The principles of quarantine date back to the 14th century in Italy, when ships arriving in Venice were required to anchor for 40 days prior to landing to ensure that there were no cases of the plague on board.(1) Quarantine refers to the separation of those that have been exposed to a disease but are not yet symptomatic from others who are susceptible to the disease (close contacts). Isolation is another aspect of quarantine, where people who have been diagnosed with the disease (cases) are separated from those who are not infected. The aim is to limit or prevent the spread of disease into a broader population.
Due to the advent of effective disease prevention with vaccination and effective medical treatment, quarantine became less of a focus in the modern world for communicable disease prevention and control. Widespread use of quarantine in Australia has not occurred since the Influenza pandemic of 1918, when Maritime quarantine commenced on 17 October 1918 prior to the first cases of influenza in January 1919. (2, 3) Internationally quarantine has been used in localised regions with the Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) epidemics. The use of quarantine on a global scale has not been seen prior to the current SARS-CoV–2 Pandemic that emerged in Wuhan, China in December 2019.
The first COVID–19 cases in Australia were diagnosed on 25 January 2020 in Victoria and NSW. By the end of March 2020 there were 2182 confirmed cases in NSW from 217 030 tests performed.(4) Initial epidemiology showed that the majority of confirmed cases were amongst recent arrivals from overseas and their contacts.(5) A major feature of Australia’s public health response to SARS-CoV–2 has been to restrict population movements especially through international travel with the use of legislated quarantine. In addition to this, other public health control measures have been implemented such as early and increased case detection through testing, tracing of contacts of confirmed cases, social distancing and prohibition of gatherings.(6, 7) These measures have been combined in the Special Health Accommodation (SHA) that provides a quarantine environment with the ability to test suspected cases, clinically manage suspected and confirmed cases and cohort individuals in a supportive setting. This paper describes the new approach to quarantine in the SHA, the first Australian “health hotel” for isolation, quarantine and clinical management.
Quarantine in NSW, Australia
The NSW Government issued multiple Orders under the Public Health Act regarding COVID–19 restricting movement of returned travellers. The first order, on 17 March, 2020, mandated self-quarantine for 14 days for any returned travellers to NSW. (8) Australian borders were closed to non-citizens and residents from 9pm AEDT Friday, 20 March, and a further order, on 29 March, enforced mandatory quarantine in a quarantine or medical facility for 14 days after arriving in NSW by air or sea. (9, 10)
When the mandatory quarantine order was enacted on 29 March, Sydney Local Health District (SLHD) extended an existing health accommodation service to establish the Special Health Accommodation (SHA), a unique service designed to support those affected by the NSW public health response to COVID–19. The existing service had been responsible for housing the majority of displaced people in NSW who could not effectively quarantine and isolate at home following earlier COVID–19 Public Health Orders (6, 9). It was broadened to include those now subject to the Public Health Orders (COVID–19 Air Transportation Quarantine and COVID–19 Maritime Quarantine) that mandated quarantine in a quarantine or medical facility for returned travellers.