Guidance to support implementation of the COVID-19 Public Health Response (Air Border) Order 2020

 
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Guidance to support implementation of the COVID-19 Public Health Response (Air Border) Order 2020
Guidance to support implementation
of the COVID-19 Public Health
Response (Air Border) Order 2020
14 JULY 2020

Purpose
This guidance supports agencies involved in the operation of border processes or responsible for managed
isolation and quarantine facilities to apply a consistent approach to implementing the COVID-19 Public Health
Response (Air Border) Order 2020.

The guidance has been developed in conjunction with MBIE and in consultation with other operational
partners – Customs, Police, Defence, MPI, MoJ, and Aviation Security.

Principles
1. The overarching principle is to protect the wider New Zealand community by requiring returning travellers
   to be isolated from others for a minimum of 14 days from the time of arrival, irrespective of their previous
   travel locations.
2. Core public health principles remain central to the effort for preventing transmission of COVID-19. These
   include:
       a. ensuring good hygiene practices
       b. maintaining physical distancing of 2 metres between people, and using PPE correctly when this
            distance cannot be maintained
       c. being alert to, and acting on, any signs or symptoms of COVID-19 to prevent its spread.
3. Agencies and people responsible for managed isolation and quarantine facilities have a responsibility for
   the care of residents in those facilities. This responsibility requires that the residents’ wider wellbeing
   needs (including both mental and physical health and wellbeing) are met, and that there are suitable
   transition arrangements in place when residents leave the facility.

Context
The COVID-19 Public Health Response (Air Border) Order 2020 came into force at 11.59pm on 22 June 2020.
The Order replaces the one made on 9 April 2020 under section 70(1)(e), (ea), and (f) of the Health Act 1956,
as amended and extended by an Order made under section 70 of the Health Act 1956 on 11 May 2020. This
Order is what requires people to go into quarantine or managed isolation upon arrival in New Zealand from
overseas by air. It will remain in effect until 24 September 2020. The Order is further amended by the COVID-
19 Public Health Response (Air Border) Amendment Order 2020 which comes into force at 11.59pm on 13 July
2020.

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Guidance to support implementation of the COVID-19 Public Health Response (Air Border) Order 2020
From 11.59pm on 13 July the Chief Executive of the Ministry of Business, Innovation and Employment (MBIE)
assumes responsibility for the operationalisation of the MIQ system. This means that many functions
previously exercised by the Director-General of Health, are now the responsibility of the Chief Executive of
MBIE.

The new Order explicitly addresses the following issues:

   •       medical examinations
   •       testing
   •       isolation and quarantine requirements
   •       excluded arrivals (those individuals for whom this Order does not apply).

The Order seeks to strengthen a range of functions and requirements associated with managed isolation and
quarantine for air arrivals. It aims to provide for a seamless system that prevents the spread of COVID-19
while meeting the government’s responsibility for care of the temporary residents in these facilities. A range
of updated provisions has been included. The main change in this Order is that everyone arriving in New
Zealand by air (other than a few rare exceptions) are required to submit to medical examinations and testing:

   •    as soon as possible after they arrive in the country (which is currently the case); and
   •    as directed by a Medical Officer of Health, or Health Protection Officer, at any reasonable time during
        their isolation or quarantine period; and
    •   before they exit managed isolation or quarantine after a minimum stay of 14 days.

Under the new order, power is granted to the Chief Executive of MBIE to make most operational decisions.
However, those decisions must still consider the public health rationale and implications, as confirmed by the
Director-General of Health. The aim of this arrangement is to ensure that MIQ facilities are still run with
protecting the public’s health as their core guiding principle. The Director-General of Health will be
accountable jointly to the Minister of Health and the Minister of Housing on the advice provided to support
key operational decisions.

Under the new order, the Director-General of Health will also retain responsibility for a specified range of
public health decisions and retains all the powers of a Medical Officer of Health. This means he/she will
continue to be responsible under the new order for:
   • setting and reviewing public health standards and guidelines,
   • designating people as critical to provide services that will assist with the COVID-19 response,
   • designating facilities as high risk facilities or low risk facilities,
   • directing people in isolation or quarantine to submit to isolation or quarantine, and
   • (along with Health Protection Officers) directing people to wear personal protective equipment.

Frequently asked questions
What does the Air Border Order do?
Physical distancing
   •    People in isolation must stay 2 metres away from other residents at all times, apart from people they
        are isolating with who are in their “isolation bubble” (their “fellow residents”).

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Testing
   •      People in mandatory isolation or quarantine facilities can be required to have a COVID-19 test at any
          reasonable time on arrival and during their stay (for example, people should not be disturbed
          overnight during their stay in facilities to be tested because that would not be ‘reasonable’).
              o People should be tested at least twice unless it would be inappropriate for them to be tested.
                  The testing should be on or around day 3 and on or around day 12 of their stay.
              o If a resident does not consent to be tested early in their stay (on or around day 3) or agrees to
                  only one test, it will be difficult to be sure they meet the low-risk criteria by day 14, and they
                  may then be required to stay for longer and potentially up to 28 days.
              o If a person does not meet low-risk criteria after 28 days, they might be placed in other
                  facilities, a hospital or other arrangements made under the Health Act.
              o A resident of these facilities will not be tested for COVID-19 if testing is inappropriate due to
                  the person’s particular physical or other needs (eg, due to mental health or disability
                  concerns). In these situations, other measures will be taken to ensure they do not exit a
                  facility before a medical officer is satisfied that they are a low risk of spreading COVID-19.
              o If a resident tests positive, they cannot be considered “low risk”, and if they are in a managed
                  isolation facility they should be transferred to a quarantine facility. They should not be given
                  permission to leave until they meet the low-risk indicators.

Permission to leave
   •      Permission for people to leave managed isolation or quarantine before the 14-day period ends (eg,
          permission under exceptional circumstances) may only be granted where medical tests and
          information indicate a person is at low risk of having or transmitting COVID-19. This is the same test
          that applies for determining whether someone should be released at the end of the required 14-day
          managed isolation or quarantine period.
              o No person will be permitted to leave quarantine or isolation until the Chief Executive of MBIE
                 on the advice of a suitably qualified health practitioner, is satisfied they have met low-risk
                 indicators for having, or transmitting, COVID-19. This includes the need to test negative for
                 COVID-19 before their proposed departure date.
              o The only exception to this would be if a Medical officer of health determined that it would be
                 inappropriate for a person to be tested. For example, if they are under 6 months of age or
                 there are mental health or disability concerns involved. Where this occurs, the person would
                 still need to meet all other criteria that deem them low risk before they can exit the facility.

Authorised travel
   •      There is no longer a provision in the Order for ‘authorised travel’ for people permitted to leave
          facilities. This is because domestic travel restrictions are no longer in place, so this is not necessary.

Merging bubbles
   •      To allay concerns about transmission in facilities, when a new resident joins another person to isolate
          or quarantine with them, the ‘clock’ of their 14-day isolation period restarts for all in that shared
          isolation. This ensures all people within the bubble have been isolated from new transmission risks for
          the intended 14 days.
              o The requirement to restart the clock should be explained to anyone considering merging
                  bubbles in isolation. This knowledge may deter some people joining together to isolate. The

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implications for their wellbeing should be considered and discussed with them prior to the
              merge.
          o   Isolation bubble size should be kept as small as possible.
          o   All members of all isolation bubbles should be recorded and carefully monitored throughout
              their stay and Covid-19 tested prior to release.

Caregivers
  •   Caregivers who are approved by the Chief Executive of MBIE to join a child in managed isolation or
      quarantine are also subject to the Order. This is to ensure that caregivers do not break the isolation
      or quarantine barrier, and risk spreading COVID-19, by entering and then leaving the facility again.
          o If the caregiver has not travelled internationally in the last 14 days, there is no need to reset
             the 14-day isolation period when they join an isolation bubble.
          o Other people who require caregivers or special arrangements to manage their health and
             wellbeing may be approved by a Medical Officer of Health to be isolated or quarantined at a
             separate site, based on their needs.

PPE
  •   If a resident is directed by a Medical Officer of Health or a Health Protection Officer to wear personal
      protective equipment (PPE), they must do so. They should be supplied with appropriate PPE and
      supported to correctly put it on, take it off, and dispose of it.

Temporary leave
  •   Residents can only temporarily leave their facilities for specific purposes. For example, this might
      include:
          o enabling them to engage in planned outdoor exercise, which is authorised by the Chief
               Executive of MBIE
          o as a matter of emergency (which may not necessarily be temporary) to preserve their own life,
               or another person’s life or safety
          o if remote attendance is not available, to attend a court or tribunal if required to attend in
               person
          o to access medical services as deemed necessary by the CE of MBIE on the basis of advice of a
               Medical Officer of Health or Health Protection Officer
          o if they need to be moved securely to a different facility.
  •   Under all these circumstances, where departure from isolation or quarantine facilities is required,
      careful arrangements must be put in place to minimise the risk of COVID-19 transmission.
          o Arrangements to avoid the need for people to leave the facilities should be considered in the
               first instance, eg, remote attendance at court proceedings.
          o   The best place for those needing active treatment for a medical condition is in a DHB hospital.
              Patients should not be discharged back to a mandatory isolation or quarantine facility unless
              they can be safely managed there.

What can a person in an isolation or quarantine facility be required to do, and by
whom?
  •   The Medical Officer of Health and Health Protection Officers have the authority to direct residents to:

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o      submit to medical examination and testing when requested to do so (as long as this is
                “reasonable” – eg, not in the middle of the night)
          o use PPE if directed
  •   The Chief Executive of MBIE has the authority to direct residents to:
          o Maintain physical distancing of at least 2 metres with people who are not their fellow
                residents (members of their isolation bubble)
          o Move securely to another isolation or quarantine or to a temporary facility. (The Chief
                Executive of MBIE must have regard to the advice of a Medical Officer of Health).
  •   The Chief Executive of MBIE authorises and determines the conditions for outdoor exercise able to be
      undertaken by people in the facilities.
  •   A full list of accountabilities for managed isolation and quarantine facilities is attached as Appendix
      One.

Who is exempt from the requirement to enter isolation or quarantine facilities for
at least 14 days?
  •   Groups previously exempt continue to be so under the renewed Order. These are:
          o Foreign diplomats, consular staff and their families. However, if they choose to enter
              managed isolation or quarantine facilities managed by the New Zealand Government, they
              will be strongly encouraged to voluntarily comply with COVID-19 testing and stay within the
              facilities for 14 days (as will anyone else who has the same immunity to jurisdiction under the
              Diplomatic Privileges and Immunities Act 1968 or the Consular Privileges and Immunities Act
              1971).
          o Air crew and pilots, maritime crew members who are transferring immediately to a vessel, and
              medical attendants assisting with medical air transfers.
          o Anyone the Director-General of Health designates as critical to provide services to assist with
              the COVID-19 response.
  •   In addition, the Order now excludes from isolation or quarantine requirements any person who is a
      member of the defence force and returning from service outside New Zealand.

Why are people classed as ‘low risk’ or ‘high risk’ for COVID-19 spread?
  •   The aim of classifying people as ‘low risk’ or ‘high risk’ relates to how likely they are to have or
      transmit COVID-19, and thus how they should be managed to avoid this. This naturally has
      implications for where they are accommodated.
  •   If someone was originally thought to be low risk, and there is evidence from health screening that
      they may be high risk, a Medical Officer of Health can transfer them from a managed isolation (low
      risk) facility to a quarantine (high risk) facility.
  •   The Order defines low risk indicators as a negative COVID-19 test and a health assessment that shows
      the person is at low risk of having or transmitting COVID-19.

What if somebody doesn’t want to be tested for COVID-19?
  •   People in mandatory isolation or quarantine facilities can be required to have a COVID-19 test at any
      reasonable time on arrival and during their stay (for example, people should not be disturbed
      overnight during their stay in facilities to be tested because that would not be ‘reasonable’).
  •   It should also be explained that COVID-19 testing does not always have to involve a nasal swab.
      Under section 7 of the Order, medical examination and testing can include taking a person’s

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temperature, seeking information on symptoms, carrying out chest auscultation (using a stethoscope
      to assess airflow through the chest) and taking mouth and/or nose swabs. The person would still need
      to meet the criteria of low risk to be able to leave the facility.
  •   The detailed requirements of testing are as follows:
          o People should be tested at least twice unless it would be inappropriate for them to be tested.
              The testing should be on or around day 3 and on or around day 12 of their stay.
          o If a resident does not consent to be tested early in their stay (on or around day 3) or agrees to
              only one test, it will be difficult to be sure they meet the low-risk criteria by day 14, and they
              may then be required to stay for longer and potentially up to 28 days.
          o If a person does not meet low-risk criteria after 28 days, they might be placed in other
              facilities, a hospital or other arrangements under the Health Act.
          o A resident of these facilities will not be tested for COVID-19 if testing is inappropriate due to
              the person’s particular physical or other needs (eg, due to mental health or disability
              concerns). In these situations, other measures will be taken to ensure they do not exit a
              facility before a medical officer is satisfied that they are a low risk of spreading COVID-19.
          o If a resident tests positive, they cannot be considered “low risk”, and if they are in a managed
              isolation facility, they should be transferred to a quarantine facility. They should not be given
              permission to leave until they meet the low-risk indicators.
  •   While compliance with testing is preferable, there are some measures available under the Order to
      enforce the testing requirement prior to exit. These are:
          o If a person chooses not to be tested, they may be required to stay in managed isolation or
              quarantine longer, in order to minimise the risk of spreading COVID-19 to the wider
              community.
          o It is an offence under the COVID-19 Public Health Response Act 2020 to refuse to submit to a
              test that is requested:
          o A person who intentionally fails to comply with a requirement under an Order is committing
              an offence under section 26(1) of the COVID-19 Public Health Response Act 2020 (the Act)
              and is liable on conviction to a penalty of imprisonment for a term not exceeding 6 months or
              a fine not exceeding $4,000.
          o Alternately, if they intentionally fail to comply with a requirement of an enforcement officer,
              then they will be committing an offence under section 27(2) of the Act and liable on
              conviction to the same penalty.

What happens if someone doesn’t want to leave the facility (despite meeting the
low-risk criteria)?
  •   A person who is reluctant to leave a facility but has met all low-risk indicators should not stay in a
      facility once the determination has been made that they are no longer required to be there (having
      met low-risk criteria after 14 days or more, or after 28 days elapses).
  •   As part of the responsibility for care required of the agency(ies) managing the facilities, inquiries into
      their wellbeing should be made early in their stay and the necessary support made available so that
      they can easily transition out of the facility.

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Process
The following diagram shows the key points in the managed isolation and quarantine process from the time a
passenger disembarks from their international flight into New Zealand to the time they depart the mandatory
isolation or quarantine facility.

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Appendix One
Table 1: Delegations/devolved accountabilities under Air Border Order

   Responsibility     Location           Accountabilities                                             Section of Order
                                            Designate an individual as critical to providing          clause 4(1), definition of “excluded arrival”, sub-
   Director                                 services to assist with the COVID-19 response, such       clause (d)
   General of            Nationwide         that they are excluded from isolation/quarantine
   Health                                   obligations

                                             Authorise an individual to leave managed isolation       clause 8(2) and clause 8(3)
                                             or quarantine (MIQ) for an exceptional reason. Must
                                             take into account risk of an outbreak or spread of
                                             Covid-19, be satisfied the individual meets low-risk
                                             qualifications, and be satisfied the individual will
   Chief Executive
                                             comply with conditions
   of MBIE (can
   delegate under        Nationwide
                                             Determine conditions for an individual leaving MIQ       clause 8(2)
   State Sector Act
                                             for an exceptional reason
   s41)

                                             Authorise a caregiver to enter MIQ to care for a child   clause 9(1) and 9(2)
                                             (subject to the need to be isolated or quarantined
                                             with that child and meeting the same requirements
                                             of this guidance)

                                                                                                                                                            1
Within              Determine whether an individual meets low-risk           clause 7(3)(a)
                  individual          indicators (on the advice of a suitably qualified
                  managed             medical practitioner) and may be discharged from
                  isolation or        MIQ after 14 days
                  quarantine sites    Determine whether an individual meets low-risk           clause 7(3)(b)
                                      indicators (on the advice of a suitably qualified
                                      medical practitioner) and may be discharged from
                                      MIQ after 15-28 days

                                      NB. Includes determining the length of any extended
                                      MIQ, which should be reviewed on a daily basis and
                                      is possible under the Health Act
                  Either nationally   Authorise a class of outdoor exercise                    clause 8(1)(a)
                  or at individual    Determine conditions for any class of outdoor            clause 8(1)(a)
                  managed             exercise
                  isolation or
                  quarantine sites
                                      Authorise an individual to leave MIQ, if necessary, to   clause 8(1)(d)
                                      access medical services
Chief Executive
                  Within a            Require an individual to move to another MIQ site        clause 8(1)(e)
of MBIE (on
                  managed             Require an individual to move to a temporary or          clause 8(1)(e)
advice of a
                  isolation or        emergency place of isolation or quarantine
Medical Officer
                  quarantine site     Consent       to   a   caregiver/support   person        clause 8(1)(i)
of Health)
                                      accompanying a child or other person leaving MIQ
                                      for a specified reason

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Medical Officer                       Designate a facility as a high-risk            facility   clause 4(1), definitions of “high-risk facility” and
of Health (may    Individual         (quarantine) or low-risk facility (isolation)              “low-risk facility”
include           managed
Director-         isolation or
General of        quarantine sites
Health)
                  Within a           Determine it would be inappropriate for an                 clause 4(3)
                  managed            individual to be tested
Medical Officer
                  isolation or
of Health or
                  quarantine site    Direct medical examination and testing of an               clause 7(1(c)
Health
                  –people            individual at any time during MIQ
Protection
                  required to be     Direct wearing of PPE                                      clause 7(1)(d)
Officer (may
                  there
include
                  Nationwide         Determine whether an individual may self- Clause 7(5)(c)
Director-
                                     isolate/self-quarantine away from a managed site, if
General of
                                     necessary due to their physical or other needs.
Health)
                  Airport            Determine whether an individual is placed in               Clauses 7(5)(a) and (b)
                                     managed isolation or quarantine.

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