NSW Health used old protocols to clear Ruby Princess: Inquiry
Outdated COVID-19 risk assessment protocols that allowed the Ruby Princess to enter Sydney waters should have already been “scrapped and rewritten,” a NSW Health official has conceded.
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A top NSW Health official has conceded an old policy designed to prevent the spread of coronavirus in Australia via cruise ships should have been “scrapped and rewritten” by the time the Ruby Princess docked in Sydney.
The department’s expert panel allowed 2,700 passengers to disembark the ill-fated vessel at Circular Quay without proper checks on March 19, in what has become the single largest source of COVID-19 infection nationally.
The assessment panel deemed the Ruby Princess as a low biosecurity risk despite pending coronavirus tests, and Commissioner Bret Walker SC said that body’s decision-making was guided by an outdated document that was “doomed to inadequacy.”
Dr Jeremy McAnulty admitted the risk assessment procedure drafted on February 19 was “no longer relevant” by the time it informed the panel one month later.
“Have you just told me in effect that should all have been scrapped and rewritten?” Mr Walker asked.
“That’s correct,” Dr McAnulty said.
He said the policy did not take into account a March 10 guideline change from the Communicable Diseases Network of Australia, which included all international travel in COVID-19 suspect case criteria.
Dr McAnulty conceded any passengers who had been overseas within the past 14 days and had acute respiratory illnesses – with or without fever – should have qualified as a suspect COVID-19 case and been tested.
“Have you just told me in effect that should all have been scrapped and rewritten?” Mr Walker asked.
“That’s correct,” Dr McAnulty said.
He said he and his team were so overwhelmed with the demands of the virus that no one was able to update the screening criteria on the cruise ship risk assessment form.
But Mr Walker said it was an important role of NSW Health to keep abreast of international coronavirus developments including high risk countries, asymptomatic transmission and testing.
“In a sense, you can’t be too busy to do what you have to do to keep yourself busy,” he said.
Dr McAnulty agreed the ship’s massive failure to test enough sick guests for COVID-19 should have triggered a refusal of permission to berth.
“If (proper swabbing) had occurred, test, trace and isolate would have proceeded more rapidly, more effectively and more cheaply with less economic destruction for the community. Isn’t that right?” Mr Walker asked.
“If that had occurred we could have made an earlier assessment that there was infection on board and then taken the appropriate response,” Dr McAnulty said.
Mr Walker asked the doctor why he shouldn’t treat NSW Health’s low, high and medium biosecurity risk classification system as an “artificial, non useful and potentially misleading approach.”
“It was not useful after the 10th of March and all ships at that point should have been treated with an on-board assessment and screening taken,” Dr McAnulty said.
The department’s Executive Director of Health Protection agreed that by the March 10 “turning point” he thought a requirement for all guests to stay on board ships until any COVID-19 swab results came back should have been a “no-brainer.”
But Dr McAnulty had previously received pushback from colleagues who suggested boarding every incoming vessel would be onerous for overworked staff, and testing sick passengers without a travel history would be “overkill”.
Mr Walker flagged concern that an undated, unattributed NSW Health review of the scandal boasted that the department’s risk assessment procedures “went far beyond the processes in most other jurisdictions at that time.”
The commissioner suggested the policies in place were not something to be proud off, because the COVID-19 risk calculation was based only on a subset of passengers with a fever and not a broader group who had a respiratory illness.
The expert panel’s pre-arrival assessment form stated 2.7 per cent of Ruby Princess passengers or crew had presented with respiratory illness but only 0.94 per cent had influenza-like illness, which met the state’s low-risk criteria of under one per cent.
Mr Walker said the threshold that would have required health officials to delay disembarkation until coronavirus swab results came back was arbitrary, and questioned why it was listed as a “key point” of the review.
“I agree, I think it’s misplaced,” Dr McAnulty said.
The doctor revealed the report had been created as a briefing for the NSW Health minister.
“In other words, political accountability at the highest level,” Mr Walker said.
“This is therefore really quite an important document in terms of the integrity of government … I’m worried there is spin in it.”
The inquiry also heard that crew members who remained on board after the cruise ship docked at Circular Quay weren’t screened en masse for COVID-19 for two weeks despite one employee testing positive for the deadly disease.
NSW Health began testing crew members when the liner arrived at Port Kembla around April 5 – a “regrettably long time” after one worker was diagnosed with coronavirus on March 20, according to Mr Walker.
Dr McAnulty told the inquiry the ship’s medical team was “very confident that they were managing the situation well” during that time.
But Mr Walker questioned whether that confidence turned out to have been misplaced, considering 202 infectious crew members out of a total of 1057 needed to be removed from the ship before it finally set sail for the Philippines.
Cruise ship industry ‘didn’t care’ about COVID-19 tests
The Ruby Princess inquiry’s commissioner has suggested the cruise ship industry “didn’t care” about providing COVID-19 tests for sick passengers during the pandemic.
Bret Walker SC grilled a NSW Health official about why the department “did nothing” to address the woefully inadequate coronavirus testing rates on liners.
Mr Walker also questioned why the NSW government let vessels leave port without being safely stocked with enough swabs.
“The notion that these very large corporations were unable to procure swabs for love or money strikes me as almost impossible to believe,” he said on Wednesday.
”What does seem quite likely is that they weren't trying hard enough, and that is because they didn't care enough.”
Public health physician Dr Vicky Sheppeard said the industry had complained of a shortage of testing equipment, adding that NSW Health started supplying ships with swabs.
“You mean at taxpayer expense, why? Cruise ships surely weren’t telling you they couldn't afford it?” Mr Walker asked.
“No,” Dr Sheppeard said.
“If NSW could obtain swabs it wasn’t really credible that Carnival couldn’t,” Mr Walker said.
In February NSW chief health officer Dr Kerry Chant wrote to the industry announcing new guidelines requiring ships to collect COVID-19 swabs when passengers were tested for influenza.
But Dr Sheppeard told the inquiry that many liners flouted these rules, and although she was “part of a group” with responsibility for addressing the shortcoming, it was “not specifically her job”.
“It was not unusual for the ships to not have collected any swabs,” she said.
Dr Sheppeard sat on a biosecurity risk-assessment panel for a Ruby Princess voyage that ended in Sydney on March 8, where no coronavirus swabs were collected despite 30 people on board being tested for influenza.
When repeatedly asked what action was taken to ensure compliance, Dr Sheppeard said the department sent another letter to the cruise ship industry on March 9.
Mr Walker noted that when faced with the “utter failure” of liners to collect two samples from each sick passenger, NSW Health requested three swabs be taken instead.
“Which doesn’t make sense to me if you were, in fact, ever impressed by the reality of a shortage of swabs available to the cruise ship operators. That would be unreasonable,” he said.
NSW Health allowed 2,700 guests to disembark the ill-fated Ruby Princess in Sydney without proper checks on March 19, in what has become the single largest source of COVID-19 infection nationally.
The expert panel deemed the liner “low risk” based only on a subset of passengers with a fever and not a broader group who had a respiratory illness.
This was despite the knowledge that coronavirus symptoms do not always include a fever.
Dr Sheppeard disagreed with Mr Walker’s suggestion that screening procedures which restricted coronavirus testing only to passengers with a fever and did not embrace “the full gamut” of patients with respiratory symptoms was inadequate.
“In a congregate setting such as a cruise ship, one doesn’t have to swab every person with a symptom because if infection is circulating you can swab a sample,” she said.
“It can be more efficient to swab the people who are sicker rather than having to swab potentially hundreds of people.”
The inquiry, which is due to report findings in August, continues.