Sweeping view from an isolation hotel

New Zealand’s military and health officials are operating a world-class managed isolation network that welcomed its 50,000th inbound traveller yesterday. But some of that half a billion dollars could be more carefully targeted, Jonathan Milne argues.

We arrived at the Air New Zealand check-in counter at Rarotonga International Airport four days ago, still wet and sandy from a swim in the lagoon just minutes before.

We walked across the tarmac on a balmy 26C afternoon, took one last look at the island’s towering mountains, and boarded the cool, air-conditioned Boeing 787. Georgie and I helped our three boys fit their brightly-coloured floral face masks – a first for all of us.

Flight NZ945 to Auckland helped prepare its 27 extremely well-spaced passengers, just a little, for the daunting prospect that was Auckland, community transmission and Level 2.5 lockdown. The flight crew showed us how to pinch our masks around our noses; I learnt that every time I exhaled, my reading glasses would mist up.

Little things, that billions of people around the world discovered months ago – but not us. We had been living in a big, tropical Covid-free bubble.

At Auckland Airport, we walked the once-familiar gangways and corridors, but this time they were deserted bar a few uniformed security and health workers. Temperature checks and questions about our health, before entering the customs hall. No queues at customs; no jostling at the baggage carousels; no wait for the x-ray machines in the biosecurity hall.

Where once there would be hundreds of people waiting to greet loved ones at arrivals, there was a single aviation security officer offering a jovial “kia ora” from behind his face mask. The McDonald’s, the Spark, the Vodafone booths, all closed. At the cafe counter where I’d bought a coffee when I last came to New Zealand, there were instead two officials checking our details, and directing us to waiting buses.

My oldest son asked the question that has been nagging us for days: “What quarantine hotel will we be in?”

I baulked at his cheek. Already, in a few hours’ travel into New Zealand, I’d become passive, waiting to be told what to do and where to go, anxious to be seen to be compliant.

“Oh,” the woman in the blue plastic medical cape replied. “You’re going to Four Points, just by the Town Hall.”

Before....  Photo: Charlotte Piho
And... after

Isolated in the CBD

It’s now day three of 14. Our first two full days in isolation were magnificent. The Government’s managed isolation and quarantine officials have provided our family adjoining rooms on the hotel’s 12th floor; we have three double beds, two TVs, two fridges, and one bath. As I write this in the dark early morning, I’m looking down on a street sweeper passing by the neon art of Aotea Square.

After 16 months living overseas, it’s exciting to be home in Auckland. The Government says it’s our right as New Zealand citizens to return home; if so, that’s not a right we take for granted. We are enormously grateful.

Of course, this is nothing like the hotels you may be used to; although we are allowed to take a lift down to the lobby and kick a rubber ball around in the wire-fenced dockway outside, we rarely see other guests. Apparently there are hundreds of people here, travellers returning to New Zealand via two weeks’ managed isolation. But they’re all hidden behind the closed doors of their well-appointed rooms.

We can’t use the gym, or the restaurant, or the rooftop cocktail bar, of course. Nor would we expect to. As we were told when our bus pulled up at the hotel, Auckland may be in Level 2.5, but here at the isolation facility we’re at Level 4.

Four times a day, pre-ordered meals and snacks in plastic containers and brown paper bags are left at our door, with a discreet knock. By the time we’ve donned our masks and opened the door, whoever delivered them is gone. Once a day, the nurse knocks at the door to take our temperatures.

There are no housekeepers to turn down the beds and clean the rooms; instead, we’re supplied with a sponge, a 500ml bottle of Palmolive dishwashing liquid, and a 450ml bottle of lavender meadows-scented Harpic toilet cleaner.

When we venture downstairs to stretch our legs in the dockway, we sign out at a desk staffed by friendly, khaki-clad NZ Army personnel. There are 15 of them, living in another hotel down the road, and working shifts in our isolation hotel. There are another four Royal NZ Air Force personnel who seem to be running the show; they live on-site.

Then there are the hotel staff, the kitchen staff, the health workers and, outside, contracted security guards – one of them kindly fetched our green rubber football when eight-year-old Joe booted it over the edge of the terrace and it ran away down Airedale St.

It’s quite an operation.

Managed isolation business is booming

This is just one of 32 quarantine and managed isolation hotels, dotted across Auckland, Hamilton, Rotorua, Wellington and Christchurch.

According to the Government, it will cost $479 million to provide managed isolation and quarantine to the end of 2020. According to Ministry of Justice legal advice to the Government, it will cost around $630 million to meet anticipated demand just for the six months from July to December.  

And that assumes the government projections are right: statistics show that each week, more New Zealand citizens, permanent residents and permit holders are arriving than expected. Today the number will top 50,000 since the facilities opened in March; there will be more than 6000 people in managed isolation at the end of this week.

Since that $630m forecast, the minister responsible Megan Woods has announced the deployment of an additional 500 defence personnel, taking their numbers to nearly 1000 working to contain the Covid risk. She’s announced new $6m hi-tech security at the isolation facilities, like thermal CCTV at the perimeters. And still, the numbers keep rising.

Back in June, Prime Minister Jacinda Ardern said: “Maintaining the strict requirements that we have and ensuring that we have the border agencies there present ... does come at some expense, but obviously Covid in New Zealand comes at an even greater expense.”

That begs the question. Even if Ardern is right that the potential cost of continued Covid transmission would outweigh any cost to government and the economy of keeping it out, is that grounds to hand Minister Woods and Air Commodore Digby Webb an open cheque-book?

Of course not. As the Government accepts, the ballooning cost of border control must be managed, and that’s why they’re already requiring a very small number of short-term travellers to pay for the privilege.

How else might the costs be controlled? New Zealand First suggests using military bases instead of hotels – as they did for the New Zealanders repatriated in February from Wuhan, China.

That’s punchy hardline rhetoric in an election campaign but the truth is, that solution doesn’t work: the Defence Force doesn’t have bunks to accommodate 7000 returnees at a time (a conservative projection), separate from each other. You can’t put travellers returning from different countries, with different risk profiles, at different points in their two-week stays, in the same shared barracks.

In order to move quarantine and isolation facilities out of the cities, government would have to spend much more money on purpose-built facilities on air bases like Ohakea.

Prof Michael Baker, Dr Amanda Kvalsvig and Prof Nick Wilson, from the Department of Public Health at the University of Otago say the border is “New Zealand’s greatest vulnerability” and must be better managed.

They want tighter controls. “There are also important questions about how to improve quarantine, the benefits of purpose-built facilities (with proper ventilation and no shared spaces), and shifting isolation and quarantine facilities out of major cities (for example, to an air force base).”

But, writing in The Conversation, they also propose greater investment in digital technologies, including the bluetooth CovidCard, to improve contact tracing.

Bluetooth and Blue Pacific

I would argue a more practical (but probably less popular) solution than barbed wire-fenced military bases, could be to better target the use of managed isolation for travellers, hand-in-hand with new monitoring and tracing technologies.

For instance, there are 14 Pacific Island nations that have never had a single case of Covid; countries confirmed Covid-free by New Zealand Ministry of Health testing – what is the point of the New Zealand taxpayer shelling out $7000 to $10,000 a head for their isolation?

Of course, I would say that: I’m bringing my family from Covid-free Cook Islands to Auckland; we pose no risk to New Zealanders. In fact, the only danger is in placing us in hotels shared with those returning from the USA, UK and other countries with high rates of the coronavirus. The isolation actually heightens our risk!

Life in a Covid-19 free nation.  Photo: Charlotte Piho
Heading for a new life.  Photo Jonathan Milne

Among those countries that have had Covid, the World Health Organisation lists seven as having no cases now; another 26 (including Fiji and New Caledonia) have only sporadic cases.

The money spent on quarantining Kiwis returning from some of these 47 countries might be better spent on surveillance testing, more sophisticated digital contact-tracing and supervised home isolation with electronic monitoring.

It’s not just travellers from the Pacific. With investment in better testing before travellers board their flights, the country might feel more comfortable in allowing more low-risk travellers to isolate at home – allowing scarce government funds to be invested in public health solutions rather than in overseas-owned hotel chains.

Writing in The Lancet Digital Health journal, Sera Whitelaw and other medical and population health experts from Canada, USA and UK identify the benefits of planning, surveillance, testing, contact-tracing and clinical management, combined with strict quarantine of potentially exposed or infected people.

They do not push for wholesale managed isolation of all travellers or residents; certainly not of those known to be Covid-free.

“The indiscriminate lockdowns for infection control in several countries have had severe socio-economic consequences,” Whitelaw and her colleagues argue. “With digital technology, quarantine can be implemented in individuals who have been exposed to or infected with the virus, with less strict restrictions imposed on other citizens.”

Even the World Health Organisation is equivocal about isolating inbound travellers, in its July 30 travel advisory. “The use of quarantine in the context of travel measures may delay the introduction or re-introduction of SARS-CoV-2 to a country or area, or may delay the peak of transmission, or both. However, if not properly implemented, quarantine of travellers may create additional sources of contamination and dissemination of the disease.”

For our family, after the initial nervousness in strapping our face masks around our ears, we are now getting our heads around the safety precautions. We do feel safe. We feel well looked after by the hard-working defence, health, hotel and security staff at Four Points managed isolation facility. We’re grateful to them and their families, putting themselves at risk as they look after travellers from all over the world.

We would be equally compliant if we were isolated at home, with electronic monitoring. But who then would chase the football down the road when one of the boys kicks it out of bounds again?

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