One of the toughest lockdowns in the world saw New Zealand eliminate COVID-19 last year, but our new "low-key" approach to keeping it out means we might have to do it all again, a leading epidemiologist has warned.
The Government announced new measures on Tuesday, including stricter isolation rules on arrival and the rollout of pre-departure testing, starting with the UK and US - where the virus is rampant. It's a shift in strategy, Director-General of Health Ashley Bloomfield as recently as October saying it wasn't necessary.
COVID-19 Response Minister Chris Hipkins this week said with the emergence of new more infectious variants it's become necessary, and with more countries bringing in pre-departure testing, easier for passengers to access.
"If only New Zealand was doing it, it would actually be very difficult for people to comply," he told reporters on Tuesday.
Michael Baker, professor of public health at the University of Otago, says it's a step in the right direction but won't achieve much.
"A test of course helps, but the testing is quite limited in many ways - it only detects whether a person is infected at that point in time, and if you get the test three days before you get on the flight, a lot can happen between when you have that test and when you get on the flight," he told Newshub.
"We're suggesting we need a much more systematic approach - that could involve a brief period of hotel quarantine at the airport and the use of rapid testing when you check into that hotel and a few days later before you get on the flight. That would greatly turn down the tap in terms of the flow of infected people from those countries."
A new study into the effectiveness of rapid saliva tests for COVID-19 found while they weren't quite as accurate as the intrusive nasopharyngeal swabs more than a million Kiwis have undergone to date, they're close enough - they're also much quicker and can be self-administered.
Statistics from the Ministry of Health and Customs showed about 0.8 percent of people crossing the border into New Zealand would go on to test positive for the SARS-CoV-2 virus - so far in January it's been 1.3 percent.
Dr Baker was made a member of the New Zealand Order of Merit at the end of last year for his work on COVID-19. A number of times he made predictions about the virus that would later turn out to be true - such as asymptomatic transmission - and would often push for new measures the Government would adopt weeks or months later - including masks public transport.
He first publicly advocated for pre-departure testing and quarantine for countries with large outbreaks as far back as October, before the infectious UK variant was discovered.
If pre-departure tests and quarantine fails to stem the flow of infected arrivals, Dr Baker says we should consider a complete ban on flights from the UK, US and South Africa for the time being. The US has the worst COVID-19 outbreak in the world, while the UK and South African outbreaks have gone into overdrive thanks to mutated versions of the virus.
"It might be that this is a time that the Government needs to seriously think about banning flights from the US and the UK until the situation improves there," Dr Baker's colleague Nick Wilson, a professor of public health, said on Tuesday.
The variants all have a mutation which makes the virus between 40 and 80 percent more infectious, while the South African and Japan/Brazil strains also have a mutation that appears to help it avoid the body's immune system.
"Many countries now have suspended travel from the UK, South Africa and parts of the US just as a way of managing this threat," said Dr Baker.
"This next stage may be the most dangerous for New Zealand. The risk of importing the virus is now higher than it's been for months. Obviously we've got vaccines on the horizon, but they won't start to have a big impact for several months. That's the situation we're in...
"To sustain our elimination approach over this really difficult and dangerous period, I do think we need to get far more proactive and systematic with what we're doing. I think we can sustain moderate numbers of travellers coming from the UK for a period, as long as we do more than just simply a single test before people get on their flight. I don't think that's good enough."
As for measures closer to home, Dr Baker says the Government should look at fast-tracking vaccine approval for border and MIQ workers. MedSafe, taking advantage of the lack of community transmission in New Zealand, at this stage has no plans to authorise vaccines it hasn't analysed thoroughly - unlike the UK and US, where vaccines were approved under emergency measures almost immediately after their phase III trials were done.
"Medsafe has streamlined its approval processes to move swiftly, but without rushing or compromising safety in any way," Duty Minister Peeni Henare said earlier this week. "It is critical the public has confidence in the safety of vaccines."
Dr Baker is also suggesting rules at MIQ facilities be tightened up, for example getting rid of outdoor smoking areas - it's impossible to wear a mask while smoking, and secondhand smoke poses a heightened infection risk.
"How we manage people, for example, who smoke - we do need a different approach, maybe with nicotine patches? Lots of incremental improvements we can make to the system."
Dr Baker and other experts have warned the UK virus is so infectious, a repeat of Auckland's level 3 lockdown in August wouldn't be enough to contain a community outbreak - it would have to be level 4.
"The big concern I've got is if in the next few months I think it would be a disaster if we had an outbreak of these more infectious variants of the virus in New Zealand. I think we have to sustain our elimination approach."