In a switch from the MIQ system, due to the sheer volume of people testing positive for Covid-19 in Auckland, an SIQ (self-isolation quarantine) system has been introduced – a sensible and necessary response.
People are required to self-isolate at home and told to monitor their symptoms and (with the use of supplied pulse oximeters) the level of oxygen in their blood. Officials assure us that people in SIQ have an initial assessment from Auckland Regional Public Health and are monitored by Healthline, with daily phone calls or emails to check on their condition.
Yet reports have emerged of people with Covid-19 isolating at home who have fallen through the cracks – in some cases receiving no emails or phone calls, being asked to report oxygen levels with no pulse oximeter and being offered throat lozenges and paracetamol as treatment.
Last week, three people with Covid-19 died at home, prompting the director of public health to say: "If you or your loved ones are being cared for in the community and you feel your – or their – condition is deteriorating, please do not leave it to chance that you will improve. Please reach out as soon as possible, or ask someone to do so on your behalf."
People who do try and "reach out" report struggling to get through to Healthline,
and not knowing when to call 111. Patients and families may also be understandably reticent to trouble an overloaded health system, and cultural and language barriers may prevent them calling for help.
This is an unacceptable state of affairs. For any patient with Covid-19, experiencing alarming symptoms including shortness of breath, and aware of the possibility of serious deterioration, it must be frightening to be left alone with limited medical treatment and emotional support.
When the State exercises protective powers to isolate or quarantine people under public health laws, and mandates medical examination and testing, it has a moral and legal duty to ensure access to health care for people subject to such compulsion. New Zealand also has a legislated Code of Patients' Rights, a legacy of the Cartwright Inquiry. At the heart of the Code is right 4, the right to services of an appropriate standard. Every provider of health services, including agencies like Healthline, is subject to a duty to provide services "with reasonable care and skill" and "in a manner consistent with … needs".
Some patients are clearly receiving minimal care that falls well short of their needs. There will doubtless be inquiries and reviews next year. But waiting for rulings from the Health and Disability Commissioner that patients' rights have been breached, or for Coronial inquest findings, is cold comfort for anxious patients self-isolating at home right now.
The introduction of the SIQ system is timely and appropriate, but it must be fit for purpose. The reported failings are a moral and legal failure of care. With more than 1700 people with Covid-19 currently quarantined at home in Auckland, and numbers growing daily, the problems need to be fixed urgently.
Government cannot "contract out" its duty of care. Having apparently left DHBs and GPs out of the loop of the new SIQ system, Government must ensure that appropriate nursing and medical advice, treatment and support is readily accessible for everyone with Covid-19 isolating at home.
• Emeritus Professor Ron Paterson, University of Auckland, and former Health and Disability Commissioner.