MIQueue: What are the alternatives to two weeks in a hotel? – Stuff.co.nz

Posted: September 29, 2021 at 6:45 am

Home detention-style GPS tracking bracelets, facial recognition check-ins, building a virtual fence around your home. Nikki Macdonald investigates the alternatives to MIQ.

Remember the time before MIQ.

It was March 2020, two weeks before Prime Minister Jacinda Ardern sent the country into lockdown.

A time when shutting out the world seemed inconceivable. To reduce the risk of travellers bringing in the dreaded virus, without barring the borders altogether, the Government introduced self-isolation.

Ricky Wilson/Stuff

Self-isolation and shorter stays are possible alternatives to the current 14-day quarantine in an MIQ hotel.

Arriving travellers had to spend 14 days at home, so they couldnt spread Covid if they happened to be infected. They could go running alone and could share a house with others, but were supposed to shut themselves off as much as possible.

As pressure mounts to let more Kiwis in and out of Fortress Aotearoa, were now considering the same process in reverse as a pathway to reopen.

The Government will today announce details of its self-isolation trial, which will allow 150 New Zealanders to quit the country on a work trip and quarantine at home on their return.

But youll remember something else about that early self-isolation some returnees abused the countrys trust.

As Sir David Skegg put it in his Reconnecting New Zealanders report, returning travellers who were required to quarantine at home did not do so consistently, and measures to check on their adherence turned out to be largely ineffective.

KEVIN STENT/Stuff

Stuff journalist Lucy Craymer was among the first in the world to try digitally monitored Covid home quarantine, while living in Hong Kong in March 2020.

Around the same time as New Zealand introduced self-isolation, Kiwi journalist Lucy Craymer flew back into Hong Kong, where she worked, at the time, for The Wall Street Journal.

In her absence, the business hub had introduced one of the worlds first digitally-monitored Covid home quarantine schemes.

At the airport, she was fitted with a hospital-style bracelet printed with a unique QR code. On arriving home, she had to download an app, scan the QR code and walk the perimeter of her apartment with her phone.

The app used her phone's GPS to draw a virtual fence that became her confinement area for two weeks.

At random times, someone could call, and shed have to take a photo on her phone showing the QR code band on her wrist. They already knew from GPS tracking that her phone was within the geofence, and the photo showed she was still with her phone.

Over the following months, Hong Kong upgraded the papery band to a bracelet with its own GPS tracking.

Since then, many countries have adopted cellphone tracking for home quarantine, to stop returnees breaking the rules.

Its not yet clear what monitoring the New Zealand pilot will include, although the requirement for cellphone coverage suggests some digital surveillance.

Skeggs report suggested anyone travelling quarantine free, or with a shorter quarantine period, could be monitored with mobile phone tracking.

Australia is trialling 7-day home quarantine using controversial facial recognition software. Users download an app that tracks the phone through geolocation. It includes random check-ins, where the user has to upload a selfie within 5-30 minutes (it varies by state). That image is checked against the file photo using facial recognition software.

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Dr Andrew Chen, researcher at the University of Aucklands Centre for Informed Futures, favours human monitoring of home quarantine, with some GPS phone tracking if absolutely necessary.

Andrew Chen, a research fellow at the University of Auckland's Centre for Informed Futures, says Poland was actually the first country to use facial recognition software for home quarantine, way back in 2020. Hed be pretty wary if the New Zealand government took that option, mostly because the technology is inaccurate.

Any monitoring technology comes with ethical questions and the potential for backlash, Chen says. Before you advocate a parole-style GPS monitoring bracelet, consider if youd wear one yourself, he says.

And any digital surveillance comes with privacy and security risks.

It doesnt really matter which of these technologies it is, it needs to be governed with the right rules and processes.

Privacy Commissioner John Edwards was not available for an interview, but said in a statement his office would ensure any innovations minimise impacts on privacy.

ROBERT KITCHIN/Stuff

Sir David Skeggs report, Reconnecting New Zealanders, found Deltas greater infectiousness made self-isolation less attractive because of the likelihood of spread within households. He also noted that, last time around, returning travellers did not all obey the self-isolation rules.

Theres also the practical problem that most people live with others. Skegg pointed out Deltas increased infectiousness meant the virus tended to infect everyone in a household, making self-isolation with others implausible. The New Zealand trial is limited to people who can quarantine alone, or with others from the same travel group.

Chens preference would be to trust people, then back that up with human monitoring and maybe some GPS phone tracking, but thered have to be a very good case for that.

Britain has used human monitoring only (daily check-ins and random visits, backed up by police visits if necessary), but Imperial College London epidemiology professor Neil Ferguson questioned its effectiveness.

Home quarantine for travellers just doesnt work, he told The Guardian in June. Everybody coming in from India in April of this year was meant to quarantine at home, but it [Delta] has still established itself.

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The Singapore home quarantine scheme includes a plug-in "gateway" and watch-like electronic bracelet which connects to the gateway via bluetooth.

Craymer reckons her phones GPS accuracy was affected by Hong Kongs cityscape, which meant she could probably have sneaked into a neighbouring apartment or even the supermarket in the next door building, if shed wanted to.

The GPS I dont think was 100 per cent accurate ... When I went for a run I would often look like I was running faster than I was, because my phone couldn't geolocate me specifically, because it would bounce off the tall buildings.

However, fear of getting caught with penalties of hefty fines or even jail time was an effective deterrent.

Chen says GPS or cellphone tower monitoring is accurate to 10-20m.

These technologies are not perfect. There are always some errors. If you rely on bracelets, people might be able to take the bracelet off and leave it at home. If you rely on geolocation, there might be accuracy issues, particularly in rural areas.

So whatever the monitoring setup, home quarantine will be easier to break than military-controlled MIQ hotels.

Ross Giblin

Otago University epidemiologist, Professor Michael Baker, says how acceptable the risk of home quarantine is depends on whether were still trying to eliminate Covid-19.

Otago University epidemiologist, Professor Michael Baker, says the new trial should be low risk youve got fully vaccinated New Zealand residents probably visiting lower risk countries, in an employer-sponsored scheme where people face employment consequences rather than just a fine if they break the rules.

But as you broaden the scheme, and open it to returning New Zealanders, the risk will increase.

If you want to scale this up hugely, whatever you do is going to result in quite a significant risk over time of reintroducing the virus. Just simply because of the numbers involved.

Unfortunately, it takes very few human errors. Once you move into tens of thousands, or hundreds of thousands, that's when things will go wrong.

Some countries reduce the risk, by only allowing home quarantine for fully vaccinated travellers from countries where Delta is not rampant.

Singapore still mandates managed quarantine for higher risk countries, but allows monitored home quarantine for fully vaccinated people coming from nations with less circulating virus.

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Singapore-based Australian Ruth Haller found Singapore's home quarantine system easy to use and a welcome alternative to hotel quarantine with a 6-month-old baby.

Singapore-based Australian Ruth Haller has just returned home, after visiting her husbands family in Switzerland.

Because they were fully vaccinated and had visited a medium-risk country, the couple was able to spend their two-week quarantine in their apartment. With a 6-month-old baby, that made the process more bearable.

I just cant imagine being in a hotel with a baby ... I cannot imagine spending two weeks in that one room with her. That would have been terrible.

The Singapore system involves an electronic bracelet like a watch with a QR code instead of a face and a gateway that you plug in at home. The two devices are paired and your movements monitored via an app, with regular monitoring calls to ensure you're with your phone.

Hong Kong, however, has ditched the home quarantine and now requires all travellers to quarantine in an approved hotel at their own cost. The timeframe ranges from three weeks for arrivals from high risk countries to seven days for fully-vaccinated travellers from low risk countries such as New Zealand.

Paul Kane/Getty Images

The acceptability of home quarantine will depend on how aggressively were trying to keep Covid out at the point were considering opening up.

Whether the greater risk of home quarantine is acceptable will depend on New Zealands overall strategy, Baker says. If we lose control of the Auckland outbreak and have to switch from elimination to suppression, the tolerance for risk will change.

If you already have virus spreading in the community, a bit of leakage from returned travellers would be less disastrous. As one modelling paper put it, keeping out 95 per cent of infections would be a win in England, but a failure in New Zealand.

But even then, you would want to limit the number of infected people arriving, through pre-departure testing, vaccination and risk profiling, Baker says.

As soon as an infected person arrives in New Zealand, whatever you do, the risk of outbreaks increases.

Chen agrees home quarantine is unlikely to be a free-for-all, especially if the country still has an elimination goal.

It seems likely the Government will still restrict the number who can come into the country, because it's all risk. I don't think that adding GPS suddenly makes home isolation viable. Whether youve got GPS or not, somebody coming into the country is still risk that has to be accounted for.

ERIC GAILLARD

The Government is exploring alternative ways to welcome Kiwis home.

Skeggs Reconnecting New Zealanders advice found a shorter managed quarantine stay, coupled with week two testing, might be a better option than quarantine-free travel or home quarantine, at least to start with.

In the early phases of re-opening, a reduced time in an MIQ facility, say for 5 to 7 days, would seem more realistic.

Ardern this week announced the government is also investigating this option. Halving the MIQ stay would double the systems capacity overnight.

An April paper by the Te Pnaha Matatini modelling team estimated the effectiveness of 5-day managed quarantine. They found that, with low-moderate transmission within MIQ, about 25 per cent of infected travellers would still be infectious on leaving.

Thats much better than relying on pre-departure and arrival tests, which would weed out only about half of infections. But much worse than 14-day MIQ, from which only about 2 per cent of people would leave infectious, with moderate transmission within MIQ.

This still poses a very high risk to the community, the authors conclude.

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Every traveller arriving in New Zealand from overseas brings risk.

Covid modeller and Canterbury University mathematics professor, Michael Plank, says since February about 100 Covid cases have been detected in the second week of MIQ. Thats about 15 per cent of all MIQ cases.

However, those numbers might exaggerate the risk of shorter stays, as they would include people infected by family members, whose disease was detected in the first seven days. They could still be captured by 7-day MIQ, if the whole family bubble was transferred to 14-day quarantine when the first person tested positive.

Having returned to New Zealand to work for Stuff, Craymer has experienced both monitored home quarantine and New Zealands MIQ. While she appreciated MIQs access to an exercise yard, sleeping in her own bed and having her own stuff made the two-week home quarantine easier. The best thing was not being reliant on hotel food a source of many MIQ complaints. Cooking helped pass time, and you can eat what you want. (Though she still needed a day 10 emergency chocolate delivery).

Theres something in it, particularly for someone like me who is single and lives by myself ... I think the biggest problem is, everyone in the house has to quarantine.

The question will be how to manage the process while minimising the risk.

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MIQueue: What are the alternatives to two weeks in a hotel? - Stuff.co.nz

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