Right: On the job: photos of security guards and food delivery personnel sleeping in corridors of quarantine hotels were circulated in the news media at the time of Melbourne's deadly "second wave" of COVID-19.
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Arguments in favour of locating quarantine centres away from major cities
1. Locating quarantine centres away from major cities reduces the risk of COVID19 spreading into large populations
Those who support quarantine centres being established away from major cities argue that this is necessary to reduce the risk of contagious diseases, such as COVID19, spreading within large population centres.
Several Australian experts in areas such as disease control have stressed the value of setting up quarantine centres in areas that are removed from major population centres. Adrian Esterman, Professor of Biostatistics and Epidemiology at the University of South Australia, has stated, 'I believe it's well and truly time to move quarantine to remote locations, to reduce the risk of transmission into dense urban areas.'
The professor has explained further, 'It's very hard to make a quarantine station 100 percent leak-free. At the end of the day, they're run by humans, who occasionally make mistakes. And SARS-CoV-2 is a very contagious virus.' regional/ Professor Esterman has added, commenting on the latest quarantine breach in Melbourne which resulted in a five-day, state-wide lockdown, 'Typically, the people working in city quarantine hotels are poorly paid, travel home on public transport, and spread it to their families. That's what happened in Melbourne.
But if we move quarantine facilities out of cities to isolated places, any leaks would be much less likely to cause major transmission events.'
A similar argument has been put by Associate Professor Philip Russo from the Australasian College for Infection Prevention and Control and president and deputy chair of the federal government's Infection Control Expert Group who has stated that moving infected people away from population centres 'just makes logical sense'.
The professor has added, 'Certainly, the further distance you have between people who are infected and the vulnerable community, that would be a good thing.' Epidemiologist Mary-Louise McLaws, a University of New South Wales professor and World Health Organization advisor has also argued, 'You don't put COVID patients in the centre of town and expect them to be looked after by people who haven't got really top-level training, only for them at the end of the day to go home, back into a highly densely populated city. And we are doing it in every major city. You have to expect that occasionally someone will acquire [it].'
Moving quarantine facilities away from the middle of major population centres has also been supported by many non-experts as a valuable way to reduce Australia's chances of widespread infection. In an opinion piece published in Red Flag on February 2, 2021, Ben Hillier has stated, 'Australia has eradicated community transmission of the virus several times. And the blindingly obvious reality (you need not be an epidemiologist or any other type of medical expert to understand this) is that the only path to a new outbreak comes through the quarantine system. Why, then, are those facilities located in the most densely populated parts of the country-right in the middle of our capital cities?'
Ben Hillier has further explained the need for remote facilities, drawing on a New South Wales expert to support his view. Hillier has argued, '"I don't think any system can ever guarantee that we won't have transmission events", New South Wales chief medical officer Kerry Chant said in December. If she is right-that, even in the best circumstances, with the best possible system, we should still expect the virus to "leak" from quarantine-then how can there be any justification for not building dedicated facilities away from major population centres? Places where, if there is a transmission event, it is already, in effect, contained?...
Isn't it a no-brainer to replace city-based hotel quarantine with dedicated quarantine facilities that put the public another step out of harm's way?'
2. Locating quarantine facilities away from major cities allows for centres to be purpose built
Those who support locating quarantine centres in remote locations argue that this would create on opportunity for these facilities to be purpose built.
Many experts have argued that Australia needs quarantine facilities that meet the strenuous standards needed to ensure that those kept within them are safe and comfortable and that infection does not spread into the community. Professor Mike Toole, an epidemiologist at the Burnet Institute, has urged authorities to engage with occupational hygienists and ventilation engineers to better understand how air moved in hotels. He has stressed the danger of inadequately equipped hotels, stating, 'We should be treating all those cold hotels like they are hot hotels because guests can convert from negative to positive during that period and therefore become infectious.'
Others have stated that such improvement measures are not sufficient as hotels are simply not adequate as quarantine centres. Professor Mary-Louise McLaws, a leading epidemiologist and COVID-19 adviser to the World Health Organisation, has called for a purpose-built facility since June of 2020. Professor McLaws has stated, 'But no one was ready to listen. Sadly, it takes four hotel outbreaks to start a conversation.'
A similar demand that quarantine centres be fit for purpose has come from Benjamin Veness, a doctor and co-founder of the advocacy group Health Care Workers Australia. Dr Veness has stated that what was needed were 'newer [facilities], ones with balconies, ones with windows that open, ones with air-conditioning systems you can upgrade so they're providing appropriate ventilation and not spreading COVID-19 potentially between rooms or into hallways.' In January 2021, Human Rights Commissioner, Scott McDougall, told a Queensland parliamentary hearing on quarantine facilities that the body had received 54 complaints about hotel quarantine, with the lack of daily access to fresh air a key concern.
Mr McDougall noted the Queensland Government had deemed it unsafe to allow travellers access to daily fresh air breaks but 'despite the efforts of the State Disaster Coordination Centre to source appropriate accommodation... many of these hotels do not have windows that open or have private balconies.' Mr McDougall concluded, 'Remote facilities would have the space and access to fresh air to ensure more humane conditions.'
Victorian Premier Daniel Andrews has indicated that his government was 'actively pursuing' the construction of a purpose-built quarantine facility to mitigate the risk of taking return travellers. Mr Andrews has stated, 'It has a lesser risk than shared facilities in the centre of Melbourne, where even if people are separated, they're still sharing the same space...
We think by building this purpose-built facility, we can get the risk level down further.'
The premier further explained, 'People would be in the same location but would not be sharing the same spaces, so they're not under the same roofline. It would be a cabin-style, village-style environment, where there would be fresh air, where there would be not zero risk but lower risk.'
The plan proposed for Victoria's dedicated quarantine facilities includes surfaces that are easily cleaned, enabling the highest standard of infection control protocols; high quality separate ventilation systems per room, including windows; one-storey structures that allow for social distancing and separate staff facilities; individual rooms that cater to a variety of family sizes, with self-contained bathroom facilities; and on-site staff accommodation provided to limit movement of quarantine workers.
Victoria's proposed new facilities have meet with the approval of several infection-control experts. Adrian Esterman, Professor of Biostatistics and Epidemiology at the University of South Australia, has stated 'When you have the accommodation blocks, the ventilation is taken care of because they have windows that open and people can go out on their balcony to have fresh air. Having a breeze going through the place will disperse virus particles. They can even build filter equipment in there and air purifiers if they wanted.'
Professor Esterman has also noted that the proposal to build staff accommodation onsite for quarantine workers would also stop them 'getting infected then carting it back to their families and into the community'.
Avalon Airport and Melbourne Airport (Tullamarine) are the two locations being considered.
3. It is possible to transport overseas arrivals to regional quarantine facilities safely
There have been two major suggestions put forward as to ways in which overseas arrivals could be safely transported to quarantine facilities outside city centres. One is that the facilities be located within reasonable travelling distance of the airport from which passengers disembark. The other is that charter flights go directly to the quarantine facility.
The Victorian plan to have a purpose-built quarantine facility away from major city centres has two tentative locations - one near Tullamarine Airport, the other near Avalon Airport. Either of these proposals means that passengers could be easily taken to the quarantine centre. Avalon Airport's chief executive officer, Justin Giddings, has stated that preliminary plans to convert the international airport into a self-contained quarantine facility have been informally presented to the state government. Under the plans put forward by Mr Giddings, the airport would become a 'one stop shop' facility, with international passengers flown in and processed on the aircraft before being taken to their self-contained cabins. Quarantine staff and health professionals could live on site in cabins situated across the facility's spare land.
Mr Giddings has further stated that although within reach of major hospitals and other medical facilities, the airport is sufficiently remote to guard against the easy spread of infection. He has stated, 'At Avalon Airport the international terminal is very isolated, there is lots of space available to set up a camp and really provide people with the opportunity to be outside.'
The Queensland Government is also considering setting up a 1000-bed quarantine facility at Wagner Corporation Airport, on the outskirts of Toowoomba, east of Brisbane.
Queensland businessman John Wagner has indicated that he strongly supports a quarantine facility next to Toowoomba's Wellcamp Airport, which would charge the same fees as existing city-based hotels and potentially take up to 1000 returnees. Mr Wagner has further explained, 'We will build it and maintain it, do the food and beverage, Queensland will be involved in how the health side of things works and every room will have its own air conditioner system. There'll be no corridors for airborne particles to be transmitted.' The other proposal as to how passengers could be safely transported to a quarantine facility is that in certain circumstances more remote regional centres could be used and those to go into quarantine would be flown directly there via chartered flights. This proposal has been made as a means of supplying agricultural regions with the seasonal workers they need. As a small-scale example of this measure in progress, on January 6, 2021, 157 Vanuatuans flew into Hobart Airport and immediately went into isolation in a government-run quarantine facility, where they will remain for 14 days before commencing work. This was achieved through the Commonwealth government's Seasonal Worker Program.
On January 20, 2021, the New South Wales Agriculture Minister, Adam Marshall, put forward a larger scheme that could service the mainland, suggesting that Pacific Island agricultural workers be flown into Australian on direct charter flights and serve their 14-day quarantine at a regional quarantine hub. Aviation experts said several regional New South Wales airports including Newcastle, Tamworth, Port Macquarie, and Illawarra could accept Boeing 737 and Airbus A320 passenger jets if they were used on direct charter flights from Pacific islands.
The mining industry is making similar, though less rigorous, arrangements. For example, in Western Australia, flights carrying mine workers from outside the state must be chartered, to avoid contact with the public. Mine workers flying into Western Australia must be greeted by their employer as they disembark and need to display photo identification on arrival. Mine sites have access to COVID-19 testing kits, and sick workers are flown offsite. Mine sites have quarantine and isolation areas if someone displays symptoms or becomes sick.
4. Setting up quarantine centres away from major cities would solve some regional employment problems and secure workforces
Those who support regional quarantine facilities argue that such facilities would not just protect major cities from infection but could be used to address the employment needs of Australian farmers as they are already being used by the mining industry to secure its workforce.
On January 20, 2021, the New South Wales Agriculture Minister, Adam Marshall, put forward the idea that Pacific Island agricultural workers fly into Australian on direct charter flights and serve their 14-day quarantine at a regional quarantine hub. Mr Marshall stated, 'I am pleading with my federal counterparts - this is a national problem, and we need national leadership.
If there was a national facility, New South Wales would be financially willing to contribute to that, or on a pro-rata basis as per the workforce required.'
AusVeg spokesman, Tyson Cattle, has also indicated that the horticulture industry supported anything that would address the problem. He has stressed that the need for agricultural workers, especially those to harvest crops, was becoming urgent. He has stated, 'We're running out of time.'
On February 17, 2021, the Queensland Farmers Federation issued a media release which drew attention to the ongoing recruitment problems being faced by Queensland farmers because of COVID19. The media release states, 'COVID-19 has led to unprecedented labour market disruption with farmers struggling to retain and recruit critical workers during harvest, with national demand for casual labour expected to peak next month with up to 26,000 jobs likely to go unfilled.'
The release highlights the major current shortfall that the farmers face, with far fewer Pacific Island workers having been able to come to Australia than are needed to complete the farm work to be done. The release notes, 'The Approved Employers Association has identified the demand for workers from the Pacific in Queensland for the first half of 2021 at 4,500 workers (more than 25 plane loads) in comparison to the two planeloads of workers that arrived in the state this year.' The release argues that individual farmers are not able to meet the quarantine needs of the number of workers they need to employ and that the best solution might be for the Queensland government to grant approval for a Regional Quarantine Hub to be established. The media release concludes, 'Clearly, time is of the essence, therefore the sector is calling on the Queensland Government to grant priority approval for this facility to ensure Queensland has an agricultural workforce solution that is safe, well resourced, fit for purpose and responsive to the labour disruption the state is experiencing.'
In January 2021, the Queensland premier, Annastacia Palaszczuk stated that the Queensland government was considering workers camps in regional Queensland as centres at which to quarantine arrivals from overseas.
An existing 1400-room workers camp 20 minutes' drive west of Gladstone and a yet-to-be-built, purpose-designed facility in Toowoomba are two sites flagged as alternatives to hotel quarantine in Queensland.
The peak representative body for Queensland's mining and gas companies, the Queensland Resources Council (QRC), has noted that it has already acted to ensure that its workforce is safe from COVID19. QRC's chief executive, Ian Macfarlane, has indicated that QRC and its coal, metal and gas members had worked successfully to protect industry workers, their families and mining communities from COVID-19 over the past 11 months by supplying secure quarantine facilities at mining camps.
QRC has indicated its readiness to liaise with the government regarding how its worker accommodation could be used to assist regional communities. Mr McFarlane has stated, 'The resources industry will co-operate and assist where requested. Keeping our workers and the Queensland community safe, particularly in regional areas, will continue to be our priority. We will work closely with the government to provide input into any decisions that impact on our workforce and the communities in which we operate.'
5. It is possible to supply medical staff to service regional quarantine facilities using ADF personnel
It has been suggested that shortfalls in medical staff in regional quarantine facilities could be overcome through the deployment of military personnel.
Former World Health Organisation epidemiologist, Professor Adrian Esterman, has claimed that concerns about logistics and medical care at remote camps could be easily allayed if the federal government deployed the Australian Defence Force (ADF). Professor Esterman has stated, 'Let's face it, they can set up field hospitals that can cover just about any emergency. So, I think a lot of these questions about "Oh we have to have access to a trauma centre" can all be handled without any problems at all.'
A similar suggestion that ADF personnel be employed medically and in a range of other capacities in dealing with COVID19 has been made by Alexey Muraviev, Associate Professor of National Security and Strategic Studies, Curtin University.
Professor Muraviev has stated, 'Modern military power is designed to respond to a comprehensive suite of conventional, asymmetric or unconventional threats. The latter includes chemical, biological, radiological and nuclear weapons, often referred to as CBRN... The Defence Science and Technology (DST) Group conducts specialised research and development to prevent and defend against CBRN attacks, including disease modelling. In simple terms, the ADF can offer specialist epidemiological detection and decontamination capabilities...
This is in addition to a wide range of other functions the ADF can offer, from trained medics to transport logistics to policing functions.'
Some precedents have already been set for the use of military personnel for medical support in dealing with the consequences of COVID19 outbreaks. Since early March, Lieutenant General John Frewen has headed up a new COVID-19 taskforce which has been created by Defence to manage its response to the pandemic.
Later in March 2020, a military-wide edict warned defence force personnel that they could soon be deployed on coronavirus duties. The edict stated, 'ADF members are not to undertake private travel outside their local area, as defined by local Commanders, when not required for duty, including on weekends, until further notice.' Immediately after, the Army was mobilised in each state and territory to help police officers enforce strict quarantine measures on new arrivals into the country. As well as helping to enforce quarantine and self-isolation, Defence has established contact tracing teams to work with governments across the country to limit the number of new infections from identified patients. Also, in March 2020, ADF staff began contributing clinical and epidemiological support to the New South Wales Department of Health, while ADF engineering maintenance specialists have been called in to assist the Victoria-based Med-Con medical supplier with the production of protective masks, sanitisers and other medical items. The military has also supplied fully trained medical personnel to help manage COVID19. When, in April 2020, between 4,000 and 5,000 Tasmanians were forced into two weeks of quarantine as part of the shutdown of two hospitals on the island's north-west coast, medical support was supplied by the Australian Defence Forces (ADF). 1,200 local hospital staff and their households were required to go into mandatory 14-day quarantine. The Tasmanian Health Minister, Sarah Courtney, announced that ADF medics would help get the emergency department at the North West Regional Hospital up and running again once it had been thoroughly cleaned. The Minister stated, 'We are going to deploy these clean staff that have been provided from the ADF and from AusMAT (Australian Medical Assistance Teams) to Burnie to enable emergency department presentations within 72 hours.'
Similarly, in July 2020, army personnel were sent to Victoria to help paramedics amid fears the spread of coronavirus could stretch Ambulance Victoria too thin. The Victorian premier, Daniel Andrews said at the time that a key role of the additional ADF members would be to 'support the inevitable number of paramedics who will finish up having to quarantine, having to isolate, having to be furloughed because of exposure or potential exposure [to coronavirus]'.