with the Chinese government over the outbreak?

So we don't have direct contact with the Chinese government. However, as you can imagine, our Foreign Affairs colleagues in China and in other countries are very much a part of information flows and are keeping us well informed about what is happening in China as well as other countries that have got cases.

Do you believe what's coming out-- what the Chinese government is saying about the outbreak and the number of deaths and the number of people that are infected?

I've no reason to have any questions about the data that are coming out. And in fact, having watched the briefing from the WHO Director-General a few days ago after the meeting of the emergency committee there, he was repeatedly complementing the Chinese government on their transparency and the way they were sharing data, recalling that they immediately shared the genotype of this virus once they had typed it-- in fact, on full genome sequencing on the 7th of January-- and that has been instrumental in helping get a diagnostic test and instrumental in helping get the early work underway towards a vaccine. So I have no reason to believe that the Chinese are being anything other than very open and helpful.

Can you give us an idea of the numbers of people that you're having to advise each day, like how many people are arriving from flights from China every day in New Zealand?

Sure. Well, on the first two flights-- there are, I understand, six flights a day coming directly into China. The first two flights had 560 people. There is one flight a day into Christchurch. So I guess we're looking at-- that's probably somewhere between 1,000 and 2,000 people a day, and some of those people will be coming as part of the Chinese New Year celebrations. Which again, we have a range of channels we are getting information out in Chinese into the Chinese community, both here and people arriving. So those channels are all being used.

And what's the total number that you've screened so far, and what do you expect for the number to screen?

Well, on those first two flights, there was no one who self-identified as symptomatic, so there was no one who required further clinical assessment. But every person was handed out the relevant information about what to do if they did develop symptoms.

What happens during a screening?

So, I mean, this is an interesting thing. In a sense, having people at the border looking at people coming off the flight is, you could argue, a form of screening. Mostly when people talk about screening, they're talking about assessment of people's temperature using thermo screening machines. That's an issue we're actively looking at to see whether that's an option for us here in New Zealand. The challenge is it's not very specific. It picks up anyone with a slightly high temperature. And of course, the other issue here is that people could be, and are likely to be, asymptomatic when they come through the border. So screening per se is just one element of the border response. The most important thing, just to reiterate that, is that everybody's receiving relevant information about what to do should they develop symptoms. I think we've got time for maybe one more question.

Some countries are looking at evacuating their citizens--

Yes.

--who are in Wuhan. Is New Zealand looking at that, and if so, what would the protocol be for them returning here?

So that would be an issue for our Foreign Affairs colleagues, and my understanding is the prime minister this morning indicated she would be seeking advice from them about that.

Has the Ministry of Health's response changed at all though, now that we know the disease can be transmitted before symptoms appear? Have you changed your response?

We're continuing to step up our response in line with all new information, and the most significant thing is that we will be activating our National Health Coordination Centre tomorrow just to help consolidate our response. And again, if there's an opportunity in the next few days, if you'd like to come down and have a look at that, we'll afford you that opportunity. Thank you very much for your time this afternoon, and we will keep you fully briefed over the next few days. Thanks again.