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Good morning, everyone. It is 9 37 on Saturday, the 23rd of May on. But it is an absolute pleasure to welcome you to our international virtual medical conference. At this has been a Herculean feet off teamwork off incredible passion on diligence from a team off at least 20 medics and medical students from around the world. Today we have people joining us from the USA from Asia from the continent of Africa from the cool continent of Europe. On it is an absolute honor to be able to host whole range off talented speakers and workshop leaders on, um, keep kicking of fireside interviews as well as welcoming are oral abstract presentation sessions on research presentation sessions. We're gonna have a nausea day. And if you didn't catch our virtual conference attic, it slides, and then they they will be running during the coffee bricks. And there are two things that you can do during coffee break. You can go to networking, which is on the left hand side on. You will be able to be matched with somebody else in the conference. We're bringing back the virtual coffee brick, and it's a good network. Go and talk to someone going Make a friend on. Do you will be You will be so, so welcome. Teo, join any session that you want to, um, at any other time at all. Break out rooms, all or ulcerations are going to be in the setting box. You can. You can see all of those sessions at the right time. They should appear at the right time. If you have any issues, we're going almost all cockpit arsenal. We will have the best got on our de m's on Twitter, which is up med or up. M e d a l l a p p is the best place to get us If you have any technical issues, drop us a d. M. We're gonna be monitoring the story the day and other channels can get little bit mixed. So that's the best place to get us. And as you can see, we have our memories that seamlessly joining us on screen, which is great on dmard. Massive, massive welcome, Doctor Carline. Michael, May You may notice that of the bottom of our screens, we have both the CME Certain him. That is not a type of, uh I I sometimes called Dr Michael Knee anti Carline on. Um, in some ways, we are recreating or taking families. Um, calls to a whole new level. So it was an absolute authority on t welcome. Welcome you're gonna refer to is Dr Michael Nathan like this? Because that is that is why you're joining us on. Do the level of respect that we want to give you. So just as a brief introduction, Doctor Carla Michael is the director of public health for a New Zealand's minister of Health which advises the Ministry of Health on matters concerning the control of covert 19 in New Zealand. As a director of the current crisis, Doctor Michael J. Cancels the ministry in the country's prime minister. Just send are doing on. She delivers regular televised delayed media briefings answering questions on all matters concerning to the control off coronavirus in New Zealand. Her interest in public health started during her times A medical student at Queens University, Belfast, before moving to the university off Manchester to take an MSE in public health. In 1995 she moved to New Zealand on was appointed as the director off population health for hawks Bay District Health Board whilst their doctor, Michael May, was involved in responses to the first case of SARS in New Zealand on a listeria epidemic. In 2014, she published a major reports on health and equity in that area. She served as a president off the New Zealand College of Public Health on moved to the post office Erector of Public Health in New Zealand in 2000 and 17. But possibly I'm sure she may argue this at whatever brightest achievements is becoming my, uh in 1987. Carline, Doctor Michael J is an honor to have you on our company today and a Z importance off family is in the focus off the world. It is even more appointment, but particularly as one of the leading figures are on the world's tablets pandemic. It is create a have you thank you. Everyone who is listening to us. We have to totals at the top of the screen on gradually way do car line and I due back stage is for us to really? But if you ping us a message on the event, if you have questions that you'd like to ask Dr Michael right this session. I would be really grateful. And I will see. Do is in. We're going to split this session up into 2 20 minutes. Sections were gonna have a little even interview to start with and conversation on. Been the 2nd 20 minutes, and we're gonna take some of your questions from the chatter box on. But if you do have questions, Ping ping those questions in there, and I will feed them, feed them and but gonna crack on document. Thank you. Um, I could start off task. You've done some incredible things in your career. Obviously. Crooner Viruses on once in a century like event on it's hard to prepare for. But of all all of the work you've done to date on all of the stuff we've just heard about or more, what do you feel has Bean? The most useful thing you've done in helping you managing so successfully a pandemic like this? Well, you're a doctor, Michael. Night. Um, can you see me? I'm not sure if my computer is working, but can you see me? That's good. That's good. Ah, don't think anything can prepare you for a pandemic. Uh, you just have to ride that way of what it comes. But I guess, like everything, um, practice on training and experience. I mean, for people in public health pens, I make So what you're trying for, uh, it's the basis off any outbreak. Control is what you do in a pandemic. So it's really applying public health principles and keeping camp on d. Ah, working out. It's what you need to do. Ah, you know, fake it until you make it basically, um, but it is It's it's it's just, um, taking those principles. I mean, a public health approach to any outbreak is about case detection. Um, contact tracing, isolation, quarantine, um, infection prevention, control. So you just take a lot of those things and you just just apply them. And I think for me, it's Ah, you know, I've been in public health for 28 years. I've worked, and so is that accumulation of experience where actually you does just like everyone when you are, you know, you know what you're doing on your in an emergency. Then you just switch into that mode off. This is what I need to do, and you just do it on I just don't think there's any short cut actually to experience and just knowing how to respond. It's just the size of the response is bigger and you try not to let that get to you. And I mean, you still has really sure are leading example. It has been healed in. If the media around the world, um, in managing, covered 19 promptly and effectively, Um, in your opinion, what is being vital to that? What has was led to that success? Well, I think we are. We were lucky in that it was happening elsewhere before it happened with us, although where are relatively close to China, But we are quite a distance from everywhere. But actually that's to our advantage because we're in island Nation. So we've got this wonderful thing called a border that you actually can close on. We started, like, everywhere in the world. We started to see what was happening in Wuhan at the end of December. Beginning of January, we started to step up our pandemic plan. Um, we were watching. We gradually started. We actually did close our borders initially, just two flights from China and we only had a small number of flights that come direct from China. So we we're incrementally able to do that and eventually got to a full border closure which didn't happen to about the middle of march. But actually we were beginning to see cases within the country by then. But I think for for us being able to have that slow start but be able to close the borders, I think has been the biggest impact for New Zealand because we've had closed borders since the middle of March. So that means we're really able to control and it is disease that comes in. We got mandatory quarantine for anybody coming into New Zealand for 14 days in a managed facility and then the disease. It's actually been in country. We've we've managed, we've detected, we've isolated with quarantined with we've tested. We've done a test test test on, but we've seen the epidemic curve within New Zealand, then just drop right off. And so we've we have zero cases today. We had one case yesterday. We've gotta run with, had a run night off, zero cases on. We're still continuing to test extensively on, but hopefully we've pretty near eliminated cocotte 19 from New Zealand. What a quarter. Incredible. Incredible achievement on. But, uh, it is inspiring. So to watch from other places around the world on to see that possible is that actually gives a lot of hope to people, I think. And, um on day is really inspiring to to watch on here. By what? A what a thing with a slightly different question. But what things look like behind the scenes, as you and the rest of the team prepared, I guess, to run in the start of this. What did that look like? Who, Um, that's a hard one. Um, like, busy. I think is the one word busy, busy, busy, Busy. Because although there wasn't the really initial eight, there wasn't a lot to see within New Zealand. But we were busy watching what was happening elsewhere in the world. Trying to find out as much as we could about this. This new emerging disease are keeping him very close contact with our Australian colleagues on um being having to provide a lot of information to our government at a at a time when actually, there wasn't a lot of information available. So really, using first principles and trying to just second guess to try to stay ahead of things, be very responsive. And we knew, actually, that's anything that we did we would have to do very quickly. So we were just constantly busy, actually. But we were I don't think we were out of control. Busy. There was a certain element off we know. We don't know what we don't what we're doing, we got we've got a plan. We had a pandemic influenza plan, which, although this's clearly a very different disease, too influenza that provided a framework for us to operate and that you know, that that talked about the need to in our influenza plan. It talks about keeping our stamp it all right, and then manage it. So we knew that we had to do those things, Sister. Just at what point in any I break you, you move from a keep it out to stamp a night to manage it. Phase on. We had always would never really test it. A true keep it out strategy. We'd always assumed with influenza that New Zealand like the rest of the country. Although although we are a lot, you know, far away from many places, actually, with their travel things move around really quickly. I guess we'd always thought that the keep it out phase would never last very long that we would have to move quite quickly into a Stanford I on if that wasn't possible, that we would be in a manager at face. And I think what we realized early on with this disease, actually, we could keep it up. Okay? And yep. And so that's why we were busy trying to work up. Well, what does that keep it out look like, sir? And that's that's that. I mean, it's worked very successfully. Um, I guess being an island nation probably helps a little bit with that on Do you on? Um uh oh, yeah. You know, land borders. So you don't have you can only get to New Zealand by plane or by boat by cruise ship. So we you've got a very small number of ways to close the border. So you you know, you you focus on the, uh, so three international airports that we've got on the cruise ships, and basically, then you're not getting people coming into New Zealand, and it's it's quite amazing. We had 260 p. Well, I think we arrived into the country yesterday on. We've actually had a day, the suite one. Nobody arrived or left while you Zealand. And that's just staggering, actually. But it comes at a cost on does, and that's what we will see going forward. The economic cost to New Zealand off that on How high do you weigh that up? So you know, there there's an obviously an economic cost, too many public health decisions as well on. But, um, you know, it must be a very difficult thing to way up. But what point do you you know, how high do you bounce? Health versus economics. It's It's tricky, I guess. Oh, it is. It's very it's very tricky. And, uh, I guess, fortunately for me, and my role is a health adviser, I don't have to be the one that that ways that that I have to give the best health advice and so was Rick was really very clear that this was a strategy that could work for health. That it would be we did some modeling. We could see what the impact was projected to be for health in diesel. And, um, we we have We have a very good health system here. But like other countries, um, modeling showed that we could very quickly get overwhelmed that our hospitals would get overwhelmed. Your intensive care units would get overwhelmed. So from a health purely looking at it from a health perspective that the the cost off not going for elimination for New Zealand Um, I wait the anything else, Really? But it's only when you take that broader perspective that it becomes more challenging. And that's one of our government had had two way up and they were very, very quickly, um came to the view that actually there really wasn't any decision, significant decision to make know balancing be had we had we had to do everything that we needed to do to prevent our health services from being overwhelmed, and so that, I think, then made things go much faster because we we had a government who was prepared to make that decision. So when we gave that advice, they accepted that advice and made the decision on. Before we knew that we had closed borders on, we were rapidly going into a locked on situation. Um, I mean, it's, um it it really is a sort of once in a century event, I guess. Where do you where do you start to get evidence for this sort of stuff? So, you know, when you're making huge decisions, you can't run a pragmatic study or a trial advance. I mean, have you have you find problems with some of the evidence as you've gone through it? I think we're still learning a lot about covered 19. But some of the basic principles are off again. Outbreak management? A bear? Um, I think, Yeah, I think probably we acted very quickly, so we we definitely didn't have. We had some modeling that was done in the early days. If you he went back and revisited that. I guess there's all sorts of arguments about whether the assumptions that were used in that modeling where where were right. But it was in keeping with what was happening in the in the rest of the country. Um, the again I come back to the principal's off public health control weren't really that different with this particular virus. Um, we We continue, I guess, with the cases that we've heard. We We've been lucky. We haven't really had, um significant burden of disease. With in New Zealand, we've had 21 deaths. We've had 1500 cases. Ah, we've We've currently we've got one person in hospital. Well, uh, finish our our clinicians. Uh, no, just no getting experience or not seeing a covert 19 in in the hospital because our disease right have been so low. We had, um we've we've had a number in intensive care, So there's been a small number of patients that are specialists have seen, but we just haven't had the number. And we've been nowhere near being overwhelmed. So what? That what they get? What has given us, though, is it's given us time. And it has felt like when we've been in I lock down, period, we've really been able to use that time to ramp up our public health response so that we can very quickly do contact tracing. Neither were in in what we call a level to lock down. So it's not a lot down with a level two. We gradually loosened. Andrea laxed our control. So we're in level too. But what? That what? That's a lot. What that's done is it's bought his time. So they're actually we're not in a situation where we say, Okay, we can we can cope with Seen what's happened in the rest of the world. We've learned to not the evidence has emerged. The evidence that wasn't there at the beginning. It's really borders time. Um, can I Can I move on to a slightly softer question? I guess so, Um I mean, you're a doctor, right? Um and you're kind of being in some ways thrust into the media's I in New Zealanders as well. However, you find that on D, were there any challenges? Do you have any tips on? You know, if Maddox in the future too fierce, that what? Why would you describe it? If you get off of the chance to do media to training, do it. That's my number one tip, and I I've had the privilege of having several media training opportunities over the course of not hardly health career. When I worked in Manchester, I did some media training there and then when I come to New Zealand and they can be quite scary doing some of those training events because it's all quite live in your honor, your green videoed, and are you being interrogated by often very professional journalists? But it's actually really good training on down on Ben. I think when you when you put in a situation where you have to speak to the media, you've got you, least you, you sort of have a sense off what's like to happen, what to expect. But actually, nothing really prepares you for it. Except again. I think it's experience. I think the more media that you that you do, the more comfortable you become, the less anxious you get. I think I've certainly noticed over the years that when you're less anxious about something, you actually perform much better. You come across much better with the media. If if you don't have that anxiety and that sort of rub it looking at the car about to hit it on again, that's this practice. Sure, sure, 11 last question before we're gonna jump onto questions that folks are sending across in the chapter books, and if you do you have questions. Please problem in the event wide chatterbox on deal. Feed them into Dr Michael Lay in the second half of it session. So I have just 11 last question from me. If you have advice to mean we've got, you know, hundreds of medical students. Junior doctor is joining us on. Bill will be watching perhaps some of these sessions later on through the day. But if you were if you were giving them advice, if they wanted to proceed a career in public health, what what's what advice to give them? Uh, do it. Yeah, do it. Uh, but don't don't do it because you think it might be uneasiness job? Uh, because it's not. It's a different job on, um, you know, some of the things that you and country and public health can be intensely stressful. So I guess, Ah, read up about it. Talk to some people and you're doing public health. Find out what the job really entails. It is a job that often as a junior doctor, you may not have any insight. A tall into what public health is a bite. So find out what it actually is. And for May, it's, um, it's always It's actually pretty much always been something that I wanted to does. I discovered public health when I was 1/4 year medical student, and something about it just really inspired me and made me want to do it. But I went into it with my eyes open on. And so I think, the very clear why you want to do public health. There's lots of different jobs in public health, so it's not like you do public health and you'll end up, you know, one size fits all that. There's this thing called AH, public health doctor and that's what they do. There are lots of different job opportunities. There are lots of opportunities outside, off sort of traditional health settings as well. On that in itself makes it quite difficult to then describe what do you do? You know what do you what do you what do you do all day? And you know, the job that I'm currently doing now is very much a advisory job. It's policy development. It's working with government, and that's that's a real privilege to be able to do that. But I couldn't I would I would find it very hard to do what I'm doing. I had I not had years off during other sorts of public health jobs and just being able to build up that that knowledge and that experience off the health sector. Um, perfect. Thank you. I'm just going to feel some of the questions that we're getting on chat box in. Didn't use the contact. Tracing up on what? Your opinions on this from the cold brine. We've only just rolled out of contact tracing up. We didn't We didn't have one. We've invested lot in our contact tracing. We have a very devolved health system and you Zealand eso, despite only being five million people. Well, you've got 20 district health boards. We've got about 14. 13 public health units who are linked to those district health boards are we don't really have a uh uh What? Uh, sort of us. We didn't have a single database for contact tracing. We've invested. That's what we spent some of our time and locked I'm doing is is developing contact tracing database in a system so that are public health units could talk to each other and share that information. We did all of that. And then we developed a nap on our view is that an app is only ever going to be able to assist and help. What is a good, basic shoe leather epidemiology? Um and so our app that we've developed a very simple app, which is really just a register your contacts. And it will help with having up to date information for people that more work going on looking at Bluetooth, APS. But we haven't actually made a decision or a commitment to go for that. Sure, um, question from Ellner Palmer, evidently the mean approved in most countries to combat covered 19 has been to enter a lot downstairs. Some countries, like New Zealand, have nice zero new cases, which you just described. Do you think it likely that those countries with a very strict locked on policy could see a more severe second week on Slow down is over? Mm, Well, we could. That's and that's a big challenge for us, is some. How do we get out off the situation that we're in? So are we have we have an elimination strategies, which has been successful because we we've got very small number of cases. We actually don't think we've got any community transmission or very, very low levels of community transmission within New Zealand will continue to get a few cases coming in across the border. But we'll catch them and people will be in quarantine. But that really unable eyes on tight border controls and we are on our strategy. Our strategy effectively means we have to hold this until there's a vaccine. Now that could be 18 months. And um, that is, uh, I think that will be a real chap. That is actually a really challenge. T see how we can do that. Because at some point we are going to have to re engage with the rest of the world, and the rest of the world has had more covert. Now it's interesting. What's what we're seeing from the rest of the world is, despite covert cases being there. There's not a huge proportion of the population who got immunity to CO that 19, so we may not be that disadvantaged, but But we could very well, if the particularly if we do relax, are controls our border control. We would expect to see cases and we could well be not necessarily for us a second wife. It actually could be a first wave because we didn't really have much of the first wave in the first place. So, yeah, it definitely is a new issue for us that we are still working through what are what what the next steps are going to be for us. A question from Marina politics and feel free to no answer this if if if it's too political. But I mean, she's comparing to contrasting countries. So, um, it's a It's a good question. Probably one that's all in the front of our mind. So, you know, the UK and island are island nations. They have tens of thousands off deaths. What do you think was the difference? So I said that again, I'm full of I don't catch the beginning of it. Sure. So the UK is an island nation, Um, on New Zealand is an island nation. But two very different death tools. That what What what? What do you think? What you think are the differences while the UK so don't nation. But still, there are a lot of people coming into the UK We I guess. What? What? For us. For us, the initial focus was very much we you had in China, and we greatly very extra gradually uh, implemented full order controls for people coming in from China. And then we extended that too escalate and Iran? Yeah, and then we sort of basically went from their pretty much straight to everywhere. No, I think the cases that we got into the country with cases that had already come in from the rest of Europe and from the US on also then from Australia, because Australia was getting cases by then and that's a demonstration of high. It's actually very hard to keep ahead off this virus, and our initial approach was sort of looking at this as it's spread across the world. Then that country became the next country that we stopped people coming in from. But actually, if we just had to close the borders completely because we just couldn't do that, we we couldn't second guess where was gonna be the next place for people to be infected. And I think that's probably the UK being much closer to Europe on what was happening in Italy in those early days. I don't think it's fully appreciate it to the extent of that, and they are much travel that there would have been between Europe and the UK in in January February. It's a bit like it's closing the stable girl door after the horse is built. It sure, but I think that's been lucky. That's where we were not actually just doing that. Really, Uh, really early. All on. Also, we're we're a single country. We're new one, New Zealand with one, uh, one Prime Minister. So you've got 111 prime minister as well, But ah, lot more negotiation that needs to happen. Um, question from Amanda. What do you think about her truck? Hydroxychloriquine and, um, de severe. Are they going to be a way out for us? Well, we're keeping a close eye on that. Um I mean, it's quite interesting with, um the the strategy that that we've adopted and Australia's very similar that not quite unlimited a shin strategy, but it's very close to a nerve. Rates were looking really good for both of us were you know, we've always said the vaccine is our way out, but actually, if you do get effective treatments, it changes. A lot of the modeling and a lot of the assumptions and on be could therefore be Ah, lot less have lot less controlled on our borders and whom you get into the country. If actually we've got effective treatments. So I think it is something that we all have to keep a really close eye on because it will change. It'll change the situation if you can really avoid the lies nations or avoid people having to be admitted to. I CEOs, you know, it changes your approach. Um, how do you think a question from Sri George, You know, strictly New Zealand related question. But I guess public health related Heidi think Cupid will impact less developed countries, especially with little testing, resources and healthcare. We're gonna come onto less a little bit later on in the day with a marker a lot from that, but would love to hear your opinion. Well, I think way see that in your Zealand, because we we have the Pacific islands on many of the Pacific Island for it to get the Pacific Islands. New Zealand is a gateway. So right from the get go, we were were very conscious off the impact that close of 19 would have on those islands. So those islands like the cook Islands. New a Tokelo Sam allow Tana. Their health system is very fragile on and they've all adopted a very strict keep it out policy. They they closed their borders. But But they also wanted New Zealand Teo to really help and either close our borders, but also do exit screening from New Zealand to those on treason. You know, we have a situation with Cook owns that the moment we're in order to get to the Coke Islands from Auckland, you have to have a two week quarantine period in Auckland before you get on the plane. And then when you get to the plain, there's another two week quarantine period in Rarotonga before you can move freely on. That is because for them the impact of coasted 19 would just be completely overwhelming. And I think we see that locally in in our patch off the world, and it will be exactly the same in other countries with very vulnerable health systems. You know, we were lucky. And you Zealand, we can cope with a certain amount of disease. We just don't want to be overwhelmed by the numbers, but we can actually cope with that. So it is a big challenge for countries with fragile health systems. Um, good question of by testing healthcare professionals, eso from here and there, he's asked, with respect to testing healthcare workers. How would you say it's effective to test? Do you? Do you think it's effective to test all of them, even if they're symptomatic? Recently on hold, you grew a bike that, on a practical level well, we have been testing some healthcare workers. We've been doing a symptomatic testing as part of targeted testing to really help us work out. If there's undetected covert 19 and and that's been has been really useful, it's been really reassuring. We've with the think the, um, in terms of, ah, case management approach, though we've we've taken quite a broad approach to any in any case, in a healthcare setting degree in aged residential care setting. Because we've had some outbreaks. There is we test all the healthcare staff around that patient who has had contact with that patient, whether they're symptomatic or not, and for us that has picked up some, um, some staff who were covert 19 positive who? You weren't symptomatic and its allies us to have a much stronger containment policy and standing down staff and ah ah, and that's the lightest, I think, to get much better control off the outbreaks in those aged residential care settings, but also what what we're currently doing. And again, we're in this situation. We were very few cases. We've got something like 28 back to cases in New Zealand at the moment and some of those air healthcare workers. But what we're saying is, before you go back to work, you have to you have to be tested and you have to be tested negative before you can go back to work. So it has been we've been able to test. But again, we've been able to test because our numbers have been low and we haven't had a health system that's been overwhelmed. Really good question from Kathryn Donnelly, who who also explains that she's a fellow Belfast girl, she says, Are you planning to 90 and lock down measures until a vaccine is made on Do? Is this solution? Is this a solution? And usually they're working on Yeah, well, that is our strategy at the moment is to maintain elimination until there's a vaccine so how that how that will look for us is we adopted this four tiered levels. 123 and four. We very simple and use it. And we have a north island on the south island. And then we have alert levels that are 123 and four. So way went very quickly up to four. And now we're going on the way back down to level two. With that, we want to get to level one. Level one. Looks like pretty much life is normal within New Zealand. But it it does stop people from coming in across the border. Unless you are in the Zealander and requires quarantine and quarantine for people who arrive for 14 days. So yeah, well, it is at the moment is it is predicated on there being a vaccine. We don't have vaccine making facilities here in New Zealand, so we will be joining the cute with other people to purchase vaccine. Australia has got some vaccine making ability. We've got some researchers who be involved and at some of the, um, some of the developments of the vaccine. But in terms of actual production, that won't be something we're able to make ourselves, Um, it's a question from, uh, definite goodness he's he's asking. In some countries, there's a growing part of the population that's not following safety measures on that they don't want their lifestyle to be affected. Is that problem in your Zealand? Um, on. But if so, how do you handle it If no. Ah, perhaps why? Yeah, yeah. Hasn't really mean on issue for us yet. And we had, uh, we had a we had great, um, agreement and compliance with the level forelock done that we had, which was very tight, was basically staying at home. We had this concept of doubles. So staying in your bubble, your household bubble, we were in locked on for nearly five weeks on, and, ah, because I rates were coming down. So I had come down so dramatically, we were then able to loosen and move out of four. But I think if we hadn't been able to do that by the five weeks, I think we were beginning to see signs or people know being that happy with continuing toe, comply with some of the rules. So I think for us it's been the ability to get out of that really quite quickly and I we're we're in level, too. We've still got some controls around masker other things, but they're they may well be released loosened in the next week or so. So we are beginning to see people wanting to get back to normality as much as possible. We haven't seen any protests or rejection off advice at any stage that the whole response has been very much based on health advice. We've we've had, ah, daily stand up with media where we've always had, ah, medical practitioner, either myself or the director general who is also a medical practitioner along with the politicians. So everything that we've done in New Zealand has always every signed public health basis behind it, and I think that that's really helped and getting out of locked on as quickly as possible has has really aided. So, you know, we haven't seen that that mass opposition, uh, to what we've what we needed to do. That's not to say that's not to say that it's sort of not. They're grumbling along at a at a low level within the community. Um, but we have seen it, uh, be very vocal yet Incredible question from maybe know which is probably the last, the last one we kind of time for. Do you? Do you see any differences in New Zealand between different ethnic populations? Well, we certainly are our general health statistics and you Zealand multi MPAs people from the Pacific do tend to have a worse health across the board from many aspects was covert 19 in particular. We haven't really seen much difference. And again, we don't have ah, large data set off cases. We've got 1500 cases. Not really. Not that many who were hospitalized. We have seen a covert 19 in, um, morning and Pacific populations for us are particularly vulnerable. Community universities would be a are rural communities and many, many off our model population still live quite rural, remote communities. But we haven't really seen much, if any, covert 19 in those populations. And again, that's because I think that reflects high covered 19 came into New Zealand was predominantly people travelers either tourists or returning New Zealanders. New Zealanders love to travel, so coming back and, um but it's been something that has been very alert to and very, very aware off the vulnerability off those populations. And I think one of the other things that we're certainly very much cognisant old night is the impact off a locked down and the thesis a shin of money, Um, routine health services of what impact that has had on our population and particular that would be on our our memory of Pacific population. But from the disease itself, we haven't seen anything particular. Sure. Um, Dr Mark late. That is all we have time for this morning. I just want to say a massive thank you for joining us, especially at a time when I knew you are gonna be so so busy on what you've shared has been, has been so helpful, really inspiring. I knew for for medical students and junior doctors who, um, you know, would would be addressed it certainly in a public health career. But also, as as they develop those doctors and every specialty so huge. Thank you. I know it's late at night for you there as well. So thank you for joining us, especially at night on. Go on, Go. Uh maybe see a christmas. Right? Great to help. Thank you, Doctor. Back on a thanks I'm just gonna take you off the street car line on day. I'll talk to you. Thank you. While what a great session that was. That was really inspiring. Thank you for all of your great questions, Andahazi. Thank you, too dot Um, actually, for joining us, we're going to take a little short break just to check for the do two Quick sign check for the next session on deal. See you in here in a little second. Thanks.