Dr Rawiri Taonui Covid Maori | All we need to know about the Trans-Tasman Bubble Risk

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The Quarantine Free Travel Trans-Tasman Bubble (TTB) with Australia that opened this week makes sense, at least on paper. New Zealand and Australia have lower Covid-19 cases than other Western countries. The number of active cases in MIQ in New Zealand has dramatically decreased from a record 108 on 11 April to 32 yesterday.

The introduction is also premature because it comes too early in our vaccination programme and new border protocols aiming to reduce positive cases from other high-risk countries are not fully embedded.

On Paper

The threat from Australia is lower than from other hotspot countries. The last positive case to arrive in New Zealand from Australia was in December. Apart from Victoria and New South Wales, states in Australia have managed Covid-19 very successfully. The Northern Territory has not had any deaths, and Queensland, with the same population as New Zealand, has had fewer cases and deaths.

The population-adjusted rate of infection for Indigenous Australians in Queensland is over six times lower than for Māori in New Zealand. Across Australia Covid-19 cases for Indigenous Australians are 21 per 100,000 (151 total) compared to 24 per 100,000 for Māori (203 total). Australia is vaccinating all Indigenous Australians over 50 years old as part of its Priority One Group alongside border workers. In New Zealand, Māori over 50 are in the Priority Four Group.

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Green Zone Travel

The TTB divides flights and travellers into those from Green Zones (New Zealand and Australia) and those from Red Zones (countries with higher numbers of Covid-19 cases). Passengers fly on different Green and Red flights and disembark along segregated routes through airport terminals.

Green Zone passengers cannot have been overseas during the previous 14 days. They must fill in pre-departure declarations showing where they will be staying during their visit. Passengers cannot fly if they have the flu or a cold. They are subject to health screening before departure. Health officials can deny boarding if they exhibit Covid-like symptoms. Passengers must wear masks in airports and on flights and be prepared for random temperature checks and further health screening upon landing. Flight crews cannot have flown recent higher risk routes.

Traffic Light Safety System

Management of outbreaks in either country will follow a traffic light system. If an outbreak is confined to the border and MIQ, flights will continue to run. Temporary suspension of air travel could follow if an event is from an unknown source. Larger occurrences will likely result in lockdowns and suspension of flights for a longer period. Travellers must prepare contingencies.

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Required Adjustments

On the first day of the bubble, a worker was infected after cleaning a Red Zone aircraft. They also cleaned a Green Zone plane. Reports say other airport staff were rostered to work both zones. This approach has obvious risks and will need to change.

Official websites in Australia and New Zealand recommend travellers watch for Covid-19 symptoms. The flu-like symptoms list is for the earlier strains of Covid-19. With new variants predominating, the list is out of date. Over the 60 days to 18 April, the variants B117 (Britain), B1351 (South Africa) and B1617 (India) were 49% of all cases in Australia and 81% of cases in New Zealand to 11 April. According to Public Health England, the symptoms for B117, the main variant in both countries, are more headache and muscle soreness than flu-like. An update is needed.

Numbers

The absence of a cap on numbers traversing the Tasman is a weakness. The overall risk of a Covid transfer between New Zealand and Australia is lower than the risk from Red Zone countries. Nevertheless, both New Zealand and Australia have had multiple breaches and failures at the border. More are certain. Between June and December last year, there were 10 breaches in New Zealand, and seven in the first four and a half months of this year.

If numbers transiting the Tasman proceed unchecked, they will by sheer volume amplify the existential low percentage risk into something significantly larger. In the first four days, 21,300 passengers at 5,300 per day traversed the ANZAC sea. The worst-case scenario is that someone boards a flight with Covid-19, they infect another passenger and someone at the airport such as a taxi driver. The three go their separate ways. One attends a sport or cultural event and there is a multi-location simultaneous outbreak.

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Vaccination

The TTB is premature. At the time of writing New Zealand had vaccinated 3.6% of the population. Of 183,300 people vaccinated, only 43,000 had received their second shot. Australia has vaccinated 7.3% of their population or 1.856 million people. This is insufficient coverage if there is a multi-site event. The Green Zone border procedures are generally good but will count for little in a widespread outbreak. A minimum community protective protocol would have scheduled the TTG for a vaccination level at least 50% of the population.

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Applying Lessons

To secure the bubble, New Zealand must reduce numbers entering from hotspot countries with high rates of Covid-19. Australia has used entry caps with success throughout the pandemic. Queensland, which has the same population as New Zealand has a cap of between 500 and 650 arrivals, New South Wales which is 60% larger than New Zealand has a cap of 430 arrivals per day.

New Zealand has been much less cautious. During the 3rd Wave, New Zealand allowed 2,800 to 3,200 entries per week. This drove up the number of active cases in MIQ. The cumulative effect precipitated the Pullman Hotel event and Papatoetoe Cluster.

The New Zealand government justified the higher number of arrivals, saying New Zealand citizens and permanent arrivals had a right to return to their country although the reality was that between April and December 2020 36.4% of arrivals were not citizens and 41% non-permanent residents.

This explains why New Zealand has managed more cases in MIQ than Australia. On the day, the bubble opened New Zealand had 102 active cases compared to 186 for all of Australia; with Australia, five times larger, the population equivalent is 37. This is also why New Zealand has a higher percentage of variants. The important Pullman and Papatoetoe lesson? Hypervirulent Covid variants penetrate our defences more easily.

MIQ Capacity

Maintaining stricter border controls over entries from higher-risk countries is crucial. What happens in one country can pop the bubble for both. Removing the requirement for travellers from Australia to quarantine will free up 1,300 rooms in MIQ facilities. The government will keep 500 as a reserve. The government should decommission inadequate facilities rather than fill them with entries from hotspot countries lest we find ourselves caught in a pincer between a Green Zone outbreak and a Red Zone border-MIQ leak.

High-Risk Countries

Yesterday, the Minister for the Covid-19 Response Chris Hipkins announced a new category of ‘Very High-Risk Countries’. Only New Zealand citizens will be able to travel from those countries. They must supply a verifiable negative test certificate from an ‘accredited laboratory’. The government believes this will reduce the number of positive cases coming across our border.

The Very High-Risk Group is a step in the right direction. Australia is also introducing a High-Risk Countries protocol. Anyone who has been in a high-risk country in the past 14 days, and is transiting through a third country, will need to return a negative test 72 hours at their last point of embarkation. Australia is also seeking rapid antigen testing for Australians at airports before boarding direct flights from high-risk countries. They have not finalised a list of countries but have announced a reduction in flights from India.

New Zealand’s Very High-Risk Group includes India, Brazil, Pakistan, and Papua New Guinea, one presumes because they are suffering significant rises in cases. It does not include any European countries although many are also experiencing higher numbers than Papua New Guinea. Britain operates a similar Red List currently naming 40 high-risk countries, including several that have contributed multiple cases to New Zealand over recent months.

The TTB makes sense on paper. It is also premature both based on the current low vaccinations in both countries and because the new high-risk country protocols are introducing are not yet embedded. Bubbles have been mounted before. Britain-Spain, India and 27 other countries, Estonia-Lithuania-Latvia. In each case the bubble burst.

Noho haumaru, stay safe and self-sovereign.

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