MIQ failings: City on verge of outbreak
As Kiwis continue to return from overseas, doubts are raised about the safety of MIQ hotel ventilation systems. Why is our MIQ model the way it is? Hannah Martin reports.
Only the quick action of a Christchurch health worker prevented a wider Covid-19 outbreak in the city late last year, according to information in a new report.
The Canterbury District Health Board (CDHB) report by doctors working in managed isolation and quarantine (MIQ) facilities said poor ventilation and double-bunking among newly-arrived fishing crews helped spread Covid and led to two health workers becoming infected.
The outbreak affected 31 out of 235 Russian and Ukrainian mariners plus the health workers at the Sudima Christchurch Airport Hotel during October and November.
The report has prompted changes to the way large groups are managed in MIQ – including a second group of Russian and Ukrainian mariners who arrived this month.
It said the health worker took a Covid test the same day they developed a temperature and runny nose, and a day after feeling fatigued and receiving a negative Covid result. They then self-quarantined at home.
Before the positive test, the worker visited a local supermarket.
‘‘We are very grateful that this staff member sought testing for mild symptoms, even though [they] just had a negative test,’’ a letter from public health physician Dr Daniel Williams, which was included in the report, says. ‘‘If [they] didn’t, we’d be in a much bigger mess.’’
Emails from CDHB staff, released under the Official Information Act, show just three of the 235 fishermen spoke English.
An email written by CDHB medical officer of health Anna Stevenson said about two-thirds of the fishermen were chain smokers and made up to four visits an hour to the outside smoking area.
‘‘Compliance with requests to physically distance from other crew was patchy and in the first couple of days there [were] frequent exchanges of cigarettes, lighters, cellphones etc,’’ Stevenson wrote to Ministry of Health officials.
Dr Josh Freeman, a microbiologist and clinical director of infection prevention and control, also observed mariners moving back and forth through the hotel’s corridors to go to the smoking area. ‘‘In a hotel environment with poor ventilation in corridors, these factors all added up to being conducive to the inhalation of Covid-19 aerosols.’’
It was these risks that led to the eventual spread of Covid-19 to two health staff, he said. Both became infected despite ‘‘exemplary adherence’’ to personal protective equipment (PPE) recommendations and infection prevention protocols.
The report states each worker separately caught the virus from different fishermen who were highly infectious at the time. Both fishermen wore masks and the health workers were in full PPE, including a visor or goggles.
The report recommends catering better for smokers, as MIQ was not set up to manage large numbers of chain-smoking guests, and says having more translators was ‘‘critical’’ for non-English speaking groups.
It also said double-bunking (two beds per room) should not be allowed to happen again, an engineering review of ventilation in Canterbury’s MIQ facilities should be done, and CCTV cameras should be mandatory.
The Sudima does not have CCTV, the report notes.
The report found the outbreak among the fishermen ‘‘severely stress-tested’’ MIQ protocols. It is thought 12 of the men had Covid-19 on arrival in Christchurch.
Double-bunking was labelled as ‘‘problematic’’ and ‘‘patently absurd’’ by University of Otago epidemiologist and public health expert Dr Nick Wilson. ‘‘New Zealand just seems to ... take shortcuts on the cheap.’’
Wilson said people would have been lifting their masks while sharing smoking areas.
‘‘This is just not how you do quarantine,’’ he said upon hearing that cigarettes were shared between returnees during their first few days.
Deputy director of public health Dr Niki Stefanogiannis said changes introduced included providing more translators, information and welcome packs in Russian and Ukrainian, and detailing expectations before people arrived. Doublebunking was banned, and smokers were allocated rooms with balconies to prevent groups gathering.
The Ministry of Business, Innovation and Employment had also formed a special team to handle large groups and make sure plans were in place for their arrival.
Officials were ‘‘working closely with the fishing companies’’, she said.
Doug Paulin, chief executive of Sealord, one of several fishing companies that brought in overseas crews, said they had required all incoming mariners to take a Covid test and provide a travel fitness certificate before leaving Russia.
After the first group arrived in October, the company made the required changes for the second group this month, he said. These included booking accommodation in Moscow for mariners whose flights were awaiting official clearance to leave.
Paulin thought the Ministry of Health had provided fishing companies with sufficient guidance. ‘‘They were working with the protocols they had at the time.’’
Last week the Hotel Grand Chancellor in Brisbane, a Covid-19 managed isolation and quarantine (MIQ) hotel, was evacuated and shut after a spread of the UK variant on its seventh floor.
More than 120 people were transferred to an undisclosed facility and required to isolate for another
14 days after six previously identified cases from the hotel were found to be linked, including a hotel cleaner, leaving health authorities scrambling to investigate whether ventilation may have played a role.
Yesterday, poor ventilation in corridors and ‘‘double-bunking’’ of fishermen in rooms at a Christchurch MIQ facility were implicated as key factors that led to two health workers contracting
Covid-19.
The emerging evidence has revived calls from experts who say change is needed to the country’s MIQ system, but the Government is steadfast that the current model is the best, and only feasible, option.
The issue reared its head again in the wake of the Brisbane incident, prompting Kiwi authorities this week to check air conditioning systems in MIQ hotels.
Earlier this week, an MIQ spokeswoman told Stuff: ‘‘Current international evidence suggests that airborne transmission of [Covid-19] is possible but dependent upon a range of complex environmental factors, and the exact risk of airborne transmission has not yet been defined.
‘‘However, as part of a precautionary approach, ventilation system checks have already been conducted in some . . . facilities and are being actively considered in the remaining facilities.’’
New Zealand currently has more than 30 managed isolation and quarantine facilities established in hotels in Auckland (18), Hamilton (3), Rotorua (3), Wellington
(2) and Christchurch (6).
Of these, four – one in Wellington and three in Christchurch – are dual-use facilities, housing both returnees for their 14-day isolation and those who require quarantine, in separate designated zones.
Epidemiologists Professor Michael Baker and Associate Professor Nick Wilson have long been suggesting MIQs shift from hotels – which they say are not designed for infection control, due to problems with shared spaces and ventilation.
For months, and again in an interview with Stuff last week, Wilson has suggested alternatives to the current model: including purpose-building quarantine facilities, moving MIQs out of Auckland, and having people quarantine at military bases such as O¯ hakea.
The latter in particular has been firmly ruled out by
Covid-19 Response Minister Chris Hipkins, who says the main challenge with shifting facilities to more remote locations is the logistical snafu staffing would cause.
Meanwhile, a city in northern China began building a 3000 unit quarantine facility this week to deal with an anticipated overflow of patients as Covid-19 cases rise ahead of the Lunar New Year.
Local media reports state crews were levelling earth, pouring concrete and assembling prefabricated rooms in farmland in an outlying part of Shijiazhuang, in the Hebei province, which has borne the brunt of new cases.
In the beginning of 2020, as the outbreak was taking hold, China rapidly built hospitals in a matter of days and converted existing buildings to isolation centres. So why aren’t we doing the same?
Until the election, New Zealand did not have a specific Minister for Covid-19 response. In the months before, Housing Minister Megan Woods was the minister in charge of MIQ facilities.
This week, Hipkins told Stuff the Minister at the time looked at ‘‘all options’’ for MIQ facilities, including asking officials to explore differentiated approaches to accommodation and services for new arrivals.
In July, officials looked into the feasibility, scale, potential time-frames to implementation and types of groups that potential facilities would be most well suited to, he says.
Discussions were had at Cabinet level the following month, considering a number of options including: renting out unused resorts, taking over serviced apartments, building campus – or barrack – type accommodation from scratch, and making use of thousands of campervans at a site.
The process highlighted a number of main challenges, namely location and staffing.
Officials concluded it would require hundreds – if not thousands – of workers, including nurses, healthcare assistants, cleaners, aviation security staff, MBIE and hotel staff and others having to willingly move to new locations to work.
These staff would then all have to be housed, creating ‘‘significant’’ logistical problems.
There were a number of factors to contend with. Hipkins says Government had to balance speed – being able to get a workable system up and running – practicality – being able to provide staff and services reliably – infection management, using taxpayers’ money efficiently, and the overall security of the quarantine system.
‘‘In the end, the Government did not consider building facilities from scratch was the best use of resources, particularly given the time it would take to complete in an urgent situation and the difficultly in predicting how long such facilities would be needed for,’’ Hipkins says.
The other ideas floated were also not considered to be feasible, for similar logistical and staffing reasons.
In late October, Hipkins was briefed on MIQ facilities and capacity as incoming minister.
The briefing to the incoming minister (BIM) stated if a future increase in MIQ capacity is desired or required, a lead-in time would be required to ‘‘safely scale’’ the health workforce.
The key reason the Government has adopted the policy it has is due to the restrictions to staff and infrastructure that alternative policies would have presented, Hipkins says.
Hotels are already staffed and are in locations that make it ‘‘more practical’’ for staff to provide the services they do, Hipkins says.
At this stage no decisions have been made to expand the MIQ system beyond high specification hotels, Hipkins says. He said facilities continue to be selected on the basis of being able to meet three criteria.
These are: adherence to infection prevention and control standards; ability to provide an appropriate standard of care and accommodate large numbers of people in the same facility; and economies of scale for, and proximity to, wrap-around health, welfare and security services.
Auckland University of Technology professor John Tookey, an expert in construction logistics, says that while building quarantine facilities from scratch is possible in theory: ‘‘Is it realistic? Probably not’’.
There are a number of reasons for this, including the time it would take, the cost to the country and overarching issues with logistics.
Putting together something permanent could take 2-3 years as a minimum – time we don’t have, as Kiwis continue to return to New Zealand.
The notion New Zealand could utilise prefabricated buildings also presented challenges, as the country does not have suitable facilities to prefabricate on the scale required, he says.
Who takes the risk and/or the ownership of this if and when Covid-19 goes away was also an issue.
‘‘Imagine we beat Covid-19 in 12 months, then what do you do with it?’’
The design ethos involved with a quarantine facility is not dissimilar to a prison, Tookey says.
People in MIQs need to be kept apart from one another, and from those monitoring them – the same model seen in corrections facilities.
But people in quarantine are not prisoners, and cannot be treated or housed as such, he says.
The Government could purchase 100 isolation containers for example, but the quality of accommodation would be problematic, he says.
Tookey says the current use of repurposed hotels for quarantine is the ‘‘best realistic option’’ for New Zealand, considering the alternatives.
MIQ facilities are technically considered ‘places of detention’ (where people are not free to leave at will) under the United Nations Optional Protocol to the Convention Against Torture, to which New Zealand is a signatory.
As such, the treatment and conditions of people detained in MIQ facilities is assessed using the same principles and criteria used by the Ombudsman to conduct his inspections of other health and disability facilities, and prisons.
A document released under the Official Information Act outlines the selection criteria required for MIQ facilities.
These must have appropriate security and entry/ exit points, unit suites or internally accessed rooms with private space and bathroom facilities, adequate provision of food and drink delivered to rooms, access to health professionals and appropriate security of the site.
Facilities with 200+ rooms were preferred but not essential, the document shows.
‘‘Current international evidence suggests that airborne transmission of [Covid-19] is possible . . .’’