April–June 2020: The calm before the storm

Morgan Liotta

15/12/2020 3:22:36 PM

While Australia’s initial COVID wave dissipated, it remained a time of great uncertainty and upheaval for general practice as pandemic preparations continued in earnest.

Map of Australian leaders
Australia’s leaders were faced with different decisions as the first COVID wave started to ran its course.

With the World Health Organization (WHO) officially declaring a pandemic in early March, Australia’s coronavirus cases were ramping up.
No longer a distant threat, the virus had well and truly became one of the most serious public health issue to arrive on our shores. Federal and state governments began implementing the first of many measures to stop the spread.
Frontline healthcare workers started to put out the call for more protection as fears of risk of infection grew.
April brought with it a slow decline, with cases plateauing until early July.
GPs also began to learn more about the virus itself from lived experience and various global studies, including the clinical course and severity levels in certain patients.
Links to conditions previously thought unrelated were emerging from COVID patients, such as risk of stroke and other neurological conditions, heart disease, onset of diabetes and higher risk of infection from vitamin D levels.
Preliminary trials of vaccine candidates also arose, including a tuberculosis vaccine tested on healthcare workers.
The National COVID-19 Clinical Evidence Taskforce released the first living clinical guidelines in early April. Developed to deliver healthcare professionals the most up-to-date, evidence-based guidance during the pandemic, the guidelines continue to be updated on emerging topics such as remdesivir and other antivirals, ACE inhibitors and CPR administration.
Principal Medical Advisor to the Department of Health, Professor Michael Kidd, acknowledged at the time that Australia’s strong primary healthcare system proved an advantage to the country’s pandemic response.
The Federal Government’s investment in telehealth services, infection prevention and control training, the establishment of GP-led respiratory clinics and mental health support all helped to strengthen the response.
Professor Kidd also highlighted the need for equality in support for all healthcare workers during the pandemic.
‘It is recognised that most vulnerable people receive their medical care and advice from primary care, usually through general practice,’ he wrote.
‘It is also recognised that the people working in primary care, aged care, home care and disability care settings need the same level of support and protection as people working in hospital settings, in order to protect both the public and our community-based essential health and support service workforces.’
From April, GPs and other frontline healthcare workers had to quickly adapt to the changes put in place as part of the pandemic response.
The expansion and widespread adoption of telehealth services enabled patient access to non-face-to-face healthcare, with GPs and practice teams adjusting to maintain financial viability.
New legislation required practices to bulk bill Medicare Benefits Schedule (MBS) telehealth services for all patients vulnerable to COVID-19. For many general practices that charge a gap or privately bill, this proved to be a challenging adjustment that resulted in significant revenue loss with, around half forced to bulk bill.
‘Medicare funding of telehealth has been great to improve access for patients and keep them and their GPs safe during the worst of the pandemic,’ Dr Michael Wright, Chair of the RACGP Expert Committee – Funding and Health System Reform, told newsGP at the time.
‘But mandating that GPs bulk bill these services means that practices are having to change their business models at a time when they’re already stressed.’
With a drop in cases by the end of April, plans for some restrictions to be eased were announced.
The Government stressed, however, that cause for concern was far from over, with significant COVID-related mental health issues predicted, particularly among young people and frontline healthcare workers.
The RACGP expanded its focus on GP self-care, hosting a webinar for those navigating the psychological impact the pandemic created, and GPs shared their own experiences on self-care.

The college also launched its Expert Advice Matters campaign to encourage patients to continue a relationship with their regular GP to avoid fragmentation of care, help steer them away from ‘pop-up’ telehealth services, and not be influenced by anti-scientific theories.
‘Ensuring continuity of care is vital in achieving the highest possible standard of primary care. If you can get to know your own GP that is ideal,’ then-RACGP President Dr Harry Nespolon told newsGP.

‘An ongoing GP–patient relationship is critical to delivering patient-centred, comprehensive and coordinated care.
‘Throughout this pandemic I have been warning Australians to be wary of false or misleading medical “advice” and updates on social media concerning the COVID-19 pandemic and other health issues. It seems like every day we have had another outlandish conspiracy theory or “cure” for COVID-19.’

Victorian Premier Daniel Andrews (left) made masks mandatory across the state in July amid a second wave. (Image: AAP)

By May, amid heightened risk of infection, GPs expressing frustration about Australia’s personal protective equipment (PPE) supply was not uncommon.
The RACGP backed these concerns from the earliest reports of anxiety among frontline healthcare workers.
Dr Nespolon welcomed Health Minister Greg Hunt’s announcement on 7 May that 40 million new masks would be made available to healthcare workers – in addition to the 60 million delivered in mid-April.
However, Dr Nespolon stressed the importance that GPs ‘see the results of this new influx of masks’.
‘We are still hearing reports that many GPs don’t have enough PPE and are having to source their own,’ he told newsGP.
‘GPs are playing a key role in keeping patients out of hospitals, and to continue flattening the curve, they need access to masks, gowns and goggles.’
The RACGP also announced its Objective Structured Clinical Examination (OSCE) would be replaced with a new clinical exam to ‘better reflect contemporary assessment principles for GPs working towards Fellowship’.
In the first signs of its devastating second wave, Victoria’s coronavirus cases showed a gradual increase in June, following suspected (though unfounded) links to the Black Lives Matter protests and public housing towers in Melbourne’s inner-north-west.
GPs also continued to call on the Government for more support and recognition of their role in the pandemic.
The WHO recommended masks be worn when social distancing was not possible ­– a short time before masks became mandatory across Victoria when the second wave hit in July.
With the flu season trumped by coronavirus, social distancing and lockdowns in place around the country, Australian flu cases were down by almost 99% as of 5 June.
For COVID-19, the global quest for a vaccine was still underway in what was called a ‘race against time’.
In non-COVID news, the RACGP welcomed the news of a 12-month ban applied on most e-cigarette imports in Australia. The move denoted that, as of 1 July, people would no longer be able to legally import e-cigarettes containing vaporiser nicotine and nicotine-containing refills, unless on prescription from a doctor.
At the end of June, Australia’s Chief Medical Officer Professor Brendan Murphy announced he would move on from his four-year post to a new role of Health Department Secretary.
Professor Murphy was widely praised for his leadership and management of Australia’s coronavirus response.
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