Lessons from Victoria: Don’t lose elimination status

A quarantine leak has put 300,000 people in Victoria back into lockdown. A former NZ epidemiologist at the University of Melbourne tells Farah Hancock how this country can avoid the same fate.

Residents of 10 postcodes in Victoria will wake to a month of ‘stay home’ localised lockdown rules today as a fresh outbreak of Covid-19 closes hot spot suburbs.

The new outbreak, driven by quarantine leaks, holds lessons for New Zealand’s hope to keep community transmission to zero.

Cases in Victoria have spiked in recent days, with the state reporting 73 new cases yesterday.  There are 370 active cases in the state and 15 people in hospital.

International flights to Melbourne have been halted. The stay at home order means only essential outings can be undertaken. People from the 10 postcodes attempting to travel to New South Wales can be fined $11,000. A door-to-door blitz of testing has been underway.

A University of Melbourne epidemiologist and public health medicine specialist, Professor Tony Blakely, spent 20 years at the University of Otago before taking up the Melbourne role in 2017.

He said based on what’s going on in Melbourne, New Zealand’s quarantine issues have been a “storm in a tea cup”.

Victoria’s problems have been different and there are lessons New Zealand could take on board. 

“There's no evidence at this point that any people within quarantine have taken the virus out to the community. It’s staff and it’s a bit of a shemozzle. It’s now the subject of a judicial inquiry.”

He said genomic sequencing of the virus shows private security guards placed in quarantine hotels and untrained in infection control had transported the virus from travellers, to themselves and then to the wider community.

Professor Tony Blakely. Photo: University of Melbourne

An outbreak at the Stamford Plaza Hotel outbreak has infected 31 people and another at The Rydges on Swanston Hotel had recorded 17 infections as of June 19.

Car-pooling and the sharing of a cigarette lighter have been mentioned as activities which may be involved in the virus spread. 

“You're in a hotel, where you’ve got a couple of lift shafts, it’s not like 100 years ago where you would have a whole lot of buildings on a big field. There was huge potential for cross-contamination. You need really, really good infection control policy to pull that off.

“Any slip ups, you’re in trouble. And there were slip ups.”

New Zealand is in a different position to Australia as there is no community transmission, said Blakely, but borders remain a conduit between infections coming from abroad and the community.

“Leakage from quarantine is possible. You have to have really good procedures and it seems to be around staff as much, if not more, than the actual people in quarantine.”

Hold onto elimination

Blakely said there had always been some community transmission in Victoria, but the current outbreak has fanned it. 

Even though, with a suppression strategy, outbreaks were expected, the current scale of work has stretched local capacity and tests are being sent to other states for processing. 

Now the focus is on suburbs bordering the hotspots. Blakely suspects tests will eventually show at least a few more suburbs will need to go into lockdown.

“That will be the best case scenario to kick it in the pants.” 

He believes this, coupled with contact tracing and testing, will bring the outbreak down to suppression level, where there are a few cases circulating but no big clusters.

The worst case scenario would be if the public health measure of a lockdown fails, and the virus spreads beyond the current hotspots. If that happens, the state might be shut down. 

Blakely said the first lesson New Zealand could take from what’s happened is not to lose the elimination status - where there are no cases of community transmission and no clusters.

The second is a water-tight quarantine, which stops cases coming in through the border infecting the community.

“The thing I’m taking out of this is you need military-like procedures in your quarantine.”

He also questions the use of hotels as quarantine facilities saying they’re not designed for quarantine and the risk of cross-contamination is high. 

“Do your quarantine well and think about the facilities you are using.”

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