Are returning international aircrew our weakest link in New Zealand’s efforts to keep Covid-19 from entering the community again?
With a spotlight on the effectiveness of border controls to ensure Covid-19 doesn’t re-enter the community, concern has been raised about international aircrew who are currently exempt from blanket 14-day isolation measures.
University of Otago Medical School epidemiologist Sir David Skegg said their exemption from the rule of 14 days isolation before they can enter the community means they’re an “obvious risk”. While aircrew are on the frontline of helping New Zealanders return home, the threat they could become infected themselves couldn’t be eliminated. He said strict precautions are needed to ensure risk is kept to a minimum.
“The Bluff wedding cluster, with 98 cases identified, showed what can happen when one infected air steward goes back into the community.”
Rules regarding aircrew tightened up on June 16. Skegg said many of the new guidelines released contain “sensible requirements” but there are gaps in them he feels should be filled. These include full PPE for crew, the logic of 48 hours of self-isolation and the rule allowing aircrew to fly domestically to their home before they self-isolate.
Even on flights to countries considered high-risk, aircrew can step off an international flight, and after a health screening that does not involve a test, step onboard a domestic flight to their home city.
At home they must self-isolate for 48 hours and be tested for Covid-19. Once a negative result is recorded they can move around in the community without further precautions.
This is despite a statement made by Minister of Health David Clark last Tuesday when discussing stepping up testing of border staff suggesting isolation happened prior to aircrew being allowed to travel home.
Clark said aircrew “flying where there is high Covid will be required to go into self-isolation upon return, complete a test that’s negative before they return into the community.” His comment was used in the first sentence of a New Zealand Herald story.
Days after his statement, the guidelines for aircrew on the Ministry of Health’s website still say different things.
They say aircrew returning from a trip between two and seven days abroad “may fly domestically to their home to complete the self-isolation”.
Newsroom attempted to clarify the mismatch between Clark’s claim and the official rules and was told by Clark’s office: “There is work under way on the MoH requirements for aircrew and they will be updated in due course.”
When asked if Clark had been incorrect in his Tuesday statement, or when changes might be made, Newsroom was told there was “nothing further to add at this stage”.
Questions to the Ministry of Health did not confirm domestic flights had, or would be, ruled out anytime soon.
“The aircrew requirements are being reviewed and on an ongoing basis, so as circumstances change around the world – and as effective vaccines and treatments are identified – the requirements will also change. There is not a specific timeframe for any future changes at this stage.”
Skegg remains concerned.
“It worries me that, after arriving back in New Zealand, such crew can get straight on to a domestic flight home. I would prefer not to be sitting next to them on an ATR flight! …
“Flight attendants coming from lower-risk destinations, such as Australia, are not required to self-isolate and may then crew domestic flights without any testing. Yet flights from Australia include passengers who have transited from high-risk countries in Asia and Europe. Some of the recent cases detected here in quarantine are in this category, and such passengers may not have worn masks during the trans-Tasman part of their journey. “
The Air New Zealand website says the airline currently offers 12 return services per week to Australian destinations, five to Los Angeles, two to Hong Kong, one each to Tokyo and Shanghai.
What are the risks for aircrew?
International aircrew currently have a range of rules they must adhere to when overseas. In theory this should mean there’s less risk they will pick up the virus even when they are travelling to hot spots.
For high-risk countries the rules are stringent. Crew must isolate in a hotel, no trips are allowed outside the hotel and crew are not allowed to mix with other crew or hotel guests. They are not allowed to use the gym, pool or any other communal facilities in the hotel.
A Ministry of Health spokesperson described the layover rules as almost like quarantine and said it has established an audit and compliance programme.
“This is intended to support aircrew to comply by identifying where our requirements are unclear or not practicable, as well as encourage aircrew to comply by identifying those who do not comply. It will also investigate anecdotal and other reports of aircrew noncompliance to see if the allegations can be substantiated or if they are rumours.”
When on board flights in passenger areas on the plane, in a terminal, or traveling to a hotel they must wear a mask and gloves. Full PPE is required if a passenger is sick and suspected to have Covid-19.
Individual airlines can choose to require staff to wear more PPE on flights than the Ministry of Health stipulates. Emirates crew wear a gown and a visor in addition to a mask and gloves. Air New Zealand does not require this.
On Friday the NZ Herald reported on a message sent by Air New Zealand chief executive Greg Foran to staff saying aircrew are often “unjustly the focus of people’s fear of another spike of Covid-19, and I know this is hard for them and their families”.
The company has not responded to Newsroom’s question for comment on their decision to not require full PPE as standard for crew rather than just a mask and gloves, or if it is considering increasing the amount of PPE in the future.
The Ministry of Health said full PPE would be considered in subsequent reviews of rules.
What will 48 hours of isolation achieve?
Even if domestic flights home before self-isolation were not allowed, there’s a question surrounding the logic of 48 hours of self-isolation.
The incubation time after being exposed to Covid-19 and then developing symptoms is between five to six days on average. This is when people are most likely to test positive for the disease.
If aircrew picked up the virus on a flight or in an airport, it may take five to six days for symptoms to develop and a positive test to be returned.
This could mean a person may have a negative test result and be allowed to leave self-isolation before symptoms develop.
It’s another area Skegg points out as a potential weakness.
“Of course a single negative test does not prove that a person is not infected, especially early in the course of their illness.”
Currently travellers returning to New Zealand must be tested on day three and day 12 of the 14 days of isolation or quarantine.
Director-general of Health Ashley Bloomfield explained why day three is chosen for testing returning travellers.
‘The reason we don’t test on arrival and we wait until day three of the managed isolation is because that is about day five of many people’s journey from where ever they have come from into New Zealand. We know that testing then is more likely to pick up infection than earlier testing when people may be incubating the virus but not test positive.”
He said testing on day 12 provides extra security.
“First of all because the tests do have a false negative rate of somewhere around 20 to 30 percent but also because it’s part of our departure planning for people to confirm that they don’t have the virus.”
The Ministry of Health said the 48 hour rule was based on if a crew member got infected on their layover “… they will have developed infection/symptoms by day two (or be pre-symptomatic) and this would be detected by their Covid-19 test … the requirement to self-isolate and then be tested before aircrew can move about normally is an extra step that will reassure the wider community that aircrew do not pose any risk to their health and safety.”
Skegg points out New Zealand is one of the few countries in the world where people can go about life without fear of contracting Covid-19, maintaining that requires rigorous border control.
“After [last] Monday’s Cabinet meeting, the Prime Minister said the Minister of Health would be sitting down with Air New Zealand “to reinforce just how important it is that airline crew uphold … expectations”. It would be interesting to know if that meeting has occurred yet, and whether any changes in practice will occur.”