Introduction by Croakey: Victoria has this week launched a new and improved hotel quarantine system and is accepting the arrival of overseas travellers for the first time in five months, after having to deal with a devastating coronavirus second wave after infections spread from CBD quarantine hotels.
In the article below, public health researcher Alison Barrett, a regular Croakey contributor, says it is time for Australia to look for an alternative to risky city-based quarantine facilities, to limit the spread of COVID-19 and better support the health and wellbeing, and human rights, of the tens of thousands of people who undergo quarantine.
Alison Barrett writes:
Australia’s response to the COVID-19 pandemic has been overall very strong and, with only 50 active cases Australia-wide, we are in a much better position compared to many countries around the world.
The hotel quarantine system has played a large part in preventing many COVID-19 cases and deaths in Australia. Between March and August, 851 travellers were diagnosed with COVID-19 whilst in hotel quarantine.
However, Victoria’s breaches in hotel quarantine show the devastating toll of uncontrolled spread, ultimately leading to a 112 day second wave lockdown, more than 20,000 confirmed COVID-19 cases and most of the state’s 820 COVID-19 deaths.
As international COVID-19 cases surge and more international arrivals are expected into Australia, pressure is on our quarantine systems to be tightly managed in order to minimise the risk of cases spilling into the community.
But we also need to ensure our hotel quarantine system can protect the health and wellbeing of returned travellers, and it appears to be time to scrap the current arrangements we have for stop-gap quarantine in the middle of our largest cities, for a better system that can protect us all for the longer haul.
Rights in quarantine
My partner returned home from overseas in October and spent two weeks in hotel quarantine in Adelaide, accommodated in a small room with no opening windows, a view of a car park across the road that looked like bars on the windows. He was told, as the door was shut behind him, he would not be able to leave for 14 days.
“I wasn’t told that one of my rights that will be taken away is to fresh air and exercise,” he told me.
Acknowledging that he was lucky to be home and that the food and friendliness of the staff were far better than could be expected, he nonetheless found that the lack of fresh air and exercise did not help his ability to cope with the 14 days in quarantine.
After many attempts to discuss this with SA Health nurses and hotel staff and management, he was moved to a balcony room by a manager and found that the access to fresh air made a huge difference to his wellbeing for the remainder of his time in quarantine.
While he was able to advocate for his own wellbeing and needs, it is possible that other returned travellers may not have the confidence or communication skills necessary to advocate for theirs.
Quarantine is a demanding challenge and, while a necessary public health burden to bear, it can also result in psychological distress for those who undergo it.
It is imperative to protect the health and wellbeing of returned travellers, not just from COVID-19 but other stressors related to quarantine, including communication so they know what to expect and are updated quickly and fully when circumstances change.
As the Victorian Equal Opportunity and Human Rights Commission has said, if rights and freedoms are being limited for the betterment of public health, they must be proportionate, time-bound, lawful, scrutinised and transparent. People must also be able to easily voice their concerns.
The National Review of Hotel Quarantine by former health department secretary Jane Halton found that, between March and August, 130,000 international and domestic travellers had undergone hotel quarantine in Australia.
It said, “many people reported, while challenging, the experience of quarantine was acceptable. The care provided by health and hotel staff was widely acknowledged; however, a lack of fresh air, support for mental health and the quality of hotel food also featured in feedback”.
The review also highlighted that, up to 28 August, 90 complaints about aspects of the quarantine program had been made to the Australian Human Rights Commission and 218 to the various Ombudsman offices, including complaints about lack of access to fresh air, food, the cost and access to medical support.
After deliberating on a guest’s complaint, the Queensland Human Rights Commission recommends that all hotels used for quarantine should have balconies or windows that open, concluding that “lack of fresh air is a significant human rights issue and one that we sincerely hope is addressed as a matter of priority.”
But civil liberties groups this week criticised a Queensland Government decision to ban “fresh air breaks” in hotel quarantine, describing the move as an “unacceptable impingement” on the freedoms of returned travellers.
Staffing and security
At the same time as protecting the health and wellbeing of returned travellers, it is important to protect the Australian community from incoming COVID-19 cases via tightly-managed quarantine programs.
Some of the risks identified include poor infection-control practices by hotel quarantine staff and the employment of casual staff who need to undertake additional employment to supplement an insecure income. That increases their potential for contact with the community, a significant risk if they contract the virus at work.
The South Australian Council of Social Service (SACOSS) and other unions and organisations warned in a letter to Premier Steven Marshall that insecure work is “the Achilles heel of our pandemic response”.
“It is imperative to our fight against this pandemic that workers have the security of a full income, so that they don’t have to undertake multiple jobs while they are working in high-risk workplaces like nursing homes, aged care, hospitals, and correctional services,” they said.
Victoria’s formal inquiry into its hotel quarantine COVID-19 spread will not report back on what happened until just before Christmas, but its interim report has addressed staffing issues in detail. It made a key recommendation that “every effort should be made to have personnel working at quarantine facilities salaried employees with terms and conditions that address the possible need to self-isolate in the event of an infection or possible infection.”
Victoria has made important changes for its hotel quarantine program that resumed this week, including having staff “employed or directly contracted” by the new COVID-19 Quarantine Victoria agency that has been implemented to oversee the program.
Other additional infection control practices include daily testing of staff and for frontline staff to work in ‘bubbles’ to ensure limited contact with other staff.
The Halton national review did not address staff issues, but did say:
With six months of quarantine experience and the likelihood that hotel quarantine will remain in place for some time, Australia’s one size fits all approach should be reconsidered to take account of greater knowledge of the virus, different prevalence in countries of origin of travellers, an understanding of how to incorporate risk-based approaches in system design and different models of quarantine made possible by new testing and monitoring arrangements.”
It said existing models of quarantine are unlikely to be able to expand significantly above current levels and “new approaches that manage risk are needed”.
Finding a permanent solution
It’s likely that we will be using quarantine facilities for the foreseeable future, with worldwide vaccination still some time away, and the costs of uncontrolled spread far too high, as shown by Victoria.
While the various changes in hotel quarantine, such as in Victoria, are welcome, it will be worthwhile to explore and invest in an alternative solution, that is more secure and can better address health and wellbeing for those who are being quarantined.
South Australia’s Opposition Leader Peter Malinauskas has called for an immediate end to ‘Medi hotels’ (as they are called in SA) in their current form.
The practice of “flying people infected with the virus into Adelaide airport, then using CBD hotels staffed with subcontracted security and ancillary casual labour, is simply not safe for those individuals or our whole community”, he said.
He has called on the Federal Government to undertake a nation-wide exploration of alternative locations, suggesting for example Darwin’s Howard Springs facility, and to purpose build new facilities if necessary, to be staffed by well-trained non casual labour.
As I have written in a submission to the Senate COVID-19 Inquiry, hotels, especially in population dense city centres, are not designed for quarantine.
While they may have been appropriate in the early stages of the pandemic because of their close proximity to airports and major hospitals, they are no longer so.
After nine months of dealing with the pandemic, we should be in a position to ensure quarantine systems are appropriate for the long-term situation we are in, with tens of thousands more Australians wanting to return home and the prospect of opening up the border to many others, including international students.
It is time to change gear from the temporary system we have now and ensure appropriate and permanent solutions are found to protect us for the long-haul.