There has been much ado of late regarding Australia's hotel quarantine system. Amongst other factors, a systemic failure of the Australian Government's Infection Control Expert Group (ICEG) guidelines regarding airborne transmission has led to numerous instances of COVID-19 escaping capital city-based hotel quarantine and generating a threat to the community. In response, state and territory government as well as federal government have proposed the setup of regional quarantine stations in areas ranging from regional towns to remote mining camps. The concept enjoys broad support, particularly amongst doctors and politicians based in cities.
As a rural doctor, what is the key to making something like this succeed? When talking about regional quarantine, many people cite the Howard Springs Quarantine facility in Darwin as a "gold standard" for how things should be done. Whilst Howard Springs has indeed been a successful example of how quarantine should be done well, it is far from an example of "regional" quarantine. The facility is 20-30 minutes' drive from a major centre (Darwin), with a nearby airport capable of handling heavy jet traffic. Sick patients (not that this occurs frequently) do not require aeromedical transfer to a larger city hospital for ongoing care, and the public health system in the NT is second to none and very capable of managing small, localised outbreaks when and if they occur.
Importantly, the process of establishing and implementing Howard Springs was driven by local doctors. As luck would have it, these local doctors were based in the decision-making centre of the Territory (i.e. Darwin) and were able to make good quality decisions in the interests of the territory.
The same cannot be said of regional quarantine proposals in other states. Proposals in Queensland and Victoria, whilst also with their merits, have been made by predominantly city based "experts" and bureaucrats without and involvement of rural doctors or the broader rural health system. The proposals ignore many issues around workforce sustainability and the management of outbreaks, both in primary care and hospitals, for the political expediency of removing the problem of quarantine from marginal seats in capital cities.
These proposals as they stand currently reflect the standard of geographic narcissism that we have come to expect from government. Rural Health is a litany of capital city-based bureaucrats and managers telling rural doctors what to do without having even visited Rural Australia or without any understanding of local context. This has led collectively to a poorly designed and under resourced rural health system that ignores the needs of communities and doctors. To date, there has been no meaningful consultation with rural doctors in primary or secondary care on any of these proposals. In addition, the leadership of these sites will be from capital cities, who have not proven themselves capable of making good decisions for Rural and Regional Australia.
Do not mistake me, Regional and Rural Quarantine can work under the right circumstances. These circumstances need to be managed by local doctors and doctors with significant rural expertise. These doctors exist however are currently ignored in a very systematic and obvious way by the bureaucracy. As rural doctors we must insist on rural leadership as the centrepiece of any regional quarantine system. No more, no less.
