In a commentary for The Guardian, Professor Mike Toole AM writes urgent action is needed to fix Australia’s quarantine system and speed up the vaccination rollout to prevent the current Victorian lockdown from happening again.
Just two weeks ago, Australians were living in a Covid-19-free environment that was unthinkable this time last year. Even in Melbourne, people were once again meeting family and friends at cafes, pubs and cinemas. Football games were played in front of packed stadiums.
But that came to an abrupt halt when a new cluster of cases was identified in Melbourne early last week. This outbreak has now grown to 60 known cases across the greater metropolitan area, including several aged care workers and two residents. Genomic sequencing links all these cases to a man who was infected while staying in an Adelaide quarantine hotel.
As Melbourne moves into a second week of lockdown, it’s worth asking why we’re back in this all too familiar situation. Two issues that loom the largest in explaining how we got here are a hotel quarantine system that clearly doesn’t work as well as it could, and a more concerning virus variant that seems to have taken full advantage of the time it circulated undetected from the Wollert man to case number five – the key piece of rotten luck in this outbreak. Add to that a painfully slow rollout of vaccines and, deeply worryingly, the related lack of attention to the safety of aged care home residents and staff.
If we include the most recent leak between adjacent rooms in a Perth hotel, there have been 18 breaches of hotel quarantine since last November. That equates on average to a breach every 11 days. At this rate, there will be 19 further leaks by Christmas and more lockdowns.
The slow pace of the vaccine rollout has resulted from problems with both supply and demand. Australia was slow to secure adequate supplies of imported vaccines to complement the two that were planned – wisely – to be manufactured in Australia.
Unfortunately, one of those vaccines was abandoned, leaving us heavily reliant on the AstraZeneca vaccine – a good vaccine but with challenges (that were both real and perceived) that left us exposed.
Of course, the rare but serious adverse effects associated with this vaccine could not have been anticipated, but it does reveal the current paucity of choices. We’ve been told that we will receive large supplies of Pfizer and Moderna vaccines (and possibly a new vaccine, Novavax) in the fourth quarter of this year, but that’s a long time to wait given the repeated reintroduction of the virus into the community.
A combination of fears about the side-effects of the AstraZeneca vaccine and a sense of complacency induced by the lack of community transmission has led to widespread hesitancy and a lacklustre uptake of the vaccines.
We shouldn’t have to wait for an outbreak to jolt us into getting the jab because once there’s an outbreak of an infectious variant, it’s too late to be protected by the vaccine in the short term.
Once again, the aged care sector has been neglected. While no exact figure is available, best estimates are that less than 12 percent of aged care workers have been fully vaccinated. This is unacceptable. After quarantine workers, aged care staff are the frontline to protect our most vulnerable citizens. With an unvaccinated workforce, the prospect of another lethal outbreak is very real.
What should happen now?
The urgent priority is to control this outbreak through the measures introduced by the Victorian government, but we need to take action to prevent it happening again.
First, urgent action is needed to fix the quarantine system. When a traveller returns uninfected from India only to get infected in what should be a safe haven, there’s something very wrong with the system. It should be obvious by now that what’s needed are fit-for-purpose facilities like Howard Springs in every state. Even if that happens, we still need to fix the hotel quarantine systems.
Instead of the current scattergun approach by different jurisdictions, we need a national code of practice that prevents, or at least minimises, airborne transmission, the cause of most recent breaches. This must include rigorous ventilation audits followed by remedial action and the provision of effective N95 respiratory masks.
It’s well beyond time for federal and state medical advisers to take a hard look at the evidence and come out forcefully with measures to prevent airborne transmission.
Second, the vaccination program has to be rolled out more rapidly through clearer communications to various demographic groups in Australia about the safety and effectiveness of the vaccines. And there must be a greater effort to vaccinate residential aged and disability care workers. This has to happen with desperate urgency.
Decisive action needs to be taken to win this race against new variants and the seemingly endless series of breaches in quarantine – a race to effectively protect our most vulnerable. I’m waiting to hear the starting gun.