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


Screen Shot at am.

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

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

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

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

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

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

A smarter way

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

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

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

Table listing design features of Q_Smart

Building 4.0 CRC

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

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




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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



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


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

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


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

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

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

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


Matt Dunham/AP/AAP

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.




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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.




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


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.The Conversation

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’


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.




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

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

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

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

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

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

So what needs to happen?

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




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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.




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We can’t afford to wait

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

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

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

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

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


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

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

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

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

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

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

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

Here’s how it could work.

Vaccinating all arrivals could reduce infection risk

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

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

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

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




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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.




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

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

Catherine Bennett, Chair in Epidemiology, Deakin University

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

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.




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


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

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

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

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

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

The Victorian government failed abysmally on both of these measures.

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

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

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

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

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

Why was the program allowed to continue?

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

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

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

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




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


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

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

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

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

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

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

A shrewd move to minimise political fallout

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

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

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




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


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

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

Mirko Bagaric, Professor of Law, Swinburne University of Technology

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

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


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

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

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

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

No more private security

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

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

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

Infection control must be handled by experts

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

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




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


Staff ‘bubbles’ and daily testing

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

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

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

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

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

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

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

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

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




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


Regional quarantine not necessarily better

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

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

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

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

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




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


The Conversation


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

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

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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Exponential growth in COVID cases would overwhelm any state’s contact tracing. Australia needs an automated system


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.