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Months into Victoria’s second wave, healthcare workers, cleaners and other front-line staff continue to be at greatest risk of contracting Covid-19, as concerns remain over infection control and the government’s transparency about outbreaks in vulnerable settings. By Osman Faruqi.

Where Victoria’s second-wave cases are still occurring

A cleaner works at the Novotel Melbourne South Wharf hotel, where people who have tested positive to Covid-19 are in quarantine.
Credit: AAP Image / James Ross

As Victoria struggles to meet targets for the next significant easing of Covid-19 restrictions, The Saturday Paper can reveal the locations of multiple cases among hospital staff and contract cleaners working in high-risk settings that are not being disclosed by the state government.

Victoria’s fortnightly daily average of cases at the end of this week was 9.5, nearly twice the number required by the government’s road map before retail and hospitality businesses can reopen and more social interaction can occur.

The state’s average was trending down before large outbreaks occurred among vulnerable workers.

Documents obtained by The Saturday Paper show that since July 28, when the government forced companies to disclose Covid-19 cases among staff, one company has had more infections than any other business or organisation in the state, excluding hospitals and aged-care centres.

Spotless, which provides contract services across many industries, has issued more than 40 notifications to WorkSafe as the result of positive staff cases. Staff working for the company work across multiple sites, which presents significant risk in a pandemic. The business also has contracts in multiple high-risk settings.

Some of the notifications relate to Spotless contractors at schools in Melbourne, although Spotless has also recorded cases in shopping centres, aged-care centres, hospitals and quarantine hotels.

It has been publicly confirmed by the state government that at least one Spotless contractor worked at both a quarantine hotel and an aged-care facility.

In a statement, Spotless said that out of its 6000 employees in Victoria, 28 staff had tested positive for Covid-19. “These were confirmed as being community transmission cases and not as a result of workplace transmission. Contact tracing determined that a very small subset of these cases were acquired from co-workers because they were close contacts outside of the workplace (for example, living in a share house, co-commuting or were related family members).”

Spotless did not provide a breakdown of where these staff worked.

The company said it had “done everything we can” to support infected staff and “prevent transmission into the broader workplace”.

However, a former Spotless staff member disputed this. They had worked as a contract cleaner throughout Victoria’s second wave and were critical of the company’s procedures.

The cleaner said that staff weren’t provided with masks and instead were told to wear their own.

“There was no attempt to organise rosters so that staff interaction was being limited. They didn’t want to know if staff were sick, because they were worried that they would lose their contracts.

“Almost everyone I worked with was an international student. They were too scared to speak up because they were desperate for money. Eventually I quit after the company denied staff [I was working with] had tested positive. We weren’t safe. Everyone felt so unsafe.”

Spotless said in a statement that its workplace settings were “carefully managed so that workers are properly trained and provided with the right PPE [personal protective equipment]”.

The largest number of Spotless cases relates to an outbreak at Chadstone shopping centre. On August 12 an employee of Spotless tested positive. The centre didn’t disclose this on its website until August 15.

Three days later, the centre revealed seven Spotless staff members working at Chadstone had tested positive. A week after that, it reported that another Spotless staff member had tested positive.

Victoria’s Department of Health and Human Services (DHHS) confirmed there was an outbreak associated with cleaning staff at Chadstone shopping centre in August.

The centre’s owners, Vicinity Centres, told The Saturday Paper “we have been rigorous in our commitment to cleaning, hygiene and sanitising our centre since Covid-19 first emerged earlier this year and this will continue for the foreseeable future”.

A second Chadstone outbreak, disclosed on October 1, is now one of two key clusters in Victoria. DHHS says the second Chadstone outbreak has been traced to a person working at The Butcher Club store. This worker was a contract cleaner, linked to aged care, but they were not a Spotless employee.

Peter Robinson, co-director of The Butcher Club, told The Saturday Paper that the cleaner worked at the store from Monday, September 21, to Wednesday, September 23. On Thursday, the cleaner informed the store’s manager they had been prevented from leaving the house by police. The cleaner lived in a household of nine and DHHS believes they contracted Covid-19 from a sick family member residing with them, and that the cleaner should have isolated.

Three days later, on Sunday, the cleaner tested positive; on Monday the manager of the store did as well. DHHS contacted other store employees the following day, September 29, advising them to get tested and self-isolate.

By October 14 there were 35 cases linked to this outbreak. That includes nine staff from four shops at the centre, five customers of The Butcher Club, and five other customers and staff who attended the centre but have no identified link to The Butcher Club.

This cluster has now spread to the regional towns of Kilmore and Shepparton, breaching the “ring of steel” separating metropolitan Melbourne from the regions, via a truck driver whose son was an apprentice at The Butcher Club.

The other significant case numbers in recent weeks come from an outbreak at Box Hill Hospital. The original source of the outbreak has not been identified, although The Saturday Paper has confirmed that staff who have contracted Covid-19 include at least two nurses and one cleaner.

Cleaning and security staff who work in healthcare environments and test positive for Covid-19 are not counted in DHHS’s healthcare worker total. However, The Saturday Paper can reveal that 160 cleaners working in hospitals and other healthcare settings have contracted the virus.

In addition to the cluster at Box Hill, The Saturday Paper can further reveal that, since September 29, staff working at Royal Children’s Hospital, Werribee Mercy Hospital, Sunshine Hospital, Cabrini Malvern hospital and Casey Hospital have tested positive to Covid-19.

None of those cases had been publicly disclosed by the hospitals or DHHS, prior to The Saturday Paper making inquiries.

The two cases at Cabrini Malvern – a nurse and a clerical worker – have been linked to the most recent Chadstone cluster.

“Both staff members immediately notified the hospital when they became symptomatic, were tested and furloughed along with close contacts,” said Cabrini’s group director of medical services and clinical governance, Dr Fergus Kerr. “No secondary contact cases of Covid-19 have resulted from these cases.”

Since October 5, DHHS has linked at least 51 cases to healthcare workers in Victoria. Unlike at earlier stages of the second wave, the majority of healthcare workers contracting the virus work in public hospitals and other healthcare settings, rather than aged-care facilities.

Professor Catherine Bennett, the chair of epidemiology at Deakin University, says the persistent cases among front-line staff demonstrates “these are really the only areas where the virus can survive”.

“It’s the only way people have enough contact through the nature of their work and through working across workplaces that the virus will actually keep hobbling along,” she says.

According to Bennett, high-risk settings such as cleaning and healthcare suggest “we could start focusing some of our active testing on whether the people are symptomatic or not in those areas” and “help close down some of those other chains of transmission that are still persisting”.

Healthcare workers and professional groups, including the Australian Medical Association (AMA), have been calling for an improvement to infection control guidelines and processes for months.

The Victorian government initially announced a trial of “fit-testing” for N95 masks to ensure healthcare workers were wearing correctly sized protective equipment. After The Saturday Paper reported on ongoing cases in hospitals in September, the then state Health minister, Jenny Mikakos, announced fit-testing would be rolled out to all Covid-19 wards in the state.

However, a month on from that announcement, Victoria’s chief medical officer, Andrew Wilson, confirmed that fit-testing was still not occurring at all hospitals.

“It is becoming increasingly difficult for staff to understand why the response is not more proportionate in terms of trying to prevent infection in healthcare facilities,” says Dr Sarah Whitelaw, a spokesperson for AMA Victoria.

“We’re still waiting for ventilation audits in many health services. We’re still waiting for the operational detail of a respiratory protection program. We’re still waiting for fit-testing programs to be started in a majority of health services across Victoria.

“I think that the delay is becoming really difficult to understand.”

One doctor working at an intensive care unit at a major Melbourne hospital said that alongside the issue of fit-testing, there are also concerns that not all masks are adequately stocked in the sizes needed.

The doctor said hospitals need to co‑ordinate staff in teams and create rotating rosters so staff aren’t interacting with one another, as well as creating new tearoom and break room facilities to limit mingling.

These measures have been implemented at some hospitals but not all.

Concerns have also been raised about how quickly DHHS acted to contain the outbreak at Box Hill. The department first notified the public of an outbreak on October 8. At that stage, two staff and one patient were linked to the outbreak.

However, documents obtained by The Saturday Paper reveal that the first case at the hospital was actually reported to the government on October 5.

By October 10, a total of 10 cases were linked to the Box Hill outbreak. At that time, only staff who had spent more than half an hour on the Covid-19 ward were being tested.

On October 11, when the outbreak had expanded to 12 cases, the government announced all staff on the affected ward would be tested, regardless of symptoms or how much time they had spent on site. By October 15, the cluster had 14 cases.

The cluster, as well as the other previously unreported cases at hospitals, shows how even a single infection can rapidly spread in a high-risk environment, putting healthcare workers at risk and jeopardising Victoria’s case targets.

“It’s clear that healthcare worker infections are a key area that is holding us back from meeting the government’s targets,” Dr Whitelaw says. “And that is a terrible responsibility to bear.

“We are so aware of the negative impacts of lockdown and the need to get out of lockdown as quickly as possible but safely as well.

“It’s awful wearing PPE. It’s awful not being to talk to colleagues in the tearooms. But if that’s what it takes to stay safe and end the lockdown, we will absolutely do it.”

This article was first published in the print edition of The Saturday Paper on Oct 17, 2020 as "Case chase".

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Osman Faruqi is a journalist and the editor of 7am, Schwartz Media’s daily news podcast.