Document One
Ministry of Health COVID-19 response - Science and
Technical Advisory
Request for independent advice and response
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1982
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Deliverable Advice
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Testing frequency of
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asymptomatic border
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workers, and testing of
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incoming passengers on
arrival
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Request for independent advice and response
ID reference # 2639
Document One
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Response to request for advice
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Question 1:
What is the most appropriate frequency for COVID-19 testing of staff in high-risk areas -
the 'Stream 4 - Border Testing [workforce]' population? This includes Managed Isolation and
Quarantine facility staff; International Airport staff (all border agencies, cleaners, air-
side retailers); and Maritime Port staff (including maritime pilots and crew). This may or may
not extend to air crew, who are also included in this population but manage
Information d under a different
schedule of testing. Is there any support for a move from monthly rol ing testing to weekly
testing?
Group position
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It is important to be clear about the purpose of testing, and the consequent principles for
decision-making. Asymptomatic testing i
the s essentially screening, and it may be helpful to
consider it as such when thinking about principles
1. On the other hand, a risk assessment and
prioritisation approach (as used in occupational health) may be useful, identifying where
people are most likely to be exposed, and how.
under
When assessing the value of more frequent testing of asymptomatic people, any potential
benefits must outweigh the various technical, logistic, personal and social risks associated with
the more frequent application of the test. These considerations are similar to the standard
ethical considerations that are taken into account for the introduction of any screening test.
Although the border does present the biggest risk to New Zealand, increasing asymptomatic
testing frequency may n
Released ot be advisable. As described as background information in the
meeting, the current testing procedure (nasopharyngeal swab) is regarded as an unpleasant
process and the opportunity to be tested is not universal y accepted at the current frequency.
Increasing opportunities for testing may not necessarily increase the demand. There are also
logistical difficulties in achieving weekly testing, and the opportunity cost of doing so should
be considered. Most important to note, is the risk that increasing asymptomatic testing may
reduce symptomatic testing (which is much more important to encourage in this context). The
main priorities should remain getting symptomatic people tested, and high-quality contact
tracing.
1 Refer: National Health Committee Screening Programme Assessment Criteria
https://www.nsu.govt.nz/system/files/resources/screening_to_improve_health.pdf
Request for independent advice and response
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If the testing frequency is increased, additional measures also need to be in place: further
monitoring, incentivisation of testing, analysis of the outcomes of the current testing regime,
exploration of alternative testing approaches/ techniques, and audits of why people do not
take up the offer of testing. In addition, it would be important to ensure there are no financial
disincentives for testing/ negative consequences of returning a positive test. This includes
working with employers to ensure that staff are not required to use limited sick or annual
leave provisions to meet requirements that result from any testing.
Further considerations
- Protecting the sustainability of the testing programme is important – people in these
high-risk occupations need to be wil ing to continue to be tested in future, potentially
for many months and especially when the risk of infection is rising.
- There is a need to ensure that it is very easy for border facing staff to get a test if
1982they
have symptoms, or are feeling unwel in any way, including when they are asked not
to attend work when unwel .
Act
- We need to be mindful of the risk of over-testing in these environments as it conveys
a message that we don’t think people are safe, despite PPE, IPC etc.
- Blanket voluntary asymptomatic testing is unlikely to be helpful – testing could be
focused where the risk is highest and benefit most likely. Different people wil have
different levels of risk of acquiring the virus, based on exposure (including PPE/ length
of interaction, role at the border, environmental context, etc). Cleaning staff at airports
and isolation/ quarantine facilities, as wel as bus drivers, were seen to be among the
Information
highest risk based on overseas research. If workers move between different
workplaces/ facilities this would be another area of higher risk.
- If prioritising of different sites of testing is needed, incoming ships that have been at
sea without symptoms in the crew/ passengers for 28 days or more could be one
situation where testing could be foregone (assuming no new crew or passengers had
Official
joined the ship in that time).
- Robust data analysis is needed to evaluate the effectiveness of any policy. Testing of
the
a sample of higher risk people could be a way of providing some reassurance/ auditing
any policy.
- Note that many Iwi were very proactive about ensuring their communities had reduced
risk of COVID-19 (e.g checks at Iwi boundaries etc), because of concern about
under
heightened vulnerability to adverse outcomes from COVID-19. Māori workers may
have similar attitudes and be more open to asymptomatic testing.
Suggestions
- Make it as easy as possible for border facing workers to get a test. For example,
consider designa
Released ted testing stations for border facing workers. Workers in high risk
populations shouldn’t have to justify getting a test. In addition, remove disincentives
to testing e.g. unlimited sick leave for high-risk workers who are symptomatic or who
have to isolate fol owing a test.
- If a returnee is found to test positive, usual public health processes (i.e. via the local
Medical Officers of Health as part of their process) should be fol owed to identify any
staff who may have come in contact with them who need to be tested (including bus
drivers etc). Contact tracing for positive cases remains essential for identifying infected
staff.
- It may be opportune to review current intel igence on testing and prevention of spread
at the border as a whole rather than these specific aspects so that any changes are
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comprehensive. Successful prevention includes multiple environmental and
management strategies.
- Consider the potential to trial less aversive tests in high-risk occupational groups, as
these tests become available. Explore options of saliva testing (although not an
immediate option) and modified regimes for self-swabbing, which may be more
acceptable. Staff could be administered swabs and media ahead of time so that they
could self-swab and contact an agency for pick up (e.g. from a letterbox) if unwel at
home.
Question 2:
s 9(2)(f)(iv)
1982
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Document Outline
