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


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.




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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.




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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.The Conversation

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


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.




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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.




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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.The Conversation

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.

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.




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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.




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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.




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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.




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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.




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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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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.

South Australia’s 6-day lockdown shows we need to take hotel quarantine more seriously


Catherine Bennett, Deakin University

South Australian Premier Steven Marshall today announced a six-day “circuit breaker” lockdown to try and snuff out the state’s COVID outbreak.

From midnight Wednesday, residents will be asked to stay in their homes. Hospitality venues will shut, as will schools and universities. Construction will grind to a halt and exercise won’t be allowed outside the home.

The only permitted reasons to leave home are to shop for food or medicine, or for essential health care. Elective surgery will be paused, except for urgent operations.

There are now 22 cases linked to the cluster that emerged from hotel quarantine, and a further seven suspected cases.

Why lockdown?

While this may seem like an overly cautious approach to a cluster that isn’t yet as big as we’ve seen in other places, I think it’s a wise move.

This is how lockdowns should be used. Indeed, the World Health Organisation advocates lockdowns as a way to buy precious time while other essential public health measures are mobilised, such as contact tracing and widespread testing. The focus here is on preventing a rise in cases, unlike the lockdown in Melbourne where the cases had already taken off widely in the community and it was about turning the wave around.

We’ve seen the virus in this particular cluster spread very rapidly. In just two weeks it has spread through five generations — that is, to five “rings” beyond the initial case.

We’ve also seen cases passed on through quite casual contact, via a pizza shop in the suburb of Woodville.

The state’s chief health officer, Nicola Spurrier, said:

This particular strain has […] a very, very short incubation period. That means when somebody gets exposed, it is taking 24 hours or even less for that person to become infectious to others, and the other characteristic of the cases we have seen so far is they have had minimal symptoms and sometimes no symptoms but have been able to pass it on to others.

This short incubation period and rapid spread is why the government has opted for a six-day lockdown, giving the space to put out the spot fire while protecting the wider community, and especially high-risk settings and vulnerable populations where cases numbers can escalate rapidly with serious consequences.

Also, as Spurrier said, the cases so far have had no, or very mild, symptoms. So this six-day window allows the testing of close and casual contacts to be completed so the cases that are out there become visible to the health department.

The decision to restrict exercise altogether is strict, but warranted in my view. The rationale is similar to putting a wide range of people into isolation, as they don’t yet know where the edge is of the current cases, or the full extent of exposure. The rationale for the extension of restrictions beyond Adelaide and surrounds to the whole state is less clear at this stage.

If it protects the population from an escalation of cases, then six days without outdoor exercise will ultimately be better for physical and mental health than longer strict rules, even with some exercise allowed.

Significant restrictions will remain after the six days, but not full lockdown, according to the state’s Police Commissioner Grant Stevens.




Read more:
South Australia’s COVID outbreak: what we know so far, and what needs to happen next


The good news

The good news is there have been no mystery cases so far. All positive cases have been linked back to hotel quarantine at the Peppers Waymouth Hotel (known as a “medi-hotel” locally).

Testing rates have been very high. Some 5,300 tests were done on Monday, and more than 6,000 on Tuesday. This number of tests is comparable to three or four times that number in a larger city like Melbourne. Local residents have been very patient in queuing up to get tested, sometimes for several hours.

South Australia’s contact tracing team hasn’t really been severely tested during the pandemic. But the team has received extensive training and is reportedly robust, having been given the tick of approval from Chief Scientist Alan Finkel’s recent review into Australia’s contact tracing, published last Friday.




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More than 4,000 people have been quarantined already, including not just contacts, but contacts of contacts, and even beyond that to ensure “casual contacts” are also followed up and tested. This is a sign of a rapid and strong public health response.

What needs to change?

Before this cluster, testing was not mandatory for hotel quarantine staff — although this has now changed to compulsory weekly testing.

This is a positive step, but in my view we should ideally start testing hotel quarantine staff daily.

Getting a nasal swab every day is quite intrusive, so I think we could use saliva tests instead. Yes, they don’t have quite the same level of sensitivity as the “gold standard” PCR tests based on nose and throat swabs, but they’re more tolerable for frequent testing.

Saliva samples can also be efficiently managed if pooled together, and if there’s evidence of a positive test in the broad sample, individual samples can then be checked. Testing early and often is the best approach.

We also need to get serious about resourcing our hotel workers. Spurrier confirmed some workers had worked at multiple sites. This obviously increases the risk of the virus spreading through the community — we saw this with some aged-care staff working across multiple venues in Victoria.

We need to prevent workers from needing to work across multiple sites, by paying them more. Even if they’re not working full-time, they need to be paid as such to ensure they don’t need to take on extra work and increase the risk of spreading the virus to other workplaces. This goes for all staff — security staff as well as cleaners. Cleaners have a very important job and are particularly vulnerable.

I’d like to see national guidelines crafted for hotel quarantine. Today there is national agreement on weekly testing, but I think this should be a minimum. Infection control protocols and monitoring, and pay rates with accompanying sole employment rules also need to be considered. It’s an issue that isn’t going to go away, and it’s an important gap that needs to be filled.




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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 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.

7 ways to better design quarantine, based on what we know about human behaviour



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Holly Seale, UNSW

When we hear of people who have allegedly escaped from mandatory quarantine — whether that’s from hotels in Perth, Toowoomba, Sydney or Auckland — it’s easy to ask: “What were they thinking? Why didn’t they just follow the rules?”.

But our recent review shows people are less likely to follow public health advice if they misunderstand, or have negative attitudes towards it.

The challenge is that while COVID-19 has been with us since the beginning of the year, we still may not necessarily know someone in our close networks who has been in quarantine. We may be relying on a deluge of misinformation about it from the media, or social media.

So how can we use our knowledge of human behaviour to better support people complying with quarantine?

Which factors affect what we think about quarantine?

We reviewed the range of factors that influence people’s engagement or compliance with COVID-19 public health advice, such as quarantine. These included:

  • perceptions around the rationale and effectiveness of quarantine

  • perceived consequences of complying (or not)

  • perceptions about the level of community and personal risk from COVID-19

  • having enough basic supplies (for instance, food, water, clothes).

Gender, age, marital status, professional status and education level also played a role in whether people complied, but clearly, these cannot be modified.




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


The facts are important, but so are emotions

Our review found one of the major factors affecting people’s likelihood to comply with quarantine is their knowledge about COVID-19, how the virus is transmitted, symptoms of infection, and quarantine protocols.

Not understanding what quarantine means and its purpose may lead to people inventing their own rules, based on what they think is an acceptable degree of contact or risk.

Perhaps not too surprising, if we believe quarantine is beneficial, then we are more likely to follow the rules. However, providing people with merely factual information may not be the answer. We need to engage with people’s emotions too.

Emotions can influence our perception of risk, sometimes more so than factual information. For example, we often hear about the negative experiences of quarantine or self-isolation, but often not the positive frame, for instance the number of people who have successfully complied. This helps normalise quarantine, and make people more likely to copy the expected behaviour.

Stick men drawn in white chalk on a blackboard with the odd one out in green chalk balancing on his head
If we think it’s normal to stick to the rules and doing so is in the collective good, then we’re less likely to muck up.
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Social norms play an important role. If people believe there is a collective commitment to protect the community from further spread of infection, they are more likely to respect the public health measure. An individual’s participation can be conditional on whether they think others are also contributing.

However, social norms can also have the opposite effect. If people think others are breaking the quarantine rules, they may follow suit.

Concerns about stigma or discrimination can also impact a person’s willingness to comply with quarantine. Stigma can make people more likely to hide symptoms or illness, keep them from seeking health care immediately, and prevent people from adopting healthy behaviours.

Lastly, people may push back against the regulations as a way of retaining a feeling of control. They may push back because they are stressed or anxious, which in turn affects how they think about the issue or how they make decisions.

So how do we use this?

To support acceptance of and community compliance with quarantine, we need to take these behavioural issues into account. We need to:

1. prepare people for what they might experience: boredom, loss of freedom or routine, irritability and/or anxiety. Priming people may help them think about ways to reduce these issues

2. encourage people to make plans as we know this helps people cope. Encouraging people to stick to similar (pre-quarantine) routines may help people avoid getting anxious or stressed. These plans need to be time-specific and intentional, not aspirational. For instance, we could encourage people to structure time for exercise and for virtual socialising. Others have suggested doing shared activities, such as watching a movie on Netflix at the same time

3. provide access to social, pyschological and medical support whether that’s via reliable internet access or access to helplines

4. provide adequate basic supplies such as food, water and clothes, and a safe and clean place to quarantine

5. encourage our leaders to clearly articulate, and others to reinforce, that complying with quarantine is in our group interest and it’s expected people will pull their weight. And if they don’t, this won’t be acceptable

6. provide media coverage that reflects the fact most people comply. Examples of people who run away from quarantine clearly represent quarantine failures, but they are outliers. Perhaps its time to look at the proportion of people who have complied with hotel quarantine as we need to establish the collective norm is to comply

7. provide people with adequate sick leave and other structural supports, such as the ability to work remotely, alongside any solutions supporting behaviour change.The Conversation

Holly Seale, Senior Lecturer, UNSW

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?



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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.




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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.

Queensland’s coronavirus controversy: past pandemics show us public shaming could harm public health



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Clare Southerton, UNSW

When the news surfaced that three young women had travelled from Melbourne to Brisbane via Sydney, failed to quarantine and two in the group subsequently tested positive to COVID-19, there was severe backlash.

The two women were named and shamed in the media, while Queensland Premier Annastacia Palaszczuk said she was “angry” they had put the community’s health at risk.

Social media feeds brimmed with community outrage, as further details about the women’s movements came to light.

Ultimately, Queensland Police laid charges against the women, alleging they provided false and misleading documents at the border. The two women will face court on September 28.




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While there’s no question these women did the wrong thing, evidence from past health crises shows us shaming and stigma don’t necessarily encourage compliance with public health advice. Public shaming could instead further marginalise already vulnerable groups.

We’ve seen a lot of public shaming during COVID-19

Whether in response to videos of people refusing to wear masks, or so-called “superspreaders”, there’s been no shortage of public shaming during the pandemic.

But it’s important to consider the role privilege plays when individuals become the subject of our collective outrage and condemnation.

We might compare the treatment of the Queensland women with a similar controversy in March, when a Melbourne couple contracted COVID-19 while on a skiing holiday in Aspen, Colorado. They tested positive back in Australia but reportedly flouted the directive to self-isolate.

The Melbourne couple were wealthy white Australians, and their case has been dealt with quite differently to the young Queensland women who are African Australian.

While both cases elicited public backlash, most publications didn’t name the Melbourne couple, citing “legal reasons”. Conversely, the young women from Queensland were identified by name, and photographs were taken from their Facebook accounts.

The online anger directed at the women became increasingly racial in nature. They were identifiable as non-white and had attended an African grocery shop while potentially infectious.

Within hours of these details being published, members of the African community in Brisbane reported intense racist harassment on social media.

The public backlash against the Melbourne couple was muted by their relative anonymity. They were protected from the level of doxxing — having one’s identity and personal information shared widely online — the young women have experienced.




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Past health crises show us shaming doesn’t work

The wealth of existing research on pandemics and epidemics shows people who contract a virus and then go on to spread it are often subject to public shaming and stigma.

Research also shows that poor, non-white and other disadvantaged groups often experience this stigma much more severely than privileged groups.

Importantly, there’s compelling evidence public shaming is an ineffective tool to encourage compliance with public health orders and restrictions.

Extensive research into the stigma experienced by people living with HIV/AIDS has found this stigmatisation reduces the likelihood a person with the disease will seek a test, diagnosis or health care.

Similarly, studies on the Ebola epidemic found stigma associated with the virus led people in affected communities to delay seeking treatment.




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Public shaming also contributed to significant psychological distress for people exposed to severe acute respiratory syndrome (SARS).

Public shaming of those who spread COVID-19 may feel cathartic in a time of collective anxiety, but the consequences can be serious. Ultimately, members of our community may become reticent or afraid to be tested — especially already marginalised groups.

Man scrolling on smartphone next to window.
Social media has been a platform for public shaming during the COVID-19 pandemic.
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A pandemic in the digital age

Traditional news media has a powerful role in public shaming, as seen in the case of the young Queensland women. The media creates long-lasting records and sets the tone for public debate.

While public shaming has a long history, COVID-19 has intensified social media-fuelled scrutiny and public shaming, exacerbating the effects of virus-related stigma.

We may assume seeing this kind of backlash might pull us all into line and deter us from behaving in the same way. But experience of shame and stigma in previous pandemics shows it’s an ineffective way to encourage compliance with public health orders.

Instead, public shaming is more likely to reinforce and inflame existing social inequalities.




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The Conversation


Clare Southerton, Postdoctoral Fellow, UNSW

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

‘Living people’: who are the sovereign citizens, or SovCits, and why do they believe they have immunity from the law?



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Kaz Ross, University of Tasmania

You might have seen articles or comments on social media lately alluding to “sovereign citizens”, or “SovCits” for short, with some reports suggesting COVID-19 government restrictions have driven a surge of interest in this movement.

So, who are these self-styled sovereign citizens, and what do they believe?

Sovereign citizens are concerned with the legal framework of society. They believe all people are born free with rights — but that these natural rights are being constrained by corporations (and they see governments as artificial corporations). They believe citizens are in an oppressive contract with the government.

SovCits reportedly believe that by declaring themselves “living people” or “natural people”, they can break this oppressive contract and avoid restrictions such as certain rates, taxes, and fines — or particular government rules on mandatory mask-wearing.

The SovCit movement arose in America decades ago, with roots in the American patriot movement, some religious communities, and tax protest groups. It has also been known as the “free-man” movement.




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Re-interpreting the law

SovCits see themselves as sovereign and not bound by the laws of the country in which they physically live. Accepting a law or regulations means they have waived their rights as a sovereign and have accepted a contract with the government, according to SovCit belief.

The SovCit movement doesn’t have a single leader, central doctrine or centralised collection of documents. It is based on their reinterpretation of the law and there are many legal document templates on the internet for SovCit use to, for example, avoid paying fines or rates they see as unfair.

SovCits tend not to follow conventional legal argument. Some have engaged in repeated court action and even been declared vexatious litigants by the courts.

The SovCit movement has many local variations but there are some key commonalities across the Australian SovCit movement.

Key beliefs and phrases

A central belief, according to news reports, is that the Australian government, the police, and other government agencies are corporations. Believers feel they must be on guard to avoid entering into a contract with the corporation. They often do this by stating, “I do not consent” and trying to get the police officer or official to recognise them as a “living” or “natural” being and therefore as a sovereign.

SovCits are often careful to avoid showing ID such as driver’s licences or giving their name and address. Saying “I understand” also risks being seen to agree to the contract so SovCits will repeat the phrase “I comprehend” to show they are refusing the contract.

Many reject their country’s constitution as false and reportedly refer to the Magna Carta of 1215 as the only true legal document constraining arbitrary power.

SovCits often come to the attention of authorities due to driving offences. It is a core belief of the movement that “sovereigns” have the right to travel freely without the need for a drivers licence, vehicle registration, or insurance.

Until COVID-19, the main threat seems to have been in committing road offences. More recently, actions protesting measures aimed at limiting the spread of COVID-19 have been linked to the sovereign citizen movement.The Conversation

Kaz Ross, Lecturer in Humanities (Asian Studies), University of Tasmania

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