Read on Twitter
Me, at Newsroom, now ungated, on the need to keep improving border systems to keep the bug out.
Otago's epidemiologists have had more than a few good ideas that bear attention. Some, like rapid PCR saliva tests for all border staff and inbound visitors, could deploy immediately https://twitter.com/NZ_Airports/status/1341485937373503488
Otago's epidemiologists have had more than a few good ideas that bear attention. Some, like rapid PCR saliva tests for all border staff and inbound visitors, could deploy immediately https://twitter.com/NZ_Airports/status/1341485937373503488
Adding a lot more testing to the current system would strengthen it.
The current test is invasive and expensive. It doesn't scale up well.
Saliva-based tests are now available that are very accurate, and cheap to run, and provide rapid results. Adding them in really helps.
The current test is invasive and expensive. It doesn't scale up well.
Saliva-based tests are now available that are very accurate, and cheap to run, and provide rapid results. Adding them in really helps.
How?
If all border-facing staff had a daily test, that was cheap and non-invasive, we'd pick up anything before it had a chance to turn into community outbreak. That really matters where lockdowns are superexpensive.
If all border-facing staff had a daily test, that was cheap and non-invasive, we'd pick up anything before it had a chance to turn into community outbreak. That really matters where lockdowns are superexpensive.
We could also add that daily test for everyone entering MIQ. Anyone who had caught COVID would be found far more quickly and transported to isolation facilities. That helps reduce risk of transmission within MIQ.
We would also learn a lot more about infection dynamics. Do the folks currently showing up as infected on Day 12 actually turn up as infected earlier than that? Could we catch things more quickly? How many only present as infected after Day 10? Would all be good to know.
The Otago folks also provide a suggestion that would be harder to implement, but really worth thinking through.
They suggest adding MIQ facilities abroad to reduce the number of cases arriving here. That matters if the health system has only so much capacity.
They suggest adding MIQ facilities abroad to reduce the number of cases arriving here. That matters if the health system has only so much capacity.
I've heard two plausible arguments against scaling up MIQ to accommodate more people.
One of them is that doing so would bid up the price of nurses for the whole health system, so a monopsonistic employer like the government might not want that.
The other is around capacity.
One of them is that doing so would bid up the price of nurses for the whole health system, so a monopsonistic employer like the government might not want that.
The other is around capacity.
The capacity argument holds that even if the system were perfect, if you had 140,000 people coming in per month instead of 14,000, you'd have 10x as many positive cases and the health system would struggle with that.
Not crazy!
Not crazy!
If that's one of the real underlying constraints, preventing positive cases from boarding in the first place means a lot more people can come through the system - whether Kiwis returning home, or others joining us.
Pre-flight testing can help, but so can pre-flight MIQ.
Pre-flight testing can help, but so can pre-flight MIQ.
There's a lot of arguments against strawman versions of pre-flight testing. Here's the steelman version of pre-flight testing. Run the FDA-approved Abbot antigen test at every departure gate. Results in 15 minutes. Reschedule your travel if you're positive.
It isn't a substitute for MIQ. Rapid antigen tests won't pick people up who have just caught it. But it reduces the number of infected people on the flight, and more importantly it reduces the number of *infectious* people on the flight.
Pre-departure testing at the gate gets around all the strawman concerns around test availability, fraudulent test results, and out-of-date tests. Run it at the gate. The Abbot test is cheap-as per test. Or pick a better test if you can find one.
Pre-departure testing could be implemented immediately. The Abbott test now has FDA approval for at-home use, results in 15 minutes. Put it in the departure lounge. Again, not perfect - but another layer of protection that reduces the risk of transmission https://www.selectscience.net/product-news/abbotts-binaxnow-covid-19-rapid-test-receives-fda-emergency-use-authorization/?&artID=53443
Pre-departure MIQ is harder. In addition to sorting the logistics of running a hotel near an airport as NZ MIQ, you also need ways of getting the passengers securely through to the departure gate. It might prove impracticable at LAX. Worth thinking through, but not easy.
Anyway, all I wanted for Christmas was a safer MIQ system with the ability to scale up. I'm not going to get that for Christmas. But there are obvious things that could be rolled out in very short order to reduce risk and make the system safer. Here's hoping for the New Year.
