What will 2 million overseas visitors do to Covid-19 rates over summer, and who pays if they get sick?

Friday, 25 November 2022

Officials say it's 'too early to say' whether the current plateau in cases will be sustained, and the outlook over summer 'remains uncertain'.

Covid-19 rates and international tourist numbers are both picking up, and it is unclear what that means for infection levels and our creaky health system.

The Tourism Export Council is expecting more than 2 million overseas visitors this summer season, and even taking into account Kiwis heading overseas, that influx could still temporarily boost the country’s total population by several hundred thousand.

Since the border opened, the Ministry of Health says only 61 people identified as overseas visitors have been hospitalised with Covid-19, but admits the true figure is likely higher.

Exactly how many international visitors have required hospital care for the virus is unknown because the ministry data is based on patients who give an overseas address, and does not include those who report staying at a hotel or private home.

* Seven hotels are on standby to provide managed isolation and quarantine rooms if they are needed

* Relief but continued uncertainty as visitor numbers pick up

Inbound disease risk

When the Majestic Princess docked at Sydney’s Circular Quay earlier this month hundreds of those on board had tested positive for Covid-19 after a cruise around New Zealand.

Covid-19 modeller and University of Auckland senior lecturer Dr Dion O’Neale does not believe tourists will increase spread of the virus, which is already prevalent in the community, where only about a third of Covid-19 infections are being reported.

O’Neale says l ong-haul plane travel has been associated with slightly elevated infection rates, and holidaymakers tended to be out and about dining in restaurants and socialising, which could also put them a little more at risk.

If travellers are on average older, Covid-19 may be more likely to turn into a severe infection needing hospital treatment, and that could be an issue on cruise ships.

“They look like they’re creating more cases than your average collection of 1000 or 5000 people,” he says.

Cruise cases

Cruise ships must report infectious diseases on board before they berth, but Te Whatu Ora Health New Zealand says keeping tabs on total Covid-19 infections is difficult because they change so rapidly.

As of November 21, on average 1.29% of crew and passengers had Covid-19, and Te Whatu Ora says the only passenger taken to hospital was someone who had suffered a broken leg, and was found to have Covid-19 on admission.

Strict hygiene standards on tour coaches is helping to keep Covid-19 cases down, but passengers who test positive have to remain in isolation for seven days, which can mean they miss most of their tour. (File photo)

However, rising infection rates on three recent voyages prompted Carnival Corporation to tighten health measures on its ships, making mask wearing compulsory indoors (except when eating or drinking), outdoors where social distancing is not possible, and on shore excursion buses.

Citing patient confidentiality, Carnival Australia said it would be inappropriate to comment on whether any passengers with Covid-19 had been admitted to New Zealand hospitals,

When the Majestic Princess arrived back in Sydney in mid-November after a trip around New Zealand, 800 people on board reportedly tested positive for Covid-19.

The New South Wales Government ranked it as a tier 3 vessel because at least 10% of passengers and crew had tested positive in the previous week, with a major impact on staffing and a risk that critical services could not be maintained, but as of Thursday the ranking showed infections had dropped to less than 3%.

The Princess Cruises website says its shipboard medical centre is equipped to handle multiple cases of Covid-19, right up to intensive care, and warns passengers who don't comply with public health measures “may be disembarked at the first available opportunity.”

Coach tour juggle

Before the season kicked off, coach tour operators were nervous about Covid-19 hitting both passengers and drivers, and in some cases those fears have proved well-founded.

A recent rise in Covid-19 rates means those travelling on Carnival cruise ships must now be masked when travelling by bus on shore excursions. (File photo)

It is understood a domestic bus tour had 20 of the 40 passengers pulled out over three days because they got Covid-19, were close contacts, or were worried about the risk of infection.

Other operators have had a much smoother ride, with few cases.

Tranzit Group operations director Keven Snelgrove says in the past two months, only 40 of 3000 overseas bus tour passengers have had to isolate, and to his knowledge none required hospital care.

“You’d think one in a bus would run through the whole bus, but it doesn’t. You might have two or three get Covid, but you don't get the whole bus going down with it.”

Even so, the logistics of organising somewhere for passengers to sit out their seven-day isolation, and replacing drivers and guides who get sick, is every bit the nightmare he had feared, and he says it may be worse during peak season in February and March.

“It’s a tiny proportion of passengers, but it’s horrific accommodating them when hotels can only run at 70% occupancy, and can't necessarily give room service because they don’t have cafes and restaurants open. You wouldn’t believe the mess.”

The cost of sick visitors pre-pandemic

Now that internationals are returning in greater numbers, it remains to be seen what impact Covid-19 has on healthcare costs for those unfortunate enough to get sick during their stay.

ACC covers tourists injured while holidaying in New Zealand and more than 8000 new visitor claims were lodged annually before the pandemic closed the borders in 2020. (file photo)

Back in 2019, overseas visitors who received medical treatment were charged close to $49m, according to figures released under the Official Information Act by Te Whatu Ora, and about $12.7m, including some charges relating to earlier years, was not paid.

Health districts put outstanding bills in the hands of debt collectors and arranged time payments, but at least $13m was written off.

At Te Toka Tumai Auckland health district, $4m was being paid off through payment plans.

At Capital and Coast Health the two single largest debts incurred by overseas visitors in 2019 were $214,935 for neonatal intensive care treatment, and $199,312 for general medical care.

Thanks to reciprocal health care agreements, visiting Australians and UK citizens needing immediate treatment receive the same level of free care as New Zealanders.

Heritage Expeditions ran cruises through the pandemic and director Aaron Russ says passengers on trips to the Subantarctic islands must have US$250,000 (NZ$409,200) worth of emergency medivac cover because of the high cost of rescue missions, which he says are thankfully rare.

More than half the 20 health districts did not track the value of reciprocal care, but for those that did, it came to approximately $5.8m.

Treating 495 overseas visitors eligible for reciprocal care cost Taranaki hospitals almost $2.6m, which included four long stays in mental health wards, nine intensive care patients, and a number who did lengthy stints in a rehab ward.

What about ACC?

ACC covers overseas visitors injured during their stay, and for the three years prior to the pandemic, visitors made more than 8000 new ACC claims annually, at a cost of between $2m and $3m a year.

Claims dipped significantly while the border was closed and began to climb once it reopened.

There were 2585 claims in the first 10 months of 2022, a big proportion of them related to incidents in Otago, possibly a result of visitor mishaps on the ski slopes.

ACC admits visitor claims are underreported because only claimants who give their occupation as “overseas visitor” are counted.

Nor does ACC get reimbursed when medical insurance pays out on visitor injuries, and a spokesman says insurers may only cover amounts in excess of ACC treatment contributions and entitlements.

What about health insurance?

The Immigration New Zealand website site urges anyone coming here to visit, study or work to consider getting comprehensive medical cover, but insurance is not compulsory.

Southern Cross Travel Insurance policies for people visiting New Zealand were the subject of 2000 claims in 2020 and 1000 last year, and chief executive Jo McCauley says visitors can rack up substantial medical bills.

A 30-year-old woman from India claimed about $100,000 after being admitted to hospital with complicated pancreatitis, and a 59-year-old Fijian man was landed with a $96,000 bill for heart bypass surgery.

In June, Southern Cross reported that Covid-19 was responsible for one-third of international and domestic travel insurance claims, but it was unable to provide any ore recent figures on claims from overseas visitors who contracted the virus while in New Zealand.

In Singapore, health insurance is still mandatory for unvaccinated visitors, but there is little appetite for New Zealand to join countries, such as Fiji, where all visitors are required to have it.

Both Health Minister Andrew Little and National’s health spokesperson Dr Shane Reti back the current voluntary approach.

”It’s up to them whether they insure themselves, but anyone travelling internationally should have good-quality travel insurance,” Little says.

“It would be difficult to enforce an insurance requirement because of the large number of visa waiver countries whose people travel here.”