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Edwin—Registered nurse
Hotel quarantine
Metropolitan Melbourne

I worked for two years in hotel quarantine.

It wasn’t what I’d planned. I was listed with a nursing agency as a critical care nurse and a diabetes educator. It was early February 2020, and I had come home from a well-earned trip to Bali. The COVID pandemic had started to escalate. The news was that hospitals were preparing for the worst as images from overseas showed healthy young people dying in their thousands. Hospitals were cancelling leave while drawing up strategic plans to cater for the imagined influx. Despite this, work for agency nurses started to dry up, leaving us concerned about our future.

In response to reducing work, the agency started to offer me shifts and later fulltime work in hotels as an emergency nurse. Hotel quarantine was set up to cater for overseas arrivals needing to quarantine for two weeks before being released into the community. We were there to provide medical care and to specifically check on residents about their health and COVID symptoms.

At first, we were moved between hotel sites until this was prohibited when the disease control implications became known. There was also little structure to the way nursing in hotel quarantine was managed. A nurse was a nurse was a nurse. But nurses are used to working in teams, with clear lines of leadership and a chain of command. Despite this haphazard design, structure developed over time. We worked together to solve problems as we saw them, and gradually leaders emerged—often the people who were there longer or who had stronger characters. Later, more formal structures were put in place.

On a morning shift, after a handover from night staff, we rang residents to run through the standard COVID question: ‘Do you have a fever, chills, cough, sore throat, shortness of breath or a runny nose?’ We then asked after their general health. That’s when everything came out. We would get the abuse, people saying, ‘Why are you keeping me in the f***ing room?’, as if it were our decision. We were just doing our jobs. Or people would have real concerns they needed help with relating to their children, food or running out of medication. For example, a pregnant woman was concerned about having her oral glucose tolerance test which was due while she was in quarantine. We organised for someone to go to her room to take her blood.

In the larger hotels, swabbing teams would come in to undertake residents’ COVID tests. In smaller ones, it was up to us. This—and every contact with residents—required full PPE. Because of this and infection control, we minimised our contact with residents as much as possible. Each time we entered a room we went through a full donning and doffing process—security guards in the corridors were vulnerable when we left rooms if we didn’t go through the proper procedures. As time passed, a system was introduced to sign in and out of rooms so the virus could be tracked and controlled.

Many of those employed in hotel quarantine had no understanding of infection control. Education and compliance surveillance issues soon emerged with groups such as security guards. Security guards had closer contact with residents because they sat in the corridors close to residents’ rooms, took them for walks, and took them to and from their rooms on arrival and leaving. The head of security complained of a lack of training, so I delivered a ten-minute training talk to security guards focussing on two concepts: one—wash hands constantly rather than wearing gloves; two—do not touch mucous membranes (mouths, noses and eyes) without first washing hands. This was important because the guards were constantly adjusting their face masks and using smartphones.

Medication management was challenging. It soon became apparent that some people were not able to manage their own medicines safely. As part of our role, we asked residents if they had enough medicines for the fourteen days. If they didn’t, and if they were also without a script, we asked the doctor to review their case and provide a script. Scripts were then sent to local pharmacies in the area.

In the nurses’ room, we had a table full of over-the-counter medicines such as simple painkillers like paracetamol and smoking-cessation products such as patches and gums. At times, we were called upon to administer regulated medications—including controlled drugs and drugs of dependence—when nurses or doctors assessed it was unsafe to leave a whole box of medications with the resident. Nurses identified that we needed a system to lock up these medications to meet legal requirements, and so safes were eventually brought into the hotels for this purpose.

Drugs, alcohol and mental health soon became part of the landscape. We quickly learned that being cooped up in a room for fourteen days with your own thoughts can play havoc with the mind, especially in the presence of grief, mental health issues and substance use. In one hotel, a resident suicided. This led to the employment of mental health nurses in every hotel who could assess residents when a registered nurse became concerned about them.

In the initial stages of the pandemic, I was asked to ring a resident to try to work through her concerns because earlier in the day she had thrown her food tray down the corridor. Later in the pandemic, a team of us was called up to the room of a woman who had taken an overdose. It was my job, together with a visiting Irish nurse, to attend to her. She was on the bed on her side, unconscious, with vomit spread over the bed. As we went through our first-aid emergency assessment—danger, response, send for help, airway, breathing, CPR, defibrillation—we noted she had low oxygen blood levels of seventy per cent, so I physically tilted her chin to help her breathe and raise her oxygen levels to ninety-eight per cent. It took the ambulance one hour to reach us. We surmised that because she was already being looked after by nurses, she may have been given a lower priority, but who knows.

Eventually, the hotels closed one by one. For those of us who had worked there for long periods, closure was an anxiety-provoking experience. We will never forget our time there. For me, the time overlapped with part-time studies for my PhD in the field of diabetes. The ‘Dr’ in front of my name has now been conferred, and I am enjoying my less intense, but valuable, role as a health educator and trainer.