The New South Wales government prepared a confidential report congratulating itself on how it managed the March 19 arrival of the Ruby Princess cruise ship, which was responsible for the largest single outbreak of Covid-19 in Australia, including 26 deaths here and overseas.
The undated and unattributed report, which was tendered into evidence at the Ruby Princess inquiry this week, appears to blame the federal government for what became at least 1000 Covid-19 cases. It defends the NSW Health assessment process that designated the ship as “low risk” ahead of it docking in Sydney.
It says if officials had kept passengers aboard longer instead of letting them disembark and travel home to self-isolate, the infection rate would have been worse.
This is despite evidence that officials inconsistently applied their own coronavirus-specific protocol, leading to passengers disembarking before the results of Covid-19 testing were known.
The nine-page document says the process “acknowledged there is no ‘no-risk’ setting for Covid-19 but balanced the level of risk against the benefit of removing passengers from a cruise ship on which the virus could be circulating”.
Grilling NSW chief biosecurity officer Dr Sean Tobin on Wednesday, commissioner Bret Walker, SC, condemned the report as “spin”. Walker said the sentence about balancing risk contradicted the sworn evidence Tobin had given, which stated there was no public health benefit in letting passengers disembark.
“How could you have let that through?” Walker demanded of Tobin, who contributed to the report.
Tobin suggested it was “a mistake”.
Walker said the document was “assembling ex post facto excuses, regardless of whether they are true or false”.
“I don’t think that was the intention,” Tobin replied. “… I was trying to provide an honest account of the process.”
Asked why the ship’s 2647 passengers were allowed to disembark before the results of Covid-19 testing were known, Tobin said officials did not want to inconvenience passengers with a delay.
“So they could get home to their beds?” Walker asked.
“To their flights,” Tobin replied.
The Ruby Princess’s arrival followed the federal government’s announcement banning cruise ships other than those already at sea.
At the time the NSW government report was prepared – apparently between late March and early April – 337 Ruby Princess passengers had been diagnosed with Covid-19.
“It is likely that many more cases were averted by their early disembarkation into self-isolation at home,” the report says. It does not mention some people had died.
The report says the Australian government determined policy for international arrivals and was responsible for border control, including granting permission to dock and “advising international travellers about any requirement to self-quarantine”.
Tobin and his colleague, Professor Mark Ferson, gave evidence as members of the assessment panel that designated the Ruby Princess low risk, based on the percentage of passengers and crew displaying flu-like symptoms.
Tobin said this was primarily because none had travelled recently to countries then listed as high risk for Covid-19: China, Iran, South Korea and Italy.
But the benchmark list had been scrapped days before the Ruby Princess docked due to the virus’s global spread and was replaced by a broader criterion of any overseas travel.
Tobin also said while “a fair number” of passengers had presented with respiratory symptoms, less than 1 per cent had a flu-like illness, distinguished by fever.
A rate above 1 per cent qualified a ship to be rated as medium or high risk.
In an email exchange while the protocol was being drafted, Professor Ferson suggested boarding every incoming vessel would be onerous for weary staff, and testing passengers without a travel history would be “overkill”.
“If a passenger is diagnosed incidentally after disembarking, we will be asked why we missed a case and it will look worse for everyone,” he wrote.
This week, he told the inquiry the comments were “silly” and said he regretted them.
The assessment panel based its risk calculation only on a subset of passengers with a fever, not a bigger group who had respiratory symptoms, despite knowing Covid-19 did not always involve a fever.
That rate came in at 0.94 per cent – just under the threshold that would have required health officials to delay disembarkation until Covid-19 test results were known. Instead, passengers departed more than 24 hours before results revealed some had tested positive.
If the calculation had been based on the broader group, the rate would have been 2.94 per cent.
Under questioning from Commissioner Walker and counsel assisting Richard Beasley, SC, Tobin acknowledged neither the protocol nor the panel considered the possibility that people without symptoms might carry the virus.
Tobin also did not see the ship’s health log, filed the day before it docked.
If he had, Beasley suggested, he might have noticed that most respiratory cases had presented to the ship’s clinic in the previous three days, suggesting something was spreading quickly.
“I think that would have been useful information,” Tobin said.
Walker suggested it was crucial to a clinical judgement to establish if numbers might have “gone from zero to 36 in two days”.
“I hadn’t considered that,” Tobin replied.
He was asked what risk rating he would have given the ship had he been aware of later evidence the trajectory had risen further.
“It would be a medium risk,” he said.
Instead, officials assumed an absence of Covid-19 risk because some passengers had tested positive for flu – unaware it was possible to have both at once.
Tobin was asked to explain the NSW Health report’s statement that self-isolation at home was “a much safer option than leaving passengers on board”.
Walker reminded him that he’d already agreed there wasn’t a need for people to disembark urgently to avoid spreading infection.
“[That] applies to other ships, other places at other times, doesn’t it?” he said. “It reads like distracting PR.”
“That wasn’t our intention, I don’t think,” Tobin responded.
Beasley suggested that sending people into the community instead of holding them “for a few hours” to wait for test results was “by no means a safer option” for those who might become infected.
Tobin quietly agreed.
This article was first published in the print edition of The Saturday Paper on June 13, 2020 as "NSW lays blame for Ruby Princess on feds".
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