Overhead transmission is responsible for most of the leaks. Without national standards or more Howard Springs-style facilities, outbreaks will continue to disrupt our lives
Last week, at least six Australians returned home uninfected just to acquire the coronavirus during quarantine at hotels in Sydney and Perth.
A traveler left a hotel after 14 days in quarantine and moved to Perth for five days before taking a flight to Melbourne, where he tested positive for Covid-19. This led to a three-day community block in Perth and Peel.
Now, it all seems quite repetitive. Since a Covid case leaked from the Peppers Hotel in Adelaide in November, there have been 16 leaks in Melbourne, Sydney, Brisbane, Adelaide and Perth.
Although the majority led to a low number of cases in the community, the Sydney spill in December led to the Avalon cluster, which infected 151 people. And, of course, at the beginning of the pandemic, the infection of employees at two quarantine hotels in Melbourne led to Victoria’s infamous second wave.
So, what’s going so wrong with Australia’s hotel quarantine and it’s finally time to move it out of the cities?
Why is the hotel quarantine failing?
Supervised quarantine was determined by the federal government on March 28 last year. State and territorial governments only had a few days to establish hotel quarantine systems.
Judge Jennifer Coate cited this short notice as one of the factors that led to the system’s failure in Victoria in the hotel’s quarantine inquiry report.
But now we have time to get it right – and not yet. It is important to note that, although it has been determined by the federal government, there is no national standard on how quarantine is implemented.
During 2020, the focus of precautions was on preventing transmission through large drops and respiratory surfaces. This was achieved by ensuring physical distance, making hotel guests stay in their rooms, providing surgical masks to employees and giving hand sanitizer to guests and employees.
However, an investigation into the Peppers Hotel breach found that it probably occurred over the air. This refers to droplets contaminated by very small viruses that remain in the air for a longer time and spread further.
Two leaks at Melbourne’s Park Royal and Holiday Inn Airport hotels in February were also likely to be caused by overhead transmission.
The recent transmission between residents in adjoining rooms at two hotels in Sydney and the Mercure Hotel in Perth can only be explained by air transmission.
Policies have not kept up
Evidence to suggest that airborne transmission is responsible for most of the transmission within Australia’s hotel quarantine system continues to accumulate. The two main measures to prevent this are improved ventilation and the use of adequate personal protective equipment (PPE) by employees.
In preparing this article, I reviewed the policies in each of the six states based on information from health department websites and press releases. I found significant differences between states.
South Australia and Victoria were similar in the sense that both states carried out ventilation audits on hotels. However, SA evaluated only the Tom’s Court of the designated medium hotel (where Covid-positive patients stay), while Victoria assessed all hotel rooms and, when necessary, made modifications to ensure that these rooms had “negative pressure”. This means that when the door is opened, air flows in and not out.
Western Australia did a ventilation audit in March and found that Mercure was at high risk. But no action was taken in time to prevent transmission from room to room.
There is no public evidence to suggest that the other three states have carried out ventilation audits.
In South Australia, in designated orange and red areas of hotels, employees must wear breathing masks such as N95 and P2. In Victoria, all employees in open areas must wear an N95 mask and face shield. In other states, employees receive surgical masks, which do not protect against airborne spread as effectively as breathing masks.
Although employees in all states are tested daily, the number of times guests are tested varies considerably – four times in Victoria, three in South Australia and twice in other states.
This is important because in a state like New South Wales, where the test is done on days two and 12, guests who test negative on day two may be incubating the virus and then become positive and become infectious for up to 10 days before they are identified.
What’s the future of hotel quarantine?
As Covid-19 cases increase worldwide, an increasing proportion of returning travelers will be infected. As of April 27, there were 255 active cases across the country in hotel quarantine.
Given the high number of cases worldwide and the slow release of vaccines in most countries, Australia will need supervised quarantine for some time, probably until 2023.
Howard Springs facilities in the Northern Territory are ideal. One-story cabins, separate air conditioning systems, outside balconies and a nearby hospital make it suitable for your purpose. And there were no leaks, despite the high number of infected residents.
Now it’s time to invest in similar facilities across states and territories. Quarantine is our first line of defense against the virus. It needs to be 100% effective to maintain our hard-earned status of zero Covid cases in the community. This achievement is what placed us in the enviable position of a growing economy and an audience almost back to its pre-pandemic quality of life.
Meanwhile, quarantined hotels in all jurisdictions must adhere to consistent, evidence-based standards. The Australian Health Protection Committee must meet as a matter of urgency to develop a national code of practice, which needs to effectively address airborne transmission through attention to ventilation and the provision of breathing masks and face shields to all employees working in areas open.
Given the rate of quarantine leaks over the past six months, with no improvement, the system will likely see more than a dozen leaks by October, causing frequent disruptions in our lives. The impact on the economy and public confidence will be immeasurable.