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.
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.
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.
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.