Is it time for a national approach to hotel quarantine?

Anastasia Tsirtsakis

4/12/2020 4:11:54 PM

With quarantine-related cases having already led to outbreaks in Victoria and SA, and a case in NSW making authorities nervous, experts think so.

Quarantine hotel cleaner in PPE
The time for a national approach may be now as Victoria continues to implement recommendations from its COVID-19 Hotel Quarantine Inquiry. (Image: AAP)

For health authorities in Victoria and South Australia, it was almost like déjà vu when a Sydney hotel quarantine worker tested positive to COVID-19 on Thursday.
The female cleaner, who travelled almost 40 km by train to and from her south-west Sydney home while infectious, worked four shifts across two quarantine sites, the Ibis Hotel and Novotel in Darling Harbour.
It was originally not know where the worker contracted the virus, but NSW Health Minister Brad Hazzard has since revealed the woman was likely infected by aircrew who arrived on a flight from the US.

Airline crew have different requirements to most incoming travelers, and are only required to self-isolate, rather than quarantine, due to the brief length of the majority of visits, Minister Hazzard said.
While NSW has enjoyed an extended run of no locally acquired casest, biosecurity expert Professor Raina MacIntyre told newsGP she was not surprised to hear that the streak was under threat due to a hotel quarantine breach.
‘It is clear hotel quarantine is a high-risk occupational setting for people who work there,’ the Head of the Biosecurity Research Program at UNSW’s Kirby Institute said.
With quarantine-related cases having seeded major outbreaks in Victoria and South Australia, and the new case in NSW making authorities nervous, the question has been asked: does Australia need a national approach to hotel quarantine?
Professor Adrian Esterman, Foundation Chair of Biostatistics at the University of South Australia and former World Health Organization (WHO) epidemiologist, certainly thinks so.
In fact, he believes the time is ripe as Victoria continues to implement recommendations from its COVID-19 Hotel Quarantine Inquiry ahead of resuming international arrivals next week.
‘The current case in Sydney … could just as easily be WA or Tasmania. The new regulations and structure put in by the Victorian Government, however, will mitigate some of the risks. We just need all other jurisdictions to do the same thing,’ he told newsGP.  
‘Which brings up the question: why on earth aren’t we taking a national approach based on the new Victorian system? The Federal Government should really put its hand up that it is responsible for border control and quarantine and sort this out.’
Given the lack of community transmission across the country – and the explosion of cases being witnessed elsewhere around the world – Professor Esterman says medi-hotels now pose the biggest risk for generating new outbreaks.
‘I really do think that unless every state and territory in Australia wants to keep stopping and starting, stopping and starting, like we [saw in Victoria and South Australia], then they have to sort out the quarantine situation,’ he said.
‘That’s so critical. If [last month’s] outbreak hadn’t happened in South Australia, we would have had zero cases in the whole of Australia for several days and, potentially, for months and basically would have eliminated COVID-19.
‘The only place it’s coming in is through these quarantine hotels and there are ways of stopping that.’

Melbourne GP Dr Vyom Sharma agrees, but took a more sarcastic tone in making his point.

Since mandatory quarantine for international arrivals was introduced on 28 March, around 130,000 travellers have been quarantined in designated facilities across Australia, the majority of which have been hotels.
The situation has presented a number of challenges.
Authorities in South Australia just last month rapidly moved to contain a cluster connected to hotel quarantine, fearing the emergence of a second wave akin to Victoria.   
Professor Esterman says the new case in Sydney is another argument for moving hotel quarantine to less populated areas.
‘Why are they having these things in the middle of cities? So that if someone does get infected, they go on public transport … and they start spreading all over the place,’ he said.
‘We could have these quarantine stations in remote areas, where the people who staff the cleaning and kitchens could live there as well.’
Last month’s National Review of Hotel Quarantine recommended the Federal Government consider operating quarantine stations in remote parts of the country.
A successful model has been the approach taken by the Northern Territory Government.
Travellers are quarantined at the Howard Springs Accommodation Village, a former 3000-bed mining camp located near Darwin’s CBD, where guests stay in single rooms on grouped compounds. Unlike people in quarantine hotels, they have access to a shared outside space where they are required to observe strict social distancing and mask wearing protocols.
Regardless of the destination, Professor McIntyre says cases among hotel workers need to be acknowledged as a ‘work, health and safety issue’.
‘This includes respirator and adequate ventilation,’ she said.
‘Perhaps hotels built more recently should be the only ones chosen for hotel quarantine, as they comply with current ventilation standards. Older buildings may not, although if they have windows that can be opened, that is a good thing.
‘We need formal guidelines and protocols on ventilation inside these hotels. They can be doing a whole lot to look at reducing risk. Staff must be provided and trained in respiratory protection.’
These are among the steps being taken by the Victorian Government in response to the recommendations made in the hotel quarantine inquiry’s interim report.
In addition to more infection controls, staff will be tested daily, while their family and household members will be offered voluntary regular testing, along with proactive contact mapping for all staff and strengthened PPE protocols.
Following the outbreak in South Australia, health authorities across the country signed up for weekly testing of quarantine staff. This approach fell short in NSW, however, with the worker tested five days after developing symptoms.
Meanwhile, the Victorian Government is also looking to mitigate risk of spread by accepting the recommendation that workers ‘should not work across multiple quarantine sites, nor should they work in any other environment’.
All staff working in the program will be employed or directly contracted by the COVID-19 Quarantine Victoria (CQV), a dedicated agency to oversee all elements of hotel quarantine, with the exception of cleaning staff who will be on secure, fixed-term contracts with Alfred Health.
Frontline staff will also work in ‘bubbles’ to ensure they only have contact with a limited number of other staff during their shift.

South Australia has also put an end to workers taking shifts at other high-risk facilities, such as hospitals or nursing homes.
But NSW Premer Gladys Berejiklian remained steadfast on her stance on Thursday, saying workers in her state would not be banned from working at other sites, as viral spread outside of work hours was still a possibility.
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A.Prof Christopher David Hogan   7/12/2020 10:06:40 PM

At school I was taught that the Australian Constitution was not a document recording a meeting of minds but a treaty between warring tribes.
As the world becomes more complex so does the Federal Government become responsible for more & more duties. The need for adequately trained & ready personnel, ongoing training, upskilling & adequate equipment & supplies is essential. The skills in logistics exhibited by the ADF have been incredible.
The historically cyclic nature of epidemics & pandemics predicted a pandemic 20 years ago. More are anticipated as expansion of humans into foreign habitats & the alteration of habitats due to climate change continues.
I believe quarantine & epidemic management should be the role of the Federal Government & the lead agency should be the ADF.