Executive Summary
In January 2020, as early stories began to emerge of a new and worrying coronavirus circulating in China, ‘quarantine’ was a term largely from the history books. Some Australians had heard of the ‘Spanish’ flu and knew of the quarantine stations used to isolate arrivals over 100 years ago. Most Australians had no or very limited awareness of modern uses for quarantine other than for animals.
Some eighteen months into the COVID-19 pandemic, quarantine is well-established as a crucial element of the public health response protecting Australia and Australians. The nature, uses of and risks posed by quarantine are also the subject of everyday conversation, political interest, academic inquiry and media analysis.
The Australian quarantine system was stood up quickly in response to the immediate threat from COVID-19 – from a standing start to fully operational over a weekend – following a decision at the National Cabinet on 28 March 2020. This was done to meet immediate needs: keep COVID-19 out of Australia, manage case numbers in the community and flatten the epidemiological curve of new cases to help preserve life and provide time to prepare the public health and hospital system response. There was no best practice quarantine handbook and arrangements were developed on a state-by-state basis.
In that context, and in the absence of large-scale dedicated facilities, hotels became the mainstay of the quarantine system for international travellers and have been a key part of Australia’s health response to COVID-19. Since 28 March 2020, when mandatory quarantine commenced, approximately 452,550 international air arrivals have been through the system. A large but unknown number of domestic travellers have also undertaken mandatory hotel quarantine as they have moved from state to state.
In common with a small number of countries, Australia has had remarkable success in managing COVID-19. Our island nation status, early decisions to manage arrivals and prompt and effective action by public health officials together with widespread public cooperation have been key to this success.
Control of the border was an early and crucial element in the response to COVID-19. By preventing the uncontrolled entry of the virus, Australia has not experienced the widespread and devastating waves of infection relative to those seen in most comparable countries.
However, this has required limits to hitherto unquestioned freedoms enjoyed by Australians. These include caps imposed on the number of international arrivals and restrictions on departures as the capacity of the hotel quarantine system is limited.
During the early stages of the pandemic in Australia, and following the effective suppression of the virus, the use of quarantine as a principal defence against COVID-19 was key to Australia’s success. In this context the need for a well-functioning quarantine system has been crucial.
Following a number of transmission events between COVID-19 positive arrivals and quarantine workers, the first National Review of Hotel Quarantine (the first review) was commissioned by the National Cabinet. The review report was released on 23 October 2020 after quarantine arrangements had been in place for seven months. At that time, understanding of COVID-19 and its variants, how to contain the virus, and best practice quarantine arrangements were evolving. While vaccine development had commenced, the time required to develop vaccinations and prospects of success were unknown.
The first review focussed on infection prevention and control, continuous improvement and traveller experience. In line with this review’s Terms of Reference (Attachment 1), the quarantine systems in all jurisdictions have been examined. Overall, this review finds that the quarantine system has improved since the first review. States and territories (states)[1] have implemented improved governance arrangements and greatly improved infection prevention and control (IPC) measures, including improved ventilation.
The six recommendations from the first review have all been implemented in full or in part (Attachment 2). This has included a risk-based approach in respect of some arrivals. Quarantine-free travel between Australia and New Zealand in at least one direction has operated for most of the last 12 months (quarantine-free travel from New Zealand started on 16 October 2020 while the two-way travel bubble started on 19 April 2021 before being suspended on 23 July 2021).
Much has changed since the first review. The pandemic has caused millions of deaths around the world. COVID-19 is now endemic in most countries including parts of Australia. A number of variants of the original COVID-19 virus have emerged, with the current highly infectious Delta variant spreading rapidly around the world and becoming dominant in Australia. It is widely understood that there is no immediate prospect that the virus can be eliminated.
Importantly, and despite concerted public health effort, there are now significant outbreaks of the Delta variant in a number of Australian jurisdictions. Cases are no longer coming primarily from overseas but from within Australia. This has led to sustained lockdowns and domestic border closures. Quarantine and isolation are also now used to respond to community outbreaks, protecting individuals and the wider community by limiting the spread of COVID-19.
With endemic COVID-19, control of the international border is no longer the principal mechanism for COVID-19 control and management in Australia. It is one of the tools available and depends on the context in which it is used.
The consequences of border closures and lockdowns for individuals, families, businesses, academic institutions, the economy (including labour shortages) and national wellbeing are being felt widely.
More hopefully there are now multiple effective vaccines available globally and rollout across the Australian community is well underway. Vaccination rates are increasing rapidly and offer the chance for more day-to-day freedoms as available vaccines are very effective in preventing transmission, severe disease and death. Modelling by the Doherty Institute and others demonstrates that once 70 and 80 per cent vaccination coverage levels are achieved the burden from the spread of COVID-19 on the Australian hospitals system can be managed with lower levels of restrictions on daily individual and community activity in conjunction with effective test, trace, isolate and quarantine (TTIQ) regimes and public health system measures.
In Australia, quarantine options are being expanded to include construction of purpose-built facilities and home quarantine is being trialled in a number of states. Continuous improvement and assurance systems have been widely implemented. More is known about modes of transmission, including the importance of ventilation. Testing technology has improved.
This review comes at a time of increased complexity. There are more quarantine options, travellers and Australians are increasingly vaccinated, and improved and more flexible testing arrangements are available to provide assurance and early detection of infectivity. The risk of COVID-19 developing in recent international arrivals during their quarantine period given pre-departure testing and vaccination is very low, indeed lower than the risk of endemic COVID-19 in at least two states.
The national environment is also more complex with ongoing community transmission of COVID-19 being present in some but not all Australian jurisdictions. While being an international traveller was a good proxy for risk at the start of the pandemic, we now need better ways to determine risk and consequential quarantine requirements.
It is in this context that the National Cabinet has agreed to a re-opening plan in four phases under the National Plan to transition Australia’s National COVID-19 Response (the National Plan, which is at Attachment 3). It is also in this broader context that the National Cabinet commissioned this review on 23 July 2021.
The review is structured in three main sections:
- System performance over the previous 18 months including what has changed since the first review, vaccine rollout, the emergence of the Delta variant and implementation of the first review’s recommendations;
- Current system operations, including risk mitigations to prevent COVID-19 transmission events in the context of phase A of the National Plan; and
- Future use of quarantine, and implementation issues, during phases B-D including the need for a framework that can support increased quarantine capacity and manage transmission risks.
[1] Throughout this report, ‘states’ is used synonymously with ‘jurisdictions’ and refers to all eight Australian states and territories.