Are Victoria’s quarantine hotels fit for purpose, particularly in containing variants of the coronavirus?
AE: No – they were not designed for this, and were only chosen because of the need to act fast.
TB: Yes and no. Yes, in that as a rapid solution to a global pandemic in 2020, they were an obvious resource to utilize. During 2020, we had roughly one breach of the virus out of hotel quarantine per month somewhere in Australia. And this was (other than, and after, the Melbourne second wave) able to be managed with contact tracing and stamping it out.But things have change. We are now seeing an increased frequency of breaches from hotel quarantine. Some of this may be random variation, but some of it is at least due to a higher rate of SARS-CoV-2 infection in people arriving at our borders (due to worsening situation in other countries) and more infectious variants.
What are the key issues?
AE: Location in the middle of a city is not a good idea. Traditionally, quarantine stations have been located in remote areas for a very good reason. With a virus that can be transmitted by aerosol, the ventilation systems are a major problem.
TB: We need to improve. We need to keep up, and even ahead, of the virus. Three actions are paramount:1. As much as we can, expanding capacity in purpose built or ‘better’ facilities such as Howard Springs – and preferentially sending higher risk people to these facilities (where there is better natural ventilation, and lesser opportunity for aerosol transmission in dead spaces like corridors, and to separate out of CBD with staff also located outside of CBD).2. We will still need to use CBD HQ as well. So we just keep on learning, and keep on improving. For example: set up an independent agency that visits and inspects quarantine on a regular basis, reporting openly and publicly, and making recommendations to improve; improve ventilation; cohorting – people on one corridor should all have arrived on same day, for example; and further improvements in facility such as mask wearing, staggered opening of doors.3. Vaccinate the border as priority. This is already the plan – good. With Pfizer, we would expect 70% to 80% (indicative only) reduction in the chance a quarantine worker is infected and able to carry the virus out of hotel. We hope this vaccination will occur in first week of March, with benefit occurring by end of March.
Move hotel quarantine out of Melbourne
Should the quarantine programs be moved to regional or remote areas?
AE: Yes – better ventilation, less risk to the general population.
TB: As above.
Should CCTV cameras replace guards in hallways to monitor travellers in hotel quarantine?
AE: Guards will still be needed for other reasons.
TB: Yes – where the balance of risks and benefits supports it. Each situation will require its own assessment, but the starting position has shifted from “have security guard on corridor” to “use CCTV”.
Should all workers in hotel quarantine be wearing the N95 masks and goggles?
AE: For normal quarantine hotels, a standard surgical mask should be okay, unless they are working on a floor with positive cases.
TB: Yes, if within 1.5 metres of travellers, or in deadspaces where aerosol likely such as poorly ventilated corridors.
Why is air flow so important in hotel quarantine? How many air flow changes should happen every hour?
AE: It is important because we know that the virus can be transmitted by aerosol. The chance of transmission drops with good airflow. The CDC recommends 12 air changes per hour for isolation rooms in hospitals. Most hotels have more like 1-4 air changes per hour.
TB: To disperse the virus that is in aerosol. As much as possible.
Should international flights into Australia be temporarily stopped until a review of hotel quarantine across the country can take place?
AE: Yes – I think this would be sensible.
TB: That is hard. I suspect not, we just need to keep improving and learning and adapting as best as possible.
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