No room for complacency in Covid hotel quarantine

The COVID-19 outbreak in South Australia is obviously a concern. It looks like a failing of hotel quarantine, which is the first line of defence against a virus still causing record numbers of infections overseas. It’s troubling if one of Adelaide’s “medi-hotels” has had poor infection control. The timing is discouraging, too, because the hope has been that the country is on a path to something resembling normal life at Christmas. There is a deep need to reconnect with family and friends, for respite from anxiety and alarm.

Even so, the likelihood is that the Adelaide cluster is just one in a series of unwelcome surprises, reversals and public health puzzles ahead of us. Early results of the Pfizer vaccine are heartening but there are a host of logistical and other challenges to overcome before herd immunity. That means we have to keep thinking how best to maximise social and economic activities while minimising pandemic risk. We have to resist panicky measures and overkill, to become more effective and consistent at applying approaches that seem to work, and to reset quickly when evidence to the contrary comes in. Decisions have to be pragmatic and balanced.

Management of the Adelaide outbreak appears reassuring, with authorities stressing rapid testing, which makes successful tracing more likely. South Australia’s hotel quarantine regime was scrutinised during the national review, and the results published last month mean the broad outlines of the best model are agreed and clear. These include well-trained staff, robust systems for infection control, effective and accountable supervision, and straightforward information for domestic and overseas people coming within quarantine. One oversight was that before this outbreak, staff in Adelaide’s medi-hotels were not tested for COVID-19 unless they reported symptoms. Now there will be weekly tests, regardless of symptoms. It’s worth considering whether it makes sense to improve national oversight of hotel quarantine. Inconsistent data across jurisdictions is also a handicap we could do without.

A more immediate question is whether South Australia’s hotel quarantine has systematic shortcomings as opposed to suffering a one-off lapse. The tragic autumn outbreak at Newmarch House in western Sydney and the Ruby Princess cruise ship fiasco seemed to galvanise NSW health authorities to deploy more effectively and quickly the test-and-trace capabilities of the state. During the ensuing months, as Victoria suffered its own hotel quarantine outbreak, it became clear that NSW had an enviable agility and expertise in testing and tracing, which is the second line of defence. It needs it because Sydney has population densities and a pressure of overseas arrivals combining to make it a high risk for contagion. Paradoxically, the less risky circumstances for a small state such as South Australia, and its relatively low number of infections, may have put it at a disadvantage if indeed it lacked the sense of urgency and concern to motivate everyone from top health authorities down to medi-hotel staff to carry out their tasks with utmost seriousness and constantly refine their systems. No doubt we will learn more about this track record in the coming weeks as the causes of the Adelaide cluster are unravelled.

But even with the best quarantine systems, and skilled and vigilant staff, there will be lapses because the virus is very infectious and humans under pressure can be erratic. The daily headlines of astronomical infection counts overseas, compared with our very low levels of the illness, are a reminder that the virus will continue to be flown across our borders and delivered with its human hosts into hotel quarantine. It is the entry point and the potential escape route out into the community.

Other jurisdictions have declared South Australia a pandemic hotspot and flagged quarantine for visitors. It would be a mistake to reinstate border closures when it should not be beyond the wit of states brought together in a national cabinet to contrive cross-border arrangements, including for testing and tracing. South Australian Premier Steven Marshall has announced a range of restrictions that will curtail social and economic life. He has said he won’t rule out any necessary measures, which no doubt sends a message of resolve, but it should be widely understood by now that a deep and prolonged lockdown similar to Victoria’s is a confession of failure in prevention, and imposes terrible costs and burdens. As Damon Johnston reports on Tuesday, there is great concern about a section of schoolchildren in Melbourne whose long-delayed return to the normality of the classroom does not seem to have restored their mental wellbeing.

Science does not dictate drastic interventions such as Victoria’s lockdown. The science, with all its shifting uncertainty, is a vital input to policy but it is accountable politicians who must decide how to manage the pandemic while keeping in mind the full range of fundamental social values.