Monday, 5 October 2020

Border testing

RNZ's Nine-to-Noon had a decent discussion of rapid antigen testing and its potential in helping to open things up. Paul Simmonds suggests a rapid antigen test at the airport before flying (negative test required for boarding), and another rapid antigen test on landing. Those testing negative both times would be considered cleared.

I really like rapid antigen testing. But I'd see it, in first instance, as a complement to managed isolation. We'd learn how effective it is, and whether other cases still get through.

How could you do this? Run the rapid testing as Simmonds describes. Maintain existing Day 3 and Day 12 PCR tests, but add daily rapid antigen testing in MIQ. They're not invasive so it's pretty easy. And add in a requirement that those leaving MIQ show up for a PCR test a few days after leaving isolation, just to be even safer. However many days Michael Baker or Nick Wilson says are the right number of days. 

This lets you testbed things. You'd learn how good the rapid antigen tests are. You'd learn what compliance is like with post-isolation testing requirements and how to do that properly. 

If it turns out that the system still catches a lot of cases in isolation at the Day 12 test, or after Day 7 on the rapid tests, then you can't use this as a way of shortening managed isolation. It instead reduces the burden on the system by keeping infectious people off planes and reducing the risk of people transmitting to each other or staff while in isolation. 

If it turns out instead that you don't see any cases turning up after Day 7 any more, and if folks are good about turning up for their required post-isolation test, then cut isolation to 7 days from 14 and maintain the requirement to turn up for post-isolation testing. One simple move and you have *doubled* the effective capacity of the whole darned MIQ system. Halving the time in isolation doubles the number of people it can handle. 

And it's all done through a series of steps ensuring that the system works. 

It's bloody obvious. It's feasible. They could do it right now. It wouldn't reduce safety at all - it would be requirements on top of existing requirements, not instead of them, and would only lead to a shortening of time in MIQ if that proved safe. 

And there are plenty of other things that can and should be being done to increase effective capacity. 

Some MIQ facilities get ruled out because they're too far from hospitals. That's a bit silly. Use those potential facilities for people coming in from places with low risk of Covid, where there'd be way fewer people needing transport to hospital. 

Not enough staff for those places? Well, has the government even considered starting to train up staff for MIQ? There are hundreds of airline cabin crew who have been laid off. They're all trained in how to get the broad-cross section of people who arrive on planes to comply with regulatory requirements. Give them some hygiene protocol training and let them help scale up MIQ. Again - obvious. Again - not being done. 

It still makes zero sense that visitors from Taiwan or places with no Covid have to go through isolation. Departure/arrival testing surely would be plenty - again with the obvious caveat that this would only apply for people who hadn't been to risky places recently and who arrive on direct flights from the safe place. 

The usual retort on Twitter is that those direct flights aren't in place so it wouldn't help, but that's endogenous. Suppose the government said "If anyone runs direct flights from Taiwan to New Zealand, anyone arriving on those flights who hasn't been outside of Taiwan in the past month doesn't have to go through MIQ - tests before flying and on arrival are enough. We'll change this if there's any outbreak and community transmission in Taiwan, obviously." I'd expect somebody to start running flights, wouldn't you? And if they didn't, it isn't like the government would have had to spend piles of money prepping for something that didn't eventuate. There aren't a lot of prep costs in not requiring arrivals from Taiwan to go through MIQ. Or they could say that any airline wanting to put on the flight has to give the government a heads-up to provide enough leadtime for whatever prep is needed. 

So many things that could usefully be done to safely increase the number of folks able to travel, so little that will get touched this side of the election. Bit frustrating. 

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