Due to the highly infectious and transmissible nature of the new variants (mutants) of the SARS-Cov2 virus, in addition to the increased evidence of its potential for small droplets and airborne transmission, it is necessary to consider the shared ventilation and air-conditioning plans in quarantine hotel buildings. Hotels were not designed to control the air flow between different rooms and levels, which is necessary in respiratory hospital wards, for example. Therefore, a system similar to the Howard Springs facility in the Northern Territory with separat ventilation for individual rooms would be a safer option. Furthermore, the use of the N95 grade masks and face shields in addition to other PPE measures should be considered for all staff working inside hotels where infected travellers are quarantined.

The use of hotels located close to the heart of Australian capital cities for quarantine will continue to put much of the surrounding population at risk. Hotels are not designed to effectively isolate those being quarantined from hotel staff and subsequent interaction of staff with the wider community.
 
Each time a hotel quarantine breach occurs in a capital city the subsequent requirement for tracing, extensive COVID-19 testing and potential lockdown is both disruptive and costly.
Quarantine needs to be undertaken away from large populations found in our capital cities and while some sensible suggestions have been proposed such as regional city locations; the Federal Government has indicated the scale needed to deliver an effective alternative problematic.
 
The historical practice of quarantine began in 1348 in Venice where ships arriving from infected ports were required to remained anchored for 40 days before passengers were allowed to disembark. Finding enough suitable locations for quarantine away from major population centres may prove difficult but necessary to prevent potentially higher transmission of COVID-19 in capital cities.
 
I cannot offer advice on potential effective real estate options for this purpose but wonder if the Venice approach (for a shorter period) might be feasible? How many currently unused cruise ships are available for offshore quarantine?

Whatever hotel quarantine system is developed going forward, whether by the Commonwealth or the States, attention must be given to the working conditions of those employed. They must be paid well enough that they only work this one job, i.e., as part of the quarantine system. They should receive medical and social benefits associated with their positions, including paid sick leave to encourage workers to step forward for COVID testing beyond whatever routine testing they have to undergo. Should quarantine workers become infected with COVID-19, they should receive free childcare, as well as safe, government-funded isolation locations, should they feel they want to avail themselves of such facilities. Doing so is in keeping with our reciprocal obligation (that of Australians as discharged via government) to those who place themselves in potentially harmful situations, not unlike healthcare workers.

Despite Australia's relative overall success in SARS CoV-2 infection management, there is no guarantee that this state-of-affairs will continue when challenged with new more infectious and/or virulent variants as we are being now. Testing methods and quarantine procedures should be reviewed regularly to be sure that they are fit-for-purpose for mitigating the spread of the most infectious variants that are currently at large. Multiple tests are in use across the States, and these should be systematically evaluated, validated and if possible standardised.

The same applies to quarantine rules. This would be best managed at a National level to make sure there is regular and informed evaluation of the changing biological threat itself,  and to ensure effective quality control of the whole process. The virus is evolving, and as this continues the biochemical and infectious properties of the virus will also change. This could affect the effectiveness of detection methods as well as changing incubation times and infectivity time-windows (when and how long infected people pose the highest transmission risks). Effective quarantine management would be dependent on understanding and responding to changes in those dynamic properties. The prevailing view is to stick with what we have got as it has worked well so far. In fact, there have been multiple biosecurity breaches, and these will continue to occur so long as potentially infectious individuals enter the country.

The fact that Australia is still relatively safe gives us an opportunity to conduct a national review and harmonisation of procedures while not under the disruptive pressure of an ongoing major outbreak that continues to plague other countries. With this virus the price of our safety is long-term vigilance at the individual, state and national levels but having national guidelines and procedures would help.

From the media reports it would appear that the use of RPE (respiratory protection equipment) among (some) hotel quarantine workers is sub-optimal. Options such as full face respirators already exist and would provide a higher level of protection for such workers. Firefighters and many other workers are provided with this type of RPE, so why not hotel quarantine workers? These RPE also protect the face/eyes from contact transmission.

Many hotels are also not optimally designed for air exchange – particularly in corridors, suggesting that aerosol transmission is a likely route of infection – especially with the more virulent strains of COVID that are now present in hotel quarantine. Unless we mandate that hotel quarantine workers live and remain in the hotels they work in for the duration (which would be impractical), then it seems we need to adopt higher levels of protection, such as those already used in many workplaces for hazardous aerosols.