From MIQ to home recovery, 5 things to watch as COVID-19 response shifts to deal with 'triple-digit' cases

With daily cases tipped to reach "triple-digits", the Government is shifting its COVID-19 response, so expect changes to MIQ, rule enforcement, and how the infected are treated, as we enter a new phase. 

1. MIQ settings will change with home recovery. 

The Government is currently reassessing state-run managed isolation and quarantine (MIQ) and it could mean some arrivals, depending on where they've travelled from and their vaccination status, could self-isolate at home.

The process has been sped up due to rising daily cases of COVID-19 in the community, making it increasingly unrealistic to put every case into a quarantine facility. If cases keep trending up, eventually they'll run out of room. 

"If they continue to come through at higher volumes, then we will need to start to move to a different process. Decisions about that are being worked on now so that they then can be deployed as soon as they're needed," Deputy Prime Minister Grant Robertson told the 1pm press conference on Thursday. 

That means, as COVID-19 Response Minister Chris Hipkins and Health Minister Andrew Little  have both signalled throughout this week, that more cases in the community could self-isolate at home rather than in quarantine.

"Throughout this outbreak there's always been individuals enabled to stay at home for a variety of reasons. Our medical officers of health have had that ability," said Public Health Director Dr Caroline McElnay.

"We're just at the beginning of a process with Auckland District Health Boards to have more people staying at home, so it's just right at the very beginning."

She said it may start off at 20 percent of cases and then increase to 50 to 60 percent. Health officials would need to do a risk assessment of the cases. People who are double vaccinated are far less likely to need hospital care. 

Those permitted to isolate at home would be given a pulse oximeter, a device that clips to your finger that measures oxygen levels. 

With just 1 case of COVID-19 registered in MIQ arrivals on Thursday compared to 71 cases in the community, it begs the question: do we still need MIQ? Is it fair to force arrivals to spend two weeks in a room and be released into a city with an outbreak?

"Those are the kinds of judgments that we do need to be looking at," Robertson said. "But we're also not without cases coming across the border as well, so we've got to work our way through that."

When could we see these changes come to fruition? 

"We're looking at contingency planning but it may be needed relatively soon," Robertson said, while Hipkins told the NZ Herald "we're at that point now". 

Dr McElnay said: "We need to have the systems in place to be able to support those people to isolate safely at home and have their welfare needs met."

Director of Public Health Dr Caroline McElnay says the Ministry of Health expects a doubling of cases over the next 14 days.
Director of Public Health Dr Caroline McElnay says the Ministry of Health expects a doubling of cases over the next 14 days. Photo credit: Getty Images

2. COVID-19 case numbers will grow. 

The need for changes to MIQ settings has been sparked by daily increases in COVID-19 cases in the community, despite eight weeks of lockdown in Auckland. 

"We will see cases heading towards the triple-digit mark, but we can manage that if New Zealanders - and Aucklanders in particular - follow the rules," Robertson said. 

"Our hospitalisation rate remains relatively low and so ICU capacity is fine at the moment but people of course need to prepare for the prospect that it might grow."

The Health Minister told reporters on Thursday that roughly two-thirds of ICU beds are currently in use. District Health Boards can surge up to 550 beds, but that would take beds from other patients.

There are roughly 430 ventilators across the network with 250 kept in reserve. Ventilator utilisation right now is about 16 percent. 

"A lot depends on what happens over the next few days. We've been working really closely with our colleagues in Auckland to make sure that they are prepared for any increase in hospitalisations or ICU admissions," Dr McElnay said. 

"Based on the numbers that we've been seeing over the last few days, we would expect a doubling of cases over the next 14 days - that's assuming the trend continues and we don't know if that's likely to be the case.

"It's not just about the current beds that they've got or the current ICU beds. There's a lot of planning around how we can start to change our approach."

3. The Government may crack down on rule-breaking. 

Triple-digit daily case numbers might seem scary, but it really comes down to how closely the alert level 3 rules are followed in Auckland. Under Step 1, Aucklanders can meet up with one other bubble outside - but not inside. 

Prime Minister Jacinda Ardern revealed this week that some transmission has occurred via food delivery, taxi services and construction sites, but Robertson said on Thursday a large proportion of cases are attributed to indoor gatherings. 

The Government has ruled out a shift back up to level 4 to help bring down cases, much to the dismay of some experts. With Māori vaccination rates below the general population, Māori leaders have also called for level 4 to protect their whānau

"We continue to look at all of the rules to make sure they're fit for purpose and we work with our public health officials on how that can be tweaked if it needs to be tweaked," Robertson said. 

"We haven't had that advice yet but it's quite clear that this is a problem so we will be continuing to discuss it... Ultimately, prosecutions are up to the police and obviously the police will be called from time-to-time to these gatherings. 

"The important thing is, throughout COVID, we have to rely on people to do the right thing. The police can't be everywhere so, even if they do find one and they do pursue a prosecution which they may well do, that is not going to be the solution to the problem. The solution to the problem is people doing the right thing and obeying the alert level 3 rules."

Prime Minister Jacinda Ardern and COVID-19 Response Minister Chris Hipkins pictured heading to the Beehive theatrette where the 1pm press conferences are held.
Prime Minister Jacinda Ardern and COVID-19 Response Minister Chris Hipkins pictured heading to the Beehive theatrette where the 1pm press conferences are held. Photo credit: Getty Images

Then there's the border issues, highlighted by two COVID-positive women who somehow managed to travel to Northland with false documents, sparking a level 3 lockdown for the entire region

The Government has asked officials to review the border exemption system after another two women managed to leave Auckland and ended up in COVID-free Blenheim

"There will be situations like this and that's why we've asked the Ministry of Business, Innovation and Employment to take another look at the way that exemptions are granted, to make sure that these sporadic cases don't grow," Robertson said. 

"The boundary is by and large working well. But given the numbers of people coming across it - many of whom have very legitimate reasons to do so - we do have to be careful about the management. 

"It's an important piece of work to see if there are process changes."

4. Contact tracing will be stretched.

With cases tipped to keep trending up, contact tracing could be stretched to its limits, as Newshub political editor Tova O'Brien has highlighted

"We're not concerned," Dr McElnay said. 

"It is part of our model that we've been using right from the beginning - it's a network of public health units across the whole country. That's been happening since the very beginning of this outbreak. 

"Obviously as the case numbers increase, the resources on the ground in Auckland get more stretched, but that doesn't mean to say that they're overwhelmed - it's just part of the processes we have where we can allocate those cases out to other parts of the country."

However, she revealed "about 170-180 cases a day would start to really put pressure on the system as a whole". 

A member of Newshub's whānau found out the hard way that the Ministry of Health won't always meet its own expectations with contact tracing. 

"We can certainly cope with a large number of cases but it does mean that the detailed investigation into those cases would decrease," Dr McElnay said. 

"The real focus is on the contacts and making sure that those contacts are identified quickly and they are quarantined so they are not passing on infection.

"What we're certainly seeing with this outbreak is we do tend to see a lot more contacts with the cases because we've had large households so we're already factoring that into how we manage those contacts."

5. Summer could go ahead - if we're lucky. 

The uncertainty of how long Auckland's lockdown will last has pushed several businesses to the edge, and big events like Bay Dreams and Christmas in the Park have been cancelled. 

But there is hope. Vaccination certificates are in the works and will be available from November, and the Prime Minister has confirmed they will be required to attend large events

Late in October, the Ministry of Health intends to make test results accessible on a new consumer app called My COVID Record.

"We've been consulting closely with the events industry about vaccine certificates, so they're very well aware of the direction of travel that we're going in," Robertson said. 

"You've heard it described here that those large-scale gatherings will need that so people know that is going to be part of their future, so there shouldn't be any uncertainty whatsoever about that. 

"Ministers Stuart Nash and David Clark have been discussing with the events sector what kind of support there could be to at least give people assurance to be able to carry on with their event."

Let's just hope the remaining events like Rhythm and Vines have enough certainty to hang in there to give Kiwis the summer they deserve.