In a timely wrap, public health researcher Alison Barrett presents the arguments for a national approach to hotel quarantine, sounds the alarm on misinformation, and shares some useful communications resources for the rollout of COVID vaccinations.
Alison Barrett writes:
This follows several COVID-19 infections escaping from hotel quarantine during the Australian summer, resulting in state border closures, and hard lockdowns in Brisbane, Perth and most recently, Victoria.
The current hotel quarantine system is no longer suitable, although it was extremely beneficial for emergency quarantine at the beginning of the pandemic, as I have written in a submission to the Senate COVID-19 Inquiry and a previous Croakey piece.
The recent outbreaks have raised concerns about aerosol transmission in hotels due to inadequate ventilation in and between hotel rooms (the most likely cause for the locally acquired COVID-19 cases in Brisbane and Melbourne); a lack of mandatory guidelines for staff to wear personal protective equipment (PPE), such as masks; and delays in implementing daily testing of quarantine staff, as highlighted with Perth’s locally-acquired case.
Evidence has emerged since the beginning of the pandemic that the SARS-CoV-2 virus can be transmitted via aerosols, tiny particles that can travel further and remain in air longer than droplets.
“We have known for a long time now that some transmission is through fine particles but there’s still a stubborn resistance to acknowledging it,” Professor Mike Toole, epidemiologist at the Burnet Institute, said on 15 February.
These issues require immediate attention to minimise the possibility of more cases escaping from hotel quarantine, which can have potentially devastating impacts on the Australian community, as shown by the 111-day lockdown Victorians endured in 2020.
However, concerns have also been raised about the management of quarantine programs in the centre of Australia’s busiest cities with multiple ways the virus can be transmitted to the community. This issue was also highlighted in the final report of Victoria’s COVID-19 hotel quarantine inquiry.
The final findings and recommendations from the Victorian hotel quarantine inquiry by the Honourable Jennifer Coate AO were published in late 2020.
These include that, regardless of what type of quarantine model is employed, the facility should:
- be within reasonable distance of a hospital
- be within suitable commuting distance for a sufficient number of skilled quarantine personnel
- have the ability to enable the physical separation of people
- have the ability to implement all necessary infection control requirements, as much as possible
- have the capacity to make essential changes to reduce the risk of transmission, as much as possible
- have the ability to provide safe access to outside areas for fresh air and exercise breaks
- have the ability to provide for specific needs such as mobility issues or the need to cater for infants.
The report also found that:
- it is important to follow expert advice, input, and supervision of infection prevention and control
- rapid and effective contact tracing systems are crucial
- hotel quarantine staff should not work at more than one location – and thus, should be employed appropriately with fair compensation to ensure they do not need to work multiple jobs.
The review also highlighted that after the H1N1 influenza pandemic in 2009, the Commonwealth reviewed Australia’s health sector response to the pandemic and recommended that clarification was required about the roles and responsibilities of all state, territory and federal governments during a pandemic; and that a “set of nationally consistent principles” could help inform the basis for state and territory jurisdictions to develop operating guidelines for quarantine and isolation.
Despite this review and recommendations, “the evidence to the Inquiry was that this work regarding the policy on quarantine and isolation was not undertaken”.
The hotel quarantine systems implemented in Australia in the early stages of the COVID-19 pandemic were implemented within a very short time-frame and without an adequate plan to guide the implementation.
Health professionals, epidemiologists and politicians have voiced their concerns about the current hotel quarantine system.
Dr Vyom Sharma (31 January)
Anna Davidson, Director of Port Stephens GP Super Clinic, shared an open letter signed by over 400 health care workers, asking for national action on aerosol transmission of COVID-19, including better protection for quarantine and border staff.
In an interview with ABC’s Virginia Trioli on 2 February, Professor Mary-Louise McLaws, epidemiologist at University of New South Wales, said “the breaches in our quarantine program are our biggest threat and have been since we got close to elimination” and that she does not understand why the Federal Government were not running the quarantine program.
Shadow Minister for Health and Ageing, and Member for Hindmarsh, Mark Butler, said in an interview with Patricia Karvelas, “there’s no question that outbreaks from hotel quarantine are the most serious failing we have right now in our COVID response and responsibility for that failing, constitutional and legal responsibility, rests with [PM] Scott Morrison.”
Recommendations to improve hotel quarantine by Professors Michael Toole and Brendan Crabb from the Burnet Institute include:
- ensuring quarantine hotels have better control of air quality
- prevention of aerosol transmission by making it mandatory for all hotel quarantine staff to wear N95 masks and face shields
- development of a national quarantine strategy.
Recommendations for new models of quarantine have been suggested by Dr Stephen Duckett and Brendan Coates from the Grattan Institute and include:
- moving quarantine for travellers out of hotels in major cities, due to their inadequate ventilation and location in densely-populated surroundings
- using regional military bases for quarantine with fly-in fly-out workers, or locally-recruited health and other workers
- adequate PPE must be made available and mandatory for all staff involved with the quarantine program, including drivers, cleaners, and security guards
With all of these discussions and expert advice, it is frustrating that PM Scott Morrison and the Federal Government have not taken responsibility for a national approach to COVID-19 quarantine to ensure the absolute best protection for the Australian community.
In an interview with Neil Mitchell on 3AW on 12th February, the PM was adamant the states and territories would remain in charge of quarantine systems:
The states share the information about what’s happening in their quarantine systems and it gets better and better. That doesn’t mean it can’t fail, of course it can fail, any system can fail.”
Although moving quarantine out of Australia’s major cities has been recommended by many and also now being explored by the Victorian and Queensland Governments, concerns have been raised about the logistics and risk to regional communities.
Some experts have warned that some suggested models, such as the for-profit quarantine facility proposed near Toowoomba by Wagner Corporation, are not appropriate. Infectious diseases specialist Professor Peter Collignon said:
The only thing I don’t like about the idea, I think it is very important that the governance of this – it sounds esoteric – is under the health department and the police.
I don’t think this is the sort of thing that should be privatised. To some degree that was the problem in Melbourne last winter.”
Throughout all of this, it is important to remember that the health and wellbeing of those in quarantine and all of the staff involved need to be prioritised, ensuring appropriate accommodation is provided to quarantine guests and that staff have access to adequate PPE, training and secure work to avoid them needing to work in multiple jobs.
“The health and wellbeing needs of those in quarantine must be a central feature of a future quarantine program,” Hon Jennifer Coate wrote in the enquiry.
Although COVID-19 vaccines in Australia are being rolled out this week, quarantine of some sort will still be required for some time to come.
While modifying quarantine so that it is fit-for-purpose will not be cheap, it will be a worthwhile investment, given the emotional, social and economic costs of a drawn-out lockdown should the virus escape and not be able to be contained.
Duckett and Coates wrote:
Improving on hotel quarantine depends on more than just dollars and cents. It will require the Federal Government to live up to its constitutional responsibilities for quarantining.”
At time of publication, the Department of Health had not responded to a request from Croakey for comment on this issue. Should one be forthcoming, we will update this post.
• The COVID-19 hotel quarantine inquiry final report can be read here.
• Listen to Virginia Trioli’s full interview with Professor Mary Louise-McLaws here.
Misinformation during vaccine rollout
Australia’s vaccine rollout has begun this week, and Facebook’s Australian news ban, which also resulted in government and community health pages being blocked, could not have come at a worse time as people need access to accurate, reliable information about the COVID-19 vaccines.
Croakey covered the Facebook news ban and impacts on public health in a rolling post as the situation unfolded on Thursday 18 February.
Croakey has also extensively covered the impacts of misinformation:
- New disinformation code slammed as “pointless, shameless, shameful”
- On Craig Kelly, misinformation and a view from the clinical frontlines
- Federal Government urged to take a public health approach to disinformation on digital platforms
- How do we counter COVID misinformation? Challenge it directly with the facts
- The Health Wrap: misinformation, pregnancy and birth, disability, access to healthcare, and the importance of leeches
Professor Julie Leask (18 February)
Dr Julia Baird (20 February)
To help counter misinformation, below are some evidence-based resources. As more are identified, they will be published in future editions of COVID-19 Wrap.
• Data for action: achieving high uptake of COVID-19 vaccines, by World Health Organization
“This guidebook will enable programmes to design, target and evaluate interventions to achieve greater impact with more efficiency, and to examine and understand trends over time.”
• Vaccine safety events: managing the communications response, by World Health Organization, regional office for Europe
“This guide provides informative strategies and tools to support effective communication planning and management in response to vaccine safety events.”
A guide for having effective conversations about vaccinations
• Boston University’s School of Public Health: video series on vaccines
• JAMA Network: Coronavirus mRNA vaccine safety and efficacy video
• COVID-19 vaccine information for Aboriginal and Torres Strait Islanders, by National Aboriginal Community Controlled Health Organisation and Australian Government Department of Health
This information includes a factsheet and community engagement toolkit.
• COVID-19 Vaccine rollout explained in your language, by SBS Australia
Videos about Australia’s vaccine rollout plan, and other coronavirus information, in 60 languages
• COVID-19 vaccines will protect individuals, families and communities, by Australian Academy of Health and Medical Sciences
Australian health and medical science experts from the Australian Academy of Health and Medical Sciences (AAHMS) are working with Science in Public to communicate key messages about Australia’s vaccine rollout.
See full AAHMS statement here.
Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow on Twitter: @AlisonSBarrett. Croakey thanks her for providing this column as a probono service to our readers.
See previous editions of the COVID wrap.
COVID-19 Twitter lists
Follow this Twitter list for informed news sources, global and Australian.
Follow this Twitter list for news from Aboriginal and Torres Strait Islander health organisations and experts.
Follow this Twitter list for news from South Australia on COVID.