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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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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

Director General of Health

Nationwide

Designate an individual as critical to providing services to assist with the COVID-19 response, such that they are excluded from isolation/quarantine obligations

clause 4(1), definition of “excluded arrival”, sub-clause (d)

Chief Executive of MBIE (can delegate under State Sector Act s41)

Nationwide

Authorise an individual to leave managed isolation 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 comply with conditions

clause 8(2) and clause 8(3)

Determine conditions for an individual leaving MIQ for an exceptional reason

clause 8(2)

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

clause 9(1) and 9(2)

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Within individual managed isolation or quarantine sites

Determine whether an individual meets low-risk indicators (on the advice of a suitably qualified medical practitioner) and may be discharged from MIQ after 14 days

clause 7(3)(a)

Determine whether an individual meets low-risk 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

clause 7(3)(b)

Either nationally or at individual managed isolation or quarantine sites

Authorise a class of outdoor exercise clause 8(1)(a) Determine conditions for any class of outdoor exercise

clause 8(1)(a)

Chief Executive of MBIE (on advice of a Medical Officer of Health)

Within a managed isolation or quarantine site

Authorise an individual to leave MIQ, if necessary, to access medical services

clause 8(1)(d)

Require an individual to move to another MIQ site clause 8(1)(e) Require an individual to move to a temporary or emergency place of isolation or quarantine

clause 8(1)(e)

Consent to a caregiver/support person accompanying a child or other person leaving MIQ for a specified reason

clause 8(1)(i)

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Medical Officer of Health (may include Director-General of Health)

Individual managed isolation or quarantine sites

Designate a facility as a high-risk facility (quarantine) or low-risk facility (isolation)

clause 4(1), definitions of “high-risk facility” and “low-risk facility”

Medical Officer of Health or Health Protection Officer (may include Director-General of Health)

Within a managed isolation or quarantine site –people required to be there

Determine it would be inappropriate for an individual to be tested

clause 4(3)

Direct medical examination and testing of an individual at any time during MIQ

clause 7(1(c)

Direct wearing of PPE clause 7(1)(d)

Nationwide Determine whether an individual may self-isolate/self-quarantine away from a managed site, if necessary due to their physical or other needs.

Clause 7(5)(c)

Airport Determine whether an individual is placed in managed isolation or quarantine.

Clauses 7(5)(a) and (b)