As UK COVID variant spreads, Australia urgently needs more purpose-built quarantine stations, experts say
With yet another cluster of people in hotel quarantine this week testing positive for COVID-19 — this time triggering a mass evacuation of Brisbane’s Hotel Grand Chancellor — epidemiologists are calling on the Government to urgently establish more purpose-built quarantine stations like the Northern Territory’s Howard Springs, pointing to features like its well-spaced rooms, fresh air and staffing arrangements as a crucial line of defence against outbreaks.
For months experts have been warning of the difficulties with hotel quarantine programs, with some arguing returning travellers should not be triaged in cities because of the risk of the virus escaping, as it has done in South Australia, New South Wales, Queensland and, most catastrophically, Victoria.
Now, with caps on international arrivals to many states slashed in half until at least mid-February, concern is growing over the threat of the significantly more contagious variant of coronavirus, which has been pummelling the UK and spreading rapidly around the world.
“The new variant is a game-changer,” said Melbourne University epidemiologist Tony Blakely, “because it means that if it leaks out of quarantine, we’re going to need to hit it much harder — a la what Brisbane did with their immediate three-day hard lockdown.” A breakout now, he said, “could easily overtake us unless we’re finding it very fast. That’s the risk.”
For that reason Australia’s quarantine outfits must swiftly be reviewed and if necessary improved, Professor Blakely said, ideally by an independent agency: “We do not actually know what is happening in quarantine around Australia.”
In the interim, he said, if the Government’s aim is to eventually increase the number of international arrivals, “Using more ‘Howards’ rather than more hotels would be a very sensible strategy, if we can find those Howard Springs-like facilities to use.”
Howard Springs is scaling up
It’s been dubbed the “gold standard” of quarantine facilities in Australia: an old mining camp of Colorbond-clad buildings, huddled together in tree lined compounds, about 25 kilometres south-east of Darwin.
The former workers’ village has this week been preparing for an influx of travellers returning from overseas after the Australian and Northern Territory governments agreed to “scale up” capacity at the quarantine centre from 500 to 850 people per fortnight.
“While the rest of the country understandably needs to reduce the number of international arrivals they bring in, we can safely and responsibly increase our numbers because we are the safest place in Australia, the best quarantine facility,” NT Chief Minister Michael Gunner said. “We are stepping up, we are doing heavy lifting, not just for the territory but for the nation.”
Some other leaders already appear to be taking notes on the Howard Springs approach, with Queensland Premier Annastacia Palaszczuk on Thursday announcing her government was considering quarantining international travellers in mining camps.
“My understanding is most of them, the ones we’re looking at, have balconies so there’s a lot of fresh air for guests and … capacity for all of the staff … to also be based on those sites as well,” she said.
Since repatriation flights began in October, the Howard Springs facility, run by the National Critical Care and Trauma Response Centre, has accommodated about 2,500 Australians returning from India, Germany and the UK.
At the time of writing, there were 673 international passengers undertaking quarantine at the facility, in addition to 127 domestic travellers who are hosted in a separate compound. The cost of quarantine is $2,500 per person, billed by the Commonwealth Government, which is in charge of who arrives and when.
And, for now at least, the numbers look promising: The Northern Territory has to date recorded 94 cases of coronavirus, all of which are linked to overseas or interstate travel. Of those, 59 cases have been reported among returned international travellers, with just one involving the UK variant.
A spokesperson for the Department of Health told ABC News there has so far been no transmission of the virus to Howard Springs staff or the community.
What is working?
Len Notaras, executive director of the National Critical Care and Trauma Response Centre, said the AUSMAT-staffed facility had strict testing and infection control protocols: all residents undergo a PCR test on day zero and day 12, while all staff have a daily rapid antigen test and weekly PCR test.
“All staff are employed full time and advised they cannot have secondary employment,” Professor Notaras said. “A small number of staff are rostered to remain onsite at Howard Springs with clinical staff managing COVID-19 positive passengers.”
Professor Blakely says quarantine facilities like Howard Springs may in principle be safer than hotel environments because they have well-spaced rooms, no shared ventilation systems and are distant from densely populated urban areas, which means that if the virus does leak out, community transmission is less likely to be “explosive”.
“The public health textbook before COVID was that quarantine should be done in remote places like Howard Springs,” he said.
Adrian Esterman, chair of biostatistics and epidemiology at the University of South Australia, agrees. “If you have people with suspected infectious disease, you isolate them. It was only very recently that we’ve decided to put them into hotels in the middle of cities,” Professor Esterman said.
“You can understand why … but it’s now been quite a few months since the initial outbreak and there has been ample time to establish quarantine stations in remote areas.” And there are “plenty” of possible sites, he said, “For example, the RAAF base in Western Australia, Howard Springs and Christmas Island” — which he said “has ample accommodation and is hardly used”.
But the chair in epidemiology at Deakin University, Catherine Bennett, says that the people moving between quarantine facilities and the community are the risk, not their physical proximity to the rest of the population.
“Managing this is the key, [as is] monitoring for infections with regular — each shift — staff testing, and weekly PCR [testing],” Professor Bennett said.
There is an argument for purpose-built quarantine stations, Professor Bennett added, if there are not “sufficient” existing facilities like hotels.
“Does the facility need to be in a remote area? No,” she said. “It makes it too hard to have skilled staff, health expertise and access to acute hospitals, plus adds risk associated with transporting arrivees long distances from international airports.”
‘I’m desperately happy to be here’
Still, for some residents currently undertaking quarantine at Howard Springs, its remoteness has been challenging.
Rebecca Stroud, a 48-year-old teacher from Melbourne, arrived with her two-year-old daughter Emma on January 3, after flying into Darwin on a Qantas repatriation flight from Frankfurt.
Last January Ms Stroud’s husband took Emma to Germany for what was supposed to be a short trip, but the onset of the pandemic — and complications with his visa — upended everything. After trying for months to find a way for them to come home, Ms Stroud said she ended up being granted a special exemption to fly to Germany herself.
She left Melbourne on August 7, she said, intending to return with Emma in four weeks. But the airline cancelled her flight at short notice, she suspects because of new caps on arrivals into Australia, beginning a months-long process of finding and finally getting on a new one.
“For people who are staying in the domestic [arrivals] section, it’s like this Howard Springs holiday resort, but the international section is totally different to that,” Ms Stroud said. “We’re allowed only in our room and on our balcony … if we’re outside we have to wear a mask; we have no exercise breaks but we do have fresh air with a mask on.”
Residents get temperature checks and a phone call every day, Ms Stroud said, and “patrols” of army members and police go past regularly, issuing “written warnings” to anyone flouting mask-wearing rules.
“Within 24 hours the girl staying diagonally opposite us had her room all boarded up and crime scene taped and they took her away … she was able to call out from the van that came and picked her up that she’d tested positive and was being relocated to a separate section,” Ms Stroud said.
“She had to wipe everything down and bag up everything in the room — her sheets and towels — and take it all with her.”
Overall, Ms Stroud says she’s been impressed with the setup and staff and, so long as she returns a final negative COVID test, is looking forward to flying home on Sunday.
But she also feels Australians returning from overseas should be able to quarantine in similar facilities in their own state, including so it’s easier — and cheaper — to get home afterwards.
“I am desperately happy to be in Howard Springs but … we have to pay our own way home from Darwin to Melbourne — I think that should at least be included in the cost,” she said (it’s costing $5,000 for her and Emma to stay at Howard Springs, on top of the ~$3,700 cost of airfares).
“Australians want to get home … and Howard Springs — proper quarantine setups — are essential to allow more families to get home and be together,” Ms Stroud said.
“As our neighbour three doors down said, ‘When we went overseas, we didn’t know we were giving up our citizenship and rights to come home in an emergency or a pandemic’. And we all agree the flight caps are a problem and that the quarantine situation needs to be federally run.”
‘A national issue, not a state issue’
The Government, however, doesn’t necessarily agree, with a spokesperson for the Department of Health telling ABC News that “the Australian Government is committed to bringing home Australians overseas who wish to return … and has worked hard to ensure both their safety and that of the broader Australian community”.
However, they said, hotel quarantine arrangements “are a matter for state and territory governments”. “Returned Australians are being hosted in approved quarantine facilities around the country that are located close to the necessary health and transport infrastructure.”
But Professor Esterman argues it shouldn’t be the responsibility of individual states to set up purpose built quarantine facilities, including because returning travellers — like Ms Stroud — don’t necessarily fly into their home state.
“We are talking about people who are arriving from overseas — Australians — and how to quarantine them,” he said. “That is a national issue, it’s not a state issue, and the Federal Government … needs to take charge and provide funding for it.”
And while some epidemiologists have suggested that the vaccines on the horizon lessen the urgency for setting up purpose-built quarantine facilities, Esterman disagrees. “It’s going to be an issue probably for at least another 12 months,” he said, until vaccination programs produce “herd immunity”.
“As far as I’m concerned, for the next 12 months we are still going to be in a ‘COVID phase’ where we need to take all the precautions, be able to lockdown etcetera,” Professor Esterman said.
“The key thing about the vaccines is they will protect the vulnerable groups … But this virus is mutating, and if we keep importing in these [more infectious] variants from overseas, eventually we’re going to get one where the vaccines don’t work.”