When it comes to the fine detail of operating a hotel quarantine system, Ireland should learn from Australia's mistakes, rather than wait to make its own, according to one of Australia's leading epidemiologists.
Professor Mike Toole, from the Burnet Institute in Melbourne, says that although Australia has one of the world's best quarantine systems, lessons are still being learned daily about how to operate it.
The system has been central to the country’s ability to almost eliminate community transmission of the virus. Despite overall success, however, the virus is still escaping.
Since November, major Australian cities – Adelaide, Perth, Brisbane, Sydney, and Melbourne – have all seen breaches in hotel quarantine: "It's really tough to make it 100 per cent effective, but you can aim for the best," he says.
Ventilation
So what lessons can be learned? Melbourne emerged from a five-day lockdown at midnight on Wednesday after a cluster linked to a quarantine hotel outbreak led to 19 cases.
The infection spread when a returned traveller, who had tested negative twice before entering the hotel, started displaying symptoms on his sixth day, said Victoria’s state government.
Because he was a severe asthmatic, he was using a nebuliser. This increased aerosols throughout his room. When the door to his room was opened, the aerosols spread into the corridor and infected staff.
Ventilation in hotels and in the vehicles used to bring people to the hotels is key, says Prof Toole. Melbourne is now checking ventilation in all of its 11 quarantine hotels , following its recent outbreak.
“Hotels are not designed for this. Each room has positive pressure, so when you open the door, the air goes out into the corridor,” says Prof Toole. “Opening a door at the wrong time, led to 19 people being infected.”
That led to a five-day lockdown in Melbourne, a city of five million people.
Calling for better measures, the president of the Australian Medical Association, Dr Omar Khorshid, said better ventilation and PPE equipment for hotel workers is needed. Meals should be staggered on each corridor, too.
Staff
Last June, the virus spread beyond Melbourne hotels because poorly-trained private security guards lost control. That led to a second wave, a punishing lockdown, and almost 800 deaths.
Security staff must be employed by the State, not by hotels, and properly protected, says Prof Toole: “Once hotel staff got infected, they went off to their second job and infected people [there].”
Now, hotel quarantine staff in Melbourne are prohibited from having a second job. They are tested twice on each shift, and get paid to be tested on their days off.
Responding to suggestions that Irish hotels might use privately-hired security firms, Prof Toole raised the alarm. That is “entirely inappropriate” and Ireland should heed the Australian experience, or pay the price.
“They don’t get standardised training, they don’t get standardised supervision, they can have two jobs or three jobs. It’s a disaster. That’s what led to the second wave in Melbourne.”
Who needs to quarantine?
Everyone entering Ireland should quarantine. Australia, he says, has proved “over and over again” that exempting travellers with negative tests prior to flying or even on arrival at the airport, simply does not work.
Melbourne has two types of quarantine hotels: one group are referred to as “hot’’ hotels for people who have the virus on arrival, while “cold” ones house those who do not.
“The problem with this is that a number of people test negative on arrival, negative on day three but then positive on day 11. The incubation period, most commonly, is four to seven days,” says Prof Toole.
Strict controls are needed, if this is to work. In Melbourne, two people on the same corridor of a “cold” hotel opened the door at the same time to collect their meal.
One guest was in a family room with five other infected people, while the second person was not infected. When the infected person opened the door, he said, “a fog of virus crossed the corridor” and infected the other person.
Having a list of countries whose citizens must quarantine does not work, either, he says, since people could fly to an intermediate airport, catch a flight, and become “mingled up” with other passengers.
Meanwhile, quarantine must mean quarantine. Referring to arguments that people should be able to exercise once a day, Prof Toole said people must not, for any reason, leave their rooms.
Describing such intentions as “a disaster”, if well-intentioned, he went on: “It’s just too difficult to control. The virus inevitably spreads between guests and from guests to staff.”
Nearly one year on from the introduction of its quarantine system, Australia is now debating whether city hotels are the best places to keep people who arrive in the country.
A recent review recommended that other types of accommodation – some of it very rural – should be used, such as disused army barracks or holiday villages, instead of poorly-ventilated hotels.