Since July 2020, New Zealand has had at least 10 border control failures and at least five “internal MIQ facility failures” involving the spread of COVID-19 between returnees
Prof Nick Wilson, Dr Leah Grout, Prof Michael Baker – University of Otago
There have been ongoing system improvements to address these failures, but hotel-based facilities have inherent problems with shared spaces and inadequate ventilation, as recognised in WHO guidance.
One approach is to improve arrangements with existing hotel-based MIQ facilities via these 12 measures:
- Reducing the number of infected travellers arriving in the MIQ facilities – which requires a particular focus on the “red zone” countries.
- Only using MIQ facilities in large cities for the lowest-risk travellers (eg, those from Australia).
- Greater use of ‘cohorting’ where floors, and ideally whole hotels, take groups of travellers arriving at the same time to reduce the potential for recently arrived (and potentially infectious people) to infect those who are about to leave MIQ facilities.
- Eliminating use of all shared areas entirely (including exercise and smoking areas) and with returnees staying in their rooms throughout the full MIQ process (as is routine in some overseas jurisdictions). Smokers should be offered nicotine replacement therapy and other smoking cessation treatments and support.
- Further improving ventilation arrangements to reduce all air flow from returnee rooms into corridors (and possibly ensuring all rooms have windows opening to the outdoors). Staggering of meal deliveries may also reduce air flow from one returnee room to another.
- Mandating daily PCR-based testing of saliva for MIQ workers. This option could also be explored for travellers in MIQ in addition to the current testing regimen to allow for comparative assessments. This testing is being used in parts of Australia and in other countries.
- Mandating that all MIQ workers must scan QR codes and to have the Bluetooth part of their smartphones enabled.
- Fast tracking vaccination against COVID-19 for all MIQ staff (which may actually be planned already).
- Urgently upgrading CCTV systems to comprehensively cover all MIQ facilities.
- Improving working conditions for staff in MIQ as per concerns voiced by staff.
- Prosecuting people who breach the MIQ rules. Also, routinely publishing all reported rule breaches and investigation reports into outbreaks on the Ministry of Health website to allow for continuous quality improvements (obviously without any identifying information on returnees).
- Introducing a post-MIQ home quarantine requirement for 5-7 days to reduce the risk that cases infected during their MIQ stay will infect others in the community. Other countries pursuing COVID-19 elimination have also focussed on this period. For example, Hong Kong recently extended the length of border quarantine from 14 to 21 days. Additionally, in New South Wales testing has been extended to include day 16.
A different approach would be to move MIQ facilities outside of cities, as per the converted workers camp at Howard Springs in Australia or to establish mobile homes/caravans at military bases (eg, at Ōhakea air base).
Alternatively, purpose-built facilities could be established, as is being considered by the Queensland Government. It is acknowledged that there would be some practical challenges in building and staffing such facilities, especially away from population centres.
We consider it useful to take a systems approach so that attention is more carefully focused on targeting future prevention efforts. Sectors such as aviation and healthcare delivery have repeatedly shown the importance of effective error management and learning from failures. It is now time to address the repeated failures in border protection against COVID-19.