Processes around identifying and containing COVID-19 cases on board the Ruby Princess have been a debacle resulting in the NSW Premier Gladys Berejiklian apologising for the suffering caused as a result of the "horrible" mistakes made by NSW authorities.
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These mistakes led to spread of COVID-19 from the ship after it docked at Sydney on March 19.
Despite these failings, just 17 days before the ship docked in Sydney, NSW Health sought to reassure people in Bega Valley that extra measures were in place in respect of cruise ship passengers visiting Eden.
The statements from NSW Health came in response to questions specifically asked by ACM about what plans or precautions relating to the coronavirus were in place around visiting cruise ships to Eden.
In a response to the questions, on March 2, a NSW Health spokesperson said Australia had put in place extra border measures, health screening and isolation recommendations for people and vessels travelling to Australia, through biosecurity officers with the Australian Department of Agriculture, Water and Environment.
"This is in addition to the normal process, where all ships entering Australian territory are legally required to report ill passengers and crew presenting on the pre-arrival report via the Maritime Arrivals Reporting System," the NSW Health spokesperson said.
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"NSW Health has an existing Cruise Ship Health Surveillance Program coordinated by the South Eastern Sydney Local Health District. In response to COVID-19, the program has been collecting additional health and travel information from all cruise ships coming into NSW, which is reviewed by a NSW Health expert panel to assess the risk of COVID-19."
NSW Health sought to provide further reassurance on how it would deal with cruise ships saying screening was "only one piece of the assessment".
"Following this risk assessment, further assessment may be done by a NSW health team when the ship docks, including assessing people with fever and respiratory symptoms or who have risk of exposure to COVID-19 and testing them. As there is an incubation period (before symptoms develop and tests are positive) for all infections including COVID-19, screening people for disease is not a failsafe and is only one piece of the assessment," the NSW Health spokesperson said.
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Cruise ships have large number of passengers (often thousands), many of whom are older and have chronic medical conditions, respiratory infections (unrelated to COVID-19) among passengers and crew are common on cruise ships, the NSW spokesperson said.
"Cruise ships are responsible for, and have policies to prevent and manage outbreaks of disease on board."
But despite the reassurances, there were a series of mistakes and failings made with respect to the Ruby Princess.
Bega Valley 'dodged a bullet'
In the weeks following the Ruby Princess debacle, it was often said the Bega Valley had "dodged a bullet" as Eden was being seen as an alternative port of call for cruise ships which were not allowed to visit the Pacific Islands.
Voyager of the Seas was one of these vessels and was due to arrive in Eden on March 15, but was turned away and proceeded to Sydney where passengers disembarked on March 18, at least one of whom died after testing positive.
Jaclyn Brown, Merimbula GP, banded together with 40 other medical practitioners in the Bega Valley to appeal to NSW Health via letter on March 13 to prevent ships disembarking passengers in Eden.
A number of Bega doctors were involved in the campaign.
"We were so grateful for the cooperation and consideration of the port master and cruise ship companies who took on our concerns and so grateful for the understanding of the community at a time when they were so desperately needing the extra financial support after the bushfires," one of the doctors said.
"We knew it would be a disaster for the Bega Valley if the cruise ships were permitted to dock in Eden."
The cancellation of the remainder of the cruise season in mid March was seen as a saving grace from a public health perspective.
In its report the Special Commission of Inquiry into the Ruby Princess pointed to failings by NSW Health on a number of issues.
These included:
"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. This would have resulted in the identification of such cases on the Ruby Princess. 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.
"The failure to ensure that swabs were collected by an onboard health assessment team in accordance with the requirements of the 9 March Enhanced Procedure was a serious failure by NSW Health.
"The delay in obtaining test results for the swabs taken from the Ruby Princess on the morning of 19 March is inexcusable. Those swabs should have been tested immediately.
"In light of all the information the Expert Panel had, the decision to assess the risk as "low risk" - meaning, in effect, "do nothing" - is as inexplicable as it is unjustifiable. It was a serious mistake."
