News

Calls for GPs to help COVID patients notify contacts as systems groan under strain


Doug Hendrie


11/08/2020 3:43:22 PM

Victoria should sanction self-initiated contact tracing to slash the time taken to contact people who may have been infected, according to frustrated GPs and other top experts.

Contact groups
Speed of testing and notification is a key factor in controlling second waves of infection as societies move to reopen.

Under such a model, confirmed coronavirus cases would immediately contact all close contacts they could remember and ask them to self-isolate, with help from GPs if necessary.  
 
This would reduce the strain on Victoria’s beleaguered contact tracers, who are reportedly battling to get on top of their immense workload and – crucially – speed up the process of informing possible new cases.
 
Rapidity of testing and notification is a key factor in controlling second waves of infection as societies move to reopen. According to new analysis published in The Lancet Public Health, contact tracing ‘has the potential to control virus transmission, and to enable alleviation of other control measures, but only if all delays are maximally reduced’.
 
The model is being pushed by GPs such as Dr Mukesh Haikerwal, Dr Esther Belleli and another GP in a COVID-testing clinic.
 
Experts such as Australian National University (ANU) infectious diseases doctor Professor Peter Collignon and the Grattan Institute’s health program director Dr Stephen Duckett have also called for the model to be taken seriously.
 
Professor Collignon told newsGP that speed is the key benefit of this approach.
 
‘The sooner you let people know, the less likely they are to spread it to others. I can’t see the harm in everyday people owning the problem and not saying, “this is for the government”,’ he said.
 
‘The [Victorian] Government is at capacity and we all have to own this problem.’
 
A GP in South Melbourne, Dr Belleli said self-initiated contact tracing could cut valuable days off the time taken to trace contacts.
 
‘As soon as a person is diagnosed they could contact trace their own contacts. They know their immediate surrounds and where they’ve been,’ she told newsGP.
 
‘This would narrow the critical timeframe of people who have been in close contact but who are still circulating.’
 
The Victorian Government now employs around 2000 contact tracers, bringing in call centre workers, bankers, health department staffers, graduate paramedics and Australian Defence Force personnel as the state’s outbreak worsened.
 
While waiting times are reducing, the goal of contacting all positive cases within 24 hours is not being met, according to a GP who works in a COVID-testing clinic.
 
That means close contacts who acquired the virus could be unwittingly spreading it further.
 
A patient at the GP’s clinic who tested positive on 31 July was only contacted by Department of Health and Human Services (DHHS) tracers six days later, on 5 August, but all of their details were incorrect. It took an additional three days to get the right details and do the tracing.
 
In the interim, the GP had been forced to call an ambulance for the patient as he worsened.
 
‘It’s not my job to follow him up. I’m the testing doctor. But I felt I had a duty of care,’ the GP, who did not want to be named, told newsGP.
 
‘DHHS told me the notification had come to their interstate site and had been written on a piece of paper. So it took 48 hours to go from a piece of paper in Queensland to their computerised database, despite me saying this is urgent.
 
‘We had six months’ notice for this pandemic. Victoria ramped up ICU beds, but that’s the end of the line.
 
‘We were going for test-trace-isolate as our strategy, but we didn’t have the capacity to trace. Contact tracing is done out of a centralised call centre with people with a checklist and a template. It’s fundamentally flawed.
 
‘Victoria was always going to be vulnerable to a pandemic. It means our only effective strategy since the beginning has been lockdown – because we have no capacity to effectively trace and isolate.’
 
The GP said Victoria’s health bureaucracy needs an urgent restructure to avoid ending up in a similar ‘mess’ after restrictions are lifted, and should model public health on the NSW system, with which they are familiar.  
 
Dr Haikerwal said GP-aided self-tracing could help cut new cases of the virus. He told newsGP he has personally informed many close contacts of positive coronavirus cases coming through his respiratory clinic.
 
‘I saw them, called their nearest and dearest, and found more cases. They’re all isolated now and out of the community. Otherwise they would have been spreading it,’ he said.
 
Dr Haikerwal said it makes sense for GPs to help coronavirus patients contact their family and friends and leave harder contacts, such as those at workplaces, for the DHHS.
 
‘They should move to self-tracing. It’s a wasted opportunity to stop people spreading the bug,’ he said.

Infected-workers-PPE-Hero.jpg
Dr Mukesh Haikerwal (right), who runs a respiratory clinic in the Melbourne suburb of Altona, said it makes sense for GPs to help coronavirus patients contact their family and friends and leave harder contacts, such as those at workplaces, for the DHHS.

A DHHS spokeswoman told The Age that everyone who had tested positive was contacted for an interview within 24 hours of the department being notified, but that there could be a delay in the labs notifying positive results due to the large volume of tests.
 
Burnet Institute epidemiologist Professor Mike Toole has called upon the Victorian Government to accept extra help from groups such as community health services, GPs and maternal child health nurses, according to the same report.
 
newsGP is aware of a number of instances where businesses and universities have been bypassing the cumbersome Victorian contact tracing system and informing close contacts of cases immediately to speed up the process and get people isolated.
 
In July, Warrnambool abattoir Midfields Meats unilaterally shut down and arranged testing for almost 1000 workers without waiting for DHHS contact after a visiting meat inspector tested positive.
 
Midfields Meats General Manager Dean McKenna told the ABC there was a lack of clear answers from the DHHS.
 
Similarly, RMIT University has moved to directly connect with close contacts of any confirmed case who had been on one of their campuses, though the university did so with DHHS approval.
 
An RMIT spokesperson told newsGP the university was working closely with the department.
 
‘Following recent increases in community transmission, with the approval of DHHS and acting on their advice, RMIT has directly contacted identified close contacts of any confirmed case, asking them to seek testing and monitor their health over the next 14 days,’ they said.
 
Grattan Institute health policy expert Dr Stephen Duckett told newsGP he believes this approach is ‘very efficient’ and could ease the workload of departmental contact tracers.
 
‘We do know contact tracing is overwhelmed and not going as fast as it should, and pathology testing is not going as fast as it should. This can speed up the process dramatically,’ he said.
 
Dr Duckett said that, more broadly, citizen contact tracing would be a ‘good thing’.
 
‘It would be logical to do this, but we haven’t been asked to do so,’ he said.
 
‘People might not know if this is legitimate, and might feel there’s a stigma. If I became infectious, I might be embarrassed ringing up my friends. But if we make it socially valorised, if the Government encourages people to do it, that could work.’
 
Dr Duckett last week called publicly for much better access to COVID data being used to manage the pandemic, including how quick and effective contact tracing is currently.
 
‘My view is that the Government should publish how quickly it is contact tracing. Other countries do this already,’ he said.
 
‘The public deserves to know.’
 
Victoria has relied almost exclusively on the work of human contact tracers, with minimal assistance from the Federal Government’s COVIDSafe app. As of late July, Victoria had not found any useful contacts using the app that were not available through human contact tracing, according to the ABC
 
New reports suggest that the app – which is intended to speed up contact tracing – may at last be proving its worth, with the ABC reporting it has been used to trace 544 new contacts in NSW, two who tested positive.
 
Australia’s Deputy Chief Medical Officer Nick Coatsworth told the broadcaster the app is ‘coming into its own’ as most states and territories ease restrictions and see more movement of people.
 
The DHHS did not respond to requests for comment prior to deadline.
 
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Dr Duncan MacWalter   12/08/2020 7:16:04 AM

Any funding from State governments flowing into Primary Care to help with this?
Or is this just another "GPs should..." from the bottomless pit of time and energy we have?


Dr James Courts   12/08/2020 7:30:32 AM

I think differentiating the type of clinics described in this article would be important.

As far as I am aware GPs involved in the 'Respiratory Clinics' do maintain responsibility to inform and manage positive patients seen.
[https://www.racgp.org.au/FSDEDEV/media/documents/RACGP/Coronavirus/Guiding-principles-COVID-respiratory-clinics.pdf]

I imagine this responsibility can be delegated on hand over to the public health team, indeed here in Queensland depending on region, they would be contacted by Public Health/contact tracing team + Covid Virtual ward/Infectious Disease team to determine management at home/hospital and with regular daily follow-up.

Testing doctors here at the Fever Clinics (Gold Coast) - of which I am one, do not have the responsibility of the follow-up of the results for which Public Health complete.


Dr Janice Faye Sheringham   12/08/2020 4:21:20 PM

Dr Courts, the situation in QLD is vastly different to that currently in VIC, both in complexity and volume. My gripe is that, as a retired GP with 50+ years of experience, I have been ignored as a potential regional contact tracer since Day One, despite going through the hoops with Torrens Health over 2 months ago! I do not expect to be paid as a doctor for this work - it is tightly controlled and scripted, as it should be, but my local knowledge and being known locally all helps in the initial contact made at what will be a difficult time for the person on the other end of the phone! Busy GPs have enough on their plates currently to be asked to add this quite onerous task to their already busy days and evenings. Using retired doctors, nurses and other health professionals, with our understanding of ethics, human frailties and stress management are ideally placed to fill this role.