Victoria has unveiled a new and improved hotel quarantine system. It’s tough, but also more holistic in its approach to resident wellbeing, and, perhaps most importantly, governance has now been centralised and clarified. But how does it stack up against other states and jurisdictions?
A week from now Victoria will recommence accepting international travellers for the first time since confused chains of command and an over reliance on external contractors led to the state’s now infamous hotel quarantine bungle.
What became a public administration failure of epic — and tragic — proportions has served as backdrop to the development of a new and improved system unveiled by Premier Daniel Andrews on Monday.
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The message and promise were one: Victoria has learned its lessons.
We will soon find out. On December 7 reams of international travellers will begin arriving in Melbourne again, and while the risk of community transmission in Victoria has not been lower since the pandemic began, the international context has worsened considerably.
The stakes are as high as ever, but with strengthened clarity in governance and an undeniably tough infection control philosophy; Victoria hopes to become the picture of best practice in Australia, ahead of what are expected to be yet-more changes to hotel quarantine processes nationally next year (more on this below).
“There are many lessons that have to be learned in relation to hotel quarantine and we have learnt those lessons, both from Victoria’s experience but also from experiences in Adelaide, experiences in Sydney,” Andrews said.
“Breaches out of hotel quarantine aren’t unique to Victoria, what we have is though, is focused on the best system, the strongest system.”
Victoria’s tough new approach to hotel quarantine
Tough is the operative word for the new approach, which is in many ways a response to both Victoria’s own hotel quarantine inquiry and a national review undertaken by former health secretary Jane Halton.
Leaving the room for exercise? No. Fresh air? No. Any reason? Not unless there are medical or compassionate grounds.
Care packages from family and friends? That’s a no too, accredited food providers only.
These restrictions set Victoria up with perhaps the most stringent hotel quarantine program in the country, but perhaps the most notable changes are to program governance.
Overseeing all aspects of the new program will be a new agency called Quarantine Victoria, Corrections Commissioner Emma Cassar. This is a sharp departure from the old approach and even cross-departmental arrangements maintained in other states.
Victoria Police will support enforcement with the help of the Australian Defence Force. Police Minister Lisa Neville will be entirely responsible from the government side and said on Monday that officials will be taking a hands on approach to ensure breaches don’t occur.
“Every element of the program has been strengthened, with increased oversight, leadership and infection prevention and control measures to protect the Victorian community,” the police minister said.
Many of the changes are the result of no less than 69 recommendations from Victoria’s hotel quarantine inquiry (52 of which were accepted in principle). But how do they stack up against other states and territories, and even other jurisdictions internationally?
Stacking up: Central governance, clear accountability
Victoria’s new centralised governance approach to hotel quarantine also aligns with best practice considerations outlaid in a late-October review of quarantine arrangements across the country by former Health Department secretary Jane Halton.
It will bring Victoria’s program into line with some other states and territories from a governance perspective, centralising decision making and accountability while diffusing specific responsibilities to a few key agencies:
- A deputy chief health officer will oversee infection prevention control and other public health functions;
- A deputy controller will manage logistics and operations; and
- A deputy controller from Victoria Police will oversee enforcement and compliance.
This approach is similar in many respects to Queensland, where police work in tandem with public health officials and an administrative unit, with the advantage that lines of responsibility are clear without overburdening one group beyond core expertise.
Crucially, clinical overlay (which basically means doctors have end-to-end visibility and input) is a foundational aspect of Victoria’s new program.
NSW’s quarantine system is also led by police and the state’s health department, although there are a host of other agencies that have input into the program, including the Department of Transport, Treasury and the Department of Premier and Cabinet.
In NSW there are two committees responsible for the coalface operations at the airport and within hotels, both of which report upwards to two other committees chaired by public health officials.
What does best practice quarantine look like?
In her review — which excluded Victoria — Halton outlined a set of principles for best practice quarantine that have been used by the Victorian government in the development of its latest program.
These principles include:
- Planning and preparedness: Guests should be adequately briefed on the quarantine experience and authorities must be prepared for expedient transfer from airport to hotel;
- End-to-end infection control: Health and infection control protocols must be applied consistently from start to finish and be subject to clinical overlay (supervision of health professionals);
- Procurement: Clear governance and accountability over all contracts, ideally housed within one agency;
- Health and well being: Holistic health assessments (including mental) that also screen for vulnerable guests, including those with disabilities and addictions; and
- Customer experience: Entertainment and the provision of amenities is important. Extra support should be provided to parents and effort should be made to facilitate a sense of community within facilities.
Victoria’s own hotel quarantine inquiry identified a similar set of best practice guidelines. Both reviews underscore the importance of public administrators considering resident experience and well being as well as infection control.
Within its new system, Victoria has committed to making improvements in each of these areas and has even singled out the food menu as something which has been re-imagined—an area that’s been the focus of resident complaints nationwide.
Strict but fair? Victoria hones in on mental health
Perhaps most notable is Victoria’s renewed focus on mental health among residents. While its new system is much stricter than many other states and territories in terms of individual freedoms being restricted, mental health professionals will be on deck to help with psychological issues.
These staff will be made available to guests from the outset of their stay and proactive efforts will look to provide pathways for escalation where guests are struggling, echoing findings from Halton’s national review in October.
“Good practice operations of mental health support is demonstrated by the presence of assertive mental health screening and treatment available to hotel quarantine guests, particularly with evidence of the use of validated mental health assessment tools. Further, good practice includes assertive in-reach and assessment, which is not reliant on the traveler to seek out support, in a timely manner (no later than 24 hours into quarantine),” Halton wrote.
This holistic approach is in line with what other countries around the world, including Canada, have learned about quarantine arrangements during the pandemic. Essentially, there’s a need for a holistic approach that recognises the need to balance infection control with resident well being.
In other words, happy guests are ones that follow the rules and doing so minimises infection risk.
Risk assessment and at-home quarantine: the future?
While the Victorian government accepted and is implementing most of its inquiry recommendations, there are a few which have been pushed back until 2021, primarily relating to the possibility of at-home quarantine.
This one is interesting. While most states and territories (with the notable exception of the ACT) have run strict 14-day supervised quarantine arrangements, there is an emerging sentiment that a hybrid model with at-home quarantine is the way to go.
Why? Halton touched on this repeatedly, arguing that because we now know much more about coronavirus — notably to curb transmission and isolate at-risk residents — a good case can be made for more nuanced risk assessments that shorten isolation periods or introduce at-home quarantine.
“It is timely to revisit the risk settings and thresholds about who should be undertaking hotel quarantine and examining options that do not introduce an unacceptable risk. This should include an explicit consideration of the prevalence of COVID-19 in source countries noting that an assessment should also be made of the extent and nature of testing regimes in those countries, and any evidence based risk of inflight transmission,” Halton wrote.
Internationally, other jurisdictions have had success with hybrid quarantine models. This includes Taiwan, which offers a shorter five day quarantine for low-risk travellers that pass COVID-19 tests before and after their arrival.
Elsewhere, Singapore — which also has a shorter seven day quarantine program for low risk countries — has boosted confidence in its at-home quarantine measures by handing out GPS devices to travellers.
In Australia the ACT has served as the model for at-home quarantine, having successfully utilised the service as a more economical resident centric approach to preventing community transition.
Halton said a variable risk management approach could be the key to reducing quarantine costs, increasing Australia’s ability to repatriate stranded citizens, all while minimising infection risks.
But National Cabinet has yet to agree on a consistent approach to at-home quarantine arrangements, leading the Victorian government to put off considering such recommendations until 2021.
Such an approach would likely be a halfway house between strict hotel quarantine arrangements and unsupervised at-home isolation, with traffic light systems employed to categorise travellers into risk categories.
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