Health officers screen arriving passengers from China with thermal scanners at Changi International airport in Singapore (Photo by ROSLAN RAHMAN/AFP via Getty Images)
Health officers screen arriving passengers from China with thermal scanners at Changi International airport in Singapore (Photo by ROSLAN RAHMAN/AFP via Getty Images)

SocietyMarch 10, 2020

Covid-19: Why does screening at New Zealand airports differ from elsewhere?

Health officers screen arriving passengers from China with thermal scanners at Changi International airport in Singapore (Photo by ROSLAN RAHMAN/AFP via Getty Images)
Health officers screen arriving passengers from China with thermal scanners at Changi International airport in Singapore (Photo by ROSLAN RAHMAN/AFP via Getty Images)

Passengers arriving from China are not having their temperatures checked at the border, as in some countries. Here the Ministry of Health explains their rationale.

While temperature checks have become commonplace across countries such as China and South Korea – together responsible for the vast majority of the almost 110,000 cases reported worldwide – New Zealand citizens arriving home from the most affected countries are not having their temperature taken unless they say they’ve been feeling unwell, or staff detect visible signs of ill health.

Last week, Jacinda Ardern said an “aggressive approach” was being undertaken at airports, but one New Zealand citizen who arrived at Auckland International Airport yesterday after travelling from Beijing with a stopover in Seoul, was surprised there was not a stricter process.

The woman, who is now self-isolated and has no symptoms or illness, said that when she filled out a form detailing her travel she was “directed to a desk where they had coronavirus information in Mandarin, Cantonese, Korean and English. Then they directed me to a counter where I had to fill in a form, where I had to state that I had not been unwell. But then I just had to post the form into a bin, no one checked that I’d actually filled out all the details.”

She said: “No one was taking temperatures. I didn’t see any thermal cameras. At the final stage, where I filled in the form and posted it in the bin, they said, ‘you know you have to self isolate?’ But that was it. No guidance on what that meant.

“Frontline health people were not wearing masks. They were wiping the pens after use but that was it.

“In China and Korea there are people with no-contact thermometers everywhere. Airports, hotels, stores. They point them at your forehead or arm and get an instant reading.”

Under current travel restrictions, foreign nationals who have been in mainland China or Iran are banned from entering New Zealand. New Zealand citizens and permanent residents are requested to undertake 14 days self-isolation, as are all arrivals from Iran and northern Italy.

Responding to questions from The Spinoff, a spokesperson for the Ministry of Health stressed that information on Covid-19, symptoms, Healthline and the importance of self-isolation was distributed on cards provided on all incoming flights. “We have also asked airlines to make in-flight announcements to passengers to explain why the cards are being provided, at the same time the passenger arrival card information is announced.”

Health staff were active at Christchurch and Auckland international arrivals, he said. “Staff have been taking the temperatures of anyone who is feeling unwell and anyone with a temperature higher than 38 degrees Celsius will be referred for appropriate assessment. However, it’s important to stress that temperature checking for all passengers has in the past been found be ineffective as the incubation period for COVID-19 is up to 14 days.”

The information sheet distributed to passengers aboard the flight from Seoul to Auckland.

The World Health Organisation advice, said the spokesperson, was that “screening and quarantining entering travellers at international borders did not substantially delay introduction of the disease in past pandemics, except in some island countries”. As such the current public health response was “focused principally at national and community levels rather than international borders”.

The spokesperson added: “We still think, however, that the chances of a sustained community outbreak are low-moderate. We’re taking this very seriously and keeping individuals, families and our communities safe and healthy in the current global environment requires a team effort and that’s what we’re seeing across New Zealand.”

In comments on TVNZ Breakfast, Ardern pointed out that New Zealand’s border approach was stricter than in many countries. “It’s much more than you’ve seen in other places, and it is an aggressive approach.”

This is true. In Britain, for example, where the Covid-19 response has come in for continued domestic criticism, there is no restriction on foreign nationals arriving from China. Several countries are ramping up their border protections, however. Overnight Israel, for example, decreed that anyone entering arriving in the country from anywhere in the world need to isolate for 14 days.

The minister of health, David Clark, told TVNZ that those with a high temperature were “easy to spot”.

He said: “If somebody has Covid-19 in active phase, they’ve got a fever of 38, they can hardly walk. They’re easy to spot … If, for example, though the person is in the early phases, they don’t have any symptoms. They’re going to look just like you and I. Anybody could be in that position.”

On Q+A on Sunday, Clark added, “What we know about the virus itself is it’s typically associated with high fever. And those people don’t look well. We have medical experts at the borders looking out for people who don’t look well. But we also know that people are not being allowed on to flights from those hot spots if they are unwell.”

China, South Korea, Italy and Iran between them account for 93% of the almost 110,000 reported cases across 100 countries, according to a World Health Organisation briefing this morning.

Director-general Tedros Adhanom Ghebreyesus said that the outbreak was getting close to being classifiable as a global pandemic.

“Now that the virus has a foothold in so many countries, the threat of a pandemic has become very real,” he said. “But it would be the first pandemic in history that could be controlled. The bottom line is we are not at the mercy of the virus.”

Irrespective of its status, he said, “the rule of the game is the same – never give up.”

He noted that China and South Korea were both witnessing a decline in new cases, while Italy had dramatically increased measures, all but banning travel from the northern part of the country. “We are encouraged that Italy is taking aggressive measures to contain its epidemic and we hope that those measures prove effective in the coming days.”

The New Zealand government announced yesterday new powers to quarantine arriving ships or planes.

As of yesterday, 274 tests for Covid-19 had been completed in New Zealand, with five positive results. There are two further cases deemed “probable”. To date there has been no detected community transmission, with the only local transmission within family households.

The Ministry of Health has announced a scaling up of testing ability, with an Auckland laboratory this week to increase capacity from 60 tests a day to as many as 750.

Keep going!
Photo: iStock
Photo: iStock

SocietyMarch 9, 2020

Hospitals are already short-staffed. Covid-19 could stretch them to the limit

Photo: iStock
Photo: iStock

It’s difficult enough caring for coronavirus patients, but when healthcare providers become sick themselves, or are forced into self-quarantine, it becomes even harder to cope. So how is New Zealand preparing for staff shortages in the health system?

News that 43 hospital staff have been put into self-quarantine after coming into close contact with a patient who tested positive for Covid-19 has highlighted the enormous pressure the health system could find itself under as a result of the virus. If one patient can put more than 40 healthcare workers and other essential staff into quarantine, how will hospitals cope with a serious nationwide outbreak? That was one of the big questions at a media conference on Saturday, when the Ministry of Health’s director-general of health Ashley Bloomfield attempted to allay fears about the ability of the health system to cope.

Warnings that New Zealand’s hospitals are understaffed and under-resourced are not new. The Public Services Association, the union representing workers in a large number of healthcare sectors, has repeatedly argued that chronic understaffing is putting patients at risk, while healthcare professions including GP, lab technician, emergency medical specialist and anaesthetist have remained on Immigrations NZ’s skills shortage list for years.

As DHBs prepare for Covid-19, those concerns remain. “We are stretched. We are really stretched,” Dr Deborah Powell, national secretary for the New Zealand Resident Doctors Association, told Stuff. “It’s not just our doctors and nurses, it’s our laboratory staff and our radiologists.”

Covid-19 experts agree. “We have excellent public health professionals in New Zealand, but we have to be honest that we don’t have enough for this task,” wrote Dr Ayesha Verrall, an infectious diseases physician and epidemiologist at the University of Otago.

A number of vulnerable frontline staff, including those who are pregnant or immune-compromised, have already been put on special leave so they aren’t exposed to the virus.

Auckland Hospital and Starship Childrens Hospital (Photo: Phil Walter/Getty Images)

So what is the government doing to ensure DHBs have the people they need – not just to cope with the increased workload, but to replace staff forced into self-isolation by exposure to the virus? Bloomfield said that a range of responses were being formulated, including talking to the Medical Council and the Nursing Council about ways to accelerate the recertification process for both doctors and nurses, to allow those who have recently retired from the profession to quickly return to their jobs if required. He did not mention any plans to up the numbers of lab staff and other technicians, a more difficult task given that there is already a nationwide skills shortage in these areas.

If a British survey of recently retired staff in their National Health Service is a guide, however, willingness among former staff to return to work is not to be taken for granted.

It’s not only DHBs that are facing staff shortages – rest homes could find themselves under severe strain if Covid-19 takes hold. The risk of death among those aged 70 or above is around three times the overall death rate and residential care homes are likely to be ground zero for any full-blown coronavirus outbreak. Kerikeri Retirement Village chief executive Hillary Sumpter told RNZ Checkpoint that beyond the known risks to residents, sickness and quarantine pose a real threat to safe staffing levels.

“A lot of our people are at hospital level care which means they need two people to assist them in their daily living at all times. So we would have people in very dire circumstances if we didn’t have staff,” she said.

Aged Care Association chief executive Simon Wallace told Checkpoint that while rest homes had plans in place for outbreaks of influenza or norovirus, Covid-19 is a whole new ball game, one that required a national-level response plan for the aged care sector. But there had been little communication from either DHBs or the government, he said. To put it bluntly, “they are ignoring us.”

The Ministry of Health says it has asked individual DHBs to liaise with rest homes in their area, and include them in their planning.

There’s another sector of the health system where a lack of staff could make a real difference to how well New Zealand deals with the outbreak. Healthline – 0800 358 5453 – is the most frontline of all ‘frontline’ services in the fight against Covid-19. This is the number to call if you are concerned you have been exposed to the virus, or worry you may have it already, or just want information on what symptoms to look out for (although it’s recommended that you visit the Ministry of Health’s Covid-19 information page first). As the general public’s first line of defence, the service is under strain already and could become even further stretched in the case of a widespread contagion.

However Bloomfield said he’s confident that Healthline will be able to cope. A significant number of new recruits are currently being trained up to take calls, he said, and the service can also call on DHB staff as back-up advisors. Pointing to the increased demand on Healthline’s mental health service following the Christchurch attacks, and during the recent measles outbreak, he said that the service has shown it could quickly “surge up” capacity if needed. One reason that’s relatively easy to do: Healthline staff can take calls from wherever they are, including from the place they live – making it perhaps the ideal job for anyone finding themselves unexpectedly marooned at home for up to 14 days.