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Mapping the System Complexity of Australia’s COVID-19 Quarantine Journey:
An Evidence Synthesis Using Systems Thinking

M. Bush, A. Hutchinson, S. Bouchoucha, and C. Bennett 1
1
2
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Health and Social Development, Deakin University, Australia, and School of Nursing and Midwifery,
1 2
Deakin University, Australia

Background: Many countries initiated quarantine COVID-19 programs that accommodated significant
numbers of returned travellers. Quarantine programs evolved during the pandemic to include diverse
cohorts in accommodation locations such as homes, hotels and facilities. Infection control breaches from
these rapidly operationalised quarantine programmes had significant community impacts.

Objective: This research aimed to develop a journey map for governance and operating systems that
evolved over the COVID-19 pandemic in Australia by synthesising evidence from grey literature. The
map can be a starting point for public health policy and pandemic preparedness activities.

Methods: Australian parliamentary and policy websites were searched for publicly available grey
literature from 2019-2023. Data about quarantine cohorts with unique rule settings, key journey
activities, virus escape events and quarantine recommendations were extracted. Systems thinking
was used to produce a comprehensive whole-of-system journey map for the identified cohorts.
Australian pandemic and public health documents, recommendations from Australian quarantine
inquiries, and reported transmission events were plotted on relevant parts of the map.

Results: During COVID-19 in Australia, 22 quarantine cohort journeys were identified. The virus escaped
quarantine 27 times, and reviews and inquiries produced 282 quarantine specific recommendations.
Cohorts included international and domestic travellers who experienced home, hotel and facility
Oral Presentation Abstracts
quarantine. Other cohorts, such as sporting, entertainment, diplomats and airline crew, had defined
journeys. There were unanticipated community entries into the quarantine system for community close
contacts, people experiencing homelessness and people with acute mental health issues. Plotting
government pandemic plans, viral escape events, and recommendations onto the journey map revealed
quarantine’s dynamic system complexity. policy gaps were evident, including a national consensus on
quarantine infection prevention and transport from a whole-of-system perspective.

Conclusion: The COVID-19 journey map for quarantine furthers the case for expanding, revising and
consolidating pandemic quarantine policy and operating procedure documents to build consistency
and promote a whole-of-system approach to quarantine preparedness.

Keywords: public health, COVID-19, pandemic preparedness, quarantine, systems thinking

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Correspondence: Matiu Bush, Health and Social Development, Deakin University, Australia
E-mail: s222205199@deakin.edu.au

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