Australian Health Protection Principal Committee statement on Australia's National Hotel Quarantine Principles

Hotel quarantining was mandated by National Cabinet on 27 March 2020. Australia's utilisation of hotel quarantine arrangements has proven to be highly successful - approximately 2,200 cases out of 164,714 arrivals have been diagnosed[1] and managed with very few documented transmissions into the community.

Quarantine arrangements have limited the spread of COVID-19 to the Australian community when compared to many nations around the world. However, as transmission of infection can lead to serious outcomes including outbreaks, governments must continue to manage risk to prevent transmission in hotel quarantine.

Throughout Australia's response to COVID-19, the following reviews relevant to hotel quarantine were undertaken:

• National Review of Hotel Quarantine conducted by Ms Jane Halton, AO PSM.
  • On 23 October 2020, National Cabinet accepted this review's recommendations.
• National Contact Tracing Review conducted by Dr Alan Finkel.
  • On 13 November 2020, National Cabinet endorsed this review's recommendations.
• Inquiry into the Victorian COVID-19 Hotel Quarantine Program conducted by the Hon. Jennifer Coate, AO.
  • An interim report was released on 6 November 2020.
  • The Inquiry's Final Report is due by 21 December 2020.

These reviews include detailed recommendations on what is required to deliver a robust hotel quarantine program for international arrivals. As state and territory governments manage hotel quarantine, many of these recommendations are implemented locally.

The National Hotel Quarantine Principles below do not replicate the recommendations from previous reviews. Rather, they provide nationally agreed guiding principles to set benchmarks for hotel quarantine programs across Australia. This way, Australia's efforts will be consistent nationally, while remaining flexible for jurisdictions to achieve a robust hotel quarantine program tailored to their local requirements.

The principles seek to protect the health and wellbeing of the Australian community, quarantined individuals and workers associated with quarantine. The majority of international arrivals to Australia are required to undertake their mandatory quarantine requirement in a hotel or equivalent government-managed quarantine program, to mitigate the potential risk of transmission in the community. For this reason, the principles in this paper apply to hotel quarantine settings.

National Hotel Quarantine Principles

1. Consistent with Australia's strategy of suppression with a goal of no community transmission, the major focus of hotel quarantine programs must be to minimise the risk of transmission of infection into the community.
2. Hotel quarantine programs commence when travellers arrive into Australia. Programs therefore extend from international ports of entry and transfers to hotels quarantine facilities.
3. The health, mental health and wellbeing of international arrivals and workers is paramount in all hotel quarantine programs and proactive supports need to be available, in-line with 'Advice on mental health screening, Assessment and support during COVID-19 quarantine'.
4. Hotel quarantine programs must be underpinned by strong and transparent governance arrangements. This includes clear chains of command and decision making processes, communication, operational plans (e.g. response to positive cases, outbreak management plans) and record keeping.
5. Hotel quarantine programs must use a systematic risk management approach to minimise the risk of transmission of SARS-CoV-2. Effective controls must be applied using the hierarchy of controls[1], a step-by-step approach to manage risks that ranks controls from the highest level of protection and reliability through to the lowest and least reliable protection. Risk management plans should use higher level controls where possible and include strong end to end infection prevention and control in line with a nationally agreed standard and comprehensive infection prevention and control training, and use of standard precautions.
6. Hotel quarantine workers must be protected as this will be where transmission of the infection into the community may occur. It should be ensured that workers have an adequate understanding of their role and responsibilities in relation to infection prevention and control practices and behaviours, and reporting requirements if concerns are identified. Appropriate supervision is required at all times and a strong reporting culture of alerting supervisors to concerns should be fostered.
7. Testing, screening and surveillance, for international arrivals and workers associated with hotel quarantine programs, should align with national guidelines endorsed by AHPPC. These may be supplemented with additional measures, such as pre-emptive contact identification of regular close contacts of workers in case transmission occurs.
8. Facilities used for hotel quarantine must be selected against specific criteria which reduce the risk of transmission as identified in the control hierarchy. This includes consideration of the hotel environment and its suitability for infection prevention and control.
9. In addition, quarantine accommodation needs to be:
   • adequately provisioned and resourced to be able to manage the health of residents and staff in the hotel quarantine facility
   • meeting cultural needs and the needs of those with disabilities, the elderly and infirm
   • located in reasonable proximity to the international port of arrival that is the port of entry
   • located in reasonable proximity of a hospital capable of managing COVID-19 patients
   • considerate of the vulnerability of the local population.
10. Hotel quarantine programs must have established escalation processes with the ambulance and hospital sector for a health emergency. Separate facilities for positive cases or those with complex needs may also be considered.
11. Hotel quarantine programs should apply an assurance process, with regular audits against standards for quarantine, a regular review of controls and their effectiveness and application of a continuous quality improvement process.
12. Hotel quarantine programs should be supported by tools for:
    • Effective data collection, sharing and validation through
      • A nationally agreed data set able to be collected daily
      • National sharing of data on cases and for contact tracing purposes
      • Information on transmission events
      • Monitor and evaluate the effectiveness of the hotel quarantine program to guide policies, protocols and procedures.
    • Monitoring the accommodation and movement of international arrivals and workers in common areas by remote means such as CCTV and/or QR codes.

[1] Figures based on overseas acquired cases that arrived in Australia by air, period: 28 March 2020 to 24 November 2020.

[2] https://www.safeworkaustralia.gov.au/risk#:~:text=Controlling%20risks%20using%20the%20hierarchy,in%20relation%20to%20any%20risk

Read previous statements from the AHPPC.