Covid-19: Australia’s quarantine system shows Ireland the way

State’s public health needs tight logistics, deep collaboration and clear leadership

In October 2020, I travelled to Sydney from Ireland. I travelled via three airports (Dublin, Frankfurt and Tokyo) where at each stage, my right to enter Australia was checked with Australian immigration. On arrival at Sydney airport, I was screened by health officials for any Covid-19 symptoms before being marshalled to a bus by a member of the Australian army. Upon entering the bus, a police officer announced to us all that we were now under the caution of New South Wales police under the Public Health Order 2020. We were then transported to a hotel to commence quarantine.

Once I checked in, I was again accompanied to my room by a member of the army. I was not given a hotel room key and was advised not to leave my room. There was a security guard sitting on my floor. I was cautioned that if I tried to leave there was significant fines and potential jail time involved and I would have to recommence the quarantine process again.

The quarantine process meant for 14 days I remained in a room without an open window. Each day I received a call from a health official checking if I had any Covid-19 symptoms. I had access to mental health supports if needed. I was tested twice – on day two and day 12. I was provided with all my daily meals. While my room was not serviced, I had access to towels and bedding to change myself when required. On my final day, I received a visit from health officials and the police who reviewed my test results and provided an approval document to exit quarantine. The cost for two weeks was €1,900.

Once I exited, I felt like I walked into an alternative world to Ireland. Life is very normal and open in Sydney. I have been to restaurants, libraries, theatres, pubs, the gym and large outdoor events. A state-wide department of health barcode scanning system tracks my locations for any potential contact tracing. Access to Covid-19 test centres is easily available without an appointment. Public health is resourced and responsive to any minor Covid-19 outbreaks. These are managed via regional lockdowns and strong communication to the public. Rules are enforced with high fines attached.

Inter-agency co-operation

As the debate in Ireland meanders towards introducing hotel quarantine, there are clear lessons and logistics that need to be considered. In New South Wales, there are thousands of staff involved, working across several agencies. It requires a highly specialised workforce to support the system, including clinical, welfare and security services, to mitigate risk. People who test positive are remotely monitored from their hotels and protocols are in place on transferring those that may need hospital care. Infection prevention and control processes are tightly managed. On any day in NSW, 300 police officers are working across the hotels, including about 200 stationed in hotels alongside security staff.

Much learning and adaptation occurred across the quarantine system. Anyone now arriving in Australia must present a Covid-19 test on arrival. Lessons were learned in ensuring that staff were not working across settings; daily tests are provided to staff. Further refinement is ongoing as some hotel staff have tested positive from the virus’s suspected aerosol spread while guarding floors.

The process cannot be ad-hoc in its implementation. All people arriving in Australia from overseas must quarantine at a designated hotel. Exemptions are rare for people to self-isolate at home due to the high risk of not quarantining. They are only considered on strong health or compassionate grounds.

Australia has a federal system. While technically hotel quarantine is the federal government’s responsibility, each state and territory has taken their own path on managing their quarantine process. What has worked well is the coming together of a national cabinet to review the quarantine caps, and share information and learnings. This model provides an ideal template for the Irish Government to take to Northern Ireland and the UK to develop a shared system that will adapt.

Driven by data

Clear communication and decision-making across agencies have been key mechanisms for success in Australia. The Irish Government Task Force on Emergency Planning could easily be charged with managing hotel quarantine logistics. The task force should refine the criteria on who can enter the State via a quarantine system and undertake ongoing reviews as the vaccine rollout expands and Covid-19 case numbers decrease.

There has been nothing lucky about the Australian experience. It has been driven by data and a strong public health system. This is perhaps the Irish Government’s biggest challenge in establishing a functioning quarantine system. The Irish public health system and the staff working within it have been underresourced for years. Public health is central to hotel quarantine, and it will require their leadership. Developing a system that bypasses them will only result in costly errors that will impact the whole country.

The return on doing quarantine right cannot be underestimated. As I write this on January 28th, we are on the 11th consecutive day with zero community cases across Australia. There are no cases of Covid-19 in ICU or on ventilation, and only 21 patients are being treated in hospital. School children are also returning to their classrooms this week after their summer holidays.

It is time for Irish politicians to stop with the excuses and implement a robust quarantine system. Clear communication is also needed to the public on what restrictions will occur on travel in and out of the country. This will mean collectively people will have to make sacrifices on non-essential travel. The reward for doing this right will be evident across the country.

Dr Éidín Ní Shé is a senior lecturer at the school of population health at the University of New South Wales