Sydney’s $ 2 billion lockdown: quarantined transport back in the spotlight
In a December 2020 article for Age, I called for a full review of the quarantined transport in Australia. The victorian COVID-19 hotel quarantine investigation failed to focus substantially on quarantine transport — high risk, in contained environments and a single point of failure in the quarantine system. While recommendations were provided regarding “return traveler transit”, flight crew transit, typically carried out by ground transport companies under contract with airlines, has not been given the same level of consideration.
Greater Sydney (including the Blue Mountains, Central Coast, Wollongong and Shellharbour) has started a 2-week lockdown that will cost the economy dearly $ 143 million per day, which led us to stand on the edge of a national epidemic (resulting in blockages in Darwin, Alice Springs, Perth, Brisbane, Gold Coast and Townsville, as well as restrictions in other states / territories), due to the infection of a crew ground transport employee air by the Delta COVID-19 variant. Surveys showed that the driver was not wearing a mask, as systemic problems with daily testing and lack of vaccination (linked to gaps in the definition of “border worker”) continue to proliferate.
On June 26, 2021, NSW Health quietly updated its air travel quarantine guidelines, but important questions of accountability and quality control remain. The continued failure of quarantine also requires rethinking our national priorities and accepted approaches to risk mitigation.
The public deserves to know about the regulatory and performance regime governing quarantine transport operators. While return travelers are carried by large bus and coach operators (e.g. ComfortDelGro, Kinetic) under contract with state governments, crew transport is more opaque and involves a relationship between companies. airlines and small private ground transport companies (eg Sydney Ground Transport, Legion Limousines). Any failure has catastrophic consequences, as we see once again.
We need clarity in the chain of custody (and who forms that chain), based on principles of shared responsibility and accountability to ensure that all infection control measures are maintained. Questions remain as to whether the “guidelines” are enforceable, and whose role is to monitor and police. Perhaps there should be separate accreditation requirements for quarantine operations as well.
Quarantine transport operators need to be given sufficient incentives beyond the protection of personal health (which in a low risk COVID-19 environment like Australia is a difficult imperative). Contractual obligations should be independently monitored, while a punishment and reward system could raise the stakes, the offending operators being even named and humiliated. Infection control violations could also be a reason for end of employment within the framework of contractual clauses.
An appropriately incentivized operator should go above and beyond to protect their employees and, by extension, the rest of the community. In Australia we have seen a light approach to individual protection equipment disposition. Using tested P2 / N95 masks, goggles, headgear and gowns in all high risk scenarios is a foolproof solution. Modernization of vehicles with physical barriers and the use of anti-epidemic technologies such as antimicrobial coatings and disinfection solutions like ultraviolet, nebulization and nanotechnology can reduce errors and inconsistencies. These initiatives can be mandated or encouraged by the appropriate market forces (operationalized through contract design).
While technological solutions are important, they are only as effective as the personal responsibilities and behaviors of individuals. We have seen little investment in appropriate infection control training for frontline quarantine staff. Border workers could be trained in the same way as medical staff, and be given additional guidance such as quarantining and disinfecting clothing and personal items to reduce the risk of spread to family contacts.
The focus should be not only on compliance, but on building a culture of zero tolerance that stigmatizes complacency and error. Total quality control and elements of Six Sigma doctrine have been effective in many industries (eg, manufacturing) in reducing variance in results. Point and call, launched in the 1920s as a Japanese rail safety protocol, is a low-cost workplace safety strategy. Verbalizing planned actions increases attention and awareness and has been shown to reduce errors by 85%.