Aged care facilities hit first, as fourth wave of COVID-19 takes hold in the Hunter

There has been a doubling in the number of aged care facilities with cases and once again mask wearing and socialising outdoors, while not mandated, is being encouraged.

The official number of cases in the Hunter New England region has risen by nearly a third in one week, from 968 to 1,280 in the week ending November 5.

Statewide, case numbers have increased by nearly 40 per cent, a total of 14,089 reported positives, which NSW Chief Health Officer Dr Kerry Chant described as "a substantial increase".

The proportion of PCR tests returning positive has also increased, from 9 to 14 per cent.

"We also now have started to see some increase of people admitted to hospital with COVID-19 and aged care cases of people with COVID-19," Dr Chant said.

In the Hunter, there were 23 people admitted to hospital with COVID-19, including two in ICU, and four COVID-19 related deaths.

Case numbers in the region have been trending down since a peak of 11,832 in the week ending July 23, down to 859 the week ending October 22.

The latest wave is made up of a COVID soup of variants including emerging BA.2 sub-lineages, BQ1, and XBB, which is taking off in Singapore and India.

Hunter New England public health physician David Durrheim said those variant case numbers were on the rise.

There are still cases of BA5, which was the cause of the big wave in winter, around about 50 per cent, but they were rapidly decreasing as a proportion of cases, Dr Durrheim said.

"What is emerging is BQ1 which has caused big outbreaks in North America and in Western Europe, and it's BA 5 sub-variant, but more worrying is the other sub-lineage XBB, which is a reassortment of two BA2 viruses, so it's a bit more tricky and it's caused a very big, sharp wave in Singapore, a well vaccinated Singaporean community, and also is the variant causing a large number of cases at the moment in India, and that seems to be the one particularly taking off locally, those are the three sub-lineages that are occurring here."

It was difficult to be precise, Dr Durrheim said, with a small proportion of cases now subject to a PCR test going on to have whole genomic sequencing, but there have been cases of those variants proven in the Hunter region, he said.

In terms of Dr Chant's messaging, to 'pop on a mask' when in crowded areas, and taking particularly care in aged care settings and around vulnerable people, Dr Durrheim said he agreed.

"We've already seen our aged care facility outbreaks double from 4 to 8 this week in the HNE region and a big increase in cases, Dr Durrheim said..

"We reached a nice low of just 90 (daily cases) on October 30, and today, and there's been a steady increase but particularly this last week, there were 369 confirmed cases, just for today, in HNE."

That was a gross underestimation, he said, because people no longer have to report a positive test.

"The trend is very valid and that escalation in numbers is real and, I think we've all enjoyed the lull, we've all enjoyed getting together to socialise, knowing that COVID was a small risk, that is now a growing risk, so now is a good time to be rolling up your sleeve for a booster."

The only respiratory virus in circulation was COVID so anyone with symptoms should be tested, Dr Durrheim said. "It is likely that you've got COVID, so please don't spread it around."

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