Quarantine must leave city hotels
A traveler left a hotel after 14 days in quarantine and moved to Perth for five days before catching a flight to Melbourne, where he tested positive for COVID-19. This led to a three-day community-wide lockdown in Perth and Peel.
Right now it all seems pretty repetitive. Since a COVID case leaked from the Peppers Hotel in Adelaide in November, there has been 16 leaks through Melbourne, Sydney, Brisbane, Adelaide and Perth.
While most have led to a low number of community cases, the Sydney leak in December led to the Avalon Cluster, which infected 151 people. And of course, earlier in the pandemic, the infection of staff at two Melbourne quarantine hotels led to Victoria’s infamous Second Wave.
So what’s wrong with the hotel quarantine in Australia, and is it finally time to move it out of the cities?
Why is the hotel quarantine failing?
Supervised quarantine has been appointed by the federal government on March 28 of last year. State and territory governments have only had a few days to put in place hotel quarantine systems.
Judge Jennifer Coate cited this short notice as one of the factors leading to the failure of the system in Victoria in the hotel quarantine investigation report.
But now we’ve had the time to get it right – and we still haven’t. Importantly, although it has been mandated by the federal government, there is no national standard for how quarantine is implemented.
In 2020, precautions focused on preventing transmission via large droplets and respiratory surfaces. This was achieved by ensuring physical distancing by forcing hotel guests to stay in their rooms, providing staff with surgical masks, and giving hand sanitizer to guests and staff.
However, a demand in the breach of the hotel Peppers discovered that it had probably occurred by airborne transmission. These are very small droplets contaminated with the virus that stay in the air longer and spread more.
The policies did not follow
Evidence to suggest that airborne transmission is responsible for the majority of transmissions within the Australian hotel quarantine system continues to mount. The two main measures to avoid this are improved ventilation and the wearing of appropriate personal protective equipment (PPE) by staff.
In preparing for this article, I have reviewed the policies of each of the six states based on information from health service websites and press releases. I found significant differences between the states.
South Australia and Victoria were similar in that both states had performed ventilation audits at hotels. However, SA only rated its designated medi-hotel Tom’s yard (where COVID-positive patients stay), while Victoria rated each hotel room and, if necessary, made modifications to ensure that these parts have “negative pressure”. This means that when the door is opened, air flows inward rather than outward.
Western Australia carried out a ventilation audit in March and found that the Mercury was at high risk. But no action was taken in time to prevent room-to-room transmission.
There is no public evidence to suggest that the other three states have performed ventilation audits.
In South australia, in designated orange and red areas of hotels, staff must wear respiratory masks such as N95 and P2. In Victoria, all personnel in open areas must wear an N95 mask and a face shield. In other states, staff are provided with surgical masks, which does not protect against airborne spread as effectively as respirator masks.
This is important because in a state like New South Wales when testing is done on days 2 and 12, guests who test negative on day 2 can incubate the virus, then become positive and be infectious for up to ten days before being identified.
What is the future of hotel quarantine?
Given the high number of cases globally and the slow rollout of vaccines in most countries, Australia will need supervised quarantine for some time, most likely until 2023.
The installation of Howard Springs in the Northern Territory is ideal. Walk-in cabins, separate air conditioning systems, outdoor verandas, and a nearby hospital make it a perfect fit. And there have been no leaks despite a high number of infected residents.
Now is the time to invest in similar facilities in every state and territory. Quarantine is our first line of defense against the virus. It must be 100% effective to maintain our hard-earned status of zero COVID cases in the community. This achievement is what put us in the enviable position of a growing economy and a public almost back to their pre-pandemic quality of life.
In the meantime, quarantine hotels in every jurisdiction must adhere to consistent, evidence-based standards. The Australian Senior Health Protection Committee should meet urgently to develop a national code of practice, which should effectively combat airborne transmission by paying special attention to ventilation and providing suitable respiratory masks and face shields to all personnel working in open areas.
Considering the quarantine leak rate over the past six months, with no improvement, the system will likely experience more than a dozen more leaks by October, causing frequent disruption in our lives. The impact on the economy and on public confidence will be immeasurable.
Michael Toole, Professor of International Health, Burnet Institute
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