The explosion of COVID-19 cases overseas will strain Australia’s hotel quarantine system and increase the chance of “leakage” into the community, leading epidemiologists say.
Victoria isn’t accepting return international travellers, but the number of positive cases in NSW hotel quarantine has doubled in the past two weeks, data has shown.
This follows the Federal Government’s increase of the international arrivals cap from 6,000 to 6,290 people per week.
The rise in COVID-19 cases in quarantine has not been unexpected, with infections surging in the US, Europe as well as Pakistan and India, which are the top two countries of origin for return travellers in Sydney.
NSW has had only one quarantine scare — when two security guards at the Sydney Marriott Hotel tested positive in August.
But epidemiologist Mary-Louise McLaws said the program was about to be “really tested”.
“There will be the occasional incident as hotels are not purpose built for quarantine,” said Professor McLaws, who is an advisor to the World Health Organization.
“This virus doesn’t understand rules and regulations, it just uses any opportunity, like contaminated surfaces or staff letting their guard down.”
Melbourne’s ‘perfect storm’
Melbourne’s second wave of COVID-19 proved just how much rides on quarantine being watertight, with one infected hotel manager causing mass infections and months of lockdowns.
“It was a perfect storm, what happened in Victoria. That would be hard to replicate in any other state but the possibility is always there,” Professor McLaws said.
The differing levels of virus surveillance in some parts of the world were making it very hard to accurately judge risk right now, she said.
“India cannot keep up and not everyone is getting tested and there is severe under-reporting in Bangladesh.”
Epidemiologist Tony Blakely from the University of Melbourne said hotel quarantine seemed to be working well in NSW but there was now increased pressure on the system.
“Doubling the rate of people infected arriving in quarantine [for example] will double this very rare occurrence to something not quite as rare.”
He admitted leakages were unlikely but said they could occur “from time to time” due to inaccuracies or carelessness.
“For example, the one-in-a-thousand (or more) person who is infected beyond 14 days, but not detected by testing, gets out of quarantine and haplessly passes it on to someone,” Professor Blakely said.
“[Or] the staff member at quarantine who picks it up, tests negative — it happens, about 20 per cent of the time — and takes it home.”
But epidemiologist from the University of Sydney, Fiona Stanaway, said the climbing cases in hotel quarantine shouldn’t cause unnecessary alarm.
“The rates are going gangbusters overseas so yes there will be more people positive but I think it is a risk that can be managed,” she said.
“Rates were really high in the US and Europe in March and April and that was managed here. I don’t think there’s necessarily a cause for concern about this third wave here.
Dr Stanaway said people in quarantine were tested on days two and 10, making the chance of them infecting anyone in the community “really small”.
She said a strong hotel quarantine system had to be complemented with an effective contact tracing team in case of leakage.
“And that’s really all we can do until there’s a vaccine unfortunately.”
Professor Blakely said NSW and Victoria had “very, very” good contact tracing systems and Queensland was also good, but the rest of the states were yet to be tested.
Quarantine facilities outside major cities
The Federal Government recently indicated it intends to scale up Darwin’s Howard Springs Facility so it can process about 1,000 international returnees a month.
Professor McLaws said Australia’s handle on COVID-19 relied on national quarantine facilities being set up outside of city centres.
She said the former workers camp of Howard Springs, which sits 25 kilometres outside of Darwin, ticked a lot of boxes.
“We really need to start getting returning Australian residents into spaces away from centrally-populated cities such as Sydney and Melbourne.
“If the numbers of positive return travellers become so high, without a purpose-built environment, without really good airflow change, without high-level trained staff, there will be a spillover and it will go into the community,” she said.
“Hotel quarantine was a reasonable interim solution to bring Australians back safely but it’s now been nine months since the public health emergency was called.”
The national review into hotel quarantine also called the hotel program “vulnerable to breaches” and backed a national quarantine facility.
NSW takes the lion’s share of return travellers at 3,000 per week but NSW Health said hotel quarantine was “running well” and services had been increased to meet the new arrival caps.
While NSW Police manage the quarantine hotels, NSW Health runs the ‘health hotels’ that accommodate those who require medical support.
A NSW Health spokesperson told the ABC the Sydney Local Health District was currently seeking out extra apartment blocks to use as quarantine facilities and was recruiting more staff.
There are currently 532 patients in health hotels in Sydney — 65 of whom are COVID-19 positive.
“[In a health hotel] there are designated floors for patients who are positive, negative or pending a result. Physical separation of patient cohorts according to COVID-19 status is a critical part of the infection prevention control process,” the spokesperson said.
Getting more Australians home
All the experts agreed getting more Australians home was a risk worth taking.
“I think we do want to keep international connections alive, and some risk is worth it,” Professor Blakely said.
“Moreover we need to seriously consider taking in international students again — who after all come from very low-risk countries most of the time, for example, China, Taiwan, Singapore, South Korea.”
Queensland and Western Australia recently upped their intake of international travellers to 1,150 and 1,165 per week respectively.
South Australia now takes 600 passengers per week, an increase from 240.
The Department of Foreign Affairs and Trade told the ABC there were about 45,400 Australians overseas who were registered with DFAT and 35,700 waiting to return home.
The Prime Minister has previously flagged the possibility of home quarantine for travellers coming from “safe” countries but Professor McLaws said this could be a big gamble.
“How do we ensure they don’t have visitors popping over to their home?
“We would need to ensure they can’t take off any monitoring devices … home quarantine could be a disaster depending on where they are coming from,” she said.