NSW Health ‘close to breaking point’ before Ruby disaster
NSW Health was so understaffed due to the COVID-19 pandemic officials were "close to breaking point" three days before the department cleared thousands of Ruby Princess passengers to disembark the cruise ship in Sydney, an inquiry heard.
Public health physician Dr Isabel Hess was on the expert panel that gave guests on the ill-fated vessel the green light to leave when it docked at Circular Quay on March 19 despite pending coronavirus tests.
But on Monday she said it should have been classified as "at least" a medium risk as sick guests who'd undertaken international travel within the previous fortnight satisfied the suspect COVID-19 case definition.
"I made an oversight," Dr Hess said.
The inquiry heard that overworked staff were burning out trying to trace infections spreading in the community, and on March 15 Dr Hess sent an email to a colleague saying: ""I think we're close to breaking point. It will be impossible to follow up on close contacts soon."
"It was very hard to cope … I saw that the numbers were rising rapidly and we needed to take action," Dr Hess told the inquiry.
The Sydney Local Health District staffer had suggested lobbying for the closure of schools and universities, adding in the email: "what is happening in Italy is not what we want to happen here. I'm starting to be worried."
Dr Hess had been talking to Dr Leena Gupta, who at the time agreed that all passengers should stay on board ships until any COVID-19 swab results come back.
However their suggestions were not adopted, and on March 18 the Ruby Princess was deemed a low biosecurity risk under a rating system the inquiry's commissioner condemned as "positively dangerous."
"Has it ever occurred to you that the category high, medium, low was artificial and virtually devoid of any evidentiary basis?" Bret Walker SC said.
"No," Dr Hess said.
Mr Walker questioned why any expert panel could assume a ship's risk level without first knowing whether any passenger had been diagnosed with the deadly disease.
"Does it not occur to you now that ranking in advance … is not a very useful public health approach because it may mislead you into taking steps that shouldn't be taken?" Mr Walker asked.
"In hindsight, yes," Dr Hess said.
Earlier Mr Walker said he was "sceptical" that the panel had been primarily concerned with guests missing their flights when allowing them to leave, having already classified the ship as low risk.
"I can't for the life of me understand why it would be a public health matter," he said.
"We're trying to reduce the impact on people," Public Health Unit Director Professor Mark Ferson said while giving evidence.
Mr Walker has slammed the department's "apparent tolerance" of the vessel's woefully inadequate coronavirus testing rates, but Prof Ferson said he didn't know who was responsible for ensuring that liners adhere to NSW Health guidelines.
"That seems a little alarming to me," Mr Walker said.
"I know there were difficulties obtaining swabs. There was a shortage of swabs everywhere," Prof Ferson said.
"If they didn't have enough supplies then they shouldn't leave port, isn't that right?" Mr Walker asked.
"Yes," Prof Ferson replied.
Mr Walker again flagged concern with an undated, unattributed NSW Health review of the scandal that claimed: "it is likely that many more cases were averted by their early disembarkation into self-isolation at home."
The confidential report claimed that guests quarantining at home was "a much safer option than leaving passengers on board" where infection could spread.
That's despite sworn evidence from Dr Sean Tobin - who helped prepare the document - which stated that keeping people on board for a few extra hours to get test results would have been safer than letting them all scatter into the community.
It also appeared to deflect blame to the federal government while glossing over several state government failings in what Mr Walker labelled as "spin."
"The Australian government is responsible for border control, including granting pratique (permission to dock), and advising international travellers about any requirements to self-quarantine because of their international travel," the report said.