Has Victoria learnt anything since the hotel quarantine inquiry?
Have Victorian authorities learnt anything from the findings of the hotel quarantine inquiry? Based on the recent problems resulting in the
Holiday Inn outbreak, it would seem not. In fact, given the Premier’s recent comments that “I think we could all agree on the fact that hospitals are different to hotels in many, many different ways”, one wonders whether Mr Andrews has actually read the
hotel quarantine inquiry report.
From an infection control point of view, the inquiry highlighted that quarantine should be a strict system of containment and isolation, where clear health guidelines are rigorously followed. Whether this is in a hotel, a hospital, or a special facility such as Howard Springs or
any new Victorian facility such as was proposed yesterday is irrelevant – these are just matters of geography. The key issue is “quarantine”, not the location in which it is carried out. After all, travellers are in hotel quarantine in case they have COVID-19 – in other words, they are considered potentially infected until, after 14 days and regular testing, they are proven to be non-infected.
From a quarantine infection control point of view, all the principles that apply to staff and patients in a hospital COVID ward, should equally apply to hotel quarantine. Yet, in Victoria, there are still clear differences in infection control procedures (N95 mask use, attention to preventing aerosol transmission, etc) between hospital-run facilities and quarantine hotels. This is totally contrary to the inquiry recommendations and, as an infectious diseases physician, absolutely exasperating and really quite unacceptable.
The hotel quarantine inquiry interim report was
released in November and contained 69 recommendations specifically regarding quarantine, with the final report delivered on December 21. Thus, how can it be that almost four months later and with clear step-by-step instructions on how to manage quarantine safely and effectively, it still gets stuffed up so badly?
The very first point in the report, regarding the appropriate features of a suitable facility-based model, are that there is a: “Primary focus on public health and infection prevention and control”, and of the 69 recommendations, 10 relate to infection prevention and control. Yet, based on what we know about the Holiday Inn outbreak, at least four of these 10 recommendations have not been followed adequately. In an area as critical as quarantine, is this even remotely acceptable?
A lot of comment has recently been made about the role of new COVID variants or mutant strains that may be more transmissible. However, the whole point of strict infection control procedures is that these minimise the risk of spread of all variants. The UK variant, regardless of any possible increased transmissibility, did not cause the breaches in infection control procedures at the Holiday Inn (and potentially in other quarantine hotels) or the failure of many Holiday Inn contacts to be followed up within the required 48 hours. These are simply signs that many of the inquiry recommendations have not been implemented.
As a physician, the most distressing issue from the recent weeks is that both the Department of Health and Human Services, and now COVID-19 Quarantine Victoria, seem willing to openly blame patients for their Department’s own failures – whether it is criticising the non English-speaking family for mistakenly sending their kids to school last year; or the latest comments about the returned traveller for
using a nebuliser.
Every health professional knows these mistakes are almost always due to a failure of adequate communication and that it is a system error, rather than any intentional patient misbehaviour. The AMA have recently described the DHHS as having a culture of being
overly defensive and displaying a lack of transparency about the truth. These recent events seem to reinforce this view.
In hospitals, if there is a suspected medical error, there is a standard safety and quality system (the so-called Morbidity & Mortality, or M&M review) whereby the case is objectively investigated and changes enacted, including corrective training of those involved to prevent the error happening again. However, if a similar mistake is made again, the entire procedure is shut down and those involved are furloughed, until it is certain that the system is safe.
The hotel quarantine inquiry was Victoria’s M&M review – and now the problems with quarantine
have occurred again and clear recommendations from the inquiry not followed. Thus, the only conclusion is that Victoria’s current system cannot be trusted to run a quarantine program and that it should be removed from the national process until it can be proven to be safe.
Professor Lindsay Grayson is Professor of Infectious Diseases at the University of Melbourne. He was an expert witness in the Victorian Hotel Quarantine Inquiry.
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