Worksafe’s hotel quarantine breach penalties are a warning for other employers to keep workers safe from COVID

Posted on October 16, 2021 by particularkev

Alex Collie, Monash UniversityVictoria’s occupational health and safety regulator, Worksafe, has charged the state’s health department with 58 breaches for failing to provide hotel quarantine staff with a safe workplace.

The breaches occurred between March and July 2020, and at up to A$1.64 million per breach, could amount to fines of $95 million.

This should serve as a warning to all employers to start assessing their workers’ safety against COVID and how they can mitigate these risks, ahead of the nation reopening.

Remind me, what is Worksafe?

States and territories have responsibility for enforcing laws designed to keep people safe at work: occupational health and safety (OHS) laws.

Worksafe Victoria is responsible for and regulates OHS in Victoria. It’s responsible for making sure employers and workers comply with OHS laws; and it provides information, advice and support.

Victoria’s parliament has given Worksafe the power to prosecute employers if they breach OHS laws. In 2018-19, it commenced 157 prosecutions which resulted in nearly A$7 million in fines.

Unlike some other state OHS regulators, Worksafe also manages the Victorian workers’ compensation system.

Why did Worksafe charge the health department?

Worksafe charged Victoria’s Department of Health with 58 breaches of sections 21 and 23 of the Victorian Occupational Health and Safety Act.

The Act requires employers to maintain a working environment that is “safe and without risks to health” of employees. These obligations extend to independent contractors or people employed by those contractors.

Worksafe is alleging that in operating the Victorian COVID-19 quarantine hotels between March and July 2020, the Department of Health failed to maintain a working environment that was safe and limited risks to health, both to its own employees and to other people working in the hotels.

Essentially Worksafe is stating that through a series of failures, the department placed government employees and other workers at risk of serious illness or death through contracting COVID-19 at work.

Worksafe alleges the Victorian health department failed to:

appoint people with expertise in infection control to work at the quarantine hotels
provide sufficient infection prevention and control training to security guards working in the hotels, as evidence shows training can improve employees’ safety practices
provide instructions, at least initially, on how to use personal protective equipment, and later did not update instructions on mask wearing in some of the quarantine hotels.

Worksafe undertook a 15-month long investigation, beginning in about July 2020. It’s possible the trigger for this investigation was a referral from the Coate inquiry into hotel quarantine, but that has not been stated.

Is it unusual for a government regulator to fine a government department?

It’s not that unusual. Government departments are subject to the same OHS laws as other employers in the state, and so Worksafe’s powers extend to them as well.

In the past few years, Worksafe has successfully prosecuted the Department of Justice, Parks Victoria and the Department of Health, resulting in fines and convictions.

In 2018, for example, Worksafe prosecuted Corrections Victoria (part of the Department of Justice) after a riot at the Metropolitan Remand Centre in 2015 that put the health and safety of staff at risk.

The riot occurred after the introduction of a smoking ban in prisons. Worksafe considered prisoner unrest was predictable and its impact on staff could have been reduced by having additional security in place in the days leading up to the smoking ban.

In that case the Department of Justice pleaded guilty and was convicted and fined A$300,000 plus legal costs.

What does this mean for other employers?

This case highlights that employers have obligations to provide safe working environments for their staff, and other people in their workplaces. This extends to reducing risks of COVID-19 infection.

These obligations don’t just apply to government departments. They apply to every employer in the state.

Employers should ensure they have appropriate systems and policies in place to reduce COVID-19 infection risk to their staff. This includes, where appropriate, physical distancing, working from home, wearing personal protective equipment (PPE), good hygiene practices, workplace ventilation, and so on.

Employers should consider the risks unique to their environment and address them appropriately, in advance of the nation reopening when we reach high levels of COVID vaccination coverage.

Some employers in high-risk settings – such as health care, retail and hospitality – will need to do more to protect their workers than others.

What happens next for the Vic health department?

The case has been filed in the Magistrates court, with an initial hearing date set for October 22. It will progress through the court system from there. Most prosecutions are heard in the Magistrates Court although some proceed to the County Court.

If the Department of Health pleads guilty, the courts will determine if a fine should be paid and how much. The court may also determine if a conviction is recorded.

Alex Collie, Professor and ARC Future Fellow, Monash University

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

I’d prefer an ankle tag: why home quarantine apps are a bad idea

Posted on September 12, 2021 by particularkev

Toby Walsh, UNSWSouth Australia has begun a trial of a new COVID app to monitor arrivals into the state. SA Premier Steven Marshall claimed “every South Australian should feel pretty proud that we are the national pilot for the home-based quarantine app”.

He then doubled down with the boast that he was “pretty sure the technology that we have developed within the South Australia government will become the national standard and will be rolled out across the country.”

Victoria too has announced impending “technologically supported” home quarantine, though details remain unclear. Home quarantine will also eventually be available for international arrivals, according to Prime Minister Scott Morrison.

The South Australian app has received little attention in Australia, but in the US the left-leaning Atlantic magazine called it “as Orwellian as any in the free world”. Right-wing outlets such as Fox News and Breitbart also joined the attack, and for once I find myself in agreement with them.

Location tracking and facial recognition

The South Australian home quarantine app uses facial recognition software to identify users.
Government of South Australia

Despite the SA Premier’s claims, this isn’t the first such app to be used in Australia. A similar home-quarantine app is already in use for arrivals into WA, and in some cases the Northern Territory.

Both apps uses geolocation and facial recognition software to track and identify those in quarantine. Users are required to prove they are at home when randomly prompted by the application.

In SA, you have 15 minutes to get the face recognition software to verify you’re still at home. In WA, it is more of a race. You have just 5 minutes before you risk a knock on the door from the police.

Another difference is that the SA app is opt-in. Currently. The WA app is already mandatory for arrivals from high risk areas like Victoria. For extreme risk areas like NSW, it’s straight into a quarantine hotel.

Reasons for concern

But why are we developing such home-quarantine apps in the first place, when we already have a cheap technology to do this? If we want to monitor that people are at home (and that’s a big if), wouldn’t one of the ankle tags already used by our corrective services for home detention be much simpler, safer and more robust?

There are many reasons to be concerned about home-quarantine apps.

First, they’ll likely be much easier to hack than ankle tags. How many of us have hacked geo-blocks to access Netflix in the US, or to watch other digital content from another country? Faking GPS location on a smartphone is not much more difficult.

Second, facial recognition software is often flawed, and is frequently biased against people of colour and against women. The documentary Coded Bias does a great job unpicking these biases.

The documentary Coded Bias explains the common inbuilt flaws of facial recognition software.

Despite years of effort, even the big tech giants like Google and Amazon have been unable to eliminate these biases from their software. I have little hope the SA government or the WA company GenVis, the developers of the two Australian home-quarantine apps, will have done better.

Indeed, the Australian Human Rights Commission has called for a moratorium on the use of facial recognition software in high-risk settings such as policing until better regulation is in place to protect human rights and privacy.

Third, there needs to be a much more detailed and public debate around issues like privacy, and safeguards put in place based on this discussion, in advance of the technology being used.

With COVID check-in apps, we were promised the data would only be used for public health purposes. But police forces around Australia have accessed this information for other ends on at least six occasions. This severely undermines the public’s confidence and use of such apps.

Before it was launched, the Commonwealth’s COVIDSafe app had legislative prohibitions put in place on the use of the data collected for anything but contact tracing. This perhaps gave us a false sense of security as the state-produced COVID check-in apps did not have any such legal safeguards. Only some states have retrospectively introduced legislation to provide such protections.

Fourth, we have to worry about how software like this legitimises technologies like facial recognition that ultimately erode fundamental rights such as the right to privacy.

If home-quarantine apps work successfully, will they open the door to facial recognition being used in other settings? To identify shop lifters? To provide access to welfare? Or to healthcare? What Orwellian world will this take us to?

The perils of facial recognition

In China, we have already seen facial recognition software used to monitor and persecute the Uighur minority. In the US, at least three Black people have already wrongly ended up in jail due to facial recognition errors.

Facial recognition is a technology that is dangerous if it doesn’t work (as it often the case). And dangerous if it does. It changes the speed, scale and cost of surveillance.

With facial recognition software behind the CCTV cameras found on many street corners, you can be tracked 24/7. You are no longer anonymous when you go out to the shops. Or when you protest about Black lives mattering or the climate emergency.

High technology is not the solution

High tech software like facial recognition isn’t a fix for the problems that have plagued Australia’s response to the pandemic. It can’t remedy the failure to buy enough vaccines, the failure to build dedicated quarantine facilities, or the in-fighting and point-scoring between states and with the Commonwealth.

I never thought I’d say this but, all in all, I think I’d prefer an ankle tag. And if the image of the ankle tag seems too unsettling for you, we could do what Hong Kong has done and make it a wristband.

Toby Walsh, Professor of AI at UNSW, Research Group Leader, UNSW

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

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

Posted on August 29, 2021 by particularkev

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?

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.

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.

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.

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.

Coronavirus Update: Australia

Posted on August 2, 2021 by particularkev

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

Posted on June 26, 2021 by particularkev

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.

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

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.

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.

Home quarantine for vaccinated returned travellers is extremely low risk, and won’t damage their mental health

Posted on June 24, 2021 by particularkev

Gregory Dore, UNSWMany thousands of people need to return to Australia, and many at home wish to reunite with partners and family abroad.

A move away from a one-size-fits-all approach to quarantine is a way to make this happen — including home quarantine for vaccinated returnees.

The federal government implemented home quarantine over a short period in March 2020, before switching to mandatory hotel quarantine for returned residents and other incoming passengers.

But the considerably changed circumstances — most importantly, access to effective vaccines — calls for its reintroduction despite caution among politicians and the community.

The low rate of positive cases, and proven effectiveness of further safeguards to limit breaches, make home quarantine a persuasive strategy.

It’s worth remembering people who contract COVID, and their contacts, have successfully self-isolated at home since the pandemic began.

How will we make sure it’s safe?

There are several protective layers which would ensure extremely limited risk of home quarantine for fully vaccinated returned overseas travellers.

The first is requiring a negative COVID test within three days of departure, which is currently a requirement for all returnees.

The second is COVID vaccination. Recent studies indicate full vaccination provides 60-90% infection risk reduction. In cases where fully vaccinated people do get infected, these “breakthrough cases” are less infectious.

It’s also important to test returnees in home quarantine. A positive case would trigger testing of any contacts and may extend self-isolation.

Also, high levels of testing in the broader community can ensure early detection of outbreaks, enabling a rapid public health response to limit spread, if it did leak out of home quarantine.

The risk would be extremely low

Data from hotel quarantine in New South Wales, which takes around half of returned travellers in Australia, suggests home quarantine for fully vaccinated returnees would likely present an extremely low risk.

In 2021, NSW has screened around 4,700 returnees a week, with the proportion of positive cases detected during quarantine averaging around 0.6%.

From March 1, since vaccination has become more accessible, only eight of 406 positive cases were fully vaccinated.

Unfortunately we don’t have the overall data on how many returnees were fully vaccinated, but even if only 10-20%, this would equate to a positive rate of around 6-12 per 10,000 among the vaccinated. This is considerably lower than the overall rate of 66 COVID cases per 10,000 since March 1.

If home quarantine was initially restricted to fully vaccinated returnees from countries with low to moderate caseloads, the rate would be lower again, probably less than five per 10,000.

If NSW increased their quarantine intake by taking an extra 2,500 per week from this population into home quarantine, it would equate to maybe a few positive cases per month, compared to around 120 cases per month in hotel quarantine. As vaccination uptake increases, this capacity could be expanded, with reduced hotel quarantine requirements.

Will people comply?

The enormous desire for stranded Australian residents, overseas partners and family of residents in Australia to return and reunite should ensure a high level of compliance with home quarantine.

Home quarantine has been successfully implemented in other countries with elimination strategies such as Taiwan and Singapore. Taiwan’s system was deployed rapidly and has 99.7% compliance. Singapore uses a grading system to enable lower-risk returnee residents to do seven days in home quarantine, with a negative test required for release on day seven.

Two major reviews of the hotel quarantine system — the Victorian government-commissioned Coate report, and the national review of hotel quarantine — recommended implementing home quarantine with monitoring technology, such as electronic bracelets. Their recommendations were made prior to the approval of vaccines.

Recent data suggests the current hotel quarantine system has harmful effects. Research published in the Medical Journal of Australia in April found mental health issues were responsible for 19% of all emergency department presentations among people in NSW hotel quarantine. It’s highly likely home quarantine would be more beneficial for the mental health of returnees.

What are the barriers?

Issues which would need to be sorted through include:

methods for determining how risky different countries are
how returnees can prove they’ve been vaccinated
how we would test returnees and home-based contacts, and how frequently
and how long home quarantine would be for.

But none of these are insurmountable, and small-scale home quarantine already exists in the ACT.

Health authorities could ensure returnees can collect their own COVID testing samples, for example by doing nasal swabs or collecting saliva themselves. This would reduce contact with health workers.

Home quarantine is undoubtedly being considered by major Australian COVID policy committees, along with other measures to enable a larger number of returnees and to increase the safety of the quarantine system.

Australians’ excessive caution continues to have direct consequences for the well-being of many thousands of stranded Australian residents, together with non-resident partners and family members desperate to return.

It’s time to change this situation and make their human rights a public health priority.

The author would like to thank John Kaldor, Esther Rockett, and Liz Hicks for their input.

Gregory Dore, Scientia Professor, Kirby Institute; Infectious Diseases Physician, St Vincent’s Hospital, Sydney, UNSW

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’

Posted on June 23, 2021 by particularkev

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.

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.

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.

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.

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

Posted on May 16, 2021 by particularkev

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.

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.

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.

Catherine Bennett, Chair in Epidemiology, Deakin University

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

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

Posted on April 30, 2021 by particularkev

Michael Toole, Burnet InstituteIn the past week, at least six Australians returned home uninfected only to acquire the coronavirus while undergoing quarantine in hotels in Sydney and Perth.

One traveller left a hotel after 14 days in quarantine and moved around Perth for five days before taking a flight to Melbourne, where he tested positive to COVID-19. This led to a three-day community-wide lockdown in Perth and Peel.

By now, this is all feeling fairly repetitive. Since a COVID case leaked from the Peppers Hotel in Adelaide in November, there have been 16 leaks across Melbourne, Sydney, Brisbane, Adelaide and Perth.

While most have led to low numbers of community cases, the Sydney leak in December led to the Avalon cluster, which infected 151 people. And of course, earlier in the pandemic, the infection of staff in two Melbourne quarantine hotels led to Victoria’s infamous second wave.

So what’s going so wrong in hotel quarantine in Australia, and is it finally time to move it out of cities?

Why is hotel quarantine failing?

Supervised quarantine was mandated by the federal government on March 28 last year. State and territory governments were given mere days to set up hotel quarantine systems.

Judge Jennifer Coate cited this short notice as one of the factors that led to the failure of the system in Victoria in the hotel quarantine inquiry report.

But we’ve had time now to get it right — and we still haven’t. Importantly, despite having been mandated by the federal government, there’s no national standard for how quarantine is implemented.

During 2020, the focus of precautions was on preventing transmission via large respiratory droplets and surfaces. This was achieved through ensuring physical distancing by making hotel guests stay in their rooms, providing staff with surgical masks, and giving hand sanitiser to guests and staff.

However, an inquiry into the Peppers Hotel breach found it probably occurred by airborne transmission. This refers to very tiny virus-contaminated droplets that hang around in the air for longer, and spread further.

Two leaks in the Park Royal and Holiday Inn Airport hotels in Melbourne in February were also most likely caused by airborne transmission.

Recent transmission between residents in adjacent rooms in two hotels in Sydney and the Mercure Hotel in Perth can only be explained by airborne transmission.

Policies haven’t kept up

Evidence suggesting airborne transmission is responsible for the majority of transmission within Australia’s hotel quarantine system continues to stack up. The two main measures to prevent this are improved ventilation and the wearing of appropriate personal protective equipment (PPE) by staff.

In preparing this article, I reviewed the policies in each of the six states based on information on health department websites and press releases. I found significant differences between the states.

South Australia and Victoria were similar in that both states had done ventilation audits in hotels. However, SA only assessed its designated medi-hotel Tom’s Court (where COVID-positive patients stay), whereas Victoria assessed every hotel room and, where necessary, made modifications to ensure these rooms have “negative pressure”. This means when the door is opened, air flows inwards rather than outwards.

Western Australia did a ventilation audit in March and found the Mercure was high-risk. But action wasn’t taken in time to prevent the room-to-room transmission.

There’s no public evidence to suggest the other three states have conducted ventilation audits.

In South Australia, in designated orange and red zones of hotels, staff must wear respiratory masks such as N95 and P2. In Victoria, all staff in open areas must wear an N95 mask and a face shield. In the other states, staff are provided with surgical masks, which don’t protect against airborne spread as effectively as respiratory masks.

While staff 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 such as New South Wales where testing is done on days two and 12, guests who test negative on day two might be incubating the virus, then become positive and be infectious for up to ten days before being identified.

What’s the future of hotel quarantine?

As COVID-19 cases surge around the world, an increasing proportion of returned travellers will be infected. As of April 27, there were 255 active cases nationwide in hotel quarantine.

Given the high number of cases globally and the slow rollout of vaccines in most countries, Australia will need supervised quarantine for some time to come, most likely until 2023.

The Howard Springs facility in the Northern Territory is ideal. Single-storey cabins, separate air conditioning systems, outdoor verandas and a nearby hospital make it fit for purpose. And there have been no leaks despite high numbers of infected residents.

It’s now time to invest in similar facilities in every state and territory. Quarantine is our first line of defence against the virus. It needs to be 100% effective to maintain our hard-earned status of having zero community COVID cases. That achievement is what has put us in the enviable position of a growing economy and a public almost back to their pre-pandemic quality of life.

In the meantime, quarantine hotels in every jurisdiction must adhere to consistent, evidence-based standards. The Australian Health Protection Principal Committee should meet urgently to develop a national code of practice, which needs to effectively address airborne transmission through attention to ventilation and the provision of fitted respiratory masks and face shields to all staff working in open areas.

Given the rate of quarantine leaks during the past six months, without improvements, the system will likely see over a dozen more leaks by October, causing frequent disruptions to our lives. The impact on the economy and public confidence will be immeasurable.

Michael Toole, Professor of International Health, Burnet Institute

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

Self-entitled prima donnas or do they have a point? Why Australian Open tennis players find hard lockdown so tough

Posted on January 25, 2021 by particularkev

Peter Terry, University of Southern Queensland

The challenge of bringing the world’s best tennis players and support staff, about 1,200 people in all, from COVID-ravaged parts of the world to our almost pandemic-free shores was always going to be a big ask.

Soon after this star-studded Australian Open entourage arrived in Melbourne, ten cases of COVID-19 were identified (some later reclassified as being old infections). As a result, 72 players classified as close contacts were confined to hotel rooms with no access to what they thought they had been promised — a daily five-hour session on the practice courts within the quarantine bubble.

Meanwhile, the superstars of the sport (Novak Djokovic, Rafa Nadal, Serena Williams and Naomi Osaka among them) were apparently enjoying much better conditions in Adelaide.

Social media turned white hot.

Spanish world number 13 Roberto Bautista Agut described conditions as like prison “but with wifi”.

Meanwhile Kazakhstan’s Yulia Putintseva wished she had she been warned about the potential for hard lockdown and sharing her room with a mouse.

The flames were fanned by Novak Djokovic’s list of demands for improved conditions, admittedly on behalf of his fellow players and which he later said were just suggestions, which Victorian Premier Daniel Andrews immediately rejected.

Then, the backlash started

Fellow players waded in, with Nick Kyrgios labelling Djokovic “a tool” on Twitter and savaging Bernard Tomic’s partner as having “no perspective” for complaining about having to wash her own hair.

Condemnation of players who complained about being in quarantine, when the population of Melbourne had recently endured 112 days of lockdown, was swift and universal.

The consensus was that, instead of complaining, the self-entitled prima donnas should be grateful for the opportunity to play in one of the world’s great sporting events, pocketing between A$100,000 and $2.75m in prize money (for the singles) after their all-expenses paid trip down under.

When we put people on a pedestal

This looks like a clear case of pedestal syndrome backfiring, a term popularised in sport psychology by Jeffrey Bond, who worked with tennis legend Pat Cash when he won Wimbledon in 1987.

Inside Sport Psychology book cover featuring Roger Federer — Hotel quarantine can easily upset players’ moods but they could benefit from the isolation to work on the psychological aspects of their game.
Booktopia

It’s not a clinical diagnosis, but refers to the tendency to exalt those we admire to a position where we (and they) perceive they can do no wrong.

After all, when the world treats you like something special, feted and adored wherever you go, is it any wonder you start to believe the normal restrictions of a pandemic, indeed of life, do not apply to you?

Maybe the Australian Open should not have been held at all this year, as some prominent health experts have advised.

However, once the decision to proceed with the tournament next month was confirmed, wasn’t it incumbent upon the organisers to create a level playing field for competitors?

There is little doubt those in hard lockdown may be disadvantaged come tournament time.

Is lockdown treating all players equally?

With several of the world’s top players having greater freedom to train in Adelaide compared with those in Melbourne quarantine, some players are also questioning if they’ll be at an advantage when the tournament starts.

The better deal for those in Adelaide includes having a larger support team available, use of the hotel gym, and the opportunity to play exhibition matches.

As Austrian doubles specialist Philipp Oswald, in Melbourne quarantine, described it:

It’s not apples and apples here, but apples and pears — and I caught the sour lemon.

Players risk losing fitness

Research by university colleague Professor Tim Gabbett would predict the decline in fitness among those in hard lockdown will be significantly greater than among those allowed to train outdoors for up to five hours a day.

More than that, the rapid increase in training once released from lockdown will significantly increase injury risk and diminish capacity to maintain performance over the course of a five-set match. In short, advantage all those who escaped hard lockdown.

Then there is the issue of players’ psychological state leading into the tournament. My own research has highlighted the significant mood disturbance associated with COVID-19 restrictions, which were less restrictive than the hard lockdown many players are currently enduring.

It is well established that mood states affect performance in sport, and the negative moods likely engendered by lockdown will not encourage tournament success.

There could be benefits

However, there may be an upside for some players, especially those arriving with niggling injuries or excessively fatigued. The enforced rest may help them heal and freshen up before resuming normal training.

Lockdown also provides them with ample time to work on the mental side of their game, especially visualisation and mindfulness training. This may help them reframe their time in quarantine from a frustrating interruption into a productive period of mental preparation.

What happens when players leave quarantine?

Some players will undoubtedly emerge from hard lockdown anxious about their physical condition and irked they were the ones who got the short straw.

Romanian player Sorona Cirstea said she will need “at least three weeks after [isolation] in order to be in decent form again”.

Unfortunately, she’ll have less than two weeks to regain her fitness and find her form post-lockdown.

No reasonable person would suggest tennis players be allowed to skip quarantine but perhaps spare a thought for those in hard lockdown who feel the playing field is ever so slightly tilted against them.

Peter Terry, Professor of Psychology, University of Southern Queensland

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

Sharing my thoughts with the world from a Particular Baptist perspective

Remind me, what is Worksafe?

Why did Worksafe charge the health department?

Is it unusual for a government regulator to fine a government department?

What does this mean for other employers?

What happens next for the Vic health department?

Share this:

Location tracking and facial recognition

Reasons for concern

The perils of facial recognition

High technology is not the solution

Share this:

Contracting out is standard practice

Why nobody is looking at this issue

Share this:

Share this:

A smarter way

An eye on the future

Share this:

How will we make sure it’s safe?

The risk would be extremely low

Will people comply?

What are the barriers?

Share this:

Rethinking the data

So what needs to happen?

We can’t afford to wait

Share this:

Vaccinating all arrivals could reduce infection risk

How many returnees are already vaccinated?

Share this:

Why is hotel quarantine failing?

Policies haven’t kept up

What’s the future of hotel quarantine?

Share this:

Then, the backlash started

When we put people on a pedestal

Is lockdown treating all players equally?

Players risk losing fitness

There could be benefits

What happens when players leave quarantine?

Share this: