Case study: COVID-19 outbreak onsite management for apartments of concern and places of shared accommodation in South Eastern Sydney

During the Delta wave of COVID-19 there was evidence of COVID-19 spread in apartment buildings. South Eastern Sydney Local Health District’s Public Health Unit routinely monitored addresses of all new COVID-19 notifications to detect cases among people living in apartment buildings or other shared accommodation. Places of shared accommodation have single or dormitory rooms and shared kitchen and bathroom facilities (for exemple, boarding houses, student accommodation and backpacker hostels).

Identified cases were interviewed to determine their ability to isolate onsite, and a desktop and environmental risk assessment was undertaken. An outbreak management plan was devised, covering communication, cleaning of shared spaces, access to hand sanitiser and masks, testing of other residents and close contacts, and access to food and other supplies for cases and close contacts ordered to isolate for 14 days. Private pathology collectors were requested to conduct onsite testing on day one, day six and day 12 to reduce potentially infectious people moving through the building and to increase compliance with testing. The results were monitored for any new cases, and the risk assessment reviewed. Private cleaning contractors and caterers were engaged if needed.

The St George Mental Health Service emailed an isolation survival kit to each person affected. Kits detailed available services and a daily schedule of activities to pass the time during isolation. Referral was also offered through standard pathways of mental health support, however resources for this service were stretched and not designed for the volume of isolation support in need.

Management was more complex for places of shared accommodation with limited onsite management. This included backpacker hostels, student accommodation, boarding houses, and small studio apartments where access to sunlight and ventilation is reduced, as is the ability to maintain a clean and tidy area.

The environmental health team provided a key role, gathering information and onsite observations during food deliveries, and supervising private sector ‘swab-squads’. Some important reflections are:

• older apartments such as 1960s–1970s-style two story walk-ups, as well as villas and townhouses, were low-risk environments for local transmission of COVID-19 and required little intervention if clear communication was provided
  
• low-cost backpacker hostels lack the resources to support cases or close contacts, and for people to effectively isolate
  
• many students were stranded with a limited network of support and reduced employment opportunities
  
• boarding houses were high-risk settings for infection transmission with poor ventilation and cleaning schedules, limited autonomy, offsite management, and poor record keeping of contact information and basic demographics
  
• early communication with strata managers in preparation for an emergency is important to assist them in better understanding their role
  
• there should be capacity for engagement of local emergency operations support at places of onsite isolation (for example, backpacker hostels) that have limited governance and onsite management
  
• appropriate supplies from Resilience NSW and charity food hampers were critical where those facing an extended period of isolation had limited cooking or reheating facilities
  
• efforts are needed to improve standards and regulation of boarding houses in terms of record keeping, cleanliness and hygiene, and governance.