Australian Society of Anaesthetists president Dr Suzi Nou holds an N95 mask. Credit: Jason South, published in the Australian Financial Review
Following COVID-19 outbreaks stemming from quarantine hotels across Australia, Burnet’s Professor Mike Toole AM and Burnet’s Professor Brendan Crabb AC provided comment for this opinion piece in the Australian Financial Review.
Small holes make for big problems in pandemic Australia
Little things matter a lot in managing COVID-19. So why isn’t Australia’s hotel quarantine system focused on extra-easy precautions like the use of N95 masks for all hotel workers?
By Jennifer Hewett
Professor Mike Toole from the Burnet Institute calls quarantine hotel corridors “the new frontline” in Australia’s fight against the virus.
It’s why the leading epidemiologist is so concerned about the failure to do everything possible to ensure better control of air quality and aerosol transmission in quarantine hotels.
“We have known for a long time now that some transmission is through fine particles but there’s still a stubborn resistance to acknowledging it,” he says.
It may not be surprising, for example, that Daniel Andrews blames anything other than more failures in Victoria’s hotel quarantine and contact tracing system for the whole state suffering through yet another lockdown for at least five days.
What’s far more surprising is that Victoria – and other states – have not adopted an additional obvious and simple measure to try to avoid any hotel quarantine workers becoming infected.
That would be requiring all hotel staff to use the more impermeable N95 face masks and shields now mandatory for healthcare workers – particularly given now irrefutable evidence the virus can escape a room into a corridor and even other rooms via aerosol transmission.
Clearly mandating more effective masks is no guarantee of no infection. But even on a precautionary principle, it seems a cheap, easy source of additional protection against community transmission from occasional examples of hotel infection spreading.
Less than 20 per cent of people who are infected then infect other people.
Yet this has not been recommended by Australia’s Infection Control Expert Group advising federal and state governments on the best containment measures, nor has it been adopted by any individual state chief health officers.
Infectious diseases experts such as Professor Brendan Crabb, chief executive of the Burnet Institute, say they are frustrated this is still not standard PPE equipment in all quarantine hotels. Crabb calls it a “blind spot” in Australia’s generally excellent system of management of the virus and is hoping it can finally be fixed quickly.
“I think there’s been a recalcitrant attitude towards accepting that airborne transmission is a significant mode of transmission,” Professor Crabb said.
Instead, the official prevailing view is that airborne transmission is real but not a major source of infection and that training people to wear uncomfortable N95 masks, for example, would not make enough of a difference.
This is far more than a bitter academic argument between experts. It is also fundamental to addressing community alarm about hotel quarantine as Australia’s key area of vulnerability – leading to calls for big changes.
The massive impact of one infected traveller using a nebuliser in his hotel room at the Holiday Inn at Tullamarine is the most dramatic example of how a turbocharged fine mist rather just than big droplets can increase risk. But it’s not the only recent case of airborne transmission.
Even marginal improvements – or failures – can make an outsized difference. So why not greater focus on N95 masks and other mitigation efforts in hotels?
Andrews prefers to demand the number of returning travellers be drastically reduced. Some other Labor states and federal Labor want the Commonwealth to take over responsibility for quarantine, creating new purpose-built centres in regional areas.
The Morrison government points out the practical problems with both while emphasising the overall success of hotel quarantine. It has no problem with N95 masks being mandatory for hotel workers or with any states enforcing this but relies on the expert committee advice. So far, no change.
And it’s true Australia’s model has mostly worked extremely well, particularly as state systems learn and adapt to weaknesses. Hotels will now stagger door openings for meals and laundry services, for example, while more ventilation engineers are busily assessing air quality and circulation in common areas.
Even without those new precautions, only a handful of cases have escaped hotels despite the 220,000 returned travellers so far. In other states, these breaches have been brought under control by a combination of contact tracing and numerical luck.
After all, less than 20 per cent of people who are infected then infect other people. Although the British variant may be 40 per cent to 70 per cent more infectious, that’s still only of that minority who go on to infect others. It’s why – in a country like Australia with minimal cases – luck also plays a major role in whether one person with the virus contributes to a spread to close contacts let alone a wider community outbreak. The odds are against it.
Andrews still insists the new more infectious British variant has abruptly and unexpectedly changed all the rules – conveniently ignoring the fact this variant has been present for months and was already dominant around much of the world when Victoria invited Australian Open players and staff to Melbourne.
What is more obvious is Victoria’s version of quarantine and contact tracing is far from being the best in the country as Premier Andrews had claimed only a week earlier. The state’s contact tracing was unable to cope with the crucial task of identifying close contacts of an obvious group at the Holiday Inn airport hotel quickly enough.
That led to the absurdity of the partner of a quarantine Holiday Inn staff member working in the airport cafe two days after the first case of an infected worker from the hotel.
Perhaps other states will get away with another Victorian error despite thousands of travellers passing through the terminal on the day. Despite the obvious risks of spread, no co-workers or customers of the Brunetti coffee shop at the airport have tested positive. It seems the infected partner was in the great majority of people who don’t pass it on.
But with two new cases of community transmission on Sunday, the state – and the country – will remain on extreme edge. Every little thing has big consequences. N95 masks anyone?