A year after the Victoria hotel quarantine inquiry, one significant question remains unanswered


Kristen Rundle, The University of MelbourneThis time last year, the nation was riveted by the Victorian COVID-19 Hotel Quarantine Inquiry, launched to determine the cause of the state’s disastrous second COVID wave. The outbreak led to 768 deaths and a 111-day lockdown of Melbourne.

It didn’t take long before a problem revealed itself. It was not at all clear who made the decision to “contract out” the hotel quarantine enforcement to private security providers, which is what led to the virus seeping into the community.

A long line of senior political and governmental officials denied any association with it. The inquiry’s chair, Jennifer Coate, came to describe the decision as an “orphan”.

We did learn what went wrong from an infection control standpoint and reset the hotel quarantine system to be safer. But now, the debate has shifted to whether we should have hotel quarantine at all.

The question the inquiry left behind is a different one, and it’s not only about Victoria. Why are governments across Australia so reliant on private contractors in the first place?




Read more:
Victoria’s hotel quarantine overhaul is a step in the right direction, but issues remain


Contracting out is standard practice

“Contracting out” government functions for delivery by the private sector has become the standard way of doing things across all levels of government in Australia.

Indeed, it has become so standard that decision-makers might not see the matter as involving choice at all. It’s just how things are done.

Elsewhere, I have said more about the disintegrating effects this situation can have on the principles of responsible government, around which Australia’s constitutional systems are built. The entrenched status of “contracting out” means the potential for more “orphan” decisions can occur at any time and place.

There’s a long story behind how governments across Australia, of all political stripes, have arrived at a place where everything from defence security to disability services (and much in between) is performed by private contractors.

Yet, justifications for why outsourcing is used to perform the work of government still tend to be based more on assertions than arguments.

One of these assertions is that the private sector is more “efficient” than government. But the reality is outsourcing government service delivery doesn’t necessarily cost less. It just means less is spent on public employees.

But there’s more to it than contestable claims about efficiency. The functions government must perform and the services the private sector can provide are not necessarily the same thing.

For example, was the choice of outsourced “security services” for the hotel quarantine program led by a careful understanding of the nature of quarantine, or by what the private sector could deliver? Too little thought is given to what might get lost in translation.




Read more:
Hotel quarantine interim report recommends changes but accountability questions remain


Why nobody is looking at this issue

All of this requires a conversation about the appropriateness of “contracting out” in different contexts that we’ve basically never had. Outsourcing has rarely, if ever, been the subject of significant parliamentary debate in any Australian jurisdiction.

Indeed, sometimes the only way the public finds out about what’s going on with government contracting – in the many forms it might take – is through inquiries launched to investigate something that has gone wrong.

Ombudsmen and auditors-general can be empowered to look at particular instances of outsourcing and make recommendations in relation to them. We might occasionally also see a specific contract questioned in a Senate Estimates hearing.

But it’s important to highlight these “watchdogs” are not there to tell governments how to govern us. Opportunities to have that say are thin on the ground.




Read more:
Melbourne’s hotel quarantine bungle is disappointing but not surprising. It was overseen by a flawed security industry


A good illustration of this is the 2019 Senate Legal and Constitutional Affairs Committee inquiry into the impact of changes to models of government service delivery (including outsourcing). There was little in its terms of reference to suggest it sought views on whether we should be doing these things at all. The changes were going to happen, the inquiry was about their likely “impact”.

Perhaps we’ll also need an inquiry into the vaccine rollout to find out about the contractual arrangements there, given the Commonwealth Department of Health has argued multiple exemptions – including “national security” – in response to freedom of information requests about the agreements in place.

Once, there was an independent body called the Administrative Review Council that kept an eye on the “big picture” developments in government administration. Well ahead of the curve, it published a report in 1998 on the possible implications of Australia’s fulsome embrace of “contracting out” for those directly affected by outsourced government service delivery.

The ARC pledged to revisit this question if there was ever a need. But it was effectively abolished before it could do so. It was a casualty of the 2015 “smaller government” reforms that dismantled multiple government agencies and radically reduced the size of the public service, leading to even more outsourcing to private contractors.

The ARC’s functions were consolidated into the attorney-general’s department, to the extent that they continue to be performed at all.

If the public wants a discussion about how governments govern us – that is not led by governments themselves – it is up to us to pursue it. The silver lining is we at least get to set the terms of the conversation.

While we work out those terms, it would be unwise to relegate the Victorian COVID-19 Hotel Quarantine Inquiry to history. There’s still a whole lot we can learn from it.The Conversation

Kristen Rundle, Professor of Law, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

A mining camp won’t cut it: Australia’s quarantine system needs a smarter design


Screen Shot at am.

Mathew Aitchison, Monash UniversityThe announcement that the Victorian and federal governments will build a 1,000-bed COVID quarantine hub at Mickleham in Melbourne’s north marks a welcome end, or at least a fresh chapter, to the finger-pointing over Australia’s quarantine saga.

Time is of the essence when protecting Australians from COVID, so hats off to both governments for setting an ambitious timeline that could see the facility up and running by the end of this year.

But in their haste to deliver an alternative to hotel quarantine, we believe the governments haven’t taken advantage of the newest available innovations.

The plan for the proposed quarantine facility produced by the Victorian government is, by its own admission, little more than a specced-up version of a mining camp, similar to the Howard Springs facility already in use in the Northern Territory. In turn, this type of construction harks back to the postwar quarantine facilities built from the 1950s onwards.

Part of the problem with the current proposal is the focus on the “hardware”, with almost no discussion of the “software”. By hardware, we mean buildings, physical structures, road layouts and infrastructure; by software, we mean how it will be used, the operational patterns and processes, and “softer” operational modes of use and their technologies.

This hardware-centric approach would be more reassuring if the hardware were the best and fittest for use, but unfortunately the proposal has reached for what it knows, and what it knows is around 70 years old.

A smarter way

We and our colleagues at the Building 4.0 Cooperative Research Centre, funded jointly by the federal government and a consortium of industry, are developing a state-of-the-art design, called Q_Smart, which we submitted to the Victorian government in March 2021.

In our proposal, building services, controls, sensors and management systems (alongside well-designed and efficiently produced buildings) all play a role in preventing the transmission of COVID-19. We might think of this as a correction towards a more “software-driven” approach, as it seeks to use a range of processes, techniques and technologies already available from our collaborators at Siemens to augment the work done by the physical structures.

In terms of the physical layout, our design avoids the large common corridors, inadequate air-tightness controls for rooms, or unhygienic air handling systems that have emerged as problems with current hotel stock.

Table listing design features of Q_Smart

Building 4.0 CRC

As leading infection control experts have already pointed out, mining dongas may have worked well so far for quarantine at the repurposed Howard Springs facility in the Northern Territory. But from an epidemiological point of view, the current design is concerning for the proximity of neighbouring verandahs, especially in cases where more than one group of quarantine residents is housed in a unit.

The government’s provisional staffing patterns for the new facility suggests that separation between residents will rely on strict protocols around staff movements and quarantine measures intended to slow and limit the spread of disease, should a breach occur.




Read more:
This is how we should build and staff Victoria’s new quarantine facility, say two infection control experts


In contrast, the smart building management system we are developing would not “wait” for a breach to occur, but would aim to stop such contact ever being made. A door would not open, an airlock would have its contents automatically evacuated, and UV light would cleanse contaminated surfaces or air in ducting.

Some of these features, such as proximity authentication, are innovations that we routinely expect from our 20-year-old cars. If we turn to our now ubiquitous smartphones, there are yet further possibilities to safely and conveniently track and control movement in more humane way that would not need to reach for punitive ankle bracelets and the like. And, yes, should a breach occur, such systems could ultimately carry out near-instantaneous contact-tracing.

But such a system could only work if the “hardware” and “software” are fully integrated and planned together from the start.

An eye on the future

There are many ways to deal with quarantine, and although it may be too late to integrate our designs into the proposed Victorian facility, perhaps other states and territories embarking on building ventures might yet consider this advice.

In viewing the current proposed plan of closely spaced mining dongas, arranged in “mini-districts”, it is nigh-on impossible to imagine it being used for anything other than a quarantine facility, or perhaps a correctional centre.

Proposed layout for the new quarantine hub
The plan for the proposed quarantine hub makes it hard to imagine it being used for anything other than quarantine – or perhaps a correctional facility.
Vic.gov.au



Read more:
Hotel quarantine causes 1 outbreak for every 204 infected travellers. It’s far from ‘fit for purpose’


Q_Smart, on the other hand, was designed to be flexible, reusable and adaptable to different sites, which, for example, may not necessarily have large amounts of flat open space. This would potentially allow facilities built for quarantine to be reused for other purposes after the pandemic. Transforming the building’s operational pattern would be a matter of simply flipping a few (virtual) switches. Depending on the use case, certain controls could be activated or deactivated, new patterns of movement through the buildings could be enabled or disabled almost instantaneously.

With more thinking and development, perhaps such buildings could also be used as affordable housing, or disaster relief accommodation or — how’s this for ironic — future hotels.


This article was coauthored by Dr Bronwyn Evans AM, chair of Building 4.0 CRC and chief executive of Engineers Australia.The Conversation

Mathew Aitchison, Professor of Architecture and CEO of Building 4.0 CRC, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Hotel quarantine causes 1 outbreak for every 204 infected travellers. It’s far from ‘fit for purpose’


Driss Ait Ouakrim, The University of Melbourne; Ameera Katar, The University of Melbourne, and Tony Blakely, The University of MelbourneWith Melbourne under lockdown for another seven days, the consequences of Australia’s inefficient and dangerous quarantine system continue.

This outbreak started with just one leak from hotel quarantine in South Australia in early May. And unless the hotel quarantine system gets a serious shake up – and fast – we’re likely to see more outbreaks.

Our analysis shows for every 204 infected travellers in hotel quarantine in Australia, there is one leak.

We have known since August 2020, through the World Health Organization, of the risks associated with quarantine in hotels with their shared spaces and inadequate ventilation systems.

Over the past ten months, a plethora of epidemiologists, public health experts, engineers and state premiers have consistently highlighted the shortcomings of a hotel-based quarantine system and the need for purpose-built facilities.

These calls have been largely ignored by the federal government, which continues to consider the current hotel-based quarantine system as “fit for purpose” and “a system that is achieving 99.99% effectiveness” and is “serving Australia very well”.

But is this true?

Rethinking the data

We teamed up with colleagues from the University of Otago to analyse hotel quarantine data from Australia and New Zealand (some of which is outlined in this pre-print paper, meaning it’s yet to be peer reviewed).

We attempted to identify all COVID-19 outbreaks and border control failures associated with quarantine systems and to estimate the failure risks in terms of the spread of COVID-19 infection into the community.




Read more:
Another day, another hotel quarantine fail. So what can Australia learn from other countries?


We identified 21 failures that have occurred between April 2020 and June 2021 in Australia:

  • three in Queensland
  • eight in New South Wales
  • two in South Australia
  • five in Victoria
  • three in Western Australia.

One of these caused more than 800 deaths and the most recent is causing the current lockdown in Victoria.

There were 4.9 failures per 1,000 SARS-CoV-2 positive cases in quarantine. This means that one outbreak from hotel quarantine is expected every 204 infected travellers.

Since April 2020, on average 308 infected travellers arrived in Australia each month, so that is 1.5 expected outbreaks per month.

This doesn’t sound like a system that is 99.99% effective.

So what needs to happen?

The proportion of returning travellers who are infected is increasing due to the global intensification of the pandemic and the increasing infectivity of new SARS-CoV-2 variants.




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What’s the ‘Indian’ variant responsible for Victoria’s outbreak and how effective are vaccines against it?


Australia’s quarantine system is our first and most important line of defence against COVID-19. If it’s not improved, the risk of outbreaks will increase.

So how can we improve the quarantine system? Based on our analysis, we recommend:

1. Capping or temporarily suspending travel from high-risk areas.

The most obvious action is to reduce arrivals, or even suspend arrivals, from high-infection locations.

Australia and New Zealand temporarily did for travel from India in April 2021 and other high-risk countries earlier in the pandemic .

This is the “red light” we need to hit from time to time.

2. Establishing adequate quarantine facilities.

Every state and territory should be equipped with Howard Spring-style facilities, with outdoor-facing cabins with free-flowing air.

These facilities could be used in priority for travellers coming from high-risk countries.

This won’t reduce the risk of leaks to zero, although we have not yet seen any leakage out of Howard Springs.

The Victorian government recently announced a project to build a 3,000-bed facility for returning travellers with support from the federal government, and other states should do the same.

Hotels could then be used just for arrivals from lower-risk countries such as Singapore and South Korea – though the classification of countries as “low risk” would change over time.

Some countries may be so low risk quarantine is not needed and may place returned travellers at increased risk of acquiring COVID-19 while in quarantine. This is the case for NZ at the moment, and should be expanded to other countries that meet suitable thresholds.

3. Expanding the use of saliva testing among facility workers and travellers.

We need to expand the daily use of PCR (polymerase chain reaction) saliva testing to workers at all facilities.

So far, as of April 2021, Victoria, WA, NSW and SA have all updated their testing rules to make daily saliva testing mandatory for quarantine staff. Other states should follow suit.

4. Protect and test border workers.

Most of the quarantine system failures in Australia involved the infection of quarantine workers.

The vaccination of all quarantine workers against COVID-19 will have reduced this risk of transmission, though no public data are available to confirm all workers have been vaccinated.

While vaccination is not mandatory for border workers, staff who refuse the jab are removed from the front line.




Read more:
Why strict border control remains crucial if we want to keep the travel bubble safe


We can’t afford to wait

Quarantine system failures can be very costly in terms of health, lives and economic impacts. The likely economic cost of the current outbreak in Victoria, A$1 billion or more, is enough to build two or more new facilities.

Embracing a more rigorous quarantine system for high-risk arrivals, in combination with an effective vaccination strategy that allows low-risk arrivals to (eventually) come in with no quarantine, is the necessary path forward.The Conversation

Driss Ait Ouakrim, Research Fellow, Population Interventions Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne; Ameera Katar, Data Analyst and Research Coordinator, Population Interventions Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne, The University of Melbourne, and Tony Blakely, Professor of Epidemiology, Population Interventions Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Should we vaccinate all returned travellers in hotel quarantine? It’s no magic fix but it could reduce risks


Catherine Bennett, Deakin UniversityThis week, a returned traveller who was quarantining in South Australia seems to have been infected with the virus during his stay, before testing positive once returning to Melbourne. It’s the latest in a long line of hotel quarantine leaks in Australia.

And in this week’s federal budget, the government has committed to welcoming back over 17,000 Australians stranded overseas over the next year, which will likely place more pressure on our hotel quarantine system.

In light of the seemingly continued spillover of hotel quarantine infections into the community, one researcher raised an intriguing possibility online: should we vaccinate all arrivals on day one of their stay in hotel quarantine?

There may be reasonably high vaccination rates among our arrivals already. But, if not, it’s definitely something worth thinking about.

In my view, overseas travellers should be considered equivalent to frontline workers, as they traverse the routes into Australia and cross through border quarantine. Therefore, they could be included in phase 1a of the vaccine rollout alongside these frontline workers.

It’s complex and there’s a lot to take into account, and vaccinating all arrivals won’t be the magic fix to our hotel quarantine troubles. But it might take the edge off some of the transmission risks.

You only have to prevent one case, which could have otherwise led to community spread and lockdown, for such a scheme to pay for itself many times over.

Here’s how it could work.

Vaccinating all arrivals could reduce infection risk

There are a number of potential ways this strategy could reduce infection risk, by:

  • preventing severe illness in people already infected
  • reducing the chance returnees will pass the virus on if they are infected, or become infected
  • protecting them from infection should they be exposed to the virus while in quarantine.

A Public Health England study found that a case who has had a single dose of either the Pfizer or AstraZeneca vaccine is up to 50% less likely to pass the virus on to their close household contacts.

However, when the researchers looked more closely at the timing, they found the full 40-50% reduction in transmission risk only occurred when the case received their first dose five or six weeks before becoming infected. In fact Pfizer didn’t reduce the transmission risk cases posed to others unless the first dose was given at least 14 days before the case became infected. In other words, giving returned travellers a dose of Pfizer while in quarantine might be too late to protect others.




Read more:
Here we go again — Perth’s snap lockdown raises familiar hotel quarantine questions


In saying that, the same study shows AstraZeneca’s vaccine does appear to at least partly reduce the transmission potential of cases even when the dose is given on the same day that person was infected.

In those who’ve received the AstraZeneca vaccine on day zero of their infection, the chance of them transmitting the virus to their close contacts over the ten days or so they’re infectious was on average roughly 20% lower than positive cases who weren’t vaccinated.

Getting the AstraZeneca vaccine when exposed to the virus, or soon after, might therefore marginally protect the wider population if, for example, a traveller contracts the virus late in quarantine and it isn’t picked up in day 12 testing and is released from quarantine.

Both Pfizer and AstraZeneca do provide partial protection from infection within 12 days of the first dose. While this is too late for those already infected, it might still provide some protection from infection for those exposed to the virus in the later stages of their stay in quarantine.

Both vaccines also appear to reduce the risk of subsequently dying from COVID-19 with an 80% reduction in deaths reported in the UK. Some in this study were infected within seven days of their first vaccine dose, but we do not know how this effectiveness against deaths changes with time since vaccination from this report.

Nevertheless, there might be some additional value in offering vaccines to both slightly reduce transmission rates and mitigate against serious illness and death in people who do become infected.

One challenge is that AstraZeneca has more to offer in reducing transmission risk in the first critical two weeks after receiving the first jab, but Australia currently doesn’t advise it for people under 50. Pfizer is in limited supply and our vaccine rollout phase 1a and 1b recipients haven’t all been fully vaccinated yet. The relative risks and benefits of reallocating some of our vaccine supply and delivery must be carefully thought through.

Many of those arriving in Australia will likely have opted for vaccination before travel, if available to them, even if just to increase their chances of testing negative and being allowed to board their flights home. Many are arriving from countries that began their vaccination programs months before Australia.

How many returnees are already vaccinated?

The number of positive cases in hotel quarantine has grown month on month, from 160 in February to 469 in April.

New South Wales provides the most detailed information on returned travellers. Its latest surveillance report on about 21,000 returnees shows 180, or 0.8%, tested positive to COVID-19. About 75% of these positive cases tested positive by day two, suggesting they were exposed before arriving in Australia or in transit.




Read more:
More than a dozen COVID leaks in 6 months: to protect Australians, it’s time to move quarantine out of city hotels


The report does include information on how many arrivals have been vaccinated since March 1. Of the 302 positive cases reported to the start of May, 20 had been vaccinated, with six fully vaccinated (two doses at least two weeks prior) and 14 partially vaccinated. Although, those considered “fully vaccinated” might not have been two weeks post-vaccine at the time they actually contracted the virus.

We haven’t been provided the overall vaccination rates for returnees across Australian hotel quarantine, so we can’t yet work out what percentage of arrivals are vaccinated. But if this is quite low, it strengthens the argument for offering vaccines to travellers on arrival.The Conversation

Catherine Bennett, Chair in Epidemiology, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Hotel quarantine report blasts government failures, but political fallout is likely to be minimal


James Ross/AAP

Mirko Bagaric, Swinburne University of Technology

The final report of the COVID-19 Hotel Quarantine Inquiry, issued by former judge Jennifer Coate, outlines monumental errors made by the Victorian government and its public servants.

Despite this, the governmental failings that led to a second wave of the pandemic, resulting in 800 deaths, are likely to be politically irrelevant.

The clever strategy by Premier Daniel Andrews to defer analysis of these missteps until the virus had been suppressed makes the findings largely academic and historical.

Victoria Premier Dan Andrews told the inquiry that Health Minister Jenny Mikakos was responsible for the program.
James Ross/AAP

Program based on ‘assumptions’, not clear decision-making

The report also contains no real surprises — it’s just a confirmation of the muddled and incomprehensible decision-making approach we already knew about.

Victoria’s hotel quarantine program was established over the weekend of March 28–29. At this point, it was known COVID-19 was highly contagious and presented the gravest public health risk to Australians in a century.

Instead of using professional and trained staff to manage the risk, the Victorian government used contract security staff, many of whom were largely oblivious to appropriate protocols for dealing with the 21,821 returned travellers who went through the program, according to the report.

Just 236 people tested positive for COVID in quarantine, but despite this low number, containment breaches caused the virus to spread to the wider community in May and June.




Read more:
Hotel quarantine interim report recommends changes but accountability questions remain


Much of the focus of the inquiry was on who was responsible for appointing untrained workers to deal with the most serious public health threat confronting Victorians in living memory.

The most compelling theme of the final report is the ruthless incompetence of the Andrews government and its agencies to put in place coherent systems and protocols to deal with such an enormous risk.

Perhaps most significantly, the report says decisions relating to the program were made at the wrong level — absent scrutiny by ministers or senior public servants. Instead, decisions were made by people

without any clear understanding of the role of security in the broader hotel quarantine program [who] had no expertise in security issues or infection prevention and control. They had no access to advice from those who had been party to the decision to use security and had limited visibility over the services being performed.

Competent institutions deal with complex problems by following several key principles. Within governments, the scope of each person’s responsibility is carefully defined and there should be meticulous attention to detail when it comes to implementing crucial decisions such as this.

The Victorian government failed abysmally on both of these measures.

The report said ‘no actual consideration’ was given to using ADF personnel instead of security guards at the start of the program.
James Ross/AAP

It beggars belief, for example, for highly-paid public servants to tell the inquiry that decisions in the hotel quarantine program were actually not made, but instead were creeping “assumptions”.

Even more disturbing is that it might actually be true, in which case the Victorian government system is fundamentally broken. Certainly, there is nothing in the report to contradict this position. The report noted the decision to appoint private security guards was

made without proper analysis or even a clear articulation that it was being made at all. On its face, this was at odds with any normal application of the principles of the Westminster system of responsible government.

That a decision of such significance for a government program, which ultimately involved the expenditure of tens of millions of dollars and the employment of thousands of people, had neither a responsible minister nor a transparent rationale for why that course was adopted, plainly does not seem to accord with those principles.

Why was the program allowed to continue?

If such errors or negligence happened in other government programs, the problem might be fixed by throwing more taxpayer money at it.

COVID was different. It was not a rail overpass or cultural event. It was a public health issue, which could only be managed through intelligent design and thorough implementation.

Of course, Victoria is now COVID-free, and the Andrews government will point to this as evidence of the success of its response.

The realty is different. Effectively barricading millions of residents at home for three months was a sure-fire way to suppress the virus. But the fact Victoria alone was the only jurisdiction in Australia that had to resort to this extreme measure is the reference point against which the actions of the Victorian government should be evaluated.




Read more:
Victoria’s hotel quarantine overhaul is a step in the right direction, but issues remain


A telling aspect of the report is what it failed to address. The inquiry (and the media) had a near-obsessive focus on who was responsible for appointing private security guards in the first place.

What hasn’t received as much scrutiny is the more pressing issue of why the government continued with this arrangement despite clear questions from the onset as to whether it was a viable approach.

It also continued using security guards for a month after ministers were first made aware of a guard testing positive at the Rydges Hotel in Carlton.

This decision to continue with a failed system is arguably far more ethically and legally problematic than how the program was set up in the first place, especially since this was an unprecedented health threat.

The Victorian government’s failure to speedily unwind the security guard quarantine program is the legal equivalent of not repairing a crater-sized hole on a busy road for many weeks: utterly reprehensible.

Rydges Hotel, one of the sources of Melbourne’s coronavirus outbreaks.
James Ross/AAP

A shrewd move to minimise political fallout

Perhaps that most important message to emerge from the inquiry is that Andrews is the shrewdest politician in Australia.

In the midst of one of longest and harshest lockdowns on the planet, his decision to launch the inquiry allowed him to deflect any questions regarding his responsibility for the second wave.

The timing of the report — well after the second wave has passed — has also lessened any political damage his government is likely to experience from the failures of the program.




Read more:
Melbourne’s hotel quarantine bungle is disappointing but not surprising. It was overseen by a flawed security industry


The disappointment and anger that many Victorians were experiencing at the height of the lockdown is now a distant memory as people are focusing on their Christmas plans in a COVID-free environment.

Against this context, the criticisms in the report are unlikely to get much traction. Rather, they will likely just become background noise as attention focuses on the new outbreak in NSW — and who is to blame for this latest quarantine failure.The Conversation

Mirko Bagaric, Professor of Law, Swinburne University of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Victoria’s hotel quarantine overhaul is a step in the right direction, but issues remain


Peta-Anne Zimmerman, Griffith University; Matt Mason, University of the Sunshine Coast, and Vanessa Sparke, James Cook University

On Monday the Victorian government announced an overhaul of the state’s hotel quarantine program. The government has introduced a new oversight agency, COVID-19 Quarantine Victoria, and crafted a “reset” of rules and regulations in the hotel quarantine process.

This robust suite of interventions, based on nationwide experience, aims to prevent transmission of COVID-19 to the Victorian community primarily from returning international travellers who have a high risk of infection.

From an infection prevention and control standpoint, the new system definitely has some improvements. But there are still issues yet to be resolved, and some unknowns that haven’t been made clear to the public.

No more private security

One of the most obvious changes, and possibly the most controversial, is Victoria Police taking the lead on security and management. They will be assisted by the Australian Defence Force (ADF), in a bid to avoid a repeat of the previous program’s high-profile breaches.

Corrections Commissioner Emma Cassar will lead the new agency, and will report to police minister Lisa Neville, who will have overall responsibility for the new system.

But we are concerned this could be perceived to be an armed security detail, with a custodial approach rather than a public health focus. Experience has shown this can be detrimental. Gaining community trust, rather than appearing to take a punitive approach, is vital. Recent events in Adelaide highlight the crucial importance of people being able to cooperate with contact tracers without fear of the ramifications.

Infection control must be handled by experts

The government has repeatedly said the new system will have stronger infection prevention and control protocols, with rigorous training and evaluation. Failure to comply with infection prevention and control resulted in numerous incidences of transmission in hotel quarantine in the past.

Reinforcing these procedures can only be a good thing, as long as the expertise is sourced from recognised experts, and supported by advice from other specialities such as public health and occupational hygiene.




Read more:
Aged-care facilities need accredited infection control experts. Who are they, and what will they do?


Staff ‘bubbles’ and daily testing

The new system will also feature “staff bubbles”. Having a group of staff who consistently work together on the same shifts, with no crossover with staff on other shifts, aims to minimise the number of people an infected person can be in contact with.

This approach has been used in a range of industries, and has been recommended by occupational hygiene experts throughout the COVID-19 response.

The addition of the current active simulation exercises, which stress-test Victoria’s strategy, can only be a positive.

Daily COVID testing of staff and weekly testing of their household contacts is another big change. Daily testing of staff has some merit, although the suggested changes and restrictions being placed on their household contacts such as increased testing and limitations on where they can work is concerning.

There are significant privacy concerns with the new “contact tracing in advance” system, which will identify staff and all their significant contacts, such as members of their households and other frequent contacts, in advance. These contacts will have to provide information on their places of work, schooling and so on. In the event a staff member contracts COVID, part of the legwork is already done.

But while undoubtedly useful for contact tracing, privacy breaches from government IT systems are not uncommon.

Also troubling is the suggestion that recruitment may exclude those with contacts who work in other high-risk industries, such as aged care. This measure could potentially put existing staff out of work. COVID-19 Quarantine Victoria suggests that other places to live may be found if workers live with an at-risk contact, which has human rights implications and doesn’t take into account family or carer responsibilities.

The hotel quarantine overhaul will also see staff exclusively employed or contracted by COVID-19 Quarantine Victoria, with cleaners and others only working at one site. This will mean more secure work for some, which is a positive, and may reduce the risk of transmission between workplaces. Indeed, insecure and casual employment has been a common theme in the spread of COVID-19.

But we don’t yet know exactly how this will work. For example, it’s not clear whether this also applies to the police, who may have casual jobs on the side.




Read more:
Mapping COVID-19 spread in Melbourne shows link to job types and ability to stay home


Regional quarantine not necessarily better

Some experts have raised the possibility of having quarantine facilities in regional areas, to reduce the risk of breaches in dense urban areas.

The Northern Territory’s quarantine program for returned travellers at Howard Springs has shown that this approach can work, but there are potential issues.

Such a facility needs a sustainable workforce who aren’t travelling between locations. There is little point in moving quarantine outside of cities only to have the workforce commute from cities or elsewhere, with the associated transmission risks this brings.

Also, extensive health care would need to be provided for returned travellers. Returnees could have many chronic and acute health-care needs that may strain local health services. A proliferation of sites like Howard Springs would test the capabilities of AUSMAT (multi-disciplinary medical assistance teams deployed during crises) and the state and territory health services that support them, particularly as we head into the storm and bushfire season.

As with anything during COVID-19, only time will tell how successful this new strategy will be. The Victorian government is certainly showing a capacity for reflection, and a determination to do better. But there is only so much preparation we can do when facing the greatest variable and challenge in any outbreak response: human nature.




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AUSMAT teams start work in aged care homes today. But what does this ‘SAS of the medical world’ actually do?


The Conversation


Peta-Anne Zimmerman, Senior Lecturer/Program Advisor Griffith Graduate Infection Prevention and Control Program, Griffith University; Matt Mason, Lecturer and Program Co-ordinator: Nursing, University of the Sunshine Coast, and Vanessa Sparke, Lecturer in Nursing and Midwifery, and Course Coordinator of the Graduate Certificate of Infection Control, James Cook University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Hotel quarantine interim report recommends changes but accountability questions remain



James Ross/AAP

Kristen Rundle, University of Melbourne

The division of the findings of the Victorian COVID-19 Hotel Quarantine Inquiry into two – the interim report published today, with a final report due December 21 – is aimed at making a timely contribution to the redesign of the quarantine systems that will remain key to Australia’s management of the COVID-19 pandemic for some time to come.

With a view to the expected influx of returnees at Christmas, the national cabinet is due to discuss necessary changes later this month. Justice Jennifer Coate’s clear recommendations for how to devise and operate a quarantine system will surely be pivotal to its deliberations.

Key recommendations

Coate’s primary message is that quarantine – in whatever form it might take – is a public health operation. So any future quarantine system needs to be designed in a manner that ensures the centrality of this public health imperative.

We must wait until the final report to find out what Coate has to say on the larger governance and accountability questions surrounding “the decision” to contract out the front line of Victoria’s hotel quarantine operation to private security provision. However, her interim report already tells us a lot – if indirectly.

The report states it “is clear from the evidence to date” that the majority of those involved in the hotel quarantine program who contracted the virus were:

private security personnel engaged by way of contracting arrangements that carried with them a range of complexities.

It is therefore unsurprising that the issue of the appropriateness of contracting-out is the elephant in the room across a number of its key recommendations.

In particular, the recommendations record that the expertise of those involved in future quarantine operations will be crucial. Moreover, every effort should be made to ensure people working at quarantine facilities are “salaried employees” who are “not working in other forms of employment”.

Rydges on Swanston was one of the quarantine hotels where coronavirus outbreaks occurred.
James Ross/AAP

It takes little effort to surmise that contracted-out service delivery is unlikely to meet any of these demands.

As I have explained elsewhere, to contract out a statutory function in whole or in part requires that it be translated into a “service” that private sector providers are capable of delivering.

In the Victorian case, this meant the front line of the hotel quarantine operation was performed pursuant to an “observe and report” security services contract. It was carried out by an entirely casualised workforce with little infection-control training and no lawful powers of enforcement. Many or most of them worked in other jobs at the same time.




Read more:
Melbourne’s hotel quarantine bungle is disappointing but not surprising. It was overseen by a flawed security industry


Coate also recommended that, alongside the “embedded” presence of expert infection-control personnel, a 24/7 police presence be established at every facility-based quarantine operation. This clearly points to the failure of contracting-out from an enforcement perspective as well.

So, by implication or otherwise, the interim report confirms that too little thought was given to whether the contracted service could meet the dual public health and detention demands of the function at issue.

Coate’s conclusions on how a facility-based quarantine program should work make the multiple dimensions of this mismatch plain.

Where to from here?

The final report of the inquiry may well prove to be the most sustained critique of contracting-out, from the perspective of public expectations of government action, that Australia has yet seen. This would be a welcome shift from what has prevailed so far, with much more effort dedicated to refining and expanding the practice than to challenging it.

As for where the interim report fits with the “whodunnit” exercise that has dominated so much of the interest in the inquiry’s work so far, Coate makes clear we must wait until the final report to find out more. Whether Victoria ended up with private security at the front line of its hotel quarantine program as a result of a “decision” by one or more individuals, or (as counsel assisting Rachel Ellyard described it) a “creeping assumption that became a reality”, is something that ultimately might never be clear.

Either way, the question of accountability will remain. Providing a clear answer to it stands to be every bit as complicated as it has been so far.

The inquiry, which found the bungled scheme cost the state $195 million, has shown the relationship between contracting-out and political accountability is incoherent. Substantial reform in both directions is needed to make it otherwise. Coate’s final report will hopefully guide that much-needed conversation.

But, again, we can already take a lot from the interim report about where – minimally – we need to be. Any future Victorian quarantine program must be operated “by one cabinet-approved department”, in accordance with a “clear line of command vesting ultimate responsibility in the approved department and Minister”.

That department must in turn be “the sole agency responsible for any necessary contracts”. Among other things, its responsible minister must also ensure senior members of its governance structure “maintain records […] of all decisions reached”.

Such is the vision for the future. But it also highlights why it is so important not to lose sight of the “why” questions when the issue of accountability for what actually happened in Victoria’s disastrous hotel quarantine program is again upon us.

If the front line of the hotel quarantine system was simply too important a responsibility to be outsourced, it is time to get to the bottom of why this was the case, and why it might also be the case for other high-stakes government functions that carry serious consequences for public health or safety.

Providing sensible answers to those questions needs to be the goal. But what matters above all else is that we actually start asking them.




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This piece was co-published with the University of Melbourne’s Pursuit.The Conversation

Kristen Rundle, Professor of Law, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Another day, another hotel quarantine fail. So what can Australia learn from other countries?



Shutterstock

Maximilian de Courten, Victoria University; Bo Klepac Pogrmilovic, Victoria University; Deborah Zion, Victoria University, and Jaimie-Lee Maple, Victoria University

This week, we heard how conditions at a Sydney quarantine hotel were so bad almost 400 returned travellers had to be moved to another one.

Before that, we heard from Victoria’s inquiry into hotel quarantine. We learned the bulk of cases during the state’s second wave could be tracked down to a family of four returned travellers staying at a single quarantine hotel.

But Australia isn’t the only country to have quarantine issues. Some countries don’t use hotel quarantine at all. And others have turned to technology to keep track of returned travellers.

So what can we learn from other countries’ successes and failures?

A short trip around the world

Cyprus

The Mediterranean island of Cyprus also uses hotel quarantine for international arrivals. But rather than “hotel quarantine hell”, hotels in Cyprus are said to have a “holiday vibe”, despite not being able to leave your room.

Travellers praised Cyprus for its luxury and positive hotel quarantine experience. Some have even said they would return for a (real) holiday.

Hotel quarantine, Cyprus style.

Cyprus recorded a peak in daily cases of only 58, in early April, and now has an average of new cases a day in the teens.

Canada

Returned travellers must give Canadian authorities a plan for how they intend to spend their mandatory 14-day quarantine. This doesn’t have to be in a hotel; it can be at home. You have to monitor your own symptoms, and police will check up on you.

However, violations can result in large fines of up to C$750,000 (A$788,000) or six months in jail.

Taiwan

Taiwan introduced 14-day hotel quarantine for returned travellers who didn’t have a single room with a separate bathroom or who lived with vulnerable people.

Since late June, business travellers from low-risk countries can visit Taiwan and spend only five days in quarantine. But they need to take a COVID-19 test before leaving quarantine.

Taiwan has 18 active COVID-19 cases.

Singapore

After flattening the curve, Singapore decided to relax its 14-day hotel quarantine to seven days self-quarantine for travellers arriving from specific countries.

But all travellers over the age of 12 not staying in a quarantine facility have to wear an electronic tracking wristband. Authorities are alerted if people go outside or tamper with the device.

Hong Kong and South Korea have also introduced wristbands to track people’s movements upon arrival and to check people comply with quarantine regulations.

Poland

Travellers arriving in Poland have to install a home quarantine phone app developed by the Polish government.

For 14 days, the app uses facial recognition and geolocation algorithms to monitor people. It also prompts people to take selfies at random times during the day.

Individuals have 20 minutes to respond to these prompts, otherwise they risk police knocking on their door.

UK

A major “quarantine failure” was the UK’s experience at the start of the pandemic, when 10,000 travellers spread the virus across the country.

Members of parliament accused the responsible ministers of making errors, such as having no border checks, no specific quarantine arrangements, and lifting self-isolation regulations.

This eventually led to the UK dealing with a total of 328,846 cases and 41,465 COVID-19-related deaths.

The UK has since tightened its quarantine arrangements.

These ideas are worth adopting in Australia…

More than 70,000 returned travellers have been quarantined in Australian hotels since it became mandatory in late March. We don’t know exactly how many of these people have gone on to test positive. But about one in five of Australia’s cases were acquired overseas.




Read more:
Is aggressive hotel isolation worth the cost to fight COVID-19? The answer depends on family size


As the headlines show, we can clearly do better in how we manage our quarantine system.

Adopting a “Cyprus-style” model of luxury hotel quarantine is simply beyond reach in Australia given the sheer number of people requiring quarantine facilities. However, improving the quality of facilities, ensuring a safe environment, and supervising staff is vital. This includes training both staff and travellers on infection control measures.

People in quarantine also need access to health care as well as to financial, social and psychosocial support, to ensure their safety and mental health.

…but we need to be careful about electronic tags

We would be particularly concerned about the human rights implications of returned travellers having to wear electronic monitoring devices.

Although we might be familiar with electronic monitoring devices in the criminal justice system, when used in the context of infection they could stigmatise people for simply being at higher risk of disease.




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They go against the presumption that all persons will be law-abiding and perform their civic duty, with no evidence to the contrary.

There are also potential privacy concerns. There is no guarantee data collected through electronic monitoring — especially when using smartphone apps — will not be used for purposes other than monitoring pandemics.

No system is perfect

Even if we implement a world best quarantine system for returned travellers, SARS-CoV-2, the virus that causes COVID-19, can still slip in.

That’s because people can still be infectious before feeling sick, before being diagnosed, or before being directed to quarantine. This becomes more likely the more people are kept under quarantine.The Conversation

Maximilian de Courten, Health Policy Lead and Professor in Global Public Health at the Mitchell Institute, Victoria University; Bo Klepac Pogrmilovic, Research Fellow in Health Policy at the Mitchell Institute for Education and Health Policy, Victoria University; Deborah Zion, Associate Professor and Chair, Victoria University Human Research Ethics Committee, Victoria University, and Jaimie-Lee Maple, Research Assistant and Policy Analyst, Mitchell Institute, Victoria University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How an Australian-born pastor survived a Molotov cocktail


Wayne Zschech, the Australian-born pastor of Calvary Chapel Kaharlyk, just south of Kiev in Ukraine with a population 15,000, says he will never forget the events that took place in the early hours of Wednesday, October 14th, when attackers smashed a window at the church building, where he and his family live, and threw a Molotov cocktail (petrol bomb) into the building, reports Dan Wooding, founder of ASSIST Ministries.

In an interview he gave me during my recent visit to Kiev, he re-lived the horrifying turn of events that could have caused the deaths of himself and his family as they slept.

“It all started when my wife Olya woke up in the morning to feed the newborn baby and she said she could smell smoke,” said Wayne. “We actually live in the church building and that night, there were six of us (including his mother-in-law) who were sleeping. We had actually sent the kids to school at eight o’clock in the morning and my wife said again that she could ‘really smell smoke.’ So we looked out the back window and there was smoke billowing out of the back of the church.

“Suddenly, it was all hands on deck. I called the fire brigade and then started finding where the fire was coming from. We originally thought that it was an electrical short because it’s an old building. I began opening up all the doors – because I didn’t want the fire brigade knocking them down – and looking in the basement trying to find where the fire was coming from.

“I kept going down into the basement and when I came up for air on the third or fourth occasion, I just happened to walk around the side of the building and suddenly the whole situation became clear. Someone had thrown a Molotov cocktail through the side of the building into our children’s ministry room and had also left spray painted markings on the side of the building saying, ‘Get out of here, you sectarians.’ So suddenly it put a big a whole new spin on the situation.”

I asked Wayne if he had ever experienced trouble before and he replied, “Not directly. We’ve had a couple of youths smashing windows and so we had to put security screens on our apartment, but nothing like this. There was no warning.”

Sitting next to Pastor Zschech was his assistant pastor, American-born Micah Claycamp, who is married with four children, who then described what he saw when he arrived at the church that morning.

“I had come to the church to do a language lesson and, as I walked in, I saw a big hose running from the back of the church into the room that had been firebombed and I could smell smoke,” he said. “They had just finished cleaning everything up and I went around to the side of the building and saw what had been spray painted and started talking to Wayne who had got the situation figured out and he told me what exactly had happened.

“This was the first big thing we’ve seen in our town. It is pretty quiet for the most part. I don’t feel threatened living there but this obviously is a situation that is a lot different and when you walk into something like this it makes you appreciate the things that you see God do, the unseen things. It makes you realize how much God protects our lives in ways you don’t see every day. So it just makes you more appreciative of His protection.”

I then asked Wayne how an Australian from Brisbane whose family hailed from the Prussian part of Germany finished up in a small town in Ukraine.

“Well, to be perfectly honest, I think God played a trick on me,” he smiled. “I graduated from school and wanted to get into the Royal Australian Air Force (RAAF) and when I applied for the Australian Defence Force Academy I got the chickenpox and so they didn’t let me in that year, even though my academic achievements were fine.

“So I quickly did a deal with God and said, ‘I’ll give you a year of my life’ and the next thing I knew three months later I was in Ukraine and started a Bible-based English schooling programs in communist government schools where kids were learning about Jesus. I was just seventeen years old at the time and began travelling all over the country and I’ve been here ever since. That is some sixteen and a half years now.”

Had he seen big changes in the country?

“Yes, many changes,” he said. “We’ve had currency changes and also seen mindset changes. We see economic things going on and we’ve learned a lot of things. But along the way, I found a beautiful Ukrainian girl and we have a wonderful marriage and we have three Ukrainian kids.”

Wayne then spoke about how he got involved in this Calvary Chapel.

“Well, I got tricked also into becoming the pastor of this church in what was then a village,” he said. “The founding pastor who moved with me from Kiev to Kaharlyk went back home to Australia to do his deputation work and a couple months later, he wrote me an email saying that he was ‘not returning to be the pastor of the church.’ He added, ‘So congratulations. You’re the pastor.’ So not only did I become a missionary by hook or by crook but also became a pastor and I’m thrilled.

“I never wanted to be those things but God has turned things around totally and I’m absolutely content and happy and it’s a very exciting life to see what God is doing despite the fact that humans would have had other choices.”

I then asked Wayne what Kaharlyk was like when he first arrived.

“We are about 80 kilometers (nearly 50 miles) south of Kiev and it was a town that had been in economic ruin as most of the country had been after the collapse of the Soviet Union,” he said. “Unemployment was rife. There were no jobs, no income and there was lots of mental and cultural baggage as the country was trying to reacclimatize to the real world situation.

“Now some 12 years later, we’re basically on the outskirts of Kiev although obviously the town hasn’t moved geographically. But it’s a thriving little town. It hasn’t grown numerically that much but you can definitely see there are changes. There are people moving out of Kiev to come and live in our town. That was never in our plan and we’re also seeing bits of investment coming in and things like that show what was once basically dead is now starting to show signs of life.”

I then asked him to describe the types of people who attended his church.

“We’re a young church and we’re different from the mainstream Orthodox and older style Baptist churches,” Wayne explained. “But the truth is that we are reaching out to orphans, to the elderly and we have a beautiful mix of all those generations in between. When you see a grandmother coming with her son and her grandson to church, you see the wholesomeness that the Gospel brings when God enters a family’s life.

“Back in the early days everyone was warned about people like us saying that these are the people ‘you’ve been warned about for all those years’ and that ‘they’ve come here to hypnotize you and take all your money.’ But that was more then based out of ignorance.

“We had an Orthodox priest back then and we had some very serious chats with him and he said, ‘Look publicly, I have to hold the government line or the Orthodox line, but personally I see that you’re a brother in Christ. So that was good. I wouldn’t call that major persecution, but I can understand the fear from their side.”

He then spoke about a unique business he has begun in the town.

“We decided that we had to become producers so people can put bread on the table and we have to show how God is in everything,” said Wayne. “So we have started a little mushroom-growing enterprise and now we’re making biodiesel. We actually collect oil from a number of restaurants, including McDonald’s Ukraine, and we make biodiesel and sell it and save money for the church and make money for the church and employ people and reinvest into the local town.”

Micah then said that he runs his car on biodiesel which he says smells like “fried chicken.”

“I can run it and I haven’t had any problems at all,” he said. “It’s also cheaper and I’ve put advertisements on the van to let people know the phone numbers so that people know what’s going on.”

It was Micah that picked me up at the Kiev (Borispol) Airport and drove me to my hotel and I have to confess that I didn’t catch a whiff of fried chicken from the exhaust of the van, though I did have a bad cold at the time.

I concluded by returning to the topic of the firebombing and asked Wayne if he had further thoughts about it.

“As soon as we discovered that it was intentional, you can just imagine the situation in your mind with totally charged different emotions,” he said. “We were targeted from the side of the building so that everyone in the town walking past it could see the damage and the spray painting.

“It was basically a political statement in that respect. The fact that the family was asleep in the building when it happened my mother in-law was staying at the time and she said that she heard some banging around at five o’clock in the morning and we looked at the fire damage and we see that it was a real a miracle. There was a fire but the damage was minimal. It should have been so much worse. What turned out to be a couple thousand dollars worth of damage when we could have lost the whole room.

“If they, for some, reason had chosen another window to throw it in, just the next window, the floor boards are totally bear there we don’t have thick linoleum on them, so the fire would have spread immediately. There’s a big air gap right under those boards and it runs right to our family’s bedrooms.”

I concluded by asking Wayne what his prayer needs were at this time.

“That Christ would be glorified to the maximum through this and the next circumstances and that He would save people and that the Christian body locally and throughout the world would pray harder to understanding the privileges that we have in our situations and that God can change them any time that He wants.”

Micah then added his prayer request: “That our church would grow together in this as they would see that God allows these things to happen to strengthen the body, to cause our eyes to be back upon Him and that for His glory to be done and bring more people to Christ.”

By the way if the name Zschech rings a bell with you, he is related to Darlene Zschech, who is perhaps most famous for the chorus "Shout to the Lord," a song that is sung by an estimated 25 to 30 million churchgoers every week, who has married in the Zschech family. “I was a Zschech first,” laughed Wayne.

Report from the Christian Telegraph