Ruby Princess inquiry: experts delivers cruise ship recommendations
Broader COVID-19 testing for cruise ship passengers, a 14-day travel history data log and transferring all disembarked guests to monitored hotel quarantine are some of the expert recommendations given to the Ruby Princess inquiry.
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A national ban on cruise ships should have been in place two weeks before the Ruby Princess docked in Sydney, and thousands of disembarking guests should have been placed into hotel quarantine, two experts have told a powerful inquiry.
Professors Anthony Kelleher and Anthony Grulich were asked to advise Commissioner Bret Walker SC ahead of his final report into what caused the country’s largest outbreak that killed more than 20 people.
They recommended more influenza and COVID-19 testing for passengers on board, or emergency transport of swabs to onshore testing laboratories while the vessel is at sea.
“This would be applied to all patients with acute respiratory infection, not just those with influenza-like illness,” Professors Kelleher and Grulich wrote in a June report.
“The (acute respiratory disease) logs that ships are required to keep should include travel history in the last 14 days, not just country of residence, because recent travel is a critical risk factor early in a pandemic.”
When the Ruby Princess berthed in Circular Quay on March 19 it was one of the last cruise ship arrivals in Australia before a national ban was implemented by the federal government.
“Between 7 and 29 March 2020, at least 17 cruise ships docked in Australia and nine of these had confirmed cases of COVID-19,” Professors Kelleher and Grulich said.
“Enforcing this ban 10-14 days earlier would have prevented any cases of COVID-19 being related to the Ruby Princess.”
The government should have acted sooner, given the World Health Organisation had already declared an international public health emergency, and considering the “well-documented” high risk cruise ships posed for contagion, the experts said.
“We believe consideration should have been given to an earlier ban of cruises, and that this should be strongly considered in future pandemics,” Professors Kelleher and Grulich said.
The experts backed NSW Health’s assertion that early disembarkation of sick cruise ship passengers is the best option.
But they said securely transferring all of them to a local hotel to quarantine for a fortnight would have more effectively reduced community transmission than letting a large amount of pre-symptomatic guests scatter into taxis, public transport, and flights interstate and overseas.
“Phased and highly-organised disembarkation procedures which maintain spatial distancing and reduced crowding during the process should be designed,” they said.
“Secure transport should be organised to monitored hotel quarantine.”
They said this method allows authorities to enforce compliance, and many countries have now adopted it “largely because of concern that arrived passengers would not completely adhere to self-isolation (at home).”
A NSW Health expert panel deemed the Ruby Princess a low biosecurity risk and let nearly 2,700 people leave the ship despite 13 pending coronavirus swabs and what Mr Walker slammed as woefully inadequate testing rates during the ill-fated voyage.
The panel had been guided by an outdated policy that 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.
The ship’s March 18 acute respiratory disease log noted several sick patients from the United Kingdom, United States, Ukraine, Italy, and New Zealand, including one who tested negative for influenza.
“The absence of data on travel in the 14 days prior to embarkation in these logs is concerning,” Professors Kelleher and Grulich said.
“It seems likely that at least some of these non-Australian residents travelled to Sydney from overseas for the purpose of the cruise.”
The panel’s ‘low risk’ rating only took into account a subset of passengers with a fever and not a broader group who had a respiratory illness.
That’s despite the CDNA including acute respiratory disease without fever in the suspect COVID-19 case definition by early February.
Professors Kelleher and Grulich said for a correct interpretation of risk, it would have been critical for both the ship’s medical staff and NSW Health to be up to date with these changes.
“Consideration should be given to directly linking changes in important criteria, such as case definition, to critical reporting forms. Self-updating electronic forms and notifications may be one way to address this,” they said.
But the experts also noted that adhering to this in the future could mean “several hundred passengers and crew being identified on every voyage of every large cruise ship.”
“There clearly needs to be a balance between screening hundreds of people unnecessarily versus more targeted screening,” they said.
“This is particularly the case when resources such as personnel, personal protective equipment and test kits are limited.”
The inquiry may resume for one more day of public hearings next week before the final report is delivered in August.