Questions over hotel quarantine as calls made for national protocols

And Wagner says it would be safer than CBD hotels, which are under fresh scrutiny this week after two hotel workers – one in Melbourne, one in Perth – almost certainly contracted the virus from airborne transmission, triggering a snap lockdown in the West Australian capital and tighter community restrictions in Melbourne.

Victorian health authorities have also been alarmed by a case of a returned passenger who picked up the virus from an infected family of five staying on the same floor at the Park Royal hotel, despite the parties having had no physical interaction.

Epidemiologist Professor Michael Toole from Melbourne’s Burnet Institute says these and numerous overseas examples point to the unequivocal risk of airborne transmission, which Australia’s peak infection control expert group has been slow to highlight.

The AMA’s Western Australian president Dr Andrew Miller is among the most forceful critics of the existing system, branding hotel quarantine “an oxymoron”.

Hotel systems are generally not designed to generate the kind of airflow turnover needed to minimise the risk of aerosol transmission, he says, especially in the face of the threat posed by the new, more highly infectious virus strains coming out of Britain, South Africa and Brazil.

“We have gone down the path of least resistance because there is great cost and inconvenience in dealing with an airborne threat” Miller argues. “However that is demonstrably less than the cost and inconvenience of repeated instances of quarantine breach, cross-infection and lockdown.”

He believes developing more quarantine facilities at “greenfield sites” must be on the agenda, but in the interim “the stepping stone to greenfield sites is to immediately upgrade the airflow within the [existing] facilities, and the way they are administered”.

Sydney-based epidemiologist Professor Mary-Louise McLaws, who sits on a World Health Organisation advisory panel, is equally perturbed. “It’s not always easy to change a hotel ventilation system” she says. “They often can’t maximise airflow change with an industrial unit that’s designed for a lower rate of airflow change [than a hospital]“ – though older hospitals too can have ventilation problems.

She says any facility being used for quarantine should have at least 10 airflow changes an hour, and would also prefer to see them located in regional areas or on the edges of CBDs.

McLaws points to Howard Springs outside Darwin, a former labour camp currently co-funded by the Commonwealth and the Northern Territory to provide up to 850 quarantine places a fortnight, as ideal. It has single-storey rooms with verandahs and open-air walkways, and proximity to top-class medical facilities.

Following Friday’s national cabinet meeting Prime Minister Scott Morrison unveiled plans to more than double Howard Springs’ capacity, but reiterated that hotel quarantine would remain the primary mode of dealing with returning travellers.

The hotel quarantine system, he declared, had been “incredibly effective”, processing more than 210,000 international returnees with only a “handful of cases that haven’t been completely contained”. He also left the gate open to the Toowoomba option – albeit warning “there is a lot more information we are going to need” – and flagged the possibility of home quarantine down the track depending on a successful vaccine rollout.

Toole is not optimistic that large-scale alternatives to hotels are possible, “but I think every option now needs to be examined”.

“Border health security is our number one priority to keep the virus out until we are vaccinated. You have to throw resources at it. I’m annoyed to see in Perth that a security guard wasn’t being paid enough to make a living and had to have a second job – why aren’t we paying these people decent salaries? It’s a drop in the bucket in terms of resources.”

Jane Halton, one of the country’s foremost experts on quarantine who completed a report on the topic for national cabinet last year, told the Herald and The Age that “the quarantine system has to continue to evolve – the pandemic is not static and neither can quarantine be. We are learning as we go, in terms of what works and what some of the risks are, so we have to take steps to mitigate those as we understand them better.”

But she believes the hotel quarantine system is generally working well. Now chair of the global Coalition for Epidemic Preparedness (CEPI), Halton says a “broad question” remains over how to ensure best practice is well-coordinated among the states and territories.

And she cautions that any facility outside a major capital needs close proximity to a major transport hub and acute-care facilities, with access to an expert workforce large enough to be rotated.

This week’s shocks have laid bare the fact that some states have been slow to shore up their defences against the virus. It has also highlighted the strikingly different policies on whether ancillary staff working in quarantine hotels should be allowed to hold down additional jobs.

In NSW, for instance, the government sees no need to ban secondary employment among hotel quarantine workers. State Health Minister Brad Hazzard argues that “in the real world, people including security guards and cleaners have lives. They go home to their families, they see their friends and if you tried to stop them living those lives, you wouldn’t have people doing the job.”

He says the state has progressively adopted “additional checks and balances, the most significant of which is the daily saliva test for every staff member working in hotel quarantine”.

National cabinet agreed on January 8 that any worker involved in quarantine should have daily COVID-19 tests. However Toole points out that while this was adopted in NSW on January 17, it didn’t get implemented in WA until January 29, too late for the Perth security guard’s infection to be promptly picked up.

The WA government says it’s now “working with hotel and security companies to negotiate an arrangement that prevents staff from having secondary employment”. It’s also testing workers for the virus daily, and requiring mask-wearing by guards in hotel corridors – which was not the case prior to this week’s reported infection in the security guard.

South Australia is running five ‘medi-hotels’ for returning travellers and, from Monday, its workers too will have daily saliva tests as well as a weekly nasal swab, but staff will continue to be allowed a second job outside hotel quarantine.

Queensland also allows hotel staff or contractors to have multiple jobs or work across multiple sites with the same employer, justified on the basis that restricting these opportunities would “have significant financial impacts”.

Victoria, seared by its harsh lockdown for 3½ months last year triggered by breaches of security at quarantine hotels, has the toughest regime. It has set up a dedicated agency, COVID-19 Quarantine Victoria (CQV), to run the system, which directly contracts ancillary workers who are banned from holding down secondary jobs.

Queensland and WA are keenest among the states to explore alternatives to quarantine in big city hotels, with WA pushing Christmas Island as one option (firmly rejected by Morrison), while the Toowoomba option holds appeal for Queensland.

But in NSW, Hazzard remains adamant that it would be impractical – indeed, downright “disadvantageous” – “for us to be considering moving our public health hotels out of the Sydney regional area”, not least because of the sheer size of the NSW quarantine workforce (3500 people daily).

Victorian Premier Dan Andrews said this week he was “always happy to sit down with the Prime Minister and see if there are some bespoke facilities that can be built” but warned “staff have lives … you can put a quarantine facility 50 kilometres from where we are standing, or 500 kilometres, but there will be people there too and the virus spreads”.

The fresh spotlight on hotel quarantine has renewed criticisms that the Morrison government has largely absented itself from the quarantine task. Labor has branded Morrison “hands-off Harry” for not picking up what it says is the Commonwealth’s primary constitutional responsibility for quarantine. How well-founded is that line of attack?

Sydney University constitutional law expert Professor Anne Twomey writes in a forthcoming article for the Australian Law Journal that “it appears that the Commonwealth Government took the view that it did not have the capacity or competence to be able to establish and run [compulsory hotel quarantine]. Instead it took the easier path of leaving it to the states to take up the financial and logistical burden of establishing an entire system from scratch within 48 hours [last March].”

Twomey says while section 51 (ix) of the Constitution does vest quarantine power in the Commonwealth it is not an exclusive power, and the states’ public health safeguards operate alongside it. While the Commonwealth could have chosen to exclude state law under section 109, it had not done so.

In past decades, she writes, the federal government had gradually taken over quarantine stations from the states but closed them after successful immunisation campaigns, particularly against smallpox. The resulting lack of large-scale quarantine capability in capital cities [with the exception of Howard Springs] has left Australia “ill-equipped to deal with a major pandemic”, Twomey concludes.

Melbourne University Professor Cheryl Saunders, also a constitutional expert, notes that “usually the Commonwealth exercises its concurrent powers – often quite aggressively”. But in this case, the federal government held back, in recognition of the fact that “it doesn’t have the personnel, it doesn’t have the presence on the ground, it doesn’t know the local scene as deeply as a state or territory government does”.

Last year’s probe into Victoria’s hotel quarantine failures by jurist Jennifer Coate noted there had been an opportunity for the Commonwealth to come up with a national quarantine scheme immediately after 2009, when it reviewed the country’s response to the H1N1 flu pandemic.

That review had recommended that “the roles and responsibilities of all governments for the management of people in quarantine … during a pandemic should be clarified”, with a set of “nationally consistent principles” to be drawn up. But that was never acted upon.

Toole and McLaws both believe the federal government should be exercising firmer leadership over how hotel quarantine is run.

Asked how national standards were currently being co-ordinated, the federal health department cited a “Statement on national hotel quarantine principles” adopted by the Australian Health Protection Principal Committee (AHPPC) – the body that brings together all federal, state and territory chief health officers – published on Christmas Eve.

But those who want to see the Commonwealth step up further say the AHPPC is already over-burdened and the December statement is not prescriptive enough, particularly on the risks of aerosol transmission.

McLaws calls for more stringent adoption of best practice around the country, including eye protection and enhanced PPE for hotel quarantine workers, and the use of CCTV instead of personnel keeping watch in corridors.

Toole says it’s now up to the federal government to “do everything in their power – and that power is considerable – to ensure that there is a national standard that is being implemented by every state”.