SHE Pod Season 2 Episode 8:Jane Williams on Quarantine

10:54AM Aug 5, 2021

Speakers:

Kathryn MacKay

Jane Williams

Keywords:

people

quarantine

hotel

laughs

home

australia

felt

guess

talking

reciprocity

situation

jane

trust

countries

bridget

travellers

spoke

thought

uncertainty

ethics

Hello, and welcome to the she research podcast. I'm your host, Kate MacKay. And today I'm joined by Jane Williams to discuss her work on quarantine. Jane has been on the podcast before, Jane's has been working on the area of pandemic preparedness for a while since at least 2018. And has a couple of papers under review on questions about quarantine and risk and COVID-19, the current pandemic. So welcome, Jane.

Hi, thanks for having me.

Thanks so much for joining me. I think that this is a very timely conversation, and especially to be talking about quarantine when we in Sydney are currently under lockdown. So I guess I wondered if you could give me a little... give me and the listeners a kind of high level understanding of what the ethical issues are around quarantine?

Hmm. It's kind of interesting, actually, because there's been quite a lot of work done pre-COVID about, I guess, the ethics of quarantine. But the interesting difference, at least in Australia is that none of that was premised on you being locked in a hotel room for 14 days.

(laughs)

So what's in the literature. And what we've been finding when we've been talking to people isn't necessarily the same thing. So I guess the ethics of quarantine are that you're severely restricting somebody's movement, and that's for the good of the public rather than the good of the individual. Right. So there's a decent amount that we that 'sin the literature about reciprocity. So ideally, you need to be helping people to quarantine. So I know that in Canada during SARS, there were quite a few people quarantined at home, I believe they were given assistance with various things, particularly around food, shelter, different shelter, if they needed it, that just that sort of thing to make sure people could essentially discharge their responsibilities to the public in as easy a way as possible. So that's been kind of the basis of talking about quarantine. So, you know, like, with all of that Least Restrictive means stuff, don't do it unless you have to. With I... yeah, I don't really want to (laughs). Whether or not, that's a good approach. But, you know, ideally, it would be something of a last resort, and that you would help people do it, you would make it as easy as possible for them to, I guess, do the right thing to protect other people.

So is the main difference with the way that quarantine has been thought about previously and the way that Australia and maybe some other countries... I'm not exactly sure, but but at least Australia is doing quarantine now, is that the difference is that it's hotels versus homes?

Yeah, yeah.

Okay.

So actually, although it was interesting, because none of the previous literature like the pre-COVID stuff really talked about where it would be so we're kind of... when I read it, I'm just, I'm kind of inferring what the reader thought, essentially, I think people think that it's mostly going to be at home, it could be that it would be in sort of quarantine space. Obviously, there's a really long history, in many countries of there being quarantine stations. In Australia, particularly we love a bit of quarantine in Australia (laughs). Itgoes along with all of the sort of closed border and Border Protection stuff. So it's not like quarantine itself is new. It's not like quarantining somebody in a space that isn't their home is new. But what we're doing in Australia now is new, as far as I know. So as far as I can tell, Australia was the second country in the world to introduce compulsory hotel quarantine. I think Macau was doing it before us for travellers from Mainland China. And I think so the real differences here anyway, is that you don't know where you going. And you don't really know what to expect a lot of the time. All of the the states and territories and individual hotels all have different rules. So when I say you don't know what to expect, it's not that you just don't know if you're getting a fancy room or a less fancy room. It's like, will you have any access to fresh air? You know, will you be able to get the kind of food that you want to get, you know, will you be able to get stuff delivered to the hotel. If you know people in that city or whatever, all of those things you just kind of figure out as you go along. So there's there's quite a lot of uncertainty involved. And I'm not sure that that has previously been the case, partly because if you're at home, you've got a lot less uncertainty. So know what to expect, and you know where your support systems are or aren't. And if you're in a quarantine station, that that's a really highly regimented situation, right. So you don't have individual hotel properties, you know, figuring out the best way for them to be able to manage the situation. So it's really messy.

And you've been I have two sort of related questions for you. But the first one is, you've been talking to people who were in quarantine...?

Yeah, we so I've been working with Bridget Haire on it. She's at UNSW at the Kirby Institute. We have spoken to 73 people.

Wow. Okay.

Who.. So we did kind of it was a... when we started this study, we didn't know that we were going to be in lockdown when we were interviewing people. So it was a really, really interesting situation. We started this in March of last year of 2020. So we, we got a little bit of funding, and there was this point... So in Australia at Hotel quarantine started on March 28th. And for... I want to say two weeks, or it might have been 10 days before that people were actually allowed to quarantine at home. So the Australian Government was saying to all Australians overseas, 'you need to come home'. Obviously, that wasn't practical for a lot of Australians living overseas, you had like, you know, jobs and lives and kids in school and all of that. But for people who were on holiday, or people who were kind of in slightly uncertain situations overseas, or particularly people who were working for Australian organisations overseas, they tended to be the people who were coming home in March. So we spoke to 15 people who quarantined at home, and 15 people who quarantined in hotels, in March and early April. Then we did a second phase, all of this comes with, you know, getting a little bit of extra money, right? (laughs).

Yeah.

We did an extra phase in talking to people who had quarantined in Melbourne, in... around the time when there was a really big leak. That, I guess, as they call it, from hotel quarantine into the population in Melbourne that that led to a very long lockdown in Melbourne, I believe it was like 112 days or something like that. So we spoke to people who'd been in those hotels just because we were really interested to know if their experiences or what they saw or how it was administered, differed from the people who we'd spoken to a few months earlier. And then we did a third phase of interviews, again, with a little bit more money (laughs), I'll give a shout out to APPRISE, which is the CRE prevention preparedness CRE that funds us... to do... to talk to people who had to pay for hotel quarantine. So it was government funded until the end of July, 2020. And now people have to pay... generally... again, changes from state to state and territory to territory, changes a little bit from hotel to hotel because some hotels do some upselling. But it's around $3,000 per person. So that was the study that we did. We tried to capture all of these different experiences. You know, it was really similar how people relayed pretty similar experiences across the whole time, which was kind of depressing, actually. Because they had to throw this programme together so so quickly. At the end of March, like they were they were really making it up on the fly. And I have some sympathy for that. But then when we're getting people telling us the same stuff, and like January 2021 it was like... oh it's a really depressing (laughs).

Yeah, they had a lot of time to figure those things out.

They really did. And I think for a long time, people thought it was going to be a pretty temporary fix. Now it doesn't feel like it's a temporary fix. It feels very much part of whatever this new normal is, at least in Australia, certainly. Probably in New Zealand as well. I would say...

That kind of leads the second question that I had for you, Jane. And I don't know. I don't know if we know this or if you know this or you know what the data is but... is hotel quarantine noticeably more effective than at home quarantine for the purposes it's supposed to serve? For sort of infection control?

I think it probably is okay. But I don't have I don't have data on that it's so hard to compare because there are some countries that do in-home quaran... well because countries do in-home quarantine differently. Some of them, it's based on trust. Some of them particular... and a lot of them it's risk assessed as well. So if you come from a country with a fairly low COVID prevalence, then you might be able to quarantine at home. Whereas if you've come from say, a hotspot, then you might not be allowed to quarantine at home. And also other countries might give you like monitoring bracelets, I know that... I don't know about today, but a few months ago... it changes so often... in Singapore and Hong Kong, they were enabling that for particular, I guess I want to say particular kinds of travellers, you know, people they deemed low risk. Australia and New Zealand are, as far as I can tell, with the exception of the Australian-New Zealand bubble, the only countries that don't do any risk assessment. So here, and I'm get... I will answer your actual question (laughs). But it doesn't matter if you're vaccinated or not vaccinated doesn't matter if you've had COVID already, or anything like that. So I would argue it comes down a bit to a trust thing. I don't think that in Australia, we do a great job of demonstrating trust, I guess, mutual trust between the population and government and public health agencies. You know, and I'm talking about that, and as a kind of mutual looping thing, not just a one way thing. At the... you know, and we love to tell on people as well (laughs). All of us little, mini police officers. At the beginning, when you could quarantine at home, there was just such a lack of trust, and people doing the right thing and doing it properly. And so that was shut down incredibly quickly. I... yeah, I mean, I do remember watching a thing on the news, right, where these young people had... (laughs) young people had arrived back from like, I don't know, Bali or somewhere. And they were being filmed by a news crew, because they were coming back in this first wave of returning Australians and, and this guy was like, 'we're gonna have a big party at home tonight'. And his partner was like, 'Jesus don't say that you're gonna go viral we're not allowed to do that' (laughs). It was just such a such a bummer of an example of the way things can go wrong, and where things like that are really highlighted. So it lead... like, I'm not blaming the whole thing on that dude. But there are a few situations like that, where it just kind of ruins it for everybody.

(laughs). Definitely.

So I think that even though quarantining in hotel is not ideal, because hotels are not built for quarantine, you know, they're not built for infection control,.

Right.

They are much more heavily supervised than anything you could do at home.

Including with the sort of ankle bracelets or...?

Yeah, because you, you can certainly monitor whether or not people leave their home, you can't necessarily monitor whether visitors come to the home.

Oh right.

And so there are certain ways of like, I've heard other things where somebody will call you and you have to go outside with your smartphone and take his photo of yourself next to your letterbox, so they can see that, that you're at the right number of house. And, you know, there are all sorts of things that people can do to make sure that the individual isn't leaving. But you can't necessarily I mean, it's complicated, right? Like, who do you live with? Do they need to quarantine as well? You know, if you have housemates who need to go work... so it's really messy. I think there's no doubt that doing it in a hotel is more effective, but I think there are some costs to that as well.

So, I guess I was gonna ask you a probabilistic question, which isn't very fair (laughs). So let me back away from that one (laughs). So in terms of the kind of ethics of quarantine, what are some of the findings that you and Bridget are are discovering through your research?

Yeah, so there's a few things, very top level. There is quite a lot of risk to participants of other health things in hotel quarantine, particularly the people who we interviewed who were at Howard Springs, which is not a hotel but that is a purpose... well it's not a purpose built quarantine facility. It is an ex-mining camp, I think, very much built for single fly in fly out workers. There were a lot of accidents and so on that happened there the people recounted because they they weren't necessarily... yeah basically, if anybody had anything non-COVID related happened to them, then it wasn't great. You know, there was excellent, I think, medical support when it came to people with COVID symptoms, for other things not so much at all. Like we had one guy who was quarantined in a hotel in Brisbane, I want to say... who had gout. And he was in a huge amount of pain, and really, really struggled to get appropriate medical care. And had to really battle with hotel receptionists and police officers to be allowed to talk to a doctor, because you know they were like, 'what do you want to talk to one for' and he was like, 'because I'm sick'. 'What with' (laughs). And he was, he was also feeling very angry about his situation. So he was like, 'I'm not going to tell you what is wrong with you, because it's not your job. You know, I need a medical professional' anyway. So we did find that a lot of people had other non-COVID related issues that were not well dealt with at all. And that really needs dealing with particularly since in Australia, they're talking about making course built... ah purpose-built quarantine facilities, not in cities. They need to be able to provide appropriate medical care. There were also some pretty significant mental health issues that quite a few people faced. Those weren't well dealt with, it may be improved, now, I mean, initially, it was like, well-meaning people sort of volunteering for the Red Cross, trying to solve those sorts of problems, not trained professionals, you know. We also found that there, that there was a huge amount of uncertainty involved in the whole process. And that really bothered people. So you know, I mentioned before that nobody knows where they're going. And one of the things that happens, and this just is so crazy to me, but I guess there are reasons for it. I just don't know what they are, is that you arrive in Australia, you arrive in the city, and then you get on a bus and the bus driver won't tell you where you're going. So if you for argument's sake, let's just say we're flying into Sydney, we know Sydney, we know (laughs), the hotels would be you know, don't know where we're going, don't know what to expect. And nobody will tell you where you're going until you pull up in front of the hotel. So many people told us this, it was like a guessing game, right? So they would be driving down the road. And it's like, okay, we're heading into the city. So you know, and they would be like, maybe it's this one, maybe it's that one. And people have been reading Facebook, often for months before they come back. And they are very aware of differences between different hotels, big differences in things like food, hotels that have balconies, hotels that don't and they're super, super anxious about these things. which is I think, probably why they don't tell people where they're going, because if they say, 'oh, we're going to this one', they don't want people to like revolt (laughs) on the bus or... I don't know. So that was extremely difficult for people. There are other kinds of uncertainties, they won't give negative COVID test results, which is not great. So there are all these compulsory COVID tests. And then people just get told, 'don't worry about it, we'll just get in contact with you, if you're positive'.

Oh.

It's sort of a no news is good news sort of approach. Which would be fine, except for that people don't know what's going to happen to them if they are positive. And people call you and knock on your door all the time for other reasons. So people found that to be incredibly difficult, like every time the phone rang, they're like, 'Oh, God, is this my COVID result? Am I positive? Or is this some well-meaning person calling from a volunteer agency to ask if I'm okay' (laughs). So yeah, that sort of thing is really hard.

Hearing about this kind of thing, just makes me kind of reflect that it's... it's strange, people are sub... people are subjected to a kind of hostile surveillance. From the point of getting off the plane like just not telling people where you're taking them seems like an act of hostile control, that is really at that point, not necessary. They have no choice anyway.

Yeah.

And I Just find that that treatment of people is very... it's presuming that they're always going to be doing something wrong. I think it comes back to what you were saying about trust and the lack of trust.

Yeah, I completely agree. And, you know, we're seeing this in Sydney now. Right? Just with, you know, calling in the whoever, whatever Armed Forces.

Yes.

Just assuming that, that people are going to be doing the wrong thing and we need to catch them.

Yeah.

That I think is a particular... a particular cultural thing that Australia often defaults to. And people... people did react really poorly to that sort of thing, understandably, right. They, they did feel undervalued. So many of our participants said they, they felt like less than human, or that they were being treated like animals, or whatever. And that all stemmed from just never quite knowing what was going on. You know, some of them also thought that it was a deliberate tactic to kind of just keep them unstable. You know, if you don't quite know what's happening when, then you're going to be more I guess, submissive, or at least more likely to comply with whatever you're asked to do. Whether or not that's the intention, I really can't say, but there was definitely the way it was felt. And so this, I guess, in terms of the ethics, this... there's a lot of talk about reciprocity, when it comes to quarantine, and the things that we ought to be doing really, to make the process as easy as possible for the people who are really not doing it for themselves, and they're doing it to protect the public. And at first, I was quite focused on the money thing, right? It's like, really? We... we're asking people to pay this much money to do this thing that is for the greater good, if you like. Actually, we found people didn't mind there being a charge involved, they, it was relatively easy to pay it, you could, you know, you can pay it off in small instalments, if you don't have the money, you can apply for exemptions and certain circumstances and so on. So people felt... you know, they didn't love it, but they, they understood it, and they felt fairly well supported on that. For me, the... the reciprocity, that that is really missing is the respect actually, and the treating people well, or treating people... really acknowledging what it is that they're doing and and not treating them like they're, you know, potentially just trying to mess up the whole system. Really, people are very compliant. And they're doing this because they know they're doing the right thing. And they've, they it's a necessary evil, if you like. And I think acknowledging that and really valuing it and, and helping people to feel valued in... and making what I think is a pretty big sacrifice for public health, I think is what's missing and what's really important.

Yeah. Well, Jane, thanks so much for speaking to me about this research. I hope that it continues to go well.

Thank you.

You're welcome.

I hope they stopped using hotels for quarantine (laughs).

I do to. Like I hope that they start to adjust the rules once people begin more vaccinated and the risk assessment that you were talking about, but I guess we'll have to see.

Yeah, yeah, we can just hope.

Yeah.

Thanks, Kate.

Oh, thanks for speaking with me, Jane. Jane's research is still under review, but we'll be sure to update the links to this episode once some of her and Bridget's work has been published. Thanks so much for listening to this episode of the SHE research podcast. You can find the transcript for this discussion links in the episodes notes. SHE Pod is hosted by me Kathryn MacKay and produced by Madeline Goldberger. You can find our other episodes on Spotify, Radio Public, Anchor, or wherever else you get your podcasts of quality. Thanks again for listening. Bye.