The official case for home-based quarantine

Expert recommendations to Australian governments

Expert recommendations to Australian governments

Key points for home-based quarantine

A judicial inquiry in Victoria found home quarantine is potentially the safest, most effective means of preventing transmission from international arrivals to quarantine staff and the Australian community.
It’s more humane, with less adverse health and wellbeing impacts than hotel quarantine.
It’s a key measure for enabling the safe expansion of the quarantine system to allow more international arrivals.
The inquiry found claims about non-compliance were overstated.
Compliance can be managed by technological monitoring and improved directions and processes.

Home-based quarantine – a recommendation of the COVID-19 Hotel Quarantine Inquiry

In November and December 2020 the COVID-19 Hotel Quarantine Inquiry commissioned by the Premier of Victoria, Dan Andrews, released its findings .

One of the key recommendations was that ‘any future Quarantine Program should provide for the option of people quarantining in their own homes, or at some other suitable residential premises.’ (COVID-19 Hotel Quarantine Inquiry Interim Report, p.65)

In summary, the reasons given by Inquiry head, The Hon. Jennifer Coate AO, were that a home-based quarantine option:

Has the potential to reduce transmission risks associated with quarantine facilities.

…a major risk of the hotel model is the daily movement of personnel in and out of the facility and then into communities in which they live… Minimising the numbers of people working in such environments by only having those unable to quarantine at home, in the facility, reduces this risk of transmission to the broader community… (Ibid., p.65)

Would be as effective or more effective than a facility-based model in preventing further transmission of the virus.
The ability to quarantine at home reduces adverse impacts on health and wellbeing, and is more amenable to families.
Would free up hotels so that only those that are most suited to the purposes of quarantine would be used.

…(that is, those with balconies, opening windows, dedicated open-air recreational areas and self-catering facilities). (Ibid., p.66)

The case against was weak

Victorian government officials argued that

only an estimated 50 – 60% of returning travellers have a suitable premises for self- isolation; and
the regime would not meet public expectations. The Australian public would not tolerate anything other than zero community transmission. (Ibid., p.71)

The Stranded Aussies Action Network (SAAN) view is that 50% of arrivals being eligible to self-isolate is a reason in favour of adopting home quarantine. It’s not a reason against it. Any reduction of hotel quarantine is worthwhile, and any safe means to repatriate more stranded Australians is desperately needed.

Ms Coate rejected the argument about public expectations. She agreed that the public needed to have confidence in government measures, but

in a program designed to curtail the spread of a potentially deadly pathogen, an evidence-based, humane and health-focussed response must be the primary driver. Those considerations, where conflicting with public perception, must carry the day and drive the nature of the response. (Ibid., p.71)

Hotel Quarantine Inquiry Report recommendations 58 – 69

In summary Ms Coate recommended that the Victorian government:

Implement home-based quarantine as an option and alternative to hotel quarantine.
Continue to control numbers of international arrivals so as not to overwhelm the system.
Conduct individual risk assessments to ensure that each premises meets the necessary criteria.
Provide any reasonable support that may assist people to quarantine at home.
Mitigate against non-compliance by

requiring eligible residents to sign a legal undertaking to comply with the conditions;
properly communicating the procedures, conditions and legal obligations to each individual quarantine resident, taking into account language and cultural needs;
supplementing the range of methods for monitoring compliance, including via electronic systems; and
instituting penalties for non-compliance with quarantine orders. (Ibid., pp. 76-77)

A home-based quarantine option was also supported by Ms Jane Halton, Chair of the Coalition for Epidemic Preparedness Innovations, who made similar recommendations in a report on hotel quarantine prepared for the Commonwealth.

Blame systems not individuals

SAAN has noted a tendency among government representatives to blame quarantine failings on individuals rather than systems. Ms Coate found that evidence of significant non-compliance was weak. She found that in most cases, directions to those in home quarantine were poorly communicated by officials. The non-compliant persons, in general, had not properly understood the orders.

Ms Coate also found that the perception of non-compliance that drove the decision to drop home-based quarantine arose in March 2020. Australia received over 900,000 international arrivals that month. Hundreds of thousands of those were ordered to quarantine at home. It was found that directives at that time were poorly issued and authorities did not have the capability to monitor all arrivals.

Since April 2020, Australia’s total monthly international arrivals have been between 15,500 and 35,000. If Australia were to base its arrivals caps on the quarantine capacity provided by world leaders, it would be able to take 60,000 per month. Even if every one of those arrivals quarantined at home, that number is far more manageable, particularly if monitoring is undertaken electronically.

The majority of arrivals who test positive to coronavirus do so in the first eight days after arrival. That is a factor in favour of reducing the time spent in hotel quarantine and allowing arrivals to self-isolate at home for the remainder of the 14 day quarantine period.

Another factor in favour is that whenever Australia has had community transmission of coronavirus, thousands of those infected and their contacts have been permitted to isolate at home, virtually unmonitored. A privileged few international arrivals, such as Australian politicians and various celebrities have also been allowed to do so.

Best practice home quarantine

We know that home quarantine works in Australia, because it’s been used extensively during test, trace isolate (TTI) measures during outbreaks in all states. The most lethal outbreak in Australia occurred when authorities failed to monitor early transmissions and did not enact TTI in time.

Apart from that, Taiwan is the most persuasive example of a successful home quarantine program. Although its population is close to that of Australia, its inbound quarantine capacity is at least double that of Australia’s currently. From April 2020 through January 2021, Taiwan took 443,000 international arrivals compared with Australia’s 238,000, and despite Taiwan having almost two million less residents. Over 400,000 people have quarantined at home there, monitored by a mobile phone tracking system. As of 9 February 2021, Taiwan has had a cumulative total of 933 coronavirus cases and nine deaths. Australia’s total on that date was nearly 29,000 cases and 909 deaths.

Other countries that operate electronically monitored home-based quarantine include South Korea, Hong Kong and Singapore. Those countries use electronic bracelets, while Kuwait and Bahrain use phone tracking.

Both independent assessments ordered by members of the National Cabinet recommended implementing home-based quarantine. SAAN urges the National Cabinet to accept these recommendations and implement them quickly. Home-based quarantine is a safe, humane way to address the emergency of Australians being abandoned overseas.