Everyone on board the Ruby Princess should have been tested for coronavirus and placed in quarantine if NSW Health had been doing its job properly, an inquiry has concluded.
Instead, 2700 passengers were allowed to disembark and spread across the country and overseas after the cruise ship was deemed “low risk” by health officials.
The special commission of inquiry report released on Friday has been scathing in its assessment of NSW’s handling of the cruise ship’s deadly disembarkation.
When the vessel docked in Sydney on March 19, at least 120 people were “suspect cases” under a new definition but were not told to self-isolate in cabins nor were other passengers alerted.
Passengers were also allowed to leave before results had been returned from the 13 tests that had been done.
The litany of errors made by health officials were “inexcusable” and “inexplicable” and the results deadly, the report concluded.
The Ruby Princess outbreak infected 663 Australians on board and led to 28 deaths, including 20 domestically and eight in the United States.
The report noted that on March 10 the Communicable Diseases Network of Australia amended its guidelines such that everyone on board the ship with newly-defined suspect cases should be tested.
But when a risk assessment was conducted on March 18, those making decisions did not have the updated definition of a “suspect case”.
“NSW Health should have ensured that cruise ships were aware of the change to the definition of a “suspect case” for COVID-19 made on 10 March,” the report concluded.
“This would have resulted in the identification of such cases on the Ruby Princess.
“One hundred and one (101) persons fell within the suspect case definition by 18 March, and 120 by the time the ship docked.
“NSW Health should also have ensured that such persons were isolated in cabins.
“These were serious mistakes by NSW Health.”
Despite the high number of people suffering COVID-like symptoms, passengers were not informed about possible cases of the coronavirus on the vessel.
If NSW Health had been doing its job properly, passengers would have undergone testing and not been allowed to disembark until the results had been returned.
Instead passengers disembarked without waiting for the results of 13 expedited tests which later showed at least three people had the virus.
The delay in having the swabs tested was “inexcusable” and should have been done immediately, Mr Walker said.
“In light of all the information the (NSW Health) Expert Panel had, the decision to assess the risk as ‘low risk’ – meaning, in effect, ‘do nothing’ – is as inexplicable as it is unjustifiable,” the report said.
Drawing on three weeks of hearings, the commission reserved its harshest criticism for NSW Health while absolving Australian Border Force officials of blame.
The NSW government erred further by allowing disembarked passengers to immediately travel interstate and abroad, breaching the state’s public health order that came into effect two days earlier.
By the time NSW Health corrected the advice on March 21, the inquiry said it was “too late” as many passengers – including some symptomatic ones – were already in transit.
“Ultimately, every passenger and crew member of the Ruby Princess should have been tested for COVID-19 while in enforced quarantine,” the inquiry said.
“Those who tested negative could then have been released, at appropriate times.”
The ABF did not play any part in the mishap, Mr Walker said, given border officials’ lack of medical or epidemiological expertise.
Reflecting on the “sorry episode”, Mr Walker said it would be unhelpful to make recommendations as they essentially amounted to “do your job”.
“There are no ‘systemic’ failures to address,” the commissioner wrote.
“Put simply, despite the best efforts of all, some serious mistakes were made.”
NSW Premier Gladys Berejiklian said she would read the report over the weekend and respond early next week.
Princess Cruises said the report confirmed none of its staff misled public authorities who oversaw the vessel’s disembarkation.
Separate NSW Police and coronial inquiries into the Ruby Princess are ongoing and not expected to report back for at least another month.
Victoria’s infection peak
Victoria’s Chief Health Officer Brett Sutton is confident the state has passed its second wave peak, with the effect of Melbourne’s stage four lockdown to show in coming days.
“The seven-day trend indicates the peak was probably four or five days ago and we will continue to see lower numbers overall from here on in,” he said.
He warned the tough restrictions will not be lifted until case numbers are much lower.
“We could not conceive of opening up with 200 cases a day. We couldn’t do it with 100 cases a day. We have to head for the lowest possible number,” Professor Sutton said.
A man in his 20s became Australia’s youngest COVID-19 fatality on Friday as the state recorded 14 more deaths – 12 of whom were aged care residents.
Aged care deaths make up 70 per cent of coronavirus deaths across the country and remain of great concern to Prof Sutton and Premier Daniel Andrews.
There are now 2034 active cases across 119 aged care facilities.
“They are most at risk of dying. We also have to drive those numbers down,” Professor Sutton said.
About 3100 of Victoria’s infections have been dubbed ‘mystery cases,’ where the source of a person’s infection cannot be identified.
The majority are among people aged 20 to 29 and within multicultural communities, Professor Sutton said.
Some 659 Victorians are battling the virus in hospital, including 41 in intensive care and 26 on ventilators.
Across the Tasman, Auckland will spend a full fortnight in lockdown after New Zealand’s fresh COVID-19 cluster grew to at least 30 people on Friday.
Health officials announced another 12 confirmed and one probable case, including two in the Waikato town of Tokoroa, 200km from Auckland.
That led Prime Minister Jacinda Ardern to extend the city’s “level three” lockdown through to Wednesday, August 26, two weeks after it began.
Around 1.5 million Aucklanders are being asked to stay home, except for essential work, supermarket shopping, exercise or health reasons.
The rest of New Zealand will remain at “level two”, with police-run checkpoints between Auckland and other regions to stop all non-essential travel.
“Our overall COVID-19 strategy remains elimination,” Ms Ardern said.
“That requires the ongoing stamping out of the virus any time that it comes back.
“Together we have got rid of COVID before. We have kept it out for 102 days. Longer than any other country.
“We have a world leading COVID response with the result that many lives were saved and our economy was getting going faster than almost anywhere else again.
“We can do all of that again.”
The first community outbreak in more than three months has thrown New Zealanders back into the clutches of the pandemic, after weeks of restriction-free living.
The country’s health officials swung into “rapid response” mode after the discovery of the community cases.
A new record was set on Thursday when more than 15,000 Kiwis were tested for COVID-19; a dramatic ramp-up of previous efforts.
However, there has been heavy criticism of the government for not testing workers within the country’s border and quarantine regime.
A Newshub investigation revealed around two-thirds of workers had not been tested prior to the new cluster, breaking government pledges.
Epidemiologist Sir David Skegg said he was “really shocked” by that “extraordinary” failure.
Ms Ardern has also announced she will take the weekend to decide whether to hold firm to the country’s election date, September 19, or push it back.
Air New Zealand has also slashed flights in and out of Auckland.