We report here on three main themes from 58 participants in designated quarantine facilities (see Table 1): feeling at risk in the quarantine process; identifying risk to the community through ‘holes’ in the process; and alternatives to hotel quarantine.
Table 1
Summary of participant demographics, location and phase of data collection.
|
Participant summary*
|
|
Gender
|
/58
|
%
|
Quarantine group
|
/59**
|
%
|
|
Male
|
19
|
33
|
Alone
|
29
|
49
|
|
Female
|
39
|
67
|
With another adult
|
20
|
34
|
|
Age
|
/58
|
%
|
With partner and children
|
7
|
12
|
|
19–29
|
12
|
21
|
With children
|
3
|
5
|
|
30–39
|
17
|
29
|
Location
|
/59*
|
%
|
|
40–49
|
10
|
17
|
New South Wales
|
28
|
48
|
|
50–59
|
3
|
5
|
Victoria
|
13
|
22
|
|
60–69
|
13
|
22
|
Western Australia
|
2
|
3
|
|
70–75
|
3
|
5
|
Northern Territory***
|
6
|
10
|
|
*15 participants in mandatory home quarantine are not included in this table nor in this analysis
**Totals 59 because one participant had quarantined twice under different circumstances
***NT participants were quarantined in a repurposed designated quarantine centre, not a hotel
|
South Australia
|
3
|
5
|
|
Queensland
|
7
|
12
|
|
Phase 1: Quarantined between March and June 2020
Phase 2: Quarantined between March and July 2020 at two hotels in Melbourne
Phase 3: Quarantined between September 2020 and January 2021
|
Feeling at risk in the quarantine process
For many participants returning from high-risk regions where mask wearing had become normalised, the lack of consistent mask wearing in airports was very concerning. These participants reported feeling more at risk when travelling back to Australia than they had felt during the pandemic up to that point, and felt powerless to reduce this risk because they couldn’t control what was happening around them.
Many phase 3 participants reported that best practice risk reduction was not adhered to during the process of getting from the aeroplane to the hotel. Participants noted that while medical personnel usually wore personal protective equipment (PPE), other staff (including Australian Defence Force personnel, police and airline staff) often did not wear masks, were not adequately distanced from each other and/or the returning passengers, and left passengers waiting on buses together for extended periods without physical distancing or ventilation.
The thing that shocked me the most was that the bus driver was not wearing a mask for the entire time. …that was the most unsafe that I felt, was on the bus, that there was no social distancing, there was no point at any time where were told to keep our masks on. There [were] no windows, there was no ventilation. We were sat on the bus on the street for probably close to an hour.
Jade, mid-October 2020, phase 3, Sydney, NSW
One phase 3 participant also noted that traveller processing points both in airports and in the hotel were not located in well-ventilated areas, posing a potential risk from incoming travellers, to each other, and to the staff doing the processing.
There were so many other, better places there could’ve been that would’ve kept a better throughput of air for the purposes of ventilation and not had people kind of forced into close proximity.
Maeve, December 2020, phase 3, Sydney, NSW
Some participants in both phases 2 and 3 perceived the hotel accommodation itself as posing a high risk for acquiring SARS-CoV-2, and were vigilant about minimising it, including thorough hand hygiene after unwrapping each meal delivery, and cleaning and disinfecting rooms upon arrival.
Whenever I open the door and get my meals, I had always been washing my hands afterwards and, when I put rubbish in front of the door, I would come back and wash my hands again. My hands got really dry.
Hannah, June-July 2020, phase 1, Melbourne, VIC
Many phase 2 participants reported that their hotel rooms were very dirty and they felt that they were at risk of harm from non-COVID illness. Accounts of dirtiness included thick dust, mould and dirt in bathrooms, stained bedlinen, bits of food and used PPE under beds and floors too dirty to lie on for exercise.
There was faeces in the toilet…And there was urine all around the seat of the toilet. So, I told the hotel staff that, but it took four days to get a toilet brush and stuff to clean it. Which I, I, I was, I was absolutely disgusted, and I couldn’t even clean it.
Terri, April 2020, phase 2, Melbourne, VIC
In all three phases, there were participants with non-COVID illnesses and injuries who did not feel that they received adequate timely medical care. Specific issues included an inadequate response to severe pain caused by gout (reported by Beng, April 2020, phase 1, Brisbane, QLD); lack of basic first aid devices such as ice packs (reported by Isobel, June-July 2020, phase 2 Melbourne, VIC); diet related stomach problems that were not catered for (Sergio, April 2020, phase 1, Sydney, NSW).
Several participants reflected that this made them feel that the quarantine process did not take adequate care of people being quarantined, but was focused only on protecting the community outside.
You are treated like a leper, and it is a horrible, horrible experience. So the humanity side for me, is absolutely missing when you go into a quarantine hotel.
Martina, September 2020, phase 3, Sydney, NSW (Martina was also quarantined later in Howard Springs)
Participants also identified flaws in infection control instructions they received – such as being told to change their masks and then sanitise hands, rather than removing the old mask and sanitising, before donning the fresh one.
I think it should be removed the old mask, and then disinfect your hand, then put on the new mask. Because when you touch the old mask there might be the germs on it.
Charlie, January 2021, phase 3, Gold Coast, QLD
Several participants who were quarantined at the two Melbourne hotels associated with the second wave in Victoria noted that the security services appeared unprofessional and that this potentially contributed to risk. Several participants, whose rooms were positioned so that they could see the security guards stationed at either end of the corridor, reported seeing guards sleeping or on their phones. Another participant quarantined at the same time, however, suggested that security guards had been scapegoated for the infection control breach when there were other factors at play, such as, for example, inconsistent use of masks and gloves by all staff at this hotel.
I was horrified that they decided to attack the lowest common denominator in that outbreak, because there was so much wrong with [the hotel] that was not about security guards.
Jean, April 2020, phase 2, Melbourne, VIC
This theme highlights that from the perspective of people entering hotel quarantine, there were breaches in infection control that made participants feel vulnerable to acquiring SARS-CoV-2.
Risks to the community identified in quarantine
We explored risks to the community identified in participants’ accounts of their experiences. Some participants were quarantined as early as 28 March 2020 (the day that the program began) and others as late as January 2021. During this period, there were changes to the implementation of the program that addressed some of the risk factors that participants identified, as noted in the following accounts.
Participants who underwent hotel quarantine early in the program were offered testing only if they reported any COVID-like symptoms. Several participants in phase 1 reported that although they had a sore throat, they attributed it to the constant air conditioning, did not report the symptom and were not tested (e.g. Margot, March-April 2020, phase 1, Sydney, NSW). Others agreed that they would not have reported symptoms due to the risk of extended quarantine.
But like, honestly, if I did have symptoms, I wouldn’t have told them because it would have meant I probably would have had to stay longer.
Hazel, April-May 2020, phase 1, Sydney, NSW
Our phase 2 sample included nine people who had been on a cruise ship, on which more than half the passengers ultimately tested positive to COVID-19. When ensconced in hotel quarantine in Melbourne, these participants reported that testing was still optional in April 2020, even when their previous COVID test had been positive. Participants reported being given the option of testing again – but having to stay another 14 days if positive – or not testing, and being released on time. This means that a positive person could easily have been discharged.
If we tested positive again, at the beginning they were talking about us then having to start our fourteen days from the positive test… but if we refused testing, that was ok, we’d go home on the same day that we were supposed to.
Jean, April 2020, phase 2, Melbourne, VIC
Some people travelling together from the cruise ship had discordant respiratory PCR results, but were nevertheless accommodated together in the hotel for several days, before there was a suggestion of separating PCR positive and negative people (which was resisted by participants and did not occur).
My previous result had been positive but [my wife’s] had been negative. So we were there for two days, three days before they actually came to us and said “oh, you should be in separate rooms, because now her fourteen days won’t start until you separate rooms… we ended up staying together after that… so, it was a mess
Nicole, April 2020, phase 2, Melbourne, VIC
Following the second wave of infection in Victoria, tests during quarantine became compulsory in some jurisdictions, and were offered in all jurisdictions, with extended quarantine usually required if a person refused testing.(18, 19) Participants in phase 3 reported that they were tested twice, usually very early in the period (such as day 2) and then towards the end (day 10–11). (The testing regimen was different at Howard Springs, with testing upon arrival at the airport and then one test at the facility.) The logic of receiving a negative test result on day 10 but having to stay in hotel quarantine for another four days without a further test was queried by participants.
This example highlights a particular risk – not fully appreciated early in the pandemic – that people could be exposed to a higher risk upon entry to or during hotel quarantine due to exposure to others in quarantine, and it may take until day 14 or later for them to return a positive test.
One participant, who was travelling with a partner who had symptoms on arrival, reported being advised by airport medical staff to fake symptoms to enable the couple to stay together.
She’d sort of said, you know, “I don’t want to be separated from my partner.” And [the health official] quickly said, “You better go and give your partner this form, tell him that he’s got some symptoms too.
Lloyd, April 2020, phase 1, Sydney, NSW
The couple were then transported to a “health hotel”, where they were separated anyway, as the partner tested positive and the participant remained negative, though both stayed in the health hotel. This participant also reported leaving his room to give vent to feelings of frustration, despite being forbidden to do so under quarantine rules.
There were times that the nurses just didn’t answer the phone. So I’d just sort of open the door, go outside… And I, I went out, and I screamed, you know, and I swore.
Lloyd, April 2020, phase 1, Sydney, NSW
This is the only account in our interviews of a participant ‘breaking out’ in hotel quarantine, though participants reported hearing similar outbursts from others, and it was likely only possible because he was housed in a health hotel which did not have security on each floor (at least in phase 1), and he had access to his room key which again was unusual, as most people are locked in without access to a key.
Alternatives to hotel quarantine
Several participants quarantined with children said that alternatives to hotel quarantine should be considered, such as home quarantine with electronic surveillance, or purpose-built facilities. The Howard Springs facility has been held up as an ideal alternative to hotel quarantine, and some features of that location were seen as preferable by the six participants in this study who had stayed there (e.g. access to fresh air). Other aspects of Howard Springs were less well regarded, and there were risks associated with being assigned to that facility rather than a hotel. Howard Springs participants did not describe feeling at risk from COVID-19 infection in quarantine, but did report risks and harms resulting from of the physical environment. The unsuitable design of the facility for families, the heat, and the facility’s location far from non-COVID medical care all contributed to this.
Medical care
Three of these six participants had small children, two of whom had accidents while at the facility. One toddler fell from a balcony and cut her head, while another cut his eye on a damaged fitting. Both bled profusely, but the only medical support available was telehealth – not in-person consultation.
It was clear they don’t want to interact with you. Obviously, any person could be a hazard to them. And I asked for some wipes and they wouldn’t send any. So I said, “The only thing I’ve got is Pine-o-Cleen,” and the doctor laughed, which was my point, “or Dettol surface wipes,” and they said, “Oh yeah, the Dettol wipes will be fine. Use that”.
Tina, December 2020, phase 3, Howard Springs, NT
While one of the parents was satisfied that her child’s injury was not serious, the other was very anxious until her son was seen by a doctor after leaving quarantine.
[My toddler] cut his eye. So we immediately called the telehealth… And I was so anxious and scared and crying because I was like, what if something happened to my child’s eye?
Sylvie, January 2021, Howard Springs, NT
The absence of medical care onsite was also a problem for another participant, who was not himself injured but witnessed a fellow detainee in acute pain from a leg injury. Staff at the centre told the participant they could not help, but advised him to call an ambulance himself and attempt to help the man to the facility entrance, disregarding quarantine rules. The ambulance took four hours to arrive (Orin, November 2020, phase 3, Howard Springs, NT).
Space and amenities
Howard Springs was designed with single able-bodied workers in mind. Accommodation is in separate self-contained rooms with a king single bed, each with its own veranda. This layout was impractical for people quarantining at Howards Springs with children, particularly small ones. Each person in the family was assigned a room, irrespective of age, and there were no adjoining doors or shared family space. This was a problem for families with children too young to be housed separate from parents, in non-adjoining rooms, but with beds too small to comfortably sleep more than one person (cots were available on request). The verandas are not fenced. Participants reported difficulties keeping small children safe and having to buy materials to try to child-proof the space.
While all participants appreciated having outdoor space, the lack of family-friendly features was a significant problem for young families. For people quarantined alone or with older children, however, the facilities offered some advantages, despite it having intermittent Internet access which was a problem for people working remotely. It was also much easier to break rules at Howard Spring as participants weren’t locked in rooms, and participants reported seeing others doing so, wandering ‘illegally’ about the compound.
There was one loveable, nutty woman who broke the rules all the time. She just walked up and down all day long.
Tina, December 2020, phase 3, Howard Springs, NT
Some participants found the heat of the Northern Territory difficult to manage, particularly as most of the interviewees in this group had come from a cold winter climate. One reported that she and her daughter had vomited, the result of (self-diagnosed) heatstroke. Many were concerned about the possibility of food poisoning, reporting that food sat in the sun for quite some time during the process of delivery around the facility.
Despite these negative experiences, several participants found the accommodation at Howard Springs to be quite acceptable, and preferable to being ‘locked up’ in a hotel.
It’s very, very humane way of safe-guarding the community health, Australia wide health…putting you into a quarantine facility that feels like it’s actually you know, geared up for quarantining people.
Martina, October-November 2020, phase 3, Howard Springs, NT (Martina had been quarantined earlier in Sydney, NSW)