A person with Covid-19 at Middlemore Hospital was able to self-discharge after learning of their positive test - one of two new exposure events at the hospital, affecting dozens of close contacts.
Health officials announced the new exposure events last night, saying two patients had tested positive on Wednesday night - but they say the risk around the patients is low, despite 66 people being deemed close contacts.
One of the two patients chose to "self-discharge" after learning about their positive result. That person's whereabouts has not been confirmed by the Ministry of Health - all it said in a statement was that they were "now being managed by the Auckland Regional Public Health Service (ARPHS)".
Sixty-six patients have been identified as close contacts of the two positive cases - 34 of whom remain at the hospital. They have been moved to an isolation ward.
Middlemore Hospital chief medical officer Pete Watson told TVNZ the pair arrived separately - they did not know each other and were not connected to each other in any way, he said.
The pair were two of six Covid-positive people who arrived at the hospital that day, he said. The other four were people they already knew had tested positive for the virus and knew were arriving at Middlemore for treatment.
The first of the pair was a patient who answered no to all screening questions but hospital staff noticed a "very minor cough", said the Ministry of Health.
The person was then isolated and tested, which returned positive. They are now in Middlemore's isolation ward.
The second case was a patient who answered yes to one of the screening questions, which was also a symptom consistent with the non-Covid-related reason for going to the hospital.
This person was then tested and given initial treatment.
After learning of the positive result, the patient chose to self-discharge. They are now being managed by the Auckland Regional Public Health Service (ARPHS).
"All staff were wearing the appropriate PPE and as such no staff members are required to stand down," a spokesperson said.
"The risk to public health of these events is deemed to be low," the Ministry said.
Watson said Middlemore currently has nine Covid patients admitted.
Asked how many people, in total, had turned up to the hospital's emergency department for unrelated health conditions and then tested positive for Covid, he would not give a figure.
However, he said: "There is a number...there's a steady stream."
They hoped, at some point, a test could be developed that would be better at showing whether or not someone had Covid before they even stepped foot into the emergency room.
Watson said they hoped for such a test that they could then use on patients at the front door.
Staff at the hospital had recently started using rapid antigen testing too, he said. "That's been helpful to confirm cases that we suspect are cases early."
Associate Health Minister Aupito William Sio confirmed today that officials had deemed both events to be "really low".
He told TVNZ that officials were providing support for the person who had self-discharged from the hospital. He said he did not know details of the person's circumstances.
However, he said previously, some people who were told they had tested positive for Covid had found the situation overwhelming.
There were other circumstances to take into account - with some people feeling overwhelmed because they had people at home, such as elderly family members, who depended on them.
"They will prioritise their families, their economic needs, over their own personal health."
Put to him that it looked as if level 2 may be up in the air at this stage, Aupito said we simply needed to trust the advice from our health officials. "Fingers crossed," he said.
Experts say a move to level 2 for Auckland next week is still looking "very risky" despite a drop in new and unlinked cases.
Regardless of any changes decided at Cabinet on Monday, Prime Minister Jacinda Ardern today said the removal of the boundary around the region will not be up for consideration.
University of Auckland associate professor of public health Dr Collin Tukuitonga said he was optimistic cases would continue to decline through next week, but "not get to zero in a hurry".
Given the nature of the current clusters spreading through transitional housing, which included people living in "very difficult situations" and were often less trusting of authorities and willing to engage and get tested, the tail of the outbreak threatened to "get very long", he said.
"That is why we really need a targeted approach, engaging people from those communities that people trust."
There were 19 new cases announced on Thursday, down from 45 the day before but still a vast increase from the days prior.
Eighteen of the cases were in Auckland and the other is a child who attended Mangatangi School, who had been isolating. The school was at the centre of an outbreak earlier this month after children of a gang member freed on parole became infected.
Sixteen were known contacts, and director-general of health Dr Ashley Bloomfield said they were expecting another 30 cases in the coming days, as 19 of the newer cases were linked to emergency or transitional housing.
Bloomfield said the transitional housing sub-clusters were a mix of hostels, motels and houses - and there was often movement between those places.
There are now seven suburbs of interest. On how the outbreak was evolving, Bloomfield said there were initially four clusters that were active.
There were now several subclusters: two newly identified subclusters were a southeastern Auckland household's subclusters and a West Auckland subcluster of households. Bloomfield said the new cases were coming from those two subclusters.
Bloomfield urged people from all suburbs of interest to get tested, regardless of whether they were symptomatic or not.
Despite a number of mystery cases circulating, consideration was still being given to whether that alert level would change, and that decision would be made by Cabinet on Monday, Ardern said.
However, she said she wanted to provide some certainty that the boundary restrictions would remain in place, even if that happened.
"We want to get to a position when we can have movement again," she said.
"It causes a huge amount of work for managing the boundary safely and also a huge amount of stress and anxiety for those who are separated.
"Of course, we want to get that movement back, but it needs to be safe."
This would mean the border would remain up through the school holidays, which start next week.
When asked if the border would remain in place until vaccine rates had climbed above 90 per cent, Ardern said that was not a "connection" being made by the Government.
However, high vaccine rates were the key to lifting all restrictions, she said.
University of Auckland emeritus professor of medicine Des Gorman said such a border restriction could be "there for a while", and could eventually see a situation where people needed to be vaccinated and return a negative test to pass through.
"I think our contact tracing and our testing capacity has been so poor and our hospitals are so unprepared and the Government will always take a very low-risk approach."
Covid-19 modeller Professor Michael Plank told Breakfast that there are "concerning signs" that it is going to be difficult to keep this current outbreak under control in alert level 3.
"There are worrying signs when you have cases popping up out of the blue and coming into hospital and then testing positive - that it is going to be difficult to contain the outbreak going forward."
In terms of Auckland moving to alert level 2, Plank said doing so in the current situation - with cases still showing up in the community - could lead to more hospitalisation and ultimately more deaths.
"It could lead to cases growing very rapidly if we moved to level 2," he said. "I think it would be extremely risky to move to level 2 at the current time.
"It is a dangerous time."
When community cases were showing up in places and suburbs where you're not looking for them - that was worrying, Plank said.
Show us a plan - Bridges
National's Simon Bridges told The AM Show that Aucklanders were frustrated and wanted to see "some semblance of a plan" from the Government. "Is it about vaccination rates or is it about Covid rates in the community?
Labour's David Parker said it was difficult to put a date on opening up because vaccination wasn't high enough. But at 90%-plus, the Government could start "replacing border restrictions with vaccinations".
Parker said a return to level 4 was very unlikely. "You've gotta maintain a social contract to keep people with you - we're all over Covid."
New Zealand would be able to sustain low rates of infection because of improving vaccination rates - but Delta was very hard to contain.
Responding to Bridges' call for a plan, he said there was already trialling of a new MIQ system in October, but vaccination was also the most important tool.
Auckland University Professor of Epidemiology Rod Jackson yesterday called for all politicians to put politics aside and stand together to tell people to get vaccinated.
Parker said "in fairness to the Opposition", politicians had shown a united front on vaccination.
But Bridges said "there is politics on the so-called podium of truth" and he claimed Jacinda Ardern did not want to share the platform with other parties.
"There is a cross-party consensus on the absolute vital importance of vaccinating."
Asked about new commercial rent rules that were introduced, Bridges said the rules were "a shocker". "If you muck around with contract law you really undermine the basis for doing business."
He accepted tenants were doing it tough but landlords weren't all "the fatcats Labour seems to think they are".
Parker said everyone had to share the consequences of Covid. "People can be laid of pretty quickly as a consequence of the pandemic...yet some landlords can be trenchant in doing nothing to meet the costs."
Rotorua tourism leader optimistic
Destination Rotorua marketing manager Haydn Marriner is "optimistic" there will still be tourists in the city this school holidays - when around 52% of the market would normally come from Auckland.
The city won't be as busy as usual, with fewer Aucklanders around as the border will be closed.
Lots of businesses were in a dire situation, Marriner told The AM Show today. He feels for hospitality businesses who are worst hit - he tries to support local food businesses whenever he can. "You might go to the luge once but you eat 3 times a day."
