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'We don't like the fact we don't know': SA Health still in dark on medi-hotel breach

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Health authorities are “quietly confident” they have the Parafield cluster “bagged up” – but they still have “no operating hypothesis” as to how COVID-19 breached South Australia’s medi-hotel regime, says SA Health CEO Chris McGowan. He spoke to InDaily’s Tom Richardson about recent events, future fears – and the art of “building the plane while flying it”, as authorities continue to learn more about the coronavirus.

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InDaily: Is there any further clarity yet as to the origin of this breach?

 

Chris McGowan: Yes and no… we’ve had the CCTV footage reviewed, and there’s nothing on there that indicates there was any breach of any protocol… nobody’s been in anybody’s rooms, nobody’s been handling bags wrongly or anything like that. So it is still perplexing for us.

As [chief public health officer] Nicola [Spurrier] says, it’s a sneaky disease.

These things kind of worry us, because they tell us the disease spreads in ways that we hadn’t expected – we expected the infection control provisions that we had in place were adequate.

This whole pandemic really, we continue to learn new things about [coronavirus] all the time, we continue to build the plane while we’re flying it. And this has told us something new about it.

So, as you know, we’re going to be going with a dedicated facility and try and dial up, particularly, the provisions around people we know to be positive.

 

We’ve been told it’s a sneaky disease, but it seems to be more sneaky in quarantine than outside of quarantine, if you know what I mean.

For example, the gentleman who went on a shopping spree a week or so ago, we’ve not seen any community transmission as yet out of that.

 

In the [scientific] literature, there was an article recently that described it as ‘a disease of the super-transmitter’. So with quite a few cases – and this is international as well as nationally, but I think this was particularly reviewing Victoria – you see a lot of spread of it with super-transmitters.

We don’t know much about it – is it that they shed more of [the virus] or whatever? We’re still learning about this, but quite a few of the outbreaks – including Victoria, and including the New South Wales one where you had that super-spreader event at the Crossroads Hotel – somebody spread it to a lot of people, and those people didn’t necessarily spread it as much.

And I don’t think there is any consensus on how that works yet.

 

So just in terms of the chain of command in terms of the medi-hotels, I appreciate there are various agencies involved. Is there an issue with coordination? I mean, who’s actually ultimately responsible for managing the medi-hotel?

 

So this is the sort of technical answer: ultimately, it’s a major emergency, which means that the [Police] Commissioner [Grant Stevens], who is the coordinator, is ultimately responsible for things, but in the context of the day-to-day stuff, Health is responsible for the medi-hotels.

Police do a fantastic job in partnership with us on the security, enforcement and assurance.

The hotels [themselves] essentially run the hotel, but have massively changed their processes to comply with what we need them to do.

But the day-to-day management essentially sits with us.

 

Do you agree with the Commissioner then about the ‘working two jobs’ element? He was pretty adamant that we can’t prevent people from working a second job if they’ve got one in a medi-hotel?

 

The answer’s yes. But what the Commissioner’s saying is if someone worked in there, and can’t work another job – he’s still going home to his family, and his wife works another job, and his kids work another job. So if you’re trying to limit that, are you really saying this worker must be in quarantine for the entire time he works in that job, and for 14 days after?

 

Well, I don’t think anyone is saying that. I think what we’re saying is, if for the duration of the emergency, people who are working in the hotel are paid an extra amount that would dissuade them from having to get a second job, that would at least prevent one avenue of the disease spreading – which it did in this event, to that pizza bar. Which wouldn’t have happened if either of those gentlemen hadn’t had a second job.

 

So, as you’re aware, we’re going to do a dedicated facility where we’re going to keep people we know to be positive. And we probably will implement that there [staff not working elsewhere] and do a whole bunch of infection control training around those people.

 

If you’re implementing it there, why can’t we concede that it’s not a good idea in general? I mean, no-one seems to be acknowledging that that’s something we should be striving for.

 

Well, it’s an additional caution, right? It’s an additional caution.

But if we were to contain, say, seven positive people in the state at the moment [as of Friday], in hotel accommodation… if we were to say to everybody else that that was the arrangement, I don’t think we’d be able to have the number of staff [or] the number of hotels that we currently have, because people just wouldn’t implement that regime.

So one of the rate-limiting things for us, in terms of the numbers of Australians we can repatriate here and the number of medi-hotels we can staff is actually getting staff: nurses, SAPOL…

 

Wouldn’t you get more people lining up if you were to say, ‘we’re going to pay you a full time equivalent for the duration of this [pandemic] if you come and work here… or if you’re already working here, you don’t need to work anywhere else’?

 

We don’t know if we would. At the moment, we know we find it hard to get people… they get whatever wage they get paid, whether they’re SAPOL or whatever else. SAPOL is putting police on the ground who are, you know, full-time, public[-funded], well-paid people… and the Police Commissioner still has a hard time providing enough police resources to do this.

From a nursing point of view, the nurses are employed by SA Health in some shape or form – often full-time – so I’m not sure that’s right.

But what we need to do… is a risk-management game, you know, where we can be reasonably positive with a good testing regime that we know who’s positive and who’s not.

We get them in one place, where we have a higher level of all these provisions, and each one of them is sort of a risk assessment. We put them in place and that’s how we’ll [manage things].

 

So has the has the testing regime been deficient? Is the fact that it’s now moved to a weekly mandatory testing regime…?

 

No, I was actually talking about testing of the people in the hotel. So once you go there, you get tested on day one, as you arrive to go in there. And with that testing regime we have good eyes on who’s positive in the hotel.

The testing regime with the staff… again, that’s been an evolving issue. We didn’t do any testing in the early days of this. In fact, we were quarantining positive people at home in the early days of this, if you recall – that was part of our strategy.

But then we stepped it up, so now they all have to do supervised quarantine, which is what we called medi-hotels then.

Then, as you’re aware, we moved to surveillance testing and making testing available to people – that was [deputy chief public health officer] Mike Cusack’s announcement. So we started supporting people to get tested on the site and made it very convenient for them.

And then with this last outbreak, we’ve said that staff will get tested every week – so you can see us continually increasing… well, our risk appetite’s diminishing as this goes on.

 

The minister said he hadn’t read that Victorian interim report. Have you? Are you across the detail of that?

 

I’ve read it… I think there’s 76 or 79 recommendations?

 

Sure, and did any of that sort of ring alarm bells, where you’d say ‘are we doing this here? Should we be doing this here?’

 

Some of those things we were doing here – I think from the get-go our medi-hotel program has been good. My understanding is it’s been on the front of the wave of what’s been happening nationally… we’ve been adopting new practices quicker and faster and our risk appetite’s been lower than the other states generally, and certainly a lot lower than Victoria’s was – [although] Victoria’s hyper-sensitive now.

But when I was reading that- [and] don’t ask me for any specifics here, because I read it, you know, a week or so after it was released, and that was four or so weeks ago now… but a lot of [it is] saying, ‘Oh, that makes sense – they should be doing that’. And we were doing those things… a lot of those things we were already doing.

[But] there were a few things we said we didn’t want to do – we didn’t want to have a program where everybody only works for our medi-hotels for a non-dedicated facility… so some [recommendations] I thought weren’t appropriate.

 

But that particular one – and I don’t want to keep harping on about it – but that one, about not having dedicated workers, that one is something where in this instance, if it had been implemented, it would have cauterized that particular spread. Because that’s how it got to Woodville – because two members of the medi-hotel staff also had a second job.

 

Well, there’s some things about that which I can’t say, that aren’t public which… um…

 

So that’s not correct but you can’t say why?

 

Leave it at, you know, I know more about that case than you do. And just to say that’s not necessarily the case.

 

Does that go some way to explaining why the police taskforce that was set up spent their first weekend looking at CCTV from an unrelated medi-hotel?

 

I didn’t know they did.

 

Well, according to them, they spent the weekend looking at Peppers [Hotel] CCTV and the gentleman that they were investigating worked at the Stamford.

 

Well I didn’t know they did that… I didn’t follow that investigation very closely, obviously. So…

 

On that point, would you concur that there seems to be some form of a rift developing between SA Health and the Police – and the Premier?

 

I know people might create that kind of public narrative but] you couldn’t have two tighter agencies than Health and SAPOL… I don’t know that you’d get two tighter chief executives, working more closely, than then we do on this, and the partnership with SAPOL has been as tight as a drum.

Without them, we would not have achieved the sort of results we have achieved. Grant [Stevens] and his assistant commissioners have been outstanding.

In the early part of this [pandemic], I remember having a conversation with him when his assistants and my assistants hadn’t had a weekend – hadn’t had a day off at all – for about 40 or 50 days. And the point of our conversation that day was trying to work out how we can get our people to take a day off. Because there’s just so much going on. [So] we’ve been as tight as a drum.

On this particular issue –  you know, it’s clear… there’s national and international evidence, and there’s a professional culture, and there’s a policy position, and there’s a legal framework that says when people call contract tracers, the only use of that information is for the purposes of public health.

And that’s a very important point.

If we don’t do that, people won’t have the confidence to call. And if they don’t have the confidence to call, or be totally disclosing in those conversations, we miss where this outbreak might be going.

 

So should there never have been a police taskforce established? Would you have advised against that?

 

I didn’t get asked. I haven’t been asked. And I don’t have a view.

 

Did you proffer a view, despite it not being sought?

 

No.

 

Was it regrettable?

No – it just is what it is, you know?

I haven’t asked Grant why he did it… I mean, I can speculate as much as anybody else. But I’ve been pretty much fully seized with the outbreak and the rest of the health system.

By the way, there’s a $7 billion system going on in the background, which can be a bit of a distraction from a pandemic at times.

 

But if the principle is that all that information needs to be sort of sacrosanct, surely the very act of saying ‘we’re investigating this, and we would like to lay charges’ is unhelpful?

 

Again, you’d have to ask Grant.

 

I’m asking your opinion.

 

Well, I learnt about it at the same time as the public learnt that it was going to happen. You know, it wasn’t a surprise to me that it was going to happen… I mean, clearly, we made some pretty big decisions on the back of a piece of information that was provided, and I understand that the public might, for whatever reason… you can ask Grant, he initiated the investigation.

Our position was the same as it’s been for 40 years, which is: public health information is for public health purposes.

 

What about the rhetoric from the Premier about the man who ‘lied’? Was that helpful?

 

That’s for the Premier.

For us in here, the way this washes in here is that it’s got nothing to do with us.

Our job is to make sure we can find where this disease is, get a good read on where it’s going – and track it down. And, we say, ‘bag it up’. So it’s not going to affect our community, not going to affect individuals, not going to affect the economy.

That’s what we try and do, and a lot goes on around it. I mean, it’s an incredibly interesting and impactful thing, but our job – our only job – is to track it down. And bag it.

 

Are you still going on the theory that the initial infection in the medi-hotel was the result of surface contact?

 

No, we don’t know what it is.

As I said before, you know, the CCTV doesn’t tell us that there’s been any obvious breach.

So… there’s no real operating hypothesis for how that disease happened.

It would be great if there was because, you know, if we saw it was somebody going into a room or we saw it was, you know… somebody handling a rubbish bag without gloves on or something, we could get a good read on what it was. And that would be very comforting for us – we take great comfort in discovering that stuff.

We don’t like the fact that we don’t know. And that’s why the dedicated facility is going to be putting in place a whole lot of systems and processes that just eliminate – to the degree we can – any chance of the virus spreading around.

 

Just going back over the last few weeks and the narrative around the surface content – which came up in the very first press conference announcing the 80-something year old woman… the initial medi-hotel transfer is the only case that I believe has been linked to a likely surface contact?

 

Well, these are questions you’d probably want to ask Nicola, to be honest with you. The actual mechanics of the spread of the disease… you don’t pay for a plumber and fix the pipe yourself. Nicola and her team are very expert at working through those. And they’re learning all the time. So what they understand to be the case today might not be what they learn from further research on it, or what we’re learning internationally.

As I say, this whole dynamic of the super-spreader as sort of the engine room behind the bigger outbreaks is quite new, and it’s learned from overseas.

 

You mentioned before in terms of the Spanish gentleman, that… his interview was, you know, the [thing] that prompted the lockdown decision.

Can you just elaborate on that, because I’m trying to get clear – there are a number of different versions of this, and the Police Commissioner says it clearly was [but] Professor Spurrier says something different…

 

I can be crystal with you on this.

We had a run of about… I think it was 15 or 17 [infected] people over the course of just a few days, from that Saturday night through to that Monday. We put some restrictions in on the Monday.

We were in here very concerned at the speed at which this was spreading, and whether we had a handle on where it was.

Now, we were [already] contemplating – we had fully intended to put in place [and] it was necessary in our view to put in place a series of restrictions.

When it was apparent that a person had gone to a pizza place and simply bought a pizza in there – that was extremely concerning for us.

And so that, you know, I think the Commissioner used [the term] ‘the straw that broke the camel’s back’… that’s what made us pull the trigger on things – and we pulled the trigger quite hard.

That’s how that fits into the overall narrative. It wasn’t only that: we certainly would have been doing [and] it was necessary to do some quite significant interventions at that point [but] I sit here now 99 per cent sure that, if we hadn’t done what we did at that time, this outbreak would have extended for weeks and possibly months.

It was the unique time in the transition of the pandemic – we had serology that said we could put it back to a person in the hotel… we knew that person had arrived, I think on the second of November, as I recall.

That meant we were on the… you imagine a wave you’re trying to surf: we were on the top of that wave. And that pause allowed us to get on the face of that wave with our contract tracing capability and get in front of it.

And another 12 hours, 24 hours, we would have slid off the back of the wave and it would have got away from us. And people just don’t get that.

 

Should we be thanking this gentleman then, instead of trying to lock him up?

 

As I say, we were going to put in place significant interventions anyway… what they would have been, I’m not quite sure. Because it didn’t happen.
But we did put in very firm restrictions. And that certainly was part of the decision-making… It concerned us enormously the fact that somebody could go into a pizza place and catch a disease. If that had been the case.

 

Are you across the detail of this modelling that was done, that was that we were told was also central to that decision?

 

Basically, yes.

 

Would you concur that you were “99 per cent sure” that we would have had more than 100 cases by Christmas, based on the modelling?

 

You would definitively not have said that from the modelling. The modelling, I think as I recall, said we’re 50 per cent likely to have 99 cases… by early December.

Models work with parameters, likelihoods… so there was a 5 per cent chance we would have had 200 cases [and] that sort of narrowed down to that 50 per cent, which is the best you can get out of a model.

So I think, if I recall rightly, it was a 50 per cent likelihood to have 100 cases by the second week of December.

 

And that was based on that current trajectory?

 

 Yes. Getting these models right, obviously, the equations [and] assumptions all evolve over time, and so they get tighter and tighter.

 

What are the current models telling us?

 

To be honest with you, I haven’t looked at the current models. So it’s a balance of the model and what that data’s telling you, but also what’s actually going on on the ground and what the epidemiologists and the CDCB team are seeing – you know, where is this disease tracking and that sort of thing.

So the model might be saying [there’s] a 50 per cent likelihood of 100 cases in three weeks or whatever it was, but the epidemiologist might be seeing, you know, super-spreader events in a couple of places and we know it’s going to be worse… that’s not necessarily what we saw – there were some worrying things, but that wasn’t what we’ve seen.

 

So how are you feeling about it now? The media keeps asking the question about the champagne – what’s the ‘champagne status’ at the moment?

 

I do not drink champagne.

I think we’re quietly confident – I say, touching a piece of wood – that we’ve got this bagged up.

But we won’t be sure for another few weeks.

There were some ‘unknown unknowns’ – these things all turn on the ‘unknown unknowns’.

With the Lyell McEwin and those sort of outbreaks, there’s a small number of people who we say are ‘lost to follow-up’ – we haven’t been able to track them down. They’re very unlikely to have the disease, but who knows?

We’ve got to keep people getting tested, particularly if they’ve got symptoms – get them tested and then it’s detected as early as we can. Detecting this disease early was a great bonus for us… because it’s all about getting in front of the wave on this stuff.

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