In the disarming afterglow of vaccines arriving, Brisbane’s Princess Alexandra (PA) Hospital has become an unlikely source of COVID-19 outbreaks that have crossed a state border.

The hospital has long boasted “one of the best infection control programs” around, according to Mary-Louise McLaws, a professor of epidemiology at the University of New South Wales.

“They have a reputation of being very much on top of their game,” she said.

That image has been shaken since the PA emerged as the source of two separate clusters, thrusting the Queensland capital into lockdown and putting the state’s punch-drunk tourism industry on tenterhooks on the eve of Easter holidays.

A doctor and a nurse became infected on the job weeks apart, then unwittingly took it home to create the two clusters, one of which spread south of the border to Byron Bay.

On Good Friday, a historical case emerged — a second PA Hospital nurse.

She and the doctor caught the virus while treating the same returned traveller at the hospital.

That traveller has been described as a superspreader.

She is the “the missing link” case, deemed to have spread the virus to her partner in the community unwittingly while she was asymptomatic.

All cases in the two clusters are most likely to have been found and the COVID-19 crisis has been averted for now.

Authorities are confident in having connected the dots with the 20 known cases of community transmission.

A record 34,711 tests turned up just a single case in the final 24 hours of a snap three-day lockdown that Chief Health Officer Jeannette Young had indicated she would rather not have to impose, now a vaccine rollout was underway.

At midday on Thursday, the state government gave the 2.5 million residents of Greater Brisbane an early pass out of lockdown.

But infection control failures at the major public hospital that kicked it all off remain a source of bewilderment to experts such as Professor McLaws.

“I’m gobsmacked how [the doctor] came to be infected,” she told the ABC.

“It really makes you wonder.”

Questions remain

On March 12, the infectious disease doctor at the PA tested positive to the highly-transmissible B117 variant of COVID-19.

This was two days after she did a face-to-face assessment of a returned traveller who had been admitted after testing positive in hotel quarantine.

Had genetic sequencing not matched up between doctor and patient, Professor McLaws said, “I would’ve said she caught it in the community”.

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She said the doctor would have known to wear a mask and eye protection before entering the room to treat the patient.

And the PA’s ward 5D, where COVID-19 patients are treated, would almost certainly meet World Health Organization guidelines around proper ventilation, Professor McLaws said.

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By March 19, more than 600 contacts had been tested without a new case and Dr Young declared the outbreak under control.

Unbeknown to authorities, by then, the virus had spread to an unidentified north Brisbane man.

It is now believed the newly traced second nurse unwittingly transmitted it to this man, her partner.

He gave it to his brother, a Stafford landscaper, who was infectious but showing no symptoms.

The landscaper, 26, visited a string of venues, from a major shopping centre in Brisbane’s south to a restaurant in Redcliffe to the city’s north-east.

He worked on March 22 while infectious, but thankfully was outdoors, Dr Young noted.

He came down with symptoms that day then stayed home sick most of the week before getting tested at a clinic in Nundah on March 25.

On March 27, his friend, a Strathpine man, tested positive.

Two of his colleagues tested positive on March 29, including one who had been in Gladstone while infectious for the previous three days.

This prompted Dr Young to call a snap three-day lockdown.

The same day, on March 29, a new cluster emerged: this time a nurse from PA hospital, who had infected her sister.

This first nurse was believed to have caught the virus from a returned traveller from India while working an overnight shift on March 23.

She had been in Ward 5 that night but not Ward 5D, set aside for COVID patients, according to a hospital source.

Staff say they’re panicking

One woman who works at the PA, speaking on condition of anonymity, said the hospital’s second infection control failure in the space of a few weeks had left some staff “panicked”.

The first nurse, unlike the doctor weeks earlier, had received her first vaccination dose when she tested positive.

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But the PA staffer told the ABC it was not lost on frontline health care workers that many of them still had not been given their first vaccine dose, unlike many senior administrative hospital staff who have no direct contact with patients.

As late as Thursday, doctors seeking Pfizer vaccinations on site were being knocked back, she said.

“Some doctors have gone to outside GPs to get their [AstraZeneca] shots,” she told the ABC.

Professor McLaws said this was far from ideal, in part given the longer wait for a second dose with AstraZeneca.

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“One dose is better than no dose; and the Israelis found one dose of Pfizer reduces viral loads,” she said.

“You don’t want any impact on the health of frontline healthcare workers.

“The effects can be long term.”

The second cluster grew when the first nurse and her sister went to a hen’s party at Byron Bay from March 26 to March 28.

On March 30, it was announced that another five people who had been at the hen’s party, held in an Airbnb rental, had tested positive.

They included a Gold Coast tradie moonlighting as a hen’s party “entertainer”.

The ‘perfect case’ helped lockdown lift

Colourful details aside, the numbers were grim news for greater Brisbane in its first 24 hours of lockdown, and many braced for an Easter holiday at home under restrictions.

The tradie’s return to the Gold Coast, which included visits to an aged care facility and a surf lifesaving championship at Tugun attended by hundreds of competitors, set off a number of contact tracing alerts.

The Premier declared the result “fantastic news” and the lockdown was lifted early at midday – a gesture to avoid the rush of holidaymakers seizing the opportunity to flee Brisbane for the Easter holidays.

The record rates of people coming forward for testing — and the fact those at the root of both coronavirus clusters fronted up for tests in the first place once they felt unwell – weighed heavily in the capital’s favour in avoiding a lengthy stint of tough restrictions.

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