We are missing the obvious at the border

Dr Eric Crampton
16 February, 2021

UK political commentator Jeremy Driver put his finger on something important about his country’s failure to deal sensibly with Covid. It’s something that has also been rather easy to see from half-way around the world.

And I wonder whether it might also matter in places where the response has, on the whole, been rather more successful.

According to Driver, UK political classes prefer to scramble for reasons why improvements cannot be made, rather than think through ways of overcoming obstacles.

Those with this fatalistic mindset take barriers to better outcomes as natural laws. Why bother spending time thinking through how to implement a 24-hour vaccination schedule if you can convince yourself that nobody would want to show up to be vaccinated at 2am? Why bother following New Zealand or Australia in implementing quarantine at the border if you believe that there wouldn’t be enough hotels or facilities to make it worth trying?

The mindset has been easy to identify from New Zealand. The UK’s failure to implement border quarantine was rather clearly a policy decision not to bother trying. New Zealand provides an existence proof: we did it, and they also could have, if they had wanted to.

The failure to even try has been galling not just because of Covid’s costs within the UK, but also because their failure provided a salutary environment for the development of interesting new variants on the virus.

We could all see it. Our distance provided perspective.

But can we see it here at home?

Since May, there has only been one plausible route for the virus to enter the country: through our border systems. That argues for a very robust set of layered border protections, in combination with the failsafe measures with which we are all very familiar.

But obvious and relatively inexpensive ways of tightening the border against incursion have not been implemented.

We were surprised to find, last August, that border-facing staff were not regularly being tested for Covid. When pressed, Covid Response Minister Chris Hipkins described compulsory testing as “quite a big lever to pull.”

The Government also worried about whether testing requirements were compatible with existing employment contracts, forgetting for a while that Public Health Orders can mandate testing regardless.

The Level 3 lever was pulled instead.

Since then, technology has improved. Just as the UK could have and should have learned from New Zealand, New Zealand could have and should have learned from developments abroad.

The University of Illinois has provided saliva-based PCR testing for staff and students for months, with its test validated in July of last year. Or, about the same time that we found out that border staff were not being tested.

Since then, the University’s system has been rolled out extensively across other campuses in the United States.

Saliva-based PCR testing is a game-changer. It is at least as accurate as the swab tests currently used, but has several advantages over the swab test.

Because it relies only on saliva collection, it does not need scarce medical professionals to gather the samples. Availability of nursing staff is a substantial constraint in the system – and especially since the government shifted border nurses back onto the lower pay rates available through the district health boards.

Swab-testing can make people sneeze in reaction to having a swab stuck up their nose. Saliva testing does not come with that risk. Sneezes are far riskier than some drool on a disposable spoon.

And, finally, because providing the sample is far less inconvenient and invasive for the person being tested, and because it comes at only a fraction of the cost of the swab tests, it is rather more feasible to require it as part of a daily testing regimen.

Daily testing of everyone involved in the border system would reduce the risk of community outbreaks down to trivial levels. Everyone working for the airlines servicing international flights. Every airport staffer who comes into contact with places where international travellers have been. Every customs official and security agent. Every bus driver shuttling passengers through to MIQ. Every worker at MIQ. Everyone.

Daily PCR testing would mean that every imported case would be caught very early, and potentially before the case became infectious.

If someone coming in from overseas managed to transmit the virus to a border worker, daily testing of border staff would very likely catch the infection before it could be transmitted to others in the worker’s family.

And it is feasible. Testing could start tomorrow, though it might take a bit of time to gear up to daily testing.

Yesterday, Jonathan Milne reported on Rako Science’s deploying of the University of Illinois SHIELD system for rapid saliva-based PCR testing. Three companies, including Air New Zealand and Auckland Airport, have contracted with Rako for saliva tests for their workers.

The Government could, right now, take the policy decision that everyone involved in the border system take a daily Covid test. It could start with less frequent testing, as saliva-testing capabilities gear up, then shift to daily testing as soon as it is in place. Maintain the existing swab tests at the same time, just to be sure that the saliva tests catch everything that the swab tests catch. And then, if the saliva tests prove as reliable as advertised, retire the swab tests.

From New Zealand, the United Kingdom’s response to the virus has seemed crazy.

But imagine sitting at the University of Illinois and looking out at New Zealand. They have had to test all of their students, faculty, and staff, all of the time, because their students and faculty are out in communities where the virus is common. Here, the only place where regular testing is urgently needed is at the border, for the small fraction of the population either in MIQ or working in the border system.

The Illinois system has been available since July, but the Government has not really considered proper testing at the border until Rako Science forced the issue by demonstrating that better testing is possible.

Now that Rako has shown it can be done here, will the Government work to implement it appropriately in our border system? Or will it instead look for reasons not to really try?



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