Sunday , April 18 2021
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Reader mailbag: quarantine edition

Summary:
This morning's Inbox comes with a plea that I advocate for self-isolation, rather than MIQ, for visitors coming in from Australia - doing so would vastly increase MIQ capacity, enabling a lot of visitors from actually-risky places to take up scarce slots in MIQ, and enabling more family reunification. My correspondent is in that latter situation. I've copied my reply below, lightly edited. I'm getting more than a little frustrated by the state of the border. Thanks for your kind words. You are absolutely right that taking Australia out of MIQ would free up a lot of space for others to enter.We have been working on and advocating for a far more risk-sensitive approach since this whole thing started. Our views on it have been in line with the public health researchers at Otago as well, for

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This morning's Inbox comes with a plea that I advocate for self-isolation, rather than MIQ, for visitors coming in from Australia - doing so would vastly increase MIQ capacity, enabling a lot of visitors from actually-risky places to take up scarce slots in MIQ, and enabling more family reunification. My correspondent is in that latter situation. 

I've copied my reply below, lightly edited. I'm getting more than a little frustrated by the state of the border. 
Thanks for your kind words. 

You are absolutely right that taking Australia out of MIQ would free up a lot of space for others to enter.

We have been working on and advocating for a far more risk-sensitive approach since this whole thing started. Our views on it have been in line with the public health researchers at Otago as well, for the most part. 

A rather more risk-sensitive system would:
  1. Recognise the reduction in risk achieved through pre-flight testing.
  2. Triage inbound passengers by risk: where they came from, and the route they took to get here;
  3. Complement existing nasopharyngeal PCR testing with daily saliva-based PCR testing for every single person in the border system, from the people who do laundry for the airlines through to every airport worker and every person in MIQ.
  4. Recognise that daily testing reduces the risk inherent in the use of some facilities. Ventilation is a big risk if you’re letting infected people sit there for days before they get caught, if they’re asymptomatic. Daily testing means that infections are caught promptly and there is far less risk of transmission within MIQ, both to other guests and to staff; recognise also that daily testing of staff means the risk of infection jumping out of MIQ drops to trivial levels. Things get caught before they’re a hop away from the border.
  5. Given (4), expand MIQ to include a lot more facilities. The shift to saliva-based testing reduces burden on nursing staff, which has been a bottle-neck in the system. Facilities that would have otherwise been ruled out because of cross-infection risk would be manifestly suitable, in conjunction with daily testing, for low-risk travellers.*
  6. Maintain data from daily testing. If after 10,000 people have gone through the augmented system, we find zero infections emerge after some day earlier than day 12, consider shortening the duration of MIQ for travellers from lower risk places while requiring that those travellers present for a post-isolation Covid test, just to be sure. Put in the post-isolation testing requirements well before any shortening of MIQ duration, to testbed the system's robustness as an addition to current measures. 
  7. Stop requiring MIQ for visitors from places without Covid. While we don’t have much travel from Taiwan currently clogging up MIQ, we would get a pile of tourists coming in on direct routes from Taiwan if we were the only safe place for them to visit. We should have been doing this since July of last year. No time like the present to start though. 
  8. Start adding MIQ abroad for visitors from high-risk places, with daily PCR testing for three days before travel. Saliva testing makes this entirely feasible. Arrive in LA on Thursday, get tested. Get tested on Friday. Get tested on Saturday again before hitting the Saturday evening flight to Auckland, with secure transit to the terminal. Let AirNZ run it to NZ spec.** 
I see next to no chance the government would agree to self-isolation for arrivals from Australia. Taiwan is able to manage it because they couple it with real monitoring and real penalties for breaches. The government here is unwilling to do that. They also worry about risks where those self-isolating people could have visitors, so even if a tracking bracelet were in place, they would need additional monitoring to prevent family from popping in and then risking spread. 

I can imagine ways of doing it, like adding security cameras at the doors, but it would not take long for something to go wrong. Travellers from Australia include the broad cross-section of New Zealand society, as the government likes to put it. That includes people who consider it appropriate to get early release from MIQ to go to a gang funeral and then breach all of the conditions that were placed on that early release. That so easily could have turned into an impossible superspreader situation. I’d bet, under an “Australians isolate at home” rule, it would be less than a month before a report about a party at one of those houses, and the whole thing would fall over. 

Because the government feels itself constrained against the kinds of monitoring and penalties that let things work in Taiwan, they won’t go near it. The best we can hope for, I think, is the scheme outlined above. And I only put maybe 1 chance in 5 that we can get to that system. 

It has been incredibly frustrating how little progress has been made. Saliva-based PCR testing has been feasible since August and has been in place privately since January. Better systems are possible. There’s no appetite for them; most people take it as a benefit, rather than a cost, that foreigners are kept out. There’s a deep underlying xenophobia driving some of it. That, combined with nervousness about MoH capabilities in managing any change to the system whatsoever has made the status quo very sticky.
Politik yesterday reported that the government's looking at 12-18 months before borders might start "more widely opening". The MIQ system has to be fit for that longer haul. It cannot currently accommodate need, and the costs of that will be increasing. 

* I think this is where there might be disagreement with folks at Otago. They've been arguing for severe reductions in the number of people allowed through, on very good grounds: the new variant is far more dangerous when combined with leaky systems. I'm here arguing for allowing more, but only with strengthened systems that reduces that risk. The new variants are riskier. But with daily testing of everyone in the system, that risk is sharply constrained. While the new variants are more infectious, there's far less chance of it making it through if pre-flight testing has triaged out people who are going to be infectious on arrival, and if daily testing in MIQ catches people very quickly on becoming infected. That reduces the risk of transmission to border workers. And daily testing of border workers massively reduces the risk that it then gets out. And recall that the border workers are all now getting vaccinated. Vaccination reduces the likelihood of infection by about 90%, from early reports. 

** OBVIOUSLY this would be in addition to the current MIQ here, not instead of it. But if it turned out that we just stopped seeing positive cases in MIQ here consequent to that change, we could start revisiting the duration of MIQ here. And, I'd hope, also obviously, if it turned out that visa issues made it impossible to stay at an MIQ facility abroad, we'd be maintaining a tighter-protocol one here for the riskier people who hadn't gone through MIQ abroad. 

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