Right: Making the best of it: A Sydney quarantine hotel allowed guests, including foreign students returning to study, a musical diversion when a performance was watched from guests' balconies.
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Arguments against locating quarantine centres away from major cities
1. Locating quarantine centres away from major cities would be unpopular with local residents
It has been noted that many regional areas are likely to reject being the location of a quarantine facility as they would see their communities' health being put at risk and local industries and employment threatened.
Two areas in Central Queensland have been proposed as possible quarantine facilities - one a disused miners' camp near Gladstone and the other a workforce accommodation village, Homeground Villages, at Calliope, which has 1,392 air-conditioned rooms with balconies and facilities including a swimming pool, tennis court, and a gym. Both have sparked letters of protest from the Gladstone's Mayor, Matt Burnett, who has written two separate letters of protest in response to each proposal, addressed to the Prime Minister and the Queensland premier. Details of the second letter were made public on February 1, 2021. Mr Burnett argued that the local the community's concerns included the risks of local transmission which could potentially shut down major industry, as well as the lack of medical facilities in the area. In media interviews he stated that 'As it currently stands there is no support for the proposal, so if they're going to go ahead with it, they've got a lot of work to do...I've probably only found one in 100, or two in 100 people that still have an open mind on the proposal.'
Robbie Katter, member of the Legislative Assembly of Queensland for Traeger and leader of Katter's Australian Party has argued that many people move to regional areas to avoid the sort of risks that COVID19 represents and that they make significant sacrifices to live their preferred lifestyle. Mr Katter has stated, 'People will often live in a remote area because they're protected from things like this virus, and they'll put up with not having a doctor or vital public services.'
Regarding the proposal to establish a quarantine facility at Calliope, local resident, Ms Eveille-Coleman, has launched a petition opposing the idea. She has claimed a quarantine camp at Calliope would be too great of a risk for the community, stating, 'People are scared and concerned because we don't have the facilities if an outbreak happened... I understand why they see the property as a good spot to do it but realistically there is nothing out there to keep it self-contained.' In January 2021, Prime Minister Scott Morrison, after visiting areas in Central Queensland, which have been proposed by the Queensland government as a possible quarantine facility site, noted he had spoken with locals who 'don't want to see Brisbane's issues dumped on those in the north; you hear that a bit about a few issues up here. They don't want to see that; they have issues around what it means for local health.' Mr Morrison has further argued that some regional areas have needs related to their national importance which would make them unsuitable as sites for quarantine facilities. Referring to Central Queensland, Mr Morrison stressed the importance of Gladstone's heavy industry. The Prime Minister stated, 'One of the reasons Australia has done well economically through the course of COVID is we've been able to keep our heavy industry going. The prospect of that being impacted in a community like [Gladstone] needs to be carefully considered.'
Ken O'Dowd, the federal member for Flynn, the electoral district which includes the areas under discussion, has also indicated his opposition to a facility because of the potential damage from a shutdown affecting local big industry as well as the Gladstone region's inadequate healthcare services. Mr O'Dowd stated, 'I never thought I'd say "not in my patch", but there you go.' The same point has been made by a number of those who live in Central Queensland. Andrew Pioch, who has lived and worked in Gladstone for 15 years, has also expressed his concerns about the region's industry. Mr Pioch has stated, 'If there is a case that gets leaked into the community, parts of the industry could get shut down, which is going to have a flow-on effect on the product that's exiting the port. I know that where I work, we're in small teams and COVID would actually shut the plant down if it was to get even one case into that plant.It's not a case of being my backyard, it's more a case that industry here is the lifeblood of Gladstone and even more so of Queensland and Australia with the amount of product that goes out of the port.'
2. Locating quarantine centres away from major cities would create significant transportation issues
Those who question the viability of establishing remote quarantine facilities argue that transporting returned Australian citizens to these centres may prove very difficult in terms of guaranteeing their health and ensuring that there was no spread of infection during transport.
The New South Wales Health Minister Brad Hazzard has pointed out the risk of keeping potentially infected travellers on long regional bus trips.
Similarly, the chair in epidemiology at Deakin University, Catherine Bennett, has argued, 'Does the facility need to be in a remote area? No. It... adds risk associated with transporting arrivees long distances from international airports.' The former head of the federal health department, Jane Halton, has detailed some of the range of transportation issues to weigh up around using regional mining camps or similar remote facilities as quarantine centres. Ms Halton has asked, 'Can we make sure that people stay safe? Can you transport them safely and effectively from their point of arrival?' Explaining further, Ms Halton has stated, 'A lot of these camps aren't near the kind of airports where people would arrive into Australia. What risk does there accrue in moving people from an international airport to some kind of remoter region?' These points have also been emphasised by South Australia's chief public health officer, Professor Nicola Spurrier. Referring to a number of proposals that her state establishes remote quarantine facilities, Professor Spurrier has stated, 'There are some [potential sites] that are smaller facilities that might take a smaller number [of arrivals], but you have to think about the transfer of people - and whenever there's a transfer of someone with COVID, you've always got a risk of transmission.' Referring to a proposal that a quarantine facility be set up at Tailem Bend, Professor Spurrier explained that the area's distance from Adelaide - around 100km from the airport and the Royal Adelaide Hospital and its dedicated COVID clinic - was the main element that precluded it from consideration. The professor stated, 'The logistics of it - if it were closer to Adelaide, I think we'd be able to take a more positive view of it.' The Professor then explained further, 'One of the issues we always need to be mindful of is how close we are to our COVID hospital - and our main hospital is the Royal Adelaide - and we need to be able to transfer positive cases... so if we used that facility as a general quarantine facility and we had positive cases, we'd need to work out how to transfer them - and when we do transfer people, there's always a risk of transfer to someone else.' The Professor noted that with several international arrivals each day, 'we'd need to transfer them by bus to a facility [and] all of that would mean a transmission risk for the driver'.
Professor Spurrier also sought to clear up some of the misconceptions she believes exist around already-established quarantine facilities that people generally regard as remote. Referring to the quarantine facility in the Northern Territory at Howard Springs, the Professor explained that though this centre was not surrounded by population, it was not remote from medical facilities, nor did it pose major transport problems for plane arrivals disembarking in the Northern Territory. Professor Spurrier stated, 'People think it's out the middle of nowhere... but it's only 20 km from Darwin - so it's close to the airport, it's close to the hospital.'
3. Locating quarantine centres away from major cities would not give access to the necessary specialist medical staff
Those opposed to establishing quarantine facilities in remote areas argue that will be very difficult to supply these facilities with the necessary medical staff both to treat those being quarantined and to support the local community should an outbreak occur.
The Australian Medical Association of Queensland (AMAQ) has expressed caution regarding remote quarantine centres. AMAQ president, Professor Chris Perry, has stated, 'The expertise of local medical professionals must be at the centre of any potential program to ensure they can manage, contain and treat any COVID cases, and have all the support they need to deliver exemplary healthcare to regional communities and those in quarantine.'
Similarly, the chair in epidemiology at Deakin University, Catherine Bennett, has argued, 'Does the facility need to be in a remote area? No. It makes it too hard to have skilled staff, health expertise and access to acute hospitals...' The Queensland Opposition rural and regional affairs spokesman, Dale Last, also opposes regional quarantine centres set up at mining camps, noting that most regional areas do not have the medical staff and facilities to support such centres and to service local communities in the event of an outbreak. Mr Last has stated, 'a lot of these mining communities do not have the resources to cope with a COVID outbreak if that was to be inadvertently introduced by virtue of having these mining camps set up as a quarantine facility.'
The federal government has also expressed reservations regarding establishing quarantine centres in regional areas. It has stated, 'Returned Australians are being hosted in approved quarantine facilities around the country that meet, and are located close to, the necessary health and transport infrastructure.' The emphasis on proximity to the necessary health infrastructure is a main reason for the federal government's caution regarding remote quarantine facilities.
The Australian Government's National Review of Hotel Quarantine outlines some of the medical obligations that need to be meet for returnees in quarantine. It states, 'During the 14-day quarantine period, travelers are tested for COVID-19 irrespective of whether they
are symptomatic, at approximately days two and 11 of quarantine. This is consistent with the AHPPC guidelines. In some jurisdictions a positive result will result in a change of accommodation in the Hotel Quarantine System, for others it will result in transfer to hospital...'
Critics of regional quarantine centres argue that remote facilities are unlikely to be able to offer the necessary hospital care close to the centre and may not be able to supply the staff needed to regularly test those being kept in quarantine. Linda Scott, president of the Australian Local Government Association and City of Sydney councilor, has stated, 'Many New South Wales regional centres have emergency and health services under significant pressure, and remote communities have large numbers of vulnerable communities. Bringing hotel quarantine to regional areas could push strained local health services to breaking point.'
Dubbo mayor, Ben Shields, has similarly rejected the proposal, stating of his town, 'Our medical facilities compared to the city are absolutely atrocious.' Cr Mack, the Albury mayor, has said of his town, 'We've got a great airport. But our health facilities are in the dark ages.'
It has further been argued that not only would regional areas have difficulty providing adequate health care for those who may have contracted COVID19 either while in quarantine or through a leak from the facility into the community, they would also have difficulty tracing the links of potentially infected people should a leak occur.
Contact tracing is a highly skilled task and while regional communities are smaller, they would not have the already established bank of people trained to perform the tracing work.
Gerard Fitzgerald, Emeritus Professor, School of Public Health, Queensland University of Technology has noted, 'The key strategy to preventing further community transmission is to identify all cases through extensive testing, isolate people who test positive, and then trace their close contacts.
These contacts require initial testing to see if they are also potential spreaders, but more importantly they need to be isolated and closely monitored. Should they develop symptoms, they also need to be tested.
The process of identification of cases, ensuring isolation and monitoring, identifying contacts and following up each of those requires extensive effort.'
4. Locating quarantine centres away from major cities would be very expensive and not sufficient to meet Australia's quarantine needs
Opponents of setting up remote quarantine centres to largely replace hotel quarantine have argued that the financial costs of such a scheme would be extremely substantial and that what could be built would not be sufficient to meet the demands on the system. The National Review of Hotel Quarantine was released in October 2020. In its executive summary it stated, 'From 28 March 2020 all returning travelers have been required to undertake 14 days of quarantine in a designated facility. Since then, some 130,000 international and domestic travelers have been quarantined [largely in hotels] slowing the spread of COVID-19 in Australia.'
Even those who support remote facilities acknowledge that to establish quarantine centres in regional areas on the scale that would be required to meet Australia's needs would be a costly process. Adrian Esterman, Professor of Biostatistics and Epidemiology, University of South Australia, is one of those who, while favouring remote quarantine centres, also recognises the expense involved. He has stated, 'One issue that arises from using rural quarantine is cost. It will be expensive to build and run these isolated facilities, and to fly workers in and out. It will also be expensive to fly returned travellers into these remote settings, presumably at the expense of the government.' Burnet Institute epidemiologist, Professor Mike Toole, though also a proponent of remote facilities, has warned this would be a time-consuming and expensive exercise. The professor has stated, 'We're not China, we can't build these things in three days, it takes months.' Critics note that not only would such as scheme be very costly and take time to establish, but it would also not be adequate to meet the demands of the number of returnees that Australia must keep in quarantine. Melbourne University epidemiologist Professor Tony Blakely, though another supporter of remote quarantine facilities, has acknowledged "I would assume that we won't be able to mobilise enough Howard Springs-like facilities to accommodate everyone who wants to come back (to Australia).'
Trade Minister Simon Birmingham, who opposes any substantial reliance on regional facilities, has stated, 'You have to realise that there are capacity limits both in terms of what can be done in the cities, but if you want to look outside of the cities there are potentially even greater capacity limits in terms of the numbers of people who could be processed...' The same point has been made by the Prime Minister, Scott Morrison, who has stated, 'It remains the case that the most effective way to deliver at the scale that Australia needs to deliver these arrangements... hotel quarantine remains the most effective way to do that.And that remains the advice I have from my experts. And the alternative is not that clear to me.'
In February 2021, the Prime Minister further stated, 'This idea that you can replace the hotel quarantine system, bring Australians back home, manage your health agenda effectively through some other mechanism, I think we have to keep a sense of realism about this and a sense of proportion. 211,500 people [the then current figure] have come back, we've had a handful of cases that haven't been completely contained within that.'
5. Remote quarantine facilities would not be necessary if hotel quarantine were managed more effectively.
Opponents of establishing more remote quarantine centres argue that if the hotel quarantine facilities were uniformly run along the best practice models that have already been recommended then there would be no need for other arrangements. They stress in particular that adequate ventilation and rigorous staff training need to be in place.
Commentators on the operation of Australia's quarantine system have noted that the risk of spreading infection could be greatly reduced with improved protocols and practices, thus removing the need for alternate facilities. Raina MacIntyre, the head of the Kirby Institute's biosecurity program, has suggested that Australia's hotel quarantine system will continue to face potential leaks of highly contagious COVID-19 strains until authorities recognise the threat posed by airborne transmission of the virus. Professor McIntyre has stated, 'Perhaps hotels built more recently should be the only ones chosen for hotel quarantine, as they comply with current ventilation standards. Older buildings may not...We need formal guidelines and protocols on ventilation inside these hotels.'
Professor McIntyre has suggested that remote quarantine facilities may not be necessary if those quarantine hotels currently in use were properly managed. Professor McIntyre has stated, 'If they just gave all the workers a N95 respirator and addressed ventilation, that would probably dramatically reduce the risk of these infections continuing to occur. The problem is airborne transmission hasn't been acknowledged. It's not in the federal guidelines, that's why it hasn't been addressed. Unless you acknowledge it's happening, you can't actually fix it. We don't even check the ventilation of hotels that we use for quarantine.' Dr McIntyre has further stated that hotel quarantine could be done safely if ventilation was an essential component of the selection criteria.
Burnet Institute epidemiologist, Professor Mike Toole, has similarly argued that what is required is that Australia develop and rigorously implement a set of infection control standards that ensure our hotel quarantine facilities are safe. Professor Toole has stated, 'We need national standards for hotel quarantine. It's beyond time. We should be thinking as a nation, not as this little cluster of states and territories.
We need to fix ventilation, to make sure there's no air duct blowing air down a corridor past all the guest rooms. Victoria sent in engineers to redo the whole hotel ventilation systems where positive people are staying.
The threat of new variants makes it even more important to get on top of any leaks.'
Professor Toole has further noted that the recent hotel quarantine breaches in Western Australia, New South Wales and Queensland suggest a lack of preparedness and a reluctance to learn from other states. The Professor has stated, 'It really stuns me that in June last year, we had that whole hoo-hah aimed at Dan Andrews over hiring private security guards. We had a long judicial review. And another federal report. And here we are - with New South Wales and Western Australia, at least, still employing private security guards.
Sydney [residents] didn't even have to wear masks until January 17th. [Meanwhile], the National Cabinet decision to test quarantine staff [daily] was on January 8th, but it took Western Australia until the 25th to implement it, and Western Australia must have one of the lowest testing burdens in the country.'
The chair in epidemiology at Deakin University, Catherine Bennett, has argued that the people moving between quarantine facilities and the community are the risk, not their physical proximity to the rest of the population. Professor Bennett has stated, 'Managing this is the key, [as is] monitoring for infections with regular - each shift - staff testing, and weekly PCR [testing].' From her point of view what is crucial is good practice, not location.
University of Sydney infectious diseases expert Robert Booy has similarly stated that a new location would not solve the problems that have plagued hotel quarantine. He has stated, 'It's often human error that's the problem, not the facility, so we need to get better at managing quarantine within the settings... Whether you've got a new facility or an old one, you need to get the best quality out of your people. We will still have the same old problem of people who need excellent training and surveillance.'