Ruby Princess inquiry: NSW Health divided over tests before ship docked
A senior NSW Health official labelled a proposal for doctors to meet every cruise ship on arrival to test passengers for COVID-19 “overkill” one month before the Ruby Princess docked in Sydney, an inquiry heard.
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A NSW Health expert warned that forcing officials to board all cruise ships amid the COVID-19 crisis would be costly and “look worse for everyone” if they missed a case, the Ruby Princess inquiry heard.
Senior health authorities were divided over a draft policy to prevent the spread of coronavirus through Australia in an email exchange sent around one month before the notorious vessel docked in Sydney.
Public Health Unit Director, Professor Mark Ferson was on the assessment panel that deemed the liner a low biosecurity risk and gave 2700 passengers the green light to disembark without proper health checks at Circular Quay on March 19.
In the email sent to multiple senior physicians, Prof Ferson said the downside of conducting extensive screening before disembarkation was “the cost and wear on staff” while if a guest was subsequently diagnosed with the deadly disease “we will be asked why we missed a case and it will look worse for everyone.”
“That sentence seems to me to convey a rather untoward attitude,” Commissioner Bret Walker SC said.
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In another email sent on February 13, Prof Ferson added that the proposed requirement for health teams to check all passengers with potential COVID-19 symptoms regardless of their travel history was “very much overkill.”
“We can ensure the ship doctors give out information and masks, which they do routinely, and get their contact details,” he wrote in an email aired at the inquiry.
But Dr Jeremy McAnulty, NSW Health’s Executive Director of Health Protection who drafted the procedure, insisted liners should be met on arrival at port to test guests as a precautionary measure.
“It is a lot of work, but it’s trying to balance the very low risk with the very big problem if we have a case on a ship,” he responded.
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The inquiry also heard that during the debate Dr Leena Gupta, who also sat on the assessment panel, repeatedly called for all passengers to be kept on-board until test results for COVID-19 were returned.
But these suggestions were ultimately rejected and several sick people were still awaiting swab results when all guests were allowed to leave the ship.
The Ruby Princess has since become the single biggest source of infection in Australia, linked to more than 700 infections and 22 deaths.
Dr Sean Tobin, a senior medical officer of NSW Health’s communicable diseases branch who was also on the panel, was grilled about those decisions on Tuesday.
“Hasn’t the horse bolted if you’ve let people off a ship and the tests come back positive?” counsel assisting Richard Beasley SC asked.
“That was always accepted as a risk,” Dr Tobin said.
“Why is that regarded as acceptable? Are you weighing money against lives?” Mr Walker asked.
“I certainly wasn’t considering money,” Dr Tobin said.
“With the benefit of hindsight we may have done things differently but one of the things that was weighing on our minds was the impact on those people.”
“They could all be confined to their cabins – not much fun, but neither is COVID,” Mr Walker replied.
Dr Tobin agreed there was no consideration given by any of his colleagues during the February email exchange to asymptomatic or presymptomatic transmission of coronavirus.
“I don’t think there is reference to that, it was very much an emerging issue at this time,” he said.
In his statement, Dr Tobin said he thought the Ruby Princess was a low risk ship primarily due to the absence of passengers or crew who travelled through China, South Korea, Iran or Italy within 14 days of embarkation.
But upon reflection he said it should have been classified as ‘medium risk’ as any sick guests who’d undertaken international travel within the previous fortnight would have satisfied the suspect COVID-19 case definition.
“I also placed weight on the fact that, while a fair number of passengers and crew presented with respiratory symptoms, less than one per cent of passengers and crew presented with influenza-like-illness,” he said.
Dr Tobin said he suspected there had been a flu outbreak on board and noted that five guests had tested negative to COVID-19 when tested in New Zealand, which had lower levels of community transmission of coronavirus than Australia in March.
Dr Tobin is also the NSW chief human biosecurity officer, who provides a co-ordinating role with the federal health department under the Commonwealth Biosecurity Act.
The inquiry heard that as part of his training Dr Tobin was shown “a series of powerpoints that appears to explain the Biosecurity Act by the use of, among other things, pictures of Muppets and screen extracts from the film Contagion.”
“Does that ring a bell that you received that document?” Mr Beasley asked.
“Yes,” Dr Tobin replied.