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COVID-19 wrap: concerns on quarantine, misinformation overload and useful resources

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:

Many medical professionals, epidemiologists and infectious disease experts have called on the Federal Government to take more action to address concerns about the hotel quarantine program.

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.

Welcome improvements have been made to hotel quarantine over the past year, including daily testing of staff and a dedicated medi-hotel in Adelaide for people who test positive to COVID-19.

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)

Dr Eric Levi (12 February)The Australian Medical Association has called for immediate national action on hotel quarantine (see this 10 February Twitter thread).

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:

Professor Julie Leask (18 February)

Dr Julia Baird (20 February)


Resources

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.”

• The COVID-19 Vaccine Communication Handbook, by behavioural science experts, SciBeh

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.

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Federal Budget 2021-22
Global health and climate change
2019-20 climate bushfire emergency
asylum seeker and refugee health
climate change
disasters
Ebola
extreme weather events
flooding 2011
global health
NHS
NZ Election 2017
WHO
health
Healthcare and health reform
abortion
adverse events
aged care
allied health care
Australian Medical Association
cancer
cardiovascular disease
child health
Choosing Wisely
chronic diseases
co-payments
Cochrane Collaboration
complementary medicines
conflicts of interest
death and dying
diabetes
digital technology
disabilities
e-health
emergency departments and care
Equally Well
euthanasia
evidence-based issues
general practice
genetics
health & medical marketing
health and medical education
health and medical research
Health Care Homes
health ethics
health financing and costs
health reform
health regulation
health workforce
HIV/AIDS
hospitals
HRT
infectious diseases
influenza
international medical graduates
journal articles
LGBTIQ
medical marijuana
Medicare Locals
men's health
mental health
MyHospitals website
National Commission of Audit 2014
National Health Performance Authority
naturopathy
NDIS
NHMRC
non communicable diseases
nurses and nursing
oral health
organ transplants
out of pocket costs
pain
palliative care
paramedics
pathology
Pharmaceutical Benefits Scheme
pharmaceutical industry
pharmacy
Pregnancy and childbirth
primary health care
Primary Health Networks
private health insurance
quality and safety of health care
rural and remote health
screening
sexual health
social media and healthcare
suicide
surgery
swine flu
telehealth
tests
TGA
trauma
women's health
youth health
Indigenous health
#CTG10
#NTRC
Acknowledgement
cultural safety
Indigenous education
Lowitja Institute
NT Intervention
social and emotional wellbeing
Uluru Statement
WA community closures
News about Croakey
PatientSafety
PIJ Commissions 2021
Public health and population health
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
air pollution
alcohol
consumer health matters
Coronavirus outbreak 2019-2020
COVIDwrap
environmental health
Fetal Alcohol Spectrum Disorders (FASD)
food and nutrition
gambling
Government 2.0
gun control
health communications
health impact assessment
Health in All Policies
health inequalities
health literacy
human rights
illicit drugs
injuries
legal issues
marriage equality
Media Doctor Australia
media-related issues
nanny state
National Preventive Health Agency
obesity
occupational health
physical activity
plain packaging
prevention
public health
public interest journalism
road safety
sport
sugar tax
tobacco control
transport
vaccination
violence
Web 2.0
weight loss products
Royal Commission
Social determinants of health
discrimination
education
justice
Justice Reinvestment
NBN
Newstart
poverty
racism
social policy
Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017