A quarantine-free transtasman bubble is set to start, raising the possibility of more returnees from Covid-rampant countries. Are our systems strong enough, and if not, how can they be strengthened? Derek Cheng reports.
An overseas returnee might have caught Covid-19 from virus-carrying air particles via a ventilation shaft connecting two rooms.
It has led to several rooms along the shaft at the Grand Mercure in Auckland being emptied, Covid-19 Response Minister Chris Hipkins revealed in an interview with the Herald before the Easter break.
The infection is the latest case from within an MIQ facility, and was followed by a shared bus ride that led to 14 people having their MIQ stay extended because proper protocols – wearing masks, distancing and sitting on the same seats - were flouted.
Bus rides, shared exercise areas and ventilation are all issues that are being specifically looked at, while the Government considers what to do with the spare 1800 MIQ rooms a fortnight once the transtasman bubble starts.
Hipkins has said every room won't be opened up, but some will. He is also acutely aware of the added risk if those rooms are opened to people flying in from countries where Covid is rampant.
The overall risk profile would rise because returnees from Australia have posed minimal threat. Only one has tested positive this year, and there have only been three since August last year, a period which saw almost 24,000 arrivals from Australia.
Returnees from the UK, the USA and India are the main sources of imported cases to New Zealand, but for the month of March, two-thirds of them - 71 cases, or more than two per day - came from India.
That has led Hipkins to seek specific advice on how to mitigate the risks from India, but Kiwis have a right to come home, so turning the tap off isn't an option.
How about turning down the tap?
"I think if you were to start quotas for different parts of the world, you really start to run into some big equity issues," Hipkins told the Herald.
"If we were to say that a Kiwi in America had more chance of getting an MIQ voucher to come back to New Zealand than a Kiwi in India, that would be quite unfair."
Most of the returnees from India tested positive on day zero or one of their MIQ stay, raising questions over whether people were cheating the pre-departure test.
"We know - in some immigration terms - we deal with fraud from that part of the world. Pre-departure testing won't be immune from that," Hipkins said.
Some spot checks on the tests are being done, but doing them before someone flies is "impractical" because of the tight timeline; the test has to be within 72 hours of departure.
Travellers may have to submit test results at the departure check-in or when they get to the Customs desk after they've landed, but epidemiologist Michael Baker said we were missing opportunities to make us safer.
"Two obvious changes would be to require people, when they use the booking system, to say what actions they'll take to minimise the risk of infection. Are you going to self-isolate at home before departure? Basically, it's a declaration of the action they'll take," Baker said.
"The second thing is also a declaration of where they're getting their test done, and information including contact details – and then we audit a sample of the results."
Baker said most travellers probably wanted to reduce the risk of bringing Covid-19 into New Zealand.
"But they're not given any advice and they're not required to record any action in the system."
"At the moment we've got this fatalistic view that there's nothing we can do."
There is a plethora of pre-flight safety information, such as minimising social activities, on several government websites. But it remains unclear what information, if any, is proactively sent to people before they fly.
Information about the pre-departure test is included in the MIQ voucher that returnees receive after they've successfully made a booking, an MIQ spokesperson said.
"Returnees are encouraged to go to the MIQ website, as those from some destinations are not required to undergo a pre-departure test.
"There are currently no other pre-departure requirements on returnees. However, MBIE is currently considering the impact of a greater number of returnees from higher-risk countries potentially entering managed isolation facilities."
Baker added that the overall Covid response remained "very good", but there was still a lack of strategic focus - with direct input from the science community - to get in front of the issues before they arose.
This aligns with the findings of a review into the outbreak in August last year, which said the Government response was too reactive.
The Government has responded to those findings by setting up a board of chief executives to take charge of the response's overall strategy and governance.
Hipkins wouldn't be drawn on what other measures could be taken to lower the risk from India.
"I haven't had the advice yet so I don't know. I wouldn't want to hazard a guess."
But he said setting up testing stations in New Zealand embassies and consulate offices in India would be "very expensive and logistically challenging".
"And it wouldn't necessarily alter the maths. Pre-departure testing is never going to be failsafe because people can be infected before their test or just afterwards.
"If you look at that flight, flying from Dubai to Malaysia to Australia to New Zealand, there's plenty of opportunities in that process for them to be moving around and coming into contact with other people."
Stopping the flight also wasn't really an option as it brought in valuable medical supplies.
He said Emirates' infection prevention systems were found to be solid, and a review of the positive cases showed that they weren't sitting close to each other on the flight.
As for the suitability of the MIQ system once returnees arrive home, Hipkins said some facilities might be ditched and new ones brought in.
"Particularly with what we find out about ventilation systems, exercise and the buses … I can't say if the MIQ we're operating right now will be the same in three months' time."
The future use of the Grand Mercure in Auckland might be up in the air following new clues about how a returnee got infected from a source case who'd only left the room to get tested.
"They've identified a vertical ventilation shaft between the rooms that could have potentially been the cause," Hipkins said.
"They've emptied all of the rooms along that vertical shaft, and they've got engineers monitoring air flows."
No further clues have emerged about the recent case of the cleaner at the Grand Millenium, except that they'd worked on the same floor as the infected returnee with a matching genome sequence.
And like the mystery surrounding the August cluster - which may have had its origins at a cold storage facility - there are no more leads on what sparked the Valentine's Day cluster.
"It's a bit like the cold store," Hipkins said. "I don't think we'll ever quite know what happened there."
These are some of the border control failures that have been popping up every few weeks. Otago University public health experts - including Baker, Dr Leah Grout, Dr Jennifer Summers, Dr Amanda Kvalsvig, and Professor Nick Wilson - have identified at least 13 since July last year, including 10 via MIQ facilities and three via non-MIQ pathways.
They have suggested a number of ways to improve the system, such as putting returnees from high-risk countries in MIQ facilities outside urban centres.
But Hipkins was lukewarm on this.
"The big risk of Covid-19 leaking out is usually because a person who's working in that facility has caught it and takes it out.
"If you moved the facility [outside of but] somewhere close to Auckland, that workforce is probably still going to be coming from the same community it's coming from now, so it doesn't necessarily reduce your risk."
Confining returnees to their rooms for their entire MIQ stay wouldn't necessarily help either, he said.
"If you look at the states in Australia that have a stay-in-your-room policy, they're still getting issues with MIQ facilities. It has to be proportionate to the risk. Based on what we understand about the risk right now, I would say 'no'."
Health experts have long pushed for a purpose-built facility at the airforce site in Ohakea, which would also move the risk away from more densely-populated centres.
The Government is now seriously considering this, Hipkins said, though he suggested the airforce base at Whenuapai as a site.
"It might be a multi-use facility so you might use it for the military, for example, on a regular basis, but you have the capacity to empty it out quickly and use it for quarantine, if needed."
Even if given the go-ahead, it wouldn't be built in time to be useful for the current pandemic, he said.
"The preliminary advice is that even if we could fast-track the consenting, by the time you build it, you'd still be 18 months down the track at a minimum."
Wider use of saliva testing in MIQ is another suggestion Hipkins is open to.
"We know that saliva testing is not quite as accurate, and if you're doing a [nasal pharyngeal test] once every week, it does have an impact on your nasal comfort.
"One of the things we're looking at is not doing that as frequently, but having more frequent saliva tests instead. Would the quality versus quantity trade off alter the risk profile much? That's what Health are looking at."
The public health experts have also suggested slashing the number of MIQ arrivals from Covid-ravaged countries, which could be achieved - without creating equity issues - by closing down some MIQ facilities or by cutting the number of available rooms.
The Government may yet decide that it wants no added risk, and turn down the tap for everyone overseas wanting to come to New Zealand.
Doing so might risk a backlash from Kiwis abroad desperate to get home, employers crying out for specialist workers, universities wanting more foreign students, and split migrant families who haven't seen their loved ones for months.
Once the transtasman bubble is up and running, some of the extra MIQ capacity will be used for extra contingencies to house, for example, a plane-load of people from Australia where an infected person is found to be aboard. Some will be used for 100 more emergency travel applications a fortnight.
Some could be used for arrivals from Covid-free parts of the Pacific, which would not increase overall risk.
And some will be freed up for returnees from other countries, though the Government is yet to decide how many.
Regardless of what happens next, Baker said the response needed to be more vigorous towards arrivals from high-risk countries.
"Given this big demand for workers and students and others, I'm just assuming they will increase the number of people from red-zone countries," he said.
"And I don't think that's necessarily a problem, as long as they take vigorous efforts to reduce the number who are infected when they arrive here.
"Despite discussing this now for many months, I have not heard any imaginative science-based projects to actually do that. That's the thing I'm most concerned about."
People are calling for free testing so people would drive safely.