Christmas Island Quarantine Is A Small Price To Pay To Stop Coronavirus
Today the WHO declared a Public Health Emergency of International Concern.
The Wuhan coronavirus epidemic has been a fast-moving situation, with rapidly rising cases, many uncertainties and new information coming in at a rapid pace. Transmission from person to person has been confirmed. Our citizens are stranded in Wuhan, and have been asking for help. Despite the WHO Director General advising countries not to evacuate their trapped citizens, many countries, including the US, France, Japan and Australia, are doing just that.
There has been some criticism of the Australian government’s strategy to evacuate citizens to Christmas Island, because it is offshore, does not have good medical facilities, and because it is designed and used as a detention centre. Some of the concerns are valid, but it’s important to not conflate the accepted public health principle of quarantine with other issues.
Travel is a major vector for spread of disease around the world. A serious epidemic anywhere can land on the shores of any other country. Quarantine has been used as far back as the Black Plague in Europe -- because it works.
Australia has a long history of using quarantine to protect its population. We are an island nation, which gives us a unique advantage in trying to reduce the risk of an epidemic starting, because we do not have the risk of infection coming in by road or rail.
Our Quarantine Station in Sydney closed in 1984 and was used to isolate ships and their passengers during the 1918 Spanish flu pandemic, as it was an isolated location at the time. Passengers on ships, even first class passengers, had to stay in special accommodation in the Quarantine Station until the incubation period had passed. The pandemic was delayed coming to Australia as a result.
By using quarantine, the hope is to prevent or delay an epidemic of coronavirus in Australia, buying valuable time for the development of drugs and vaccines.
A dedicated quarantine facility is the best option, whether it be the Christmas Island facility or any other suitable facility that is ready to use.
The alternative for the current situation for people arriving from Wuhan is home quarantine, which is less reliable and harder to manage with people scattered around the country. Those people would also have to be relied on for voluntary self-quarantine in this situation, and there is a risk some may break quarantine.
Whether people are quarantined at home or in a dedicated station, there is always a risk that someone who becomes newly ill can infect another person. That risk has a high likelihood of growing if a person is removed from quarantine before the incubation period is over.
If kept in quarantine, however, people can be monitored daily and separated if they develop symptoms. Spatial separation zones, such as those used by Medecins Sans Frontieres in their Ebola care centres, can be created within a building to minimise infection risk.
We do not have a drug or vaccine for this virus yet, so we need to use every other measure at our disposal to control the spread. Normal public health measures include:
- Detecting new cases as soon as they occur through surveillance and screening
- Rapid isolation of patients who are infected
- Hospital infection control
- Tracking and quarantine of the close contacts of those infected
- Quarantine of people coming from high risk zones such as Wuhan
There are advantages to using Christmas Island as a two-week quarantine station for travellers from Wuhan. The facilities are already functional, which is beneficial from a cost perspective.
But of course there is the stigma of being quarantined in a detention centre. And the distance from tertiary care hospitals in Australia is not ideal. If someone develops illness, it is best they be treated in a tertiary care facility by experienced, specialist staff. It is also important that people under quarantine have access to all essential supplies, healthy food, clean water, medicines, clean, comfortable and hygienic accommodation, as well as communication capabilities such as Internet access. There must also be good medical facilities with meticulous infection control to avoid an outbreak.
Uninfected people detained on Christmas Island, like the Biloela family, should be spatially separated so there is no risk of transmission of infection to them.
With cases still increasing and the epidemic not yet under control, staying in Wuhan would be a greater risk than evacuating to an undesirable location for two weeks. The high risk of infection was seen in the first evacuees from Wuhan to Japan, where it was reported several were already ill. This risk will grow as the epidemic gets bigger.
We want to prevent an epidemic taking off in Australia. At this stage we have a few cases of infection, but no epidemic. All cases are in special isolation rooms in hospitals.
An epidemic could see us run out of isolation beds very quickly, run out of general beds to treat other diseases, run out of personal protective equipment (PPE) for health workers, run out of the capacity to trace all contacts and cause severe stress on our health system. We could see health workers and first responders become ill or even die.
We need to think beyond today, to what may unfold tomorrow if an epidemic arrives here.
The timing has been particularly bad for us compared to some other countries, with schools and universities opening from late January through to March. We may see cases in the first two weeks after these educational institutions open. One way to ensure this does not happen is to use a two-week quarantine period for people returning from the affected area, as we are doing in NSW schools.
If the government can find a better location than Christmas Island for evacuees from Wuhan that can be used immediately as a dedicated quarantine station, even better. Mostly, people are community-minded and do not want to spread infection to others, so they will cooperate with such measures, as long as we ensure their needs are met for that period.
It is small price to pay for attempting to prevent an epidemic in Australia.