How ‘user pays’ quarantine could work

A leaked report shows we could relieve a major "choke point" on our economy safely if someone was willing to fund it

Mark Louis can't understand why his friend and employee Ramidu Lokugalapaththige, who has lived here for years, isn't allowed back into the country. 

"You look at things like the Avatar crew coming in and the America's Cup crew coming in and it kind of rubs salt in the wound. You kind of think: hang on a minute these guys are going to be here for a few months. This guy has made a life here and he wants to live here.

"Can they not bump the filming time of that movie out by a couple of months and let someone [in] who is on a work visa who has a life here?"

Both the Avatar film crew and the America's Cup personnel were allowed through the border under a small set of exceptions where they could enter if they paid for their own self-isolation.

The breach

A high-profile breach of quarantine through an Auckland to Wellington road trip - by two New Zealanders who weren't tested before they left the facility - has been painted as another reason why people like Lokugalapaththige can't be let back in to the country to access their homes and possessions. 

The day of the quarantine breach, Prime Minister Jacinda Ardern was asked how that news had impacted previous plans to increase quarantine supply:

"There has been significant pressure coming from a wide range of quarters. Not least some of my colleagues on the other side of the house to widely expand our borders.

"We have always said that we needed to be cautious. I utterly stand by that.

"This is proof of why we need to act with New Zealand's best interests at heart. This is a growing pandemic not a slowing one and I send that message to the opposition."

However, a leaked report from a managed isolation pilot suggests the Government could still safely expand its quarantining supply if it were prepared to fund it or get those coming in to pay. That was especially the case for people who weren't citizens or residents of New Zealand.

Those are just some of the conclusions from a report created about the country's first self-funded Managed Isolation Facility (MIF) at the SO Hotel in Auckland where a group of foreigners - granted exemptions by Economic Development Minister Phil Twyford - funded their own quarantine.

It found that more money - whether delivered through user pays or Government subsidy - could reduce key bottlenecks around quarantine supply for non-New Zealand citizens because of the steeper penalties foreigners faced if they didn't comply.

Housing Minister Megan Woods, who is working on a government effort to expand quarantine supply for those people legally able to enter the country right now, hadn't seen the report.

“The Government’s work on quarantine measures continues with the overarching aim to ensure that Covid-19 is not brought into the community and the collective effort of five million people to stop the spread of the virus is not undone," Woods said.

"We will be getting advice about increasing quarantine capacity in the coming months and decisions will be made accordingly.”

Easing the choke point

A daily limit of 250 quarantine places has been termed the "the single biggest choke point for an economic recovery".

Pressure on governments to open borders has been seen in other countries and is recognised even by those who urge caution like Otago University (Christchurch) Dean David Murdoch:

"In Iceland because of pressures from the tourism industry - and of course it's their summer - they are opening up apparently by just having a test and allowing people in if the test is negative.

"The scientific community were very opposed to it. You would hope it would never go to that stage where it would then be reliant on a test. The test isn't good enough to do that."

ACT MP David Seymour has said the most recent breach doesn't mean the country shouldn't try and expand its quarantine capability. 

"This event should accelerate the work in truly having the world's smartest borders. The Government should be working proactively with the private sector to use better technology to trace Covid-19, and trace Covid-19 better."

The SO Hotel report

Twyford granted a range of border exceptions for essential personnel including for crews of the America's Cup yachts and Avatar.

All of these quarantine spots were self-funded and presented an opportunity to look at how a user-pays quarantine system could work. 

The first lot went through the SO Hotel on May 23 and user-pays facilities there were examined for a period of 20 days. 

A report produced for Government by Auckland Regional Isolation and Quarantine - who monitored the facility - said physical exercise options were a key constraint on our ability to safely expand quarantine.

Facilities that didn't allow for physical activity encountered a greater number of complaints from those staying there, but that was overcome at the SO Hotel (where people weren't allowed out at all) with a rooftop deck and gym facilities.

"The provision of adequate exercise options has been a logistical challenge since day one of standard MIF operation, requiring at one point 663 managed walking groups a week navigating through the streets of Auckland.

"The focus today is on providing more internal or grounds-based options that require less resourcing and do not impact the broader community."

People quarantining at the SO Hotel weren't allowed to walk outside, but the extra funds paid by those quarantining were used to split the hotel's gym between seven rooms. 

More funding allowed seven people to exercise in isolation at the same time - 70 per day - followed by 15-minute sanitation sessions by cleaning staff.

"Standard MIFs do not allow the use of gyms due to the challenges of maintaining a high level of hygiene between hundreds of users." 

"The UP-MIF [User-Pays MIF] is better placed to support ongoing cleaning between users through the funding of a dedicated professional cleaning and gym management staff."

Ramidu and Lidiia are living in separate countries now thanks to the border lockdown. Photo: Supplied.

"For the smaller standard MIFs this may become a viable option with greater government funding."

A yoga studio and rooftop exercise space further cut down on complaints seen at other facilities where physical activity had been limited. 

The hotel was also able to operate with a smaller footprint of government employees because foreign nationals who could be deported at any point - or whose employers could face sanctions - were more willing to follow quarantine rules than New Zealand citizens or permanent residents. 

That might have limited application to younger international students (another key group many want to provide private quarantine for), but might apply to thousands of migrants stranded offshore desperate to get back to their homes and jobs.

A normal Government-funded MIF required 12-14 government staff. That could include three aviation security (AVSEC) interviewers, three AVSEC assurance team members, two Ministry of Health representatives, four nurses, and a counsellor. Roving between all facilities were three psychiatric-mental health nurses, and six police patrol officers.  

In contrast, the greater willingness of non-New Zealanders to follow the rules meant this footprint could be cutdown to regular hotel staff (including security) supervised by three key government personnel: a Site Assurance Manager (SAM) and two nurses.

A roving Ministry of Health supervisor oversaw all of that and would be capable of supervising several such facilities at once.

"Working closely with hotel management and hotel employed security, the SAM ensures that the PRI [Person Requiring Isolation] is complying with all isolation requirements."

"The two nurses (one at night) carry out daily health checks on both the oncoming staff and the PRI."

Safety first

New Zealand Initiative chief economist Eric Crampton said the conclusions of the report echoed his own that more quarantining options could be created if a transparent process existed for people coming through the border - and hotels - to prove they could quarantine safely.

That would lead to the private sector stepping up to meet the quarantine demand for foreigners and make the process a lot fairer.

Although he believed a humanitarian case existed not to charge people like Lokugalapaththige for their quarantine.

"The problem across everything that the Government has been doing is the focus has been wrong.

"Where there is a substantial economic reason for it - or humanitarian reason for it - safety becomes a secondary consideration.

"If it's vitally economically important to bring in a crew of Avatar filmmakers then it's easy to overlook what seem like minor safety breaches ... or if you've brought someone in on compassionate grounds it's really easy - if that compassionate case changes and worsens - to extend the compassion a little bit further."

However, University of Otago's Murdoch urged caution around any expansion of quarantine or of using a process that trusted private providers to quarantine people.

Desperate employers could pressure hotels to cut corners in quarantine, as could migrants. 

"I wouldn't automatically assume that the private ones would have been more likely to adhere ... [employers would] want them to be in the country as soon as possible. The Universities would want the students to be here as soon as possible.

"All I can really say if we're going to alter something ... it's just going to be an increased risk and we're just going to have to know if we accept that and have other means to mitigate it."

'How is this okay?'

Louis believed his friend shouldn't have to pay for quarantine, but said if a user pays option were made available to some it should have been offered to his friend too. 

Lokugalapaththige was visiting family in Sri Lanka with his wife when that country's border closed. By the time they rebooked flights New Zealand's border had closed too.

Then his wife, a Russian citizen who normally lives in New Zealand with him, was forced to leave Sri Lanka (she was on a tourist visa) and the two are now stranded in two different countries.

Lokugalapaththige can't enter Russia to be with her either because the documents he needs - including his marriage certificate - are still in their New Plymouth home. 

Adding to his run of bad luck, back home in New Zealand Lokugalapaththige's house has been burgled and his car stolen.

"I laugh when I tell people because it's almost like some kind of TV show that's not real ... he's coming home he pays $1000 to change his tickets ... then he gets stuck there because there's a lockdown imposed in Sri Lanka," Louis said.

"And then, whilst that's all happening, someone steals his bike, steals his car ... and he's got to pay to get the thing towed."

"How is this okay?"

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