Covid-19

Border quarantine mulled to quell virus

Strict border controls are being considered to prevent a second wave of Covid-19 cases. David Williams and Dileepa Fonseka report.

On March 23, Prime Minister Jacinda Ardern gave the country 48 hours’ notice of a four-week lockdown designed to stop Covid-19. She warned without such drastic measures the country’s health system would be overwhelmed and thousands would die.

“The Government will do all it can to protect you,” Ardern said back then, when the country had 102 coronavirus cases. “Now I’m asking you to do everything you can to protect all of us. Kiwis – go home.”

As the lockdown approaches the two-week mark, with 1106 confirmed or probable cases, the Government is considering putting all overseas arrivals into quarantine – effectively their own lockdown – to protect the wider public from the most obvious source of re-infection.

Asked by Newsroom yesterday if the Government is considering a mandatory quarantine at the border, post-lockdown, Director-General of Health Ashley Bloomfield confirms that’s the case, especially to help authorities’ objective is to stamp out the virus.

“One of the things we will be actively looking at is, what's the posture we need at the border to keep us safe and to stop that growth in imported cases and then potential further transmission.”

Bloomfield says he hasn’t seen any arguments against such a quarantine “at this point”. “But, of course, there is a lot of work to do in how you actually stand up that arrangement. And at the moment it also will depend on who is able to come through the border and for what purposes.”

Right now, the only people allowed back into the country – apart from the occasional, essential exception – are Kiwi citizens and residents. But Bloomfield says 22,000 Kiwi citizens and residents have registered with the Government’s SafeTravel website.

“We’re assuming those are people who are overseas and at some point may wish to come back because they’re just visiting overseas, they’re not there long-term. Whatever happens at the border we’ll need to make sure it is very carefully managed and controlled so that we don’t see an increased risk from imported cases.”

In February, New Zealanders flown back from Wuhan, China – then the global epicentre of the outbreak – were quarantined at a defence force training base at Whangapāroa, in north Auckland. The Government has said since it was considering what to do about the risk from returning Kiwis, but has shied away from implementing a mandatory quarantine.

Ardern has said there were limitations to how many people could be safely quarantined in a facility. But since then the number of people arriving from overseas has dwindled. Airways, which controls the country’s air traffic, says there would normally be 703 international flight arrivals in March, but in the previous week just 50 international passenger flights had arrived.

Also, a big increase in testing is yet to reveal widespread community transmission of Covid-19 – so it’s hard to argue the relatively light, trust-based monitoring regime has failed, especially as Google’s mobile phone location data show a massive drop in visits to shops, supermarkets, parks and beaches.

“Obviously the border is our first line of defence against more imported cases.” – Ayesha Verrall

David Murdoch, an expert in infectious diseases and dean of the University of Otago, Christchurch, says increased testing for the virus around the country hasn’t led to a big increase in confirmed cases. “Which is really good – indicating that if there is some hidden, ongoing transmission it’s probably not huge and at least been contained at the moment.”

(University of Auckland Professor Shaun Hendy, of Te Pūnaha Matatini, a centre complex systems research and data analytics, is encouraged by the trend in confirmed cases. “While they’re plateauing, or even starting to decrease, it shows that the lockdown is working. I think we can take some confidence that what we’re doing is actually working at the moment.” He says there should be more certainty in a week or so.)

Murdoch says the country’s border controls will be critical to the next step – stopping a second wave of cases. That’s especially important as other countries haven’t limited the virus’s spread as well as we have. Without a vaccine, New Zealand remains vulnerable to re-infection, he says. “The border restrictions will be a major feature, I would think, of any de-escalation [from a national lockdown].”

The country opening up to international travel will be gradual, he thinks, starting with some countries before others. “It’s going to require a lot of careful thought.”

Infectious diseases specialist Ayesha Verrall, a senior lecturer at the Otago Medical School in Wellington, says the risk from returning New Zealanders will have to be managed “for the foreseeable future”. “Obviously the border is our first line of defence against more imported cases.”

She thinks a simple quarantine arrangement for returnees is preferable to a risk-based approach. In the early days of the outbreak, the Government had to regularly revise its recommendations about high-risk countries. “There doesn’t seem to be a place on earth that we could say is really unaffected.”

The Government could also choose to have all international flights arrive at one airport, like Auckland, for ease of access to quarantine facilities and employing staff.

Don’t forget the needs of those in quarantine

It’s not clear how such a quarantine facility would be configured – although there’s previous experience at Whangapāroa.

Technically speaking, Verrall says quarantine could happen at home – but she thinks Bloomfield means people being sent to a quarantine facility at the point of arrival. “I think that’s showing he recognises that we want to finish the lockdown in a better place, so we don’t want to undo the benefit of the lockdown by then having more imported cases.”

(The Ministry of Health couldn’t raise Bloomfield last night, to ask if home quarantine was part of this thinking.)

What’s also important, Verrall says, is to consider the needs of those being quarantined.

“They have welfare need that we shouldn’t ignore – and I don’t just mean feeding them, but also to feel connected and part of the community. We could send them something to read or some magazines or something.”

The benefit to all of those already inside the borders, of course, is a lower of the alert level, with fewer restrictions.

According to the Government’s official Covid-19 website, alert level three measures, which can apply locally or nationally, include: Limited travel in and out of areas with Covid-19 clusters or community transmission; the closure of affected educational facilities; mass gatherings cancelled and public venues closed; and the closure of “some” non-essential businesses.

Kirk Hope, the chief executive of lobby group BusinessNZ, says: “We’d support any steps that the Government feels that it needs to take in that regard to ensure that we can move back through the alert levels as quickly as possible and get some sort of functioning economy operating.

“Yes it would be tough and challenging for the people who needed to be quarantined but that is preferable to hundreds and thousands if not a couple of million people not working and the subsequent impact that has on the economy, frankly.”

Verrall, of Otago Medical School says if the country puts its effort “up front” by taking measures at the border, and the public health system stamps out cases and small clusters of cases in the community, then the public should be able to enjoy “a normal life”.

She quickly corrects herself: “Or get used to a new normal life, I guess I should say.”

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