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USING hotels to quarantine overseas arrivals was an effective solution at the beginning of the COVID-19 pandemic, but should they still be the centre of our quarantine policy over 18 months later?
That’s the question many have been asking, particularly with extended lockdowns plaguing residents in New South Wales, the Australian Capital Territory, Victoria and New Zealand because of a Sydney quarantine failure in June 2021 (here, here and here).
According to epidemiologist Dr Driss Ait Ouakrim, from the Centre for Epidemiology and Biostatistics at the University of Melbourne, hotel quarantine has dragged on far too long.
“Hotel quarantine was good at the beginning because it was a quick and dirty solution,” he told InSight+.
“But 12 months after the start of the pandemic, we needed to move to something more robust, and that didn’t happen.”
Dr Ait Ouakrim is a co-author of research published in the MJA. The researchers analysed several quarantine failures in Australia and New Zealand up until 15 June 2021.
They found there were 22 quarantine system failures in Australia and 10 in New Zealand. These failures were linked to nine lockdowns and one failure caused over 800 deaths (the second Victorian wave).
Dr Ait Ouakrim and his co-authors started the research after Victoria’s second wave.
“We tried to write this paper to warn of the risk of not having a proper quarantine system. Unfortunately, that’s exactly what happened in Sydney. It was enhanced by a variant that was highly infectious, the Delta variant,” he said.
According to Kate Cole, President-elect of the Australian Institute of Occupational Hygienists, there hasn’t been enough done at a national level to address the control of airborne exposures of COVID-19.
“We were really late in the piece in Australia in recognising aerosol spread or airborne transmission. Because of that, there was inadequate planning in high-risk workplaces like health care and hotel quarantine to make sure workers were protected from this major transmission route,” Ms Cole told InSight+.
“Had we really got on the front foot, used the precautionary principles, and put appropriate control measures in place, arguably a significant number of these infections could have been prevented,” she said.
There are two failures that she says persist in hotel quarantine. The first is ventilation.
“We have been recommending a focus on ventilation in hotel quarantine for a really long time and that’s because the virus can move from rooms into hallways and into other rooms and shared spaces that workers occupy,” she said.
The other focus should be on adequate personal protective equipment, such as the use of N95 (or P2) face masks.
“Unfortunately, still now, in some of our current state guidance, we see the use of surgical masks for workers like security guards on guest floors or service staff for meal delivery. So, we still have a long way to go if we want to prevent future quarantine outbreaks,” Ms Cole warned.
One quarantine facility lauded as a success is the converted workers’ camp at Howard Springs in the Northern Territory. These open-air cabins allow for natural ventilation and eliminate shared indoor spaces.
Experts have been pushing for more of these types of facilities for some time. Only recently has the federal government announced they will build specialist quarantine camps at Bullsbrook on the outskirts of Perth, Mickleham in Melbourne, and Pinkenba, near Brisbane Airport. They should be up and running in 2022.
In addition, the Queensland Government has gone out on its own. They’ve announced they’re funding an additional quarantine facility just outside Toowoomba, west of Brisbane (here and here).
Ms Cole warned that open air facilities are an improvement on the current system, but they’re not risk free.
“We have to remember we need to get people to these quarantine facilities as well. They’re transported in buses and other vehicles and those workers are also servicing quarantine hotels. We’re still seeing a significant number of infections from those workers into the community as well,” Ms Cole said.
To avoid future COVID-19 variants, and in particular for states still pursuing COVID-19-zero, learning from these mistakes will be paramount.
“We reported on this in the media, we wrote opinion pieces. There were plenty of warnings,” said Dr Ait Ouakrim.
“It’s very frustrating to see how people get away with this. There’s so much happening, people are struggling to handle the current situation that evolves constantly. They forget that this could have been avoided easily,” he said.
Also online first at the MJA
Research letter: Sex differences in the management and outcomes of non‐ST‐elevation acute coronary syndromes
Bachelet et al; doi: 10.5694/mja2.51220 … FREE ACCESS permanently.
Editorial: Sex disparities continue to characterise the management of non‐ST‐elevation acute coronary syndrome
Pivato et al; doi: 10.5694/mja2.51253 … FREE ACCESS for 1 week.
Podcast: Professor Roxana Mehran, Director of the Center for Interventional Cardiovascular Research and Clinical Trials at the Cardiovascular Research Institute at Mount Sinai School of Medicine in New York … FREE ACCESS permanently.
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The basic principle of quarantine through the centuries, was not letting infected people out.
That included for medical treatment, as the large graveyards around quarantine centres indicate. The Covid virus has escaped from multiple teaching hospitals in multiple states.
Quarantine also included staff living on premises. Many of our ‘quarantine’ failures were when infected staff returned to their large households. Transport was not an issue as people went from the ship straight into the waterfront quarantine centre.
A standalone facility such as Howard Springs will fail if sick people are then transported to the major city teaching hospital. For future pandemics, especially if the virus is as infectious as Delta and as lethal as the original SARS, the only safe option is a completely isolated facility such as Christmas Island. For those who arrive by sea, an onshore facility could be kept dormant until needed, then staffed by military or state hospital staff, who would be confined to the facility until it was disease-free. Given the massive economic cost of lockdowns, offering comparable salaries as FIFO miners/oil-rig workers receive, would see plenty of volunteers.
The lesson of Lassa fever, Marburg virus, rabbit calicivirus, and now (possibly) the Wuhan bioweapons lab, is that infections will always leak from a ‘secure’ facility.
For the current pandemic, the horse has well and truly left the stable. Journalist Latika Bourke has eloquently pointed out the stupidity of hotel quarantining people who have come here from overseas after negative testing, when patients with actual Covid infection are allowed to isolate at home.
The real question is not addressed or answered. The Question is: “Is quarantine needed for all arrivals?”
We need to recognise things have changed since February 2020. . We now have a level of vaccination, the ability to test frequently, the possible use of other options such as adequate home isolation for some, and we have recognised but not assessed the mental health costs for others, the social costs of isolation and the restrictions placed on travel and our communities. There is much more to this discussion than just examining and comparing facilities for quarantine. All solutions for quarantine carry significant cost, risk and disadvantages.
Only had 18 months to realise what millions upon millions of citizens of the world have known for hundreds of years have realised!
Quarantine does not mean concentrating highly infected snd infectious people slap bang in the middle densely populated central city areas in totally unfit for purpose hotel rooms for an 18 month period with bugger all action to fix the system. Criminally stupid.
Not realising people with Covid would actually spread the virus when they either coughed or simply exhaled. Unbelievably criminally stupid also.
The Chinese, when they finally came clean about Covid had clearly demonstrated research showing aerosol spread to be a major factor early last year for heavens sake. The bureaucratic Commonwealth health advice was appalling and was constantly being called out for months. Criminally stupid.
Hotel quarantine has been a taxpayer funded financial bonanza for hotel chains but a total economic disaster for the rest of the economy (apart from Public Servants of course) due to constantly leaking the virus like a sieve and locking down our two largest states constantly.
desperately hoping for a visit by daughter and family from Yorkshire. all have been fully vaccinated and returned negative results. Upon arrival they could comfortably isolate at our isolated beach house in Kingston SE. We are healthy and fully vaccinated and a visit would bring great joy to us all
Thank you for the opportunity to participate
Valerie Ferguson
effective solution, you are kidding me right ?
so many failures in the hotel quarantine system is what resulted in the virus getting into Australia from overseas.
proper quarantine facilities should have been built, along the lines of Howard Springs. so what if it’s costly.
they understood the importance of strict quarantining of overseas arrivals in Venice in the 13th century Black Plague, but obviously our modern governments do not.
The research does not appear to identify the specific quarantine failures that related to the use of hotels and those that related to transport or unknown causes. This would appear to invalidate the conclusion.