South Australians are in lockdown for the next six days following Covid-19’s escape from a Medi Hotel. This follows the Medi Hotel breach in Victoria, which led to residents of that state having to lockdown for 112 days. On the back of these outbreaks, serious questions are being asked about the effectiveness of Medi Hotels, including as part of national and state inquiries.

So, what can Australia do better? What can we learn from the way other countries are managing Medi Hotels for incoming travellers?

In an ever-changing pandemic environment, regulations are evolving as governments deal with the unprecedented situation. Some Australian states have now closed the borders with South Australia and international arrivals to the state have been banned while South Australia copes with its current Covid-19 outbreak. However, with the exception of South Australia, most state travel restrictions and quarantine requirements are easing, while international travel regulations remain rigid for the time being.

The rules around hotel quarantine vary from state to state in Australia. When South Australia was accepting flights from overseas, travellers were required to quarantine in a hotel upon arrival for 14 days.

Since 18 July, international arrivals have experienced hotel quarantine at their own financial cost. The total cost of a two-week stay in hotel quarantine in South Australia was $3000 for an adult and $500 for a child at a flat rate. After their stay, travellers had 30 days to pay their hotel quarantine fee.

British-Australian Joseph McKenna was lucky to return to Australia via Sydney from the United Kingdom in April as he did not have to pay a fee in quarantine. In July, the New South Wales Government announced it would introduce a hotel quarantine fee, with the same rates as South Australia.

“Australian residents have been given plenty of time to return home – and we feel it is only fair that they cover some of the costs of their hotel accommodation,” New South Wales Premier, Gladys Berejiklian said.

McKenna was required to quarantine in a hotel upon his arrival at Sydney airport. “It was a half-empty flight to Sydney and when we got off; when we landed, we had to wait quite a long time, probably an hour, before they let us off the plane because they were preparing the quarantine measures,” he said.

McKenna’s journey to the hotel was where he had his first encounter with Australia’s coronavirus quarantine measures. “Of course, you couldn’t leave the airport until the Australian Army officers were organising the bus to go to the hotel,” he said.

McKenna recalled there was confusion with hotel staff upon his arrival. “There was another delay when we got to the hotel because the hotel didn’t know that they were bringing all these quarantine people in,” he said.

Security was tight for McKenna in Sydney. “They assign you a room and it’s basically surrounded by Australian police at all times… there were always a couple officers on each floor making sure no one leaves their room,” he said.

However, the biggest issue McKenna encountered during his quarantine was the lack of fresh air.

“The window was permanently closed so there was no fresh air at all… the air conditioning was good but there was no fresh air.”

Meanwhile, in Singapore, citizens and residents returning from Australia do not need to quarantine in a hotel. Travellers returning from a list of countries including mainland China, Vietnam and Malaysia, only need to take a coronavirus test and quarantine at home for a week, according to Singapore Government directions.

The whole quarantine experience in Singapore for returning citizens (who left the country before 27 March according to travel advisory) is paid for by the government and while the principle of staying in one room remains the same to maintain community health, travellers are assigned hotels randomly. The hotel lottery system has resulted in some travellers completing their mandatory quarantine in luxury accommodation.

Andrea Goh was one of the lucky travellers to be assigned to a five-star hotel for her quarantine period in Singapore after arriving from London. Goh documented her stay on YouTube.

On the first day of Goh’s quarantine in March, she showed the view from the hotel room balcony which is open to fresh air and overlooking palm trees and blue sea. “I have a sea-view room with a view of the pool as well… you can see people on their balconies as well… can’t complain with a view like that,” she said.

In September, Queensland Health published the story of an Australian traveller who was required to quarantine in a hotel after returning to Brisbane from Amsterdam to mourn the passing of his grandmother. The traveller, referred to in the story as Ben, has asthma and required a room with access to fresh air.

Initially, Ben was placed in a room without the flow of fresh air.

“When I was checking in, I asked if I could have a room with a balcony to get some fresh air, but all the rooms were already allocated, and you needed a mental health waiver to get a balcony room,” he said.

Ben required a letter from his family GP to verify his health condition so he could switch hotels. The move took four days from when he arrived in Brisbane. “That move made all the difference,” he said.

Moving past hotel quarantine may be an option, especially if coronavirus numbers decrease in Australia. Countries such as Canada allow returning travellers who are not displaying symptoms to quarantine in a designated private dwelling.

The Canadian Government trusts returning travellers to quarantine privately as they warn those who do not comply will receive hefty fines of up to CAN$750,000.

The home quarantine model used in places such as Canada was discussed in the interim report of Victoria’s Inquiry. The report suggests implementing a similar system to Canada based on the reliance of the returning traveller’s acknowledgement of potential fines for non-compliance. This could involve the returning traveller signing a document agreeing to the terms of their private quarantine upon arrival in Australia.

The report discussed that private quarantine not only makes adequate health and living standards for travellers more manageable, but it limits the number of people who could potentially make contact.

A hybrid system was also discussed in the report, which maintains the need for hotel quarantine for high risk cases and/or people who cannot safely quarantine at home. With differences in populations between countries, it may not be viable to adopt a luxury lottery approach at the taxpayer’s cost such as in Singapore. However, Australian state and federal government could look abroad to improve living standards for quarantining Australian travellers.

In South Australia, health authorities have now introduced mandatory seven-day Covid-19 tests for those working in Medi Hotels. As the state grapples with containing what may become a second wave of the virus, it’s not yet clear whether changes to the Medi Hotel system may be made in the future.

Speaking to InDaily, SA’s Chief Public Health Officer Professor Nicola Spurrier said there are no plans at this point a plan to move away from quarantining returned passengers in SA, saying “it’s our responsibility as a state to repatriate stranded Australians overseas [and] we’ve put in place a very, very robust Medi Hotel system”.

Watch this space.