In an attempt to maintain elimination of Covid-19, the New Zealand government has closed the border to everyone except citizens and residents. All arrivals are required to spend 14 days in government-managed isolation/quarantine and to be tested for Covid-19 on day 3 and on day 12 of their stay. We model the testing, isolation and potential transmission of Covid-19 within managed isolation facilities to estimate the risk of undetected cases and the risk of infectious cases being released into the community.
We use a stochastic individual-based that includes a time-dependent probability of a false negative test result, complete isolation of confirmed and probable cases, and secondary transmission of Covid-19 between close contacts. We show that the combination of 14-day quarantine with day 3 and day 12 testing reduces risk of releasing an infectious case to around 0.1% per infected arrival. Shorter quarantine periods, or reliance on testing only with no quarantine, substantially increase this risk. It is important to avoid contacts between individuals staying in quarantine to minimise the risk of secondary transmission. We calculate the ratio of cases detected on day 3 to cases detected on day 12 in the model and show that this may be a useful indicator of the likelihood of secondary transmission occurring within quarantine. We do not explicitly model transmission of Covid-19 from individuals in quarantine to staff, but this is likely to present a significant risk. This needs to be minimised by strict infection control, use of personal protective equipment by staff at all times, and avoiding close contact between staff and hotel guests.
- A 14-day period of managed isolation or quarantine (MIQ) with day 3 and day 12 testing reduces the risk of an infectious case being released into the community to a very low level.
- A five-day quarantine period is ineffective and would present a much greater risk to the community.
- Any mixing of individuals in MIQ that could allow transmission of Covid-19 increases the risk of an infectious case being released into the community.
- Strict infection control and use of personal protective equipment (PPE) by staff at MIQ is essential and close contact between individuals in MIQ and staff must be avoided.
- Provided the above guidelines are followed, special exemptions restricted to the second week of stay and after an additional negative test result has been returned pose little additional risk.
- The ratio of cases detected in the second week to cases detected in the first week can be used to estimate whether transmission within MIQ is occurring, although this requires a larger sample size than is currently available.