Six passengers from the hantavirus cruise ship have started their quarantine at Australia's purpose-built facility in Western Australia.
Over the next three weeks, the Australians and one New Zealander will be housed at the 500-bed Bullsbrook facility north-east of Perth, one of three purpose-built "centres for national resilience" around the country.
There, staff from the National Critical Care and Trauma Response Centre will monitor the returned passengers' health, before authorities decide what happens next.
We are both infection prevention and control experts who advised the Victorian government on best-practice quarantine arrangements during COVID. This included the design of a dedicated quarantine facility.
Here's how the Perth facility - and similar purpose-built ones in Melbourne and Brisbane - have been designed to minimise the spread of infectious diseases.
What actually is quarantine?
The word itself comes from the Italian phrase quaranta giorni, meaning "40 days". Back during the Black Death, ships had to anchor off the coast for 40 days before they could land in European cities to make sure no one on board was sick.
Today, quarantine is specifically for people who have been exposed to a virus - in this case the Andes strain of hantavirus - but aren't showing any symptoms yet.
Experience from managing other infectious diseases, including COVID, has taught us that people can spread a virus before they even feel sick. We use quarantine to protect the community and also to make sure the person who was exposed doesn't catch anything else.
During the early stages of the COVID pandemic, Australia was among countries that used hotels for quarantine purposes. But hotels are designed for comfort, not for stopping airborne pathogens. Shared spaces, inadequate ventilation systems, poor workflow (see points two and three below), and staff often with little or no expertise in infection control contributed to several breaches .
Many of these hotels were in the middle of busy cities. This was risky because any breach could immediately expose a lot of people in a crowded area.
So Australia built three centres for national resilience in Mickleham (near Melbourne), Perth and Brisbane. These were placed outside crowded city centres but still close to airports.
So what are these facilities like?
When architects and health experts design these facilities, they focus on four main things: fresh air, design, workflow and dignity.
1. Fresh air inside and out
These buildings need a constant supply of fresh air. The air is never recirculated (reused). Instead, old air is pushed outside so people aren't breathing in "re-breathed" particles from someone else. So a lot of thought goes into air handling , that is, stopping germs from hanging around in the air and spreading to others.
That includes designing facilities with verandahs (for residents) and open-air walkways (for staff).
2. Designed with zones
The safest way to run a facility is to split it into three "traffic light" zones :
the green zone (clean): where staff enter, have their offices, and take breaks
orange zone (transition): a buffer area, like a verandah or porch, where staff put on their protective gear or hand over meals and medical samples
red zone (contaminated): the actual room or area where the person stays. Anyone entering this area must wear full personal protective equipment. This often includes properly fitted long-sleeved gowns, gloves, N95 masks and face shields or goggles, combined with mandatory training in "donning and doffing" (putting on and taking off personal protective equipment).
3. One-way workflow
A crucial rule in infection control is that you never move "dirty" items back into "clean" areas. Everything must move in one direction: from clean to dirty .
So staff and supplies follow a strict path to ensure nothing from the "red zone" accidentally moves back into the "green zone". This could include infectious air, as well as people and objects or equipment.
Sometimes, however, objects from the "red zone" have to move back into other zones, but need to be cleaned and disinfected first. This would be the case for the dirty laundry of people in quarantine. In this case, there are strict protocols to make sure any risk is minimised. Once cleaned and disinfected, these items can then be re-used.
4. Ensuring dignity
One of the hardest parts of quarantine is the mental toll. Staying in a room for weeks is hard. Those in quarantine often experience mental health stressors .
This may include a fear of infection, constantly being on alert for symptoms, and having trouble sleeping.
In the old hotel quarantine, some people couldn't even go outside. By contrast, purpose-built facilities are designed to be more humane. This means:
accessing natural light, outdoor space and fresh air
good quality food and water
internet and entertainment so they can stay connected
emotional support to help with the stress of being isolated.
What happens now?
If anyone in the Perth facility does become sick, there is a medical clinic on-site so they can be treated or stabilised before transferring to hospital. People in quarantine also have access to telehealth.
What happens after the three-week period is up has yet to be decided. The World Health Organization recommends active monitoring and home or facility quarantine of high-risk contacts for 42 days after their last potential exposure.
As hantaviruses are rarely transmitted between people, the risk to the general public remains low and the virus is not a pandemic threat .
But this outbreak is a reminder that we need to be prepared for future outbreaks of infectious diseases. So our quarantine facilities need to be ready to go should they be needed again.
Philip Russo is an NHMRC Early Career Research Fellow at Monash University and Director of Nursing Research at Cabrini Health. During the pandemic he was Deputy Chair of the Infection Control Expert Group to the Department of Health, and a member of the COVID Evidence Taskforce Steering Committee. He was also Executive Director, Infection Control and Prevention, COVID-19 Quarantine Victoria.
Brett Mitchell receives funding from the NHMRC and MRFF. During the pandemic Brett held a position as Executive Director, Infection Control and Prevention, COVID-19 Quarantine Victoria.
