Why not build a national facility?

Key points

The establishment of dedicated federal quarantine facilities of the required scale are a partial solution that will not be available in the short term.
Australia needs to provide at least 25,000 quarantine spaces at a time. It’s not possible to rapidly establish facilities capable of receiving tens of thousands of arrivals per month with the required proximity to major hospitals and airports.
More facilities would be useful in the long term for future pandemics but they are not a cost effective solution for the entire volume required.

A lot of commentators suggest that international arrivals should be sent to a facility or facilities like Howard Springs or Christmas Island, imagining that would solve the stranded Aussies crisis. It won’t.

A federal facility – Howard Springs

In October 2020, the Australian federal government released a ‘National Review of Hotel Quarantine’ by Jane Halton. One of her recommendations, apart from developing a system of home-based quarantine, was the construction of a national quarantine facility. Ms Halton mentioned Howard Springs in the Northern Territory and claimed that it could hold 3,500 people. Otherwise she did not elaborate on the required size or number of any such facilities or any other logistics.

In practice, Howard Springs’ maximum capacity is 1,700 to 1,900 per month. The Commonwealth recently spent $513.5 million to be able to provide 2000 spaces per fortnight by the end of May 2021, however, the facility’s intake was suspended in April due to Darwin Hospital’s limited ability to deal with coronavirus patients.

If we base a sustainable quarantine capacity in Australia on the best practice examples of Taiwan and New Zealand, Australia requires at least 60,000 quarantine spaces per month. That’s the equivalent of over 30 Howard Springs Facilities at its original capacity.

Prohibitive logistical issues

Disappointingly, media articles that cover proposals for dedicated facilities never raise the numbers of quarantine spaces needed. At least this article on dedicated camps as a future quarantine solution looks at other logistical issues.

“…mainland facilities, not too far from appropriate levels of healthcare, are definitely worth considering in the longer term,” [AMA president Dr Omar Khorshid] said, while adding that by the time new facilities were completed, they may no longer be needed.

While more facilities like Howard Springs would be ideal, experts point to a number of issues that rule out any large scale establishment of such facilities in time to help stranded Aussies. In short, they would be prohibitively costly, difficult to locate and take years to construct to the capacity required.

Location

Facilities must be close to tertiary hospital facilities. Coronavirus infections and other complex medical events can rapidly escalate and are inevitable among large numbers of residents.
The nearby hospitals must be large, well equipped and well staffed to cope with coronavirus infections on top of their day to day caseload.
Facilities must be constructed or adapted to provide appropriately spaced accommodation for individuals, couples or family groups, without shared amenities.
They must be close to airports. Transfer of arrivals to the facility must be as short as possible to minimise transmission risk to other travellers and transport staff.
Residents need to make post quarantine journeys from the facility to their intended destination within Australia. Remote facilities would make this extremely difficult and expensive.
A large workforce of health professionals and other staff are required. The costs and logistics of relocating and, if necessary, accommodating such workforces are enormous.

Timing and cost

Construction of facilities to the size and specifications required would take months or years.
According to news reports, Howard Springs cost $400m to build and now a further $513m to expand its capacity to 2000 spaces. Estimates for constructing a 850 bed facility in Victoria are that it would cost up to $170m. It’s estimated that a facility capable of taking 300 arrivals at a time could be completed in four to six months if the project was rushed.
Victoria would need 19 of those 300 bed facilities to bring it to par with New Zealand’s quarantine capacity per capita.
Aside from billions of dollars required to construct such facilities, the running and maintenance costs are additional.

Politics

Whichever quarantine arrangements are in place, they require cooperation between both levels of government. So far that has been a serious impediment to establishing a coherent system. The intransparency of National Cabinet has led to a lack of accountability for the stalemate.
The federal government could certainly fund more facilities, but under the Commonwealth Biosecurity Act, facilities in the states would be operated by state health departments, with back up from state run hospitals. Commonwealth territories lack hospitals large enough to cope with the volume of international arrivals.
While fresh air gaps would greatly improve protections against airborne transmission, there is no guarantee such facilities would be better run than hotel quarantine.
Given Australian political leaders’ inordinate level of risk aversion, resistance to public health expenditure, and callous disregard for Australians abroad, it’s possible that even with such facilities available, they would not have the capacity to meet demand and the government would still maintain draconian arrivals caps.

In short, the establishment of dedicated facilities is not possible in the short to medium term, would not be adequate to solve the stranded Aussies crisis, and is not in any way cost effective.

On the other hand, both the Halton report and the Victorian Inquiry into Hotel Quarantine made recommendations to implement home-based quarantine as the safest and most humane way to supplement the hotel quarantine system. Home-based quarantine was implemented very quickly in Taiwan – a country with a population slightly less than Australia’s. By April 2020, the Taiwanese government was efficiently managing 55,000 people quarantining at home. Australia’s hotel quarantine rarely holds more than 14,000 at a time.

There was no reason that Australian governments could not have cooperated to develop a similar system. The talk of constructing facilities, a year into the pandemic, is too little and too late.