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.
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.