Challenges linger as Victoria opens up
As metropolitan Melbourne reopened this week after more than 100 days in lockdown, the Andrews government’s focus shifted from regaining control of the second wave to the challenge of managing the coronavirus and keeping Victoria open until there is a vaccine.
A government database comprising all Covid-19 cases among workers, exclusively obtained by The Saturday Paper, confirms workplaces were a key vector of transmission during the three-month lockdown, something the Andrews government has sought to address through a program of “surveillance testing” announced in October.
The program will require relevant employers to test 25 per cent of their workforce each week, with a goal of every worker being tested over a four-week period.
But epidemiologists have raised concerns that the program has been rolled out only in certain food processing facilities – including abattoirs and meatworks – as well as supermarket distribution centres and other perishable food distribution centres.
The database of more than 5000 workplace Covid-19 notifications shows that since July, healthcare settings, including aged care and hospitals, have been the most common worksites for positive infections by far, making up 36 per cent of all notifications. Education settings, including schools, made up just under 10 per cent.
Retail, manufacturing and construction workplaces have all had more notifications than meatworks but aren’t included in the surveillance testing program.
There have been more than 260 staff notifications across contract job agencies, including contract cleaners. The Saturday Paper has previously reported that one contract cleaning company, Spotless, has reported more positive cases among staff than any other organisation, excluding aged care and hospitals.
Professor Catherine Bennett, the chair in epidemiology at Deakin University, told The Saturday Paper that although the surveillance testing program was vital, it needs to be expanded to other high-risk industries.
“We know contract cleaners moving between multiple sites are the people that are most vulnerable to infection,” she said.
Testing requirements, Bennett said, is “not just about protecting the workforce, it’s about getting a read on what’s happening in the wider community”.
“It would be good to extend that into cleaners just because they featured in more recent outbreaks. But they were also a logical group to be an indicator of what’s happening more widely.”
Reflecting on the second wave, Bennett said “the key element, if you’re looking at that time line in contact tracing, is testing”.
The Covid-19 case database also shows that suburbs with the highest rates of workplace notifications correlate to areas where outbreaks have been most commonly occurring. Excluding Melbourne’s CBD, the highest number of workplace notifications occurred in Dandenong, Werribee and Hoppers Crossing. Those suburbs have the highest rates of positive Covid-19 cases in Victoria.
Bennett said the Andrews government should be responsive to new outbreaks and adapt its surveillance testing program based on what workplaces emerge as high-risk as the state eases out of lockdown.
Despite the fact aged-care facilities and hospitals have been key sites of transmission during the second wave, there is still no government requirement for ongoing asymptomatic or surveillance testing of workers in those settings.
Some hospitals and aged-care centres have established regular testing of their staff, but only on an ad-hoc basis. The risks of inconsistency in public-hospital staff testing were made clear after an outbreak at Box Hill Hospital earlier this month.
Initially, only staff who worked on the hospital’s Covid-19 ward for more than 30 minutes were tested. Following an outcry from healthcare workers and organisations such as the Australian Medical Association, the Department of Health and Human Services announced all workers on the site would be tested. By that stage, the cluster had already grown.
It has been confirmed by DHHS that the Box Hill Hospital outbreak was the catalyst for the cluster in Melbourne’s northern metropolitan region, which this week threatened to hold up the city’s reopening.
But the Victorian government’s management of the northern metro outbreak is also a clear case study of how much Covid-19 processes have improved, after the state’s contact tracing system has effectively been rebuilt in response to the second wave.
At the start of Victoria’s second wave, tracing capacity was overwhelmed. Patients waited days for test results and there were multiple reports that DHHS took weeks to speak to close contacts and ask them to isolate. Very little information was shared with the public about high-risk exposure locations.
The number of cases “under investigation” by DHHS, meaning contact tracers had not yet identified a source of transmission, peaked at just under 4000 at the beginning of August. The inability of contact tracers to rapidly identify how the virus was spreading and isolate those at risk has been shown to be the reason a handful of cases linked to staff in hotel quarantine ballooned to thousands.
At the time, the Victorian tracing system relied on pen, paper and fax machines, creating serious bottlenecks. “We had some old systems, and when we wanted to have surge support from all other jurisdictions, we had to go to a paper-based system,” Victoria’s chief health officer, Brett Sutton, told doctors in a candid briefing, as previously reported by The Saturday Paper.
Four months on, contact tracing has been substantially overhauled. DHHS staff now work in different teams to manage positive cases, close contacts and secondary contacts (contacts of close contacts). A new database management tool, implemented by the United States tech giant Salesforce, is being rolled out to improve the system’s efficiency. In regional areas, tracing teams have been devolved to local health services, rather than being managed centrally by DHHS.
In October, the deputy chief health officer, Allan Cheng, announced that Covid-19 case managers would be assigned to family cases to streamline communication and avoid confusing messages being sent, after GPs raised concerns that patients linked to the outbreak at East Preston Islamic College were being contacted by multiple contact tracing teams.
“It’s a really complex system when you manage people within larger households, which is often where we see these outbreaks,” Professor Bennett said. “Some people might have the virus, some people are quarantined because they were exposed, so you have to actually have incredibly clear communication so that the situations for each individual can be managed. And I think we’ve heard in this last outbreak that there’s still some work to do.”
Despite the progress, however, epidemiologists and those familiar with Victoria’s current contact tracing system told The Saturday Paper that gaps remain in the state’s pandemic response plan.
The government announced in September it would also establish suburban tracing hubs across Melbourne. As of this week, they still weren’t operational.
The Andrews government also announced this week that it was planning to expedite contact tracing by developing an online tool allowing positive cases to answer questions before they spoke to a member of the contact tracing team. A source familiar with the tool said it was available only in English and would thus be of limited use, given clusters have often centred on migrant communities who face language barriers.
It also isn’t clear when Victoria will roll out its QR code system, similar to that used by patrons in New South Wales and the ACT to check in at restaurants and bars. The ACT government offered its QR platform to the Victorian government to help map movements and identify individuals at risk, but Premier Daniel Andrews said the ACT system was not able to be connected to his government’s IT platform. Until the state develops its own QR system, businesses are relying on pen and paper for maintaining records.
For their part, doctors still have concerns about Victoria’s ability to manage testing.
One doctor who operates a testing clinic said they have been experiencing delays in results for Covid-19 tests. “At the start of this week I had over 40 patients come in for tests,” they said, “and only 25 per cent of them got their test results back in 24 hours.”
Another doctor who manages positive patients told The Saturday Paper they were concerned feedback from healthcare workers on the ground wasn’t able to be easily fed into the centralised tracing system.
“If I find out information that means a patient should be immediately put into hotel quarantine, I have no way to directly contact the public health team,” they said. “I have to call the same hotline as the general public and speak to an operator.”
One patient who had a Covid-19 test at St Vincent’s Hospital this week was told that due to an “IT error” it would take up to four days for their test to be processed. The hospital confirmed there had been a “network outage” but said it had been able to resolve the issue.
The Saturday Paper put questions to DHHS about its contact tracing upgrades, including how many staff it included, whether outsourced call centre workers were still being used and if software upgrades had been completed. At time of press, the department had not responded.
This article was first published in the print edition of The Saturday Paper on Oct 31, 2020 as "Open to improvement".
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