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MIQ is dead, long live MIQ?

New Zealand’s Managed Isolation and Quarantine (MIQ) system served us well up until the delta variant outbreak started in August but it is no longer useful in its current form for protecting New Zealanders. Isolation was first used in February 2020 for repatriated Kiwis returning from Wuhan China, “ground zero” of the COVID-19 pandemic. In April 2020 the Director-General of Health issued an Order requiring those entering New Zealand to enter MIQ. Since then, more than 190,000 travelers have passed through our 32 MIQ facilities. About 1,400 people (less than 1%) have been identified with COVID-19 during their MIQ stay. While MIQ is a significant restriction of liberty the benefits for the country far outweighed the imposition on individuals. Put in place when COVID-19 was spreading rapidly elsewhere the purpose of MIQ was to prevent infected people entering an unvaccinated population which had no transmission. Purpose met. Job well done.

The country owes thanks to all those who have managed and staffed the MIQ system, not the least of whom have been those advising on appropriate infection control practices.

The context now though is drastically different. There is community transmission, even with an ever increasingly vaccinated population. Most infections are in the unvaccinated as the Delta seeks them out. While active local cases used to be sent to MIQ, now we have more than 2,000 in home isolation.

These changes have been acknowledged by the recently updated MIQ rules where the duration has been reduced to 7 days followed by home isolation and a negative day 9 COVID-19 test. This reflects an “abundance of caution” approach. However, this approach is now misplaced. The vaccinated and tested traveler will not have any impact on the current community transmission. An example shows why.

Let’s consider the almost 25,000 people wanting a MIQ voucher in last week’s ballot. Let’s assume that while all are vaccinated, they arrive over several weeks from a place with high COVID-19 transmission, eg. the USA or UK where the current rate for active infections is almost 1,100 cases per 100,000 people (275 cases for our 25,000 wanting a voucher last week). Now assume they all get tested twice, once before departure and once at home on day 5 after arriving. Vaccination halves infection risk and testing detects at least 85% of infections. In this scenario the number of people leaving home isolation with infection would be around three to six. This translates to comfortably less than one possible case per day exiting home isolation. This is immaterial compared to the ongoing 100-250 new cases a day. Vaccinated and tested travelers pose no discernable threat to unvaccinated New Zealanders nor would they set off chains of transmission that would swamp the hospital system.

Forcing vaccinated and tested citizens through MIQ is illogical. For those overseas wishing to come home, and those of us here wishing to travel, MIQ is redundant. The Director-General can safely issue a death certificate.

Given there is non-material risk are there any benefits for the demise of MIQ? In his column last week Matthew Hooton gave stark examples of the anguish currently experienced by those needing to come home. Abandoning their MIQ requirement would stop this torment. It will free up rooms for others, including those unable to isolate at home because of numbers or, importantly, the presence of high-risk people. For those who have received vaccines not deemed adequate or from countries where the veracity of vaccination or testing certificates are questionable, long live MIQ? We may need MIQ space for people for our wine crop, wool crop, horticulture, and agriculture. Professional services like accounting and computing, especially cyber security, are calling out for people to help meet our country’s needs. And all that is before we consider the demand for healthcare workers for our hospitals and especially for our most vulnerable, those in aged care facilities.

While vaccination does not prevent all infections and vaccinated people can transmit infection, vaccination is our key to “freedom”. Forthcoming new treatments will be welcomed additional tools, but it is vaccination, followed by an efficient booster program, which enable us to move into the upcoming COVID-19 Protection Framework.

The principles of the Health and Safety at Work Act 2015 are also relevant here. Actions taken to mitigate any risks must be reasonable and proportionate to that risk. And actions taken to mitigate risk must be based, wherever possible, on evidence. Mitigated risk is not required to be zero risk. For a vaccinated population, with ongoing community transmission of COVID-19, requiring MIQ for vaccinated and tested travelers to protect it is not risk based and is no longer justified. A date for stopping MIQ should be set now, and for the near future, to enable airlines and citizens to plan travel to and from our country.

​Dr Arthur Morris.

Arthur Morris is a pathologist, clinical microbiologist, with a long-term interest in infection prevention and control. He is the supervising pathologist for IGENZ.

In January 2021, IGENZ Ltd, a contracted testing laboratory, achieved IANZ accreditation for saliva testing using the Rako Science methodology, based on validation work that used a set of contemporaneously collected paired saliva and nasopharyngeal samples.

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