Verrall AyeshaHon Dr AYESHA VERRALL (Minister for Food Safety): I'm pleased to be able to contribute to this debate because it is my honest opinion that New Zealand is the safest place on earth when it comes to COVID-19. We have achieved this through a deliberate strategy of going hard and early and in relation to the discussion about the recent move to alert level 3 in Auckland and level 2 elsewhere in the country the Government has been safe proactive and evidence-based in its measures.I received the information about this new case on Sunday and let me share some of the thoughts that went through my mind that explain our move to alert level 3. The most important thing to understand is that the germ does not just spread by being in the same general area as the person; being in a workplace that is connected through its business to the airport is not enough to say you have a plausible link to international cases. Instead we have to be able to establish the mode of transmission. The worker who was ill was a laundry worker. As Professor Baker has said in the media recently there has not been a single documented case of transmission through the laundry. It may appear a plausible theory now but that is the state of the science. So one cannot immediately make the conclusion that that case was linked to the border and therefore it shouldn't prompt consideration of alternative hypotheses.The other thing that was unusual about this case was that the onset of the daughter's symptoms—referred to as case A—and the mother's symptoms were at about the same time. They were only separated by one day. This suggested that they could potentially be part of the same generation of transmission and infected by someone else not necessarily from the mother's workplace. Therefore there were a number of things that didn't hang together about these cases and the decision was made to move to alert level 3 in Auckland and elsewhere.I just want to reflect on the words of the previous speaker the Hon Michael Woodhouse about non - COVID-related casualties of the elimination strategy. These weigh heavily on my mind too but I would like to remind the House that there is no country in the world that is not having the collateral consequences of COVID. Try getting your cancer care in a UK hospital right now. It's a disaster. By pursuing an elimination strategy we are able to make sure our health system is able to run as well as it can given the global situation. We have the most chance of catching up on cancer waiting lists for example than compared to places where there is an ongoing pandemic where immune-compromised people feel scared to enter their hospitals.Let's talk a little bit more about the case investigation because this has been an object raised by the Opposition. Case investigations are dynamic situations. They are done under high pressure and I want to commend the work of the Auckland Regional Public Health Service and the national contact tracing staff for their contributions to this. What we require of our case investigations is that they work through an ordered set of hypotheses about how cases might have arisen. Of course one of these started with the investigation into the LSG Sky Chefs workplace. As I said before it is not enough just to suggest that because this workplace is at the airport it is linked to the border. We instead need to find a plausible link between our case and an international traveller with COVID or a suspected international traveller with COVID. Let's remember: this is a workplace where there is routine testing.So the first possibility is that a person undetected through that routine testing might have been a case and came into contact with the case we have discovered. To cover off this hypothesis we are re-testing that workplace and of course going over the records of previous testing. The next question is: could transmission come from an object that this worker was in contact with? As has been said this is not recorded in the scientific literature yet none the less we are considering this possibility because we want to take all the opportunities to improve our systems that we can. We know from the scientific literature that COVID can be recovered from surfaces up to seven days after it is deposited there and it can be found to be living—that is still capable of reinfecting other people. However this is much harder to do in practice and it is much harder to recover COVID from textiles so the possibility of assessing whether this happened in the laundry is not really feasible.One of the unsatisfying things about these types of case investigations is when it comes to hypothesising non - person-to-person transmission—so transmission in an indirect route through the environment or through fomites—we don't find a smoking gun. I've been on many investigations of infection prevention and control in my previous job and one of the things that a sensible infection prevention and control report will often do is list these hypotheses in a structured way and then identify ways in which the most plausible of them can be prevented in the future. Unfortunately the problem in finding proof of transmission through these non-conventional or atypical means is also present in the scientific literature.I don't imagine there are many places around the world where public health units have the time to go out and do the detailed case investigations that we are doing in New Zealand. We might well discover things that other countries haven't experienced because they are not testing the laundry for example for COVID. None the less we are covering off all these possibilities looking into fomite transmission and we are also covering off the more likely transmission of human-to-human transmission in the workplace by re-testing the workplace. We have also looked at the whole-genome sequence of the isolate in the three cases that we have identified and seeking to find a match in any New Zealand case. As that hasn't been found we're now searching international databases to confirm there is no match.The other hypothesis is that the family could have been infected through community transmission and of course that is the most worrying scenario. For that reason we've gone through the whole-genome sequence specifically of every case in the managed isolation and quarantine (MIQ) facilities to check for a match. We are also doing widespread community testing in Auckland and also testing sewage.In this debate members have raised the matter of continuous improvement in the COVID response particularly in the area of technology. I want to touch in my time remaining on a few areas where technology has led to significant improvements in our COVID-19 response—firstly in the realm of whole-genome sequencing. During this last case this has allowed us to identify the so-called UK variant—or B.1.1.7. It has also enabled us to exclude the link to other cases in MIQ. This has been a huge development that I know members of the infectious diseases community have wanted for a long time and it's excellent that it was able to be brought forward as part of the COVID response. I'm aware the workers in our whole-genome sequencing laboratories often work through the night to make sure we can find out if we have a link to a known case or if it is a case of unrecognised community transmission.We are also implementing sewage testing. Over the summer the Institute of Environmental Science and Research Ltd tested the sensitivity of the sewage test and now it's being used as part of this outbreak and the Northland outbreak. It is probably sensitive enough to detect a handful of cases. We think it's probably not sensitive enough to detect a single case. Through repeated use we could probably confidently exclude community transmission. Performing sewage testing is not a glamourous role. After a machine has collected the sewage over a period of 24 hours with periodic collections it then needs to be concentrated in the laboratory. I'm very grateful for the workers who have undertaken this work to make sure that we have this new tool that is not dependent on human behaviour as is polymerase chain reaction testing.We also have implemented new technology in our National Contact Tracing Solution as a result of my report that identified fragmented information technology systems throughout our public health system. A system that linked cases and their contacts and passed all of the contacts through a clinical pathway of management for contacts has been implemented. We also have digital contact tracing using both Bluetooth and QR code scanning. Finally we are implementing saliva testing. That is already under way for people at the Jet Park and I understand it's being rolled out across other laboratories in the coming weeks. There will be more developments in our response as we get to the vaccine roll-out. I'm very proud of the work done by our border workers to keep us all safe and pleased that they will be the first to be offered this vaccine that will keep them safe and our community safe. We have done well by going hard and early through this global pandemic and as a result we are one of the freest societies and economies in the world.The debate having concluded the motion lapsed.