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How can our borders manage this outbreak? – Expert Reaction

Auckland’s hard boundary has been put into focus after two Covid-19 cases were detected in Christchurch, one of whom had returned from a visit to Auckland.

Christchurch will stay at its current Alert Level 2 settings. Regarding New Zealand’s international border, the Government announced that people returning from abroad will have a reduced stays in New Zealand’s Managed Isolation and Quarantine (MIQ) facilities from 14 days to seven, followed by a three-day stay self-isolating at home and rapid antigen test.

The SMC asked experts about the role New Zealand’s domestic and international borders have in this current outbreak and to respond to today’s briefing announcements.

Professor Nick Wilson, Department of Public Health, University of Otago, comments:

“We need tighter internal border arrangements urgently.

“With the reported Christchurch cases it is clear that there is an urgent need to tighten the internal borders around Auckland and the Waikato where there are community cases. It is now a very serious deficit that people crossing these borders are not required to be fully vaccinated and are not required to have a rapid antigen test at the border crossing point. The rest of the country needs to avoid Covid-19 outbreaks for as long as possible so that there is time to improve vaccination levels and to vaccinate 5–11-year-olds when that approval is obtained. Fortunately, there is still a reasonable chance that elimination status can be regained for Christchurch (as it has after Delta cases were identified in Wellington, Blenheim and Palmerston North).

“The international border should probably be different for people just returning to Auckland.

“It was somewhat surprising that the Government made no announcement that the MIQ system was to be made much simpler for people returning just to Auckland. Given that the goal of Covid-19 control in Auckland is no longer elimination, but rather to just suppress the level of community transmission so as to reduce the burden on the healthcare system, there seems to be a need for a different approach to MIQ for that city.

“So perhaps vaccinated people returning from overseas to just Auckland should be able to by-pass MIQ facilities completely and go straight to home quarantine for a few days (ideally with testing requirements). As perhaps a third of people wishing to return to New Zealand might be wanting to just return to Auckland, this would help a lot in reducing pressure on the MIQ system. But for those returning to the rest of New Zealand, the current 14-day stay in MIQ might still be needed for some weeks and months (though less if Covid-19 spreads around the country due to deficient internal border controls).”

No conflict of interest.

Dr Dion O’Neale, Principal Investigator, Te Pūnaha Matatini; and Lecturer, Physics Department, University of Auckland, comments:

“It’s not unexpected that we should have transmission to the South Island from within Auckland border. While the situation in this particular case is unfortunate with the individuals involved being symptomatic for some time before seeking a test, the lack of any kind of ‘post-arrival’ testing requirement for travellers in this sort of scenario is an ongoing cause of concern.

“For arrivals from across the international border, we require post-arrival tests on days 0, 3, and 12, in addition to managed isolation, precisely because we know that pre-departure testing is insufficient to detect and prevent movement of infectious individuals.

“For the case of workers who are regularly crossing the Auckland border, the current regime of weekly testing manages to capture a similar effect to the international travel post-arrival testing. However, the lack of post-arrival testing for people making one-off movements between Auckland and the rest of Aotearoa is a gap in testing requirements that could be easily filled.

“With ongoing community transmission within Tāmaki Makaurau, there is a case to be made for treating travel to and from Auckland as being similar to international travel. In addition to post-arrival testing for people travelling out of Auckland, this could include expectations for people to have some degree of isolation after travelling from Auckland, at least until they return a negative test.

“While pre-departure tests have a role to play in trying to prevent movement of people who are infectious, the reliance on PCR tests, which are slow to return a result, means that there is an opportunity for people to become infected in the period of up to 72 hours between being tested and when they travel. Cases such as this could be better addressed through the use of rapid antigen (or lateral flow) tests for people immediately prior to travel, which will help to pick up people who may have become infectious after having a PCR test but before travelling.

“This case is also a reminder of the importance of people everywhere promptly seeking a COVID test if they have any sort of symptoms. One of the clearest messages from the modelling is that if it is possible to detect an outbreak promptly, while it is still small, then the chance of being able to contain that outbreak and eliminate it through contact tracing and Alert Level interventions is an order of magnitude greater.

“An effect of recent lockdowns is that there are still low rates of incidence for cold and flu like symptoms around the country, particularly in Auckland. This means that people should treat the onset of any new symptoms as potentially being due to COVID. This applies even for people who are vaccinated.”

Conflict of interest statement: I, along with others from Te Pūnaha Matatini, are funded by Department of Prime Minister and Cabinet to provide advice on the COVID response and from a Health Research Council grant to look at equity related to COVID in Aotearoa.

Dr Jesse Whitehead, Health Geographer & Research Fellow, Te Rūnanga Tātari Tatauranga – National Institute of Demographic and Economic Analysis, University of Waikato, comments:

“Given the continued spread of Delta within the Auckland region, it is imperative to maintain the internal border between Tāmaki-makau-rau and the rest of New Zealand.

“Much of the population remains potentially vulnerable to Covid-19 infection and there is no DHB region that has reached the 90 per cent target for vaccination. In fact, as Ministry of Health data on neighbourhood level vaccination rates show, there are many areas around that country with low levels of vaccination coverage, even in DHBs where close to 90 per cent of the eligible population are vaccinated. Research has also shown that many regional and rural areas are at high risk of Covid-19.

“This combination of factors means that many areas are at high risk of being impacted by a local outbreak of Covid-19.

“As the Government moves away from its elimination strategy and encourages New Zealanders to rely on the ‘individual armour of vaccination’, it should consider vaccination mandates for internal travel to limit the geographic spread of Delta, particularly while less than 90 per cent of the eligible population of many suburbs and neighbourhoods are fully vaccinated.”

No conflict of interest.

Lesley Gray, Senior Lecturer, Department of Primary Health Care & General Practice, University of Otago, comments:

On the Christchurch cases:

“I am a little surprised that Christchurch will remain in Alert Level 2 at the moment given these new cases were not regular users of the scan app to keep track of places visited and that at least one of the cases had been active in the community over the last week/up to two weeks and that other contacts have been identified (although at the time of writing test results were not yet known).

“Once we know more about the potential transmission, it may be pertinent for Christchurch to move to a rapid/short lockdown level 3, although I would urge everyone to follow all the usual protection measures – mask up, hand hygiene, scan/Bluetooth/record your movements, take time to think where you have visited in the last week or so and if you have any symptoms, even a ‘scratchy’ throat, please do go get tested for COVID-19.

“I also wonder if the government could roll out rapid antigen testing (if tests are in the country yet) to Christchurch. That said, I was reassured that wastewater testing showed no new detections (but as a semi-rural owner of a septic tank, I recognise some limitations in the wastewater testing regime).”

On the MIQ changes:

“Changes to MIQ are now needed as we adjust to the new government rules relating to Covid-19 (Delta) in the community and the introduction of self-isolating at home for people who have tested positive with Covid-19 with mild symptoms if their living arrangements are suitable.

“The announcements today signal a three-step change. I would have liked to see a stronger focus for those wishing to return to New Zealand who are double vaccinated to have the ability to safely self-isolate at home and not be subject to securing a voucher in the MIQ voucher lottery that currently exists and will continue under the move to seven-day MIQ, although I take on board the signal that in Quarter 1 next year, we will progress to this

“The many other New Zealanders still overseas trying to get back to families and loved ones have experienced many months of anxiety, especially in the last few months when securing a voucher for dates from about August 2021 became increasingly difficult. Making more vouchers available does not remove the anxiety and the many, many hours and days being spent by people trying to secure a voucher. Indeed, many of the dates that become available, even if you get through the ‘lobby,’ are for days that flights are not landing from many countries, so people cannot travel on those dates even if they manage to secure a voucher.”

Conflict of interest statement: Dr Gray is currently part of two Health Research Council grants: “COVID-19 Pandemic in Aotearoa NZ: Impact, Inequalities & Improving our response” (PI Baker, M) and “Te matatini o te horapa: a population based contagion network for Aotearoa NZ” (PI O’Neale, D)

Professor Michael Plank, Te Pūnaha Matatini and University of Canterbury, comments:

On the Christchurch cases:

“It’s good news that the two cases in Christchurch have had only a limited number of contacts during their infectious period. The decision to remain at Alert Level 2 for now is a ‘wait and see’ approach, which is reasonable.

“The close to 70 per cent vaccination rate in Canterbury will definitely reduce the potential for the virus to spread. But the two cases were likely infectious from around 16/17 October, so if either of them did pass the virus on at that time, it could have spread to dozens of people since then. So, it will be crucial to do lots of testing in the city and if it turns out the virus has spread more widely than one household, an increase in alert level may still be needed. In the meantime, this is a timely reminder that Covid could crop up anywhere and it’s really important to use the tracer app to scan in and get tested if you have any symptoms, even if you have been vaccinated.”

MIQ changes and Auckland border:

“Shortening MIQ stays from 14 days to seven days is a sensible first step to relaxing our border controls and allowing more New Zealanders to come home. The majority of MIQ cases are picked up in the first seven days after arriving, with only a handful detected in the second week. The addition of a rapid antigen test on leaving MIQ and a period of home isolation and follow-up test are additional safeguards that will limit the potential for community transmission. Preliminary modelling results suggest that this type of strategy can still keep the risk at the border very low.

“With large parts of New Zealand still Covid-free and with lots of people yet to be fully vaccinated, it will be important to retain the seven-day MIQ requirement until we have passed the government’s 90 per cent vaccination targets.

“The Auckland boundary is still important during this period as a short-term measure to delay the arrival of the virus to other regions. Rapid tests and vaccination requirements for people boarding flights or travelling between the North and South Islands would also help limit the spread. This could buy precious time for more people to be vaccinated and avoid the need for alert level restrictions to be widened.”

Conflict of interest statement: I am partly funded by MBIE for research on mathematical modelling of COVID-19.

Dr Dianne Sika-Paotonu, Immunologist, Associate Dean (Pacific), Head of University of Otago Wellington Pacific Office, and Senior Lecturer, Pathology & Molecular Medicine, University of Otago Wellington, comments:

On the MIQ changes:

“Sweeping changes to the Managed Isolation and Quarantine (MIQ) system for Aotearoa New Zealand were announced today by Covid-19 Response Minister Chris Hipkins.

“Described as a system ‘rebalance’, this recalibration of the MIQ system is needed. We’ve sadly ended up with a situation in Aotearoa New Zealand where there is more Delta spreading in our communities than entering at our borders.

“Those travelling to Aotearoa New Zealand from low-risk Pacific countries such as Samoa, Tonga, Vanuatu, and Tokelau who have been fully vaccinated, won’t have to quarantine from 8 November 2021.

“Shorter stays in MIQ will be possible for fully vaccinated individuals who reach Aotearoa New Zealand from 14 November 2021, where the previously required 14-day isolation stay will be reduced to just seven days. Home isolation will be needed after this period only until a negative result for PCR test taken on Day 9 is achieved.

“The option for ‘self-isolation’ at home for those fully vaccinated travellers wanting to enter Aotearoa New Zealand will be within reach once the government’s vaccination target of 90 per cent for each DHB has been reached, and the transition made from the current Alert Level system to the Traffic Light System/COVID-19 Protection Framework-announced by the Government last week.

“To ensure no-one is left behind, vaccination target details for Aotearoa New Zealand actually needed to include at least 90 – 95 per cent full vaccinations for Māori and Pacific peoples. This would help keep our most vulnerable communities safe from COVID-19 – and also includes protecting our children and young people.

“Accessibility issues persist for hard-to-reach communities and more vaccination outreach activities and events that are resourced appropriately are needed. Although improving, Māori and Pacific vaccination rates remain behind the overall rate as more time was needed to catch-up with other groups given the initial vaccination roll-out in Aotearoa New Zealand prioritised other groups to get vaccinated first.

“Leaving any of our most vulnerable behind and unprotected, given the adverse health impact already seen for vulnerable groups in Aotearoa New Zealand, will have far reaching consequences. It will be important for DHBs to ensure an equity focus for their vaccination efforts that results in appropriate and targeted approaches for people that reduces barriers and builds trust, to get help and assistance out to those who need it most.

“Please get vaccinated – and keep others round you safe.”

On the Christchurch cases:

“The new cases detected in Christchurch indicate Delta is on the move and continuing to transmit beyond borders across Aotearoa New Zealand. Border controls require focus – we have to stay vigilant.

“A high degree of risk remains for all in Aotearoa New Zealand, but especially for our most vulnerable communities at this time.

“Vaccination is still key right now.

“Although vaccination rates have improved, focus and momentum must continue, with work underway to increase accessibility and reduce barriers for those needing the COVID-19 vaccine still needed – this also applies for COVID-19 testing and prevention efforts.

“We’re continuing to see double and triple digits reflecting daily COVID-19 case numbers as a result of Delta transmission within communities and across borders. Increased unlinked mystery cases of unknown origin continue to appear.

“It is critical for anyone who is currently unvaccinated to get the COVID-19 vaccine as quickly as possible. Current vaccination levels in Aotearoa New Zealand must continue to increase across age groups, geographic locations and all ethnic groups to help keep everyone safe from COVID-19.

“To ensure no-one is left behind, vaccination target details for Aotearoa New Zealand need to include at least 90 – 95% full vaccinations for Māori and Pacific peoples. This would help keep our most vulnerable communities safe from COVID-19 – and also includes protecting our children and young people.

“It is important also that those who need to have a COVID-19 test still come forward to have this done and should not be afraid to do so. Additionally, for those who are unwell and require emergency care and attention at this time, it is important to seek medical help as needed.

“Please get vaccinated – and keep others round you safe.”

No conflict of interest.