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Personal welfare under border quarantine – Expert Reaction

As more New Zealanders continue to return from abroad, additional quarantine facilities are being set up to meet demand.

A report, released on Sunday, says the rapidly expanding system is under “extreme stress” from the demand. New recommendations being rolled out now include more clinical oversight to ensure consistency across facilities, and an improved model of care.

The SMC asked experts to comment on issues relating to personal welfare for those in quarantine.

Associate Professor Lynn McBain, Head of Department of Primary Health and General Practice, University of Otago, Wellington, comments:

“The New Zealand border is the source of expected new cases of COVID-19 – mainly in those returning from overseas to New Zealand. As the world situation continues with increasing number of cases, more people wishing to return to New Zealand, and consequently more people who may have been exposed to the disease in the time before arrival, there will be cases detected in the isolation facilities as we have experienced over the last 10 days.

“Staff who work at the border or are in contact with the returnees are also at higher risk of COVID-19 than the general population. The more people that return, the more staff will need to be involved – airline staff, border workers, transport workers, hotel staff and health and management staff involved in running the facilities.

“The increased number of facilities required in more geographic locations raises concerns about consistency of approach and ability to actually manage the numbers. There is a need for clinical oversight in the managed isolation and quarantine facilities.

“It is not clear through the information currently available on the Ministry of Health website or in the media how much clinical oversight actually occurs in the facilities. Clinical oversight is essential, with clear processes that are consistent in all the facilities. This would be a new role for many health professionals so finding the right clinical people may be difficult.

“Communication is always key in healthcare and there is a risk that this becomes fragmented when the messages are changing, and when the numbers of people involved are increasing.

“New Zealand does not have a pre-existing ‘isolation management’ workforce; people involved are learning these roles in the context of their prior roles.

“The more facilities that are involved – the more challenging the coordination becomes. This will rely on very clear, direct, and repeated communications.

“It would also be useful to have clear processes in place from the time a person planning to return to New Zealand checks in for their flight so that health needs can be anticipated.”

Conflict of interest statement: Dr McBain owns a general practice in Wellington.

Dr Caryn Zinn, Senior Lecturer and Dietician, Auckland University of Technology, comments:

“Eating well and doing regular exercising in quarantine is important to keep the body (and mind) healthy. What’s more, for those who have COVID-19 and a pre-existing condition, such as diabetes or high blood pressure, it’s even more important, as we know these individuals are at much higher risk of poor outcomes. Despite the ‘on the house’ (aka taxpayer-funded) food and board for returning Kiwis, I’d like to know how the standards were set for what’s on offer for two weeks’ worth of meals, or in fact if standards have been set.

“So far, it sounds very piecemeal – mind the pun. It sounds to me as if some are getting top quality gourmet meals, and opportunities to exercise freely for an hour a day, while others, colourless, vegetable-devoid options, governed by refined carbohydrates – white bread, jam, spaghetti, pastry, with exercise confined to tiny spaces.

“Worryingly, I’m also hearing a lot about sugary treats, slices, cakes and soft drink. While I realise the challenging situation for all concerned, I’m not convinced a regular supply of sugar is going to help the situation. For an unprecedented, yet ‘institutionalised’ temporary situation, shouldn’t people be receiving institutionalised meals? I’m not saying that this would be ideal, but perhaps more appropriate and consistent in that it would improve the nutrition for some and curb the gourmet party sugar fest of others.

“I would be comforted knowing that expert advice was sought about nutrition and exercise considerations and expectations for those in quarantine. If not, I’d be happy to volunteer mine!”

No conflict of interest.

Jacqui Maguire, Registered Clinical Psychologist, comments:

“In February, the Department of Psychological Medicine at King’s College London completed a rapid review of 24 research studies examining the impact of quarantine (managed-isolation) on wellbeing and mental health. The review strongly indicates that quarantine can have significant and long-lasting impacts on individuals. This included, but is not restricted to: fatigue, stress, depression, insomnia, irritability, concentration difficulties, detachment from others and symptoms akin to post-traumatic stress. Restricting people’s liberty is not a decision to be made lightly.

“What appears critically important from this review is understanding the risk factors during and after quarantine, and subsequently ensuring our practice as a nation proactively reflects these findings.

“Given the country’s current situation, I will provide commentary on the ‘during quarantine’ risk factors and protective actions:

1. “Duration – quarantine periods should be kept as short as possible and all effort should be taken to prevent the extension of quarantine.

“The current 14-day period appears appropriate given COVID-19’s incubation period.

2. “Fear of spread – clear information given to those in quarantine regarding how they keep themselves and others safe can significantly reduce individuals’ worry and anxiety. This has been shown as particularly important for pregnant women and those with young children.

“This has been a source of great contention as [there have been] repeated reports of mingling and socialising, mixing of returnee cohorts, exercising in public, doubling of hotel facilities for those in isolation and the general public, as well as COVID-19 positive individuals placed in managed isolation (rather than quarantine facilities). Confidence in the set-up and execution of managed isolation/quarantine facilities is critical to protect wellbeing and reduce risk of heightened anxiety.

3. “Inconsistent and inadequate communication–

“Consistent and frequent messaging from our Prime Minister, Director-General of Health, Government and public health workers is required. Ensuring those in quarantine have a good understanding of COVID-19, the reasons for quarantine and the parameters for quarantine (testing requirements, restricted movement, social distancing even within managed facilities etc.)

“The Prime Minister’s review of MIQ [Managed Isolation and Quarantine] facilities identified there was an absence of standardised information for those returning to New Zealand. This must be improved.

4. “Boredom and frustration – Lack of routine, social interactions and inability to participate in usual daily activities are stressors. Providing clear stress management techniques is deemed helpful. Engaging in activities that provide a sense of purpose, employers enabling flexible work from home and staying connected via social media and video apps is encouraged. 

“I’d like to see some clarity around what guidelines are in place to mitigate boredom and frustration.

5. “Lack of supplies is a risk factor, therefore ensuring individuals have access to resources required to support their mental and physical health, work and maintain connection to significant others is important.

“Ensuring appropriate supplies and resources for individuals appears to have been well managed through this process.

6. “An individual’s mindset during quarantine also impacts on wellbeing and mental health. Those who can take an altruistic approach, focusing on how their self-isolation is protecting vulnerable members of their community, fare psychologically better.’

“It is unclear what mental health and wellbeing support has been provided to individuals. Psychoeducation and the provision of practical wellbeing strategies would be beneficial, and it is encouraging to see the Government announce they are improving their model of care for those in MIQ, including taking into account issues like mental health and addiction issues.”

No conflict of interest.