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Securing NZ Quarantine And Managed Isolation Facilities – Expert Reaction

 

Recent escapes from managed isolation facilities have drawn attention to security and compliance among returning New Zealanders.

But with many more Kiwis expected to return to New Zealand in the coming weeks, quarantine and managed isolation facilities are facing increased pressures.

The latest escape from an Auckland hotel comes as Melbourne re-enters lockdown conditions following a surge in cases, including some linked to infection control breaches in quarantine facilities.

The SMC asked experts to comment on the security of NZ border facilities.

Professor Nick Wilson, Department of Public Health, University of Otago, comments:

“Border controls are what are keeping NZ safe from this pandemic – given we have eliminated transmission of the COVID-19 virus in NZ. There have been system failures recently with people leaving quarantine due to inadequate fencing and security. All systems should be designed to account for the whole range of human behaviour – including people who don’t follow the rules. So it is far more important to think in terms of system failures than to focus attention on individuals who behave ‘badly’.

“In terms of lessons from overseas, NZ needs to learn all the lessons possible from the apparent failure of quarantine systems in Melbourne (which has resulted in a return to lockdown). NZ could also explore the benefits and costs of the use of electronic bracelets for people in quarantine (e.g. as used in Hong Kong).

“Other surveillance technologies could be used to ensure appropriate mask use in quarantine. Digital tools could also be used to monitor early signs of illness amongst those in quarantine. For example, some wearable devices can potentially detect changes in temperature and heart rate, and so alert individuals (or quarantine management) of potential illness developing before overt symptoms appear. One NZ software company has actually developed an app (ëlarm) that can harvest data from a range of wearables to provide such early warning information.”

No conflict of interest.

Dr Ian de Terte, Senior Lecturer and Clinical Psychologist, Massey University, comments:

“There has been discussion in the media that there may be an increased police presence at the managed isolation facilities. If police are utilised as a measure to get the small percentage of people who are breaching the rules to conform, then there may be several outcomes. I want to point out that human behaviour is very hard to predict, but there are some comments on the proposed utilisation of police staff at these managed facilities that I want to address.

“There are a small minority of people who are breaching the rules. I think that the people in charge need to keep repeating the rules of self-isolation and the testing regime. In addition, they need to reinforce why this strategy is important and need to update the public on the current information available from the World Health Organisation. Some people think we have ‘beaten’ this virus so they do not need to self-isolate; whilst others may think that ‘I do not have the virus’. I think it is important that we lead our life like we have the virus, or the virus may reappear in New Zealand. This pandemic is far from over and we are very lucky in New Zealand, but we need to be continually vigilant and keep repeating the rationale of the point of self-isolation.

“There will be some people that think that bringing the police into a self-isolation facility to manage the few who appear to be breaking the rules is the correct move. However, the increased police presence may increase the anxiety for those individuals that are abiding by the rules. If the government uses the police to ‘enforce’ the rules and this method does not work, there are no other options available to them. It appears that this breach of the rules has been considered in quite a black and white problem-solving approach. There should be other methods used to get individuals to adhere to the rules before the police are utilised.”

Conflict of interest: Ex-member of the New Zealand Police.

Dr Dougal Sutherland, Clinical Psychologist, Victoria University of Wellington and Umbrella Health, comments:

“The recent ‘escapes’ from managed isolation may reflect a different mindset of people returning to New Zealand. Those of us who were here during lockdown developed a unified sense of identity: the team of 5 million working together to beat the virus. Since the end of lockdown these messages of oneness and unity have dropped off markedly, meaning that recent returnees may not have this shared sense of purpose and identity.

“The solution may be to have a targeted campaign aimed at new returnees to bring them into the nation-wide whānau. It is also possible that prosecuting a few escapees may have a deterrent effect.

“An increased police presence at quarantine facilities is likely to heighten the sense of those in quarantine that they have lost their liberty and could be regarded as a threat to others’ wellbeing. This sense of isolation and vulnerability could have a detrimental effect on the mental wellbeing of those in quarantine, with heightened levels of stress, anxiety, and low mood a real possibility.”

No conflict of interest.

Dr Amanda Kvalsvig, Senior Research Fellow, Department of Public Health, University of Otago, Wellington, comments:

“We can look carefully at other quarantine models and share experiences internationally, but this is a new pandemic and New Zealand’s situation is unusual. In many ways this is about problem-solving from first principles, and New Zealanders are good at that. Good systems are also constantly evaluating their own experience to refine their risk management strategies and we can expect our border management systems to be learning and evolving for some time to come.”

“The system will work best when there’s good communication and a clear process, and when those in quarantine feel supported and are supporting one another. When there’s a strong sense of community and a common goal, it’s much easier for people to do the right thing. We know this approach works because we saw it happen during lockdown, when the whole country came together to eliminate the virus.

“Depending on people’s life experience, they may feel reassured by increased police presence or they may feel very unsafe. The police will be aware of these dynamics and will have strategies to manage them.”

No conflict of interest.

Professor John Hopkins, Professor of Law specialising in Law and Disasters, University of Canterbury, comments:

“The recent examples of individuals absconding from quarantine and managed isolation facilities again raises a number of important questions around whether the legal framework under which New Zealand is operating in response to the CoVID-19 crisis is “fit for purpose”. The issue revolves around the application of the traditional methods of Criminal Law to enforce the current system.

“The quarantine system thus relies upon the physical difficulty of evading the detention, the threat of criminal sanction (which will be applied after the event – after the horse has bolted so to speak) and the compliance of those within the quarantine. The recent evidence suggests that although most will comply, for a few this is not enough and in the current crisis, it only takes a few to re-ignite an Emergency.

“Although the Orders allow for individuals to be delegated with the authority to enforce them, at present this authority only lies with the Police, who will now be present at all quarantine facilities. This will result in a significant strain on Police manpower and consideration should be given to delegating such authority to others and perhaps, longer term, re-assessing how to manage public order in emergencies.”

No conflict of interest.

Professor Dave Parry, Head of Department of Computer Science, Auckland University of Technology, comments:

“Positive identification and location approaches for managing people in isolation and quarantine facilities include:

  1. Phone-based approaches using Bluetooth beacons to identify location of the phone – in this case of course you know where the phone is rather than the person, so this doesn’t work for deliberate absconding
  2. There are some interesting ‘teen tracking’ apps – a worryingly long list
  3. There are similar systems for use with people with dementia
  4. In/out checking using swipe card information and/or QR code reading – basically setting up the quarantine area so that you have to identify yourself to leave. There is a lot of existing software out there for this, mostly used in dangerous work environments to check who is present. You can get wearable Bluetooth beacon systems too.
  5. In the extreme case, using home detention ankle bracelets may be an option that has to be considered for people at risk of deliberate absconding

“Overwhelmingly this is a system issue – the more robust the system the less oppressive the controls have to be. I would be perfectly happy with a phone tracking system being used if it meant I was able to move round a comfortable environment and exercise etc. in a safe place. The basic technology needs are:

  1. A simple, easily accessible and understandable location reporting system for the managers of the facility. RFID-based approaches – often known as real-time location systems – can use the Wi-Fi in the building for location, and everyone carries a tag. This maps location and gives you a record of where people have been. This is also really useful if you need to identify interactions within the facility for transmission tracing.
  2. Robust identity management. I believe the NHI (National Health Index) is being used. Everyone should have an NHI that is recorded. GPs and others should have access to this system so that if a patient turns up with symptoms they can be immediately checked to see if they have been through a border and which location they have been quarantined.
  3. The same in reverse – if someone has contact with the health system and has positive symptoms then the GP should be able to send their NHI to the border control/quarantine system to check f they have been in quarantine or in contact with someone who has.
  4. A simple app recording location via QR code, asking about symptoms and pushing out advice is very easy to implement.

“The argument about privacy in many of these cases is often simply a cover for poorly-designed systems and reluctance to collaborate. This has been true for many years (see the Simpson report and research by a student here at AUT). There is absolutely no problem in having a clear consent process that allows NHI to be used to confirm identity.”

No conflict of interest declared.

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