The Holiday Inn at the Melbourne airport has drawn the attention of the AMA and other health organizations after two new cases were discovered in quarantine — one patient and one quarantine worker. The hotel’s quarantine system serves as a shield between recent travellers and the rest of the country. But is the shield still effective when the quarantine staff isn’t safe?
The AMA president, Dr. Khorshid, stated that the two cases had exposed weaknesses in the quarantine system. He also said that they are evidently results of airborne spread, contrary to the Infection Control Expert Group’s (ICEG) earlier suggestions.
The ICEG has stated in the past that aerosol spread wasn’t a threat in hotel quarantine situations, but the mini-outbreak at the Melbourne hotel dictates differently.
The group had previously been commissioned to look at the protection of healthcare workers, and Dr. Khorshid has requested the same treatment be extended to quarantine workers as well. Specifically, he called for smart changes in the airflow facilities and better PPE like N95 masks and safety goggles.
The ICEG’s stance on the aerosol spread of SARS Cov-2
During their investigation, the ICEG found that the Covid-19 may spread via aerosol means in highly specific conditions, mostly in a hospital setting. However, they determined that it is relatively uncommon and may not pose a real danger in the hotel quarantine settings. The ICEG found that the virus may spread in the air while patients are being intubated.
However, with the recent cases in the quarantine hotels nationwide, the group is forced to reconsider its steps. Professor Lyn Gilbert of the ICEG said that the group would be updating its advice in light of the new cases.
How did the infection spread?
Victorian health authorities speculate that an aerosol-based medical device used by asthma patients may be responsible for the spread at the Holiday Inn. According to the Chief health officer, Prof Brett Sutton, the working theory is a nebulizer that was used by an infected resident earlier in the month.
He believes the vaporized air was carried into the corridor, and it exposed a guest and a worker who happened to be passing by.
Epidemiologist Associate Prof Hassan Vally also added that the risk of nebulizers had been known since the beginning of the pandemic. He also said that several warnings had been issued about using nebulizers outside of infection-control hospital settings.
Vally went further to state that common protection against airborne risks, like increasing turnover or allowing guests to open windows, may not have prevented this particular spread because of its uniqueness.
Medical officers also noted that the nebulizer was a personal device and not provided by the quarantine workers. Extra precautions, such as a ban on nebulizers and screening traveller luggage for aerosol devices, have been implemented.
Travellers in the Holiday Inn have been moved to make way for deep cleaning of the hotel. But the travellers aren’t out of the woods yet because they will need to complete an additional three days of quarantine, followed by testing, whether or not they were scheduled to leave.
Isolating travellers for 14 days after the return has been one of the staples of curbing the virus. However, recent findings suggest that the hotel quarantine barrier is even more critical. Between November and January, the hotel quarantine system identified about 800 Covid-19 cases.
Only four of these individuals infected someone out of quarantine, and three of these four infections led to community outbreaks.
The potential outbreaks curbed by the Hotel quarantine barrier shows just how critical it is, acting as a primary defense mechanism. However, the discovery of these cases, and the preventive actions that will follow, may improve the quarantine system’s effectiveness even higher.
Concerns about vaccine wastage
Even though the vaccine is expected to arrive any day now, it may not be a permanent solution to the quarantine outbreaks because the vaccine wastage percentage may be up to 30%
The Pfizer vaccine will come in vails and has to be diluted with saline before administration.According to Dr. Chris Moy during his ABC interview, the vaccine dose is only about 0.3ml, a small amount that leaves a wide gap for wastage lost in the needle and at the bottom of the syringe.
To defeat the virus, it is evident that Australia will need a combination of efforts that includes vaccination training for concerned individuals and improvement of hotel quarantine systems.
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