Quarantine the Australian way: Tight logistics and high cost

Louise Curtis, a psychiatry registrar from Mallow, Co Cork, today works in a Melbourne hotel offering help to people held under Australia’s tough 14-day quarantine rule. And she is needed because many struggle.

“Once you’re in the hotel room you’re not allowed to leave it for any reason at all. It’s very hard, a lot of people do suffer,” she told The Irish Times, but it “is a necessary evil” to keep Australian Covid-19 numbers under control.

For 10 months, anyone entering Australia must spend 14 days in quarantine. Some states are enforcing such curbs on domestic travellers, too. Guests must pay, too, costing a single person 3,000 Australian dollars (€1,900) and a family of four 5,000 Australian dollars.

Public health experts say the quarantine rules have been instrumental in slowing the spread of Covid-19 in Australia, where nearly 29,000 cases and just over 900 deaths have been reported to date.

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Dr Niall Conroy, a Dublin-born public health consultant in Queensland, says it is impossible to keep infections down while new cases come in from overseas as they lead to new tranmissions. Conroy says quarantine must last for 14 days. "You can do shorter durations, but those will miss cases. The problem is that if you miss cases, then it doesn't work."

Logistical headache

Operating it, however, is a logistical headache, with a slew of infection risks. Managing it relies on specialised transport, and clinical, hygiene and security staff. Usually, it is run by the state’s police force and department of health.

“We have a meeting twice a day. There’s a lot of logistics involved. It’s a big operation,” Curtis says, adding that the hotel comes to a halt if someone requires an unscheduled 10-minute fresh-air break.

For travellers arriving into Australia, the rules are strict and heavily policed. Before boarding, travellers must supply a negative Covid-19 test. Following landing, biosecurity officers and border officials board to explain the regulations.

After disembarking, passengers are screened by airport medical staff, marshalled through baggage collection and loaded onto buses by the Australian Defence Force or local police and taken to hotels in the city.

Once there, they are escorted by security to their rooms, and they must stay in them – bar just three fresh-air breaks during their entire stay in the quarantine hotel.

Breaches are met with an 11,000 Australian dollar fine or six months in jail: “I don’t think anyone has tried to run away. There’s loads of security. In the front foyer, there’s police and the army. It would be very hard to get past them,” says Curtis.

Infection prevention and control are fundamental to effective operation. Appropriate personal protective equipment (PPE) use and training for police, hotel and transport staff, private security, and health and welfare professionals is crucial.

“Security teams have quite a bit of contact with people in quarantine, when they’re transporting them to their rooms for example, so it’s really important that they’re both well-protected and well-trained,” says Conroy.

All staff in the hotel where she works are tested daily, says Curtis: “There’s a huge emphasis on sanitation. When you’re leaving work you have to sanitise your hands three times. It’s very, very strict.”

Those in quarantine are usually tested on the second and 11th day. To be released from it after 14 days, returned travellers need to have two negative test results and to be symptom-free. If not, they stay in quarantine.

“[Then] we can be virtually sure they’re not carrying Covid. Then we can concentrate on mopping up the cases and the associated transmission chains that are already here. That’s how you achieve zero-Covid,” says Conroy.

However, the Australian government has been careful not to overwhelm the system by capping the number who can arrive into Australia. In Sydney, for example, just 1,505 people a week are allowed to land at the city's airport.

That has come at a cost, since the rules apply not to just to foreigners, but to returning Australians, too. Currently, more than 30,000 Australians are stranded overseas, some of them struggling badly.

Windows won’t open

The conditions and size of the hotel rooms can vary wildly, with some travellers getting luxury rooms with balconies and plenty of fresh air, while others are ending up in rooms with windows that do not open.

A recent government review found that many held are distressed by the lack of fresh air and ventilation, support for mental health and the quality of hotel food, causing some guests to make complaints to the Human Rights Commission.

“There’s no natural light in the rooms in the hotel I’m in and that upsets a lot of people,” says Curtis, “There have been times where I’ve considered transferring people to a different hotel because they’re really struggling with their mental health or anxiety.

“You can have three fresh-air breaks in the whole two-week period,” says Curtis, who advises anyone entering quarantine to come up with a plan to keep busy – bring plenty of books, plan to exercise and stay active in your room.

Extra fresh-air breaks are only granted in extreme circumstances, for example if a resident is grieving or has a mental health condition. “There’s not much else we can do for them.”

The system is not without fault. There have been quarantine breaches, including the infection of guards and cleaning staff. People have escaped from hotels in Victoria and South Australia.

Victoria’s second wave, where more than 750 people died, was found to have stemmed from infection control breaches in two hotels in Melbourne that were being used to quarantine returned international travellers.

A national review now suggests moving quarantined people out of city hotels to rural areas with more space and fresh air as well as using electronic tagging and apps to monitor the whereabouts of returned low-risk travellers.