China’s GPs overlooked while hospitals overwhelmed by coronavirus: GP speaks out

Matt Woodley

25/02/2020 1:18:52 PM

Parts of the country’s health system are under major pressure due to underused primary care workers and overcrowded hospitals, according to an Australian GP in China.

Coronavirus response in China
GPs have been largely sidelined in China during the response to the coronavirus, an Australian GP on the ground claims. (images: AAP)

The coronavirus epidemic sweeping through China would be less severe if the country had a system of clinically capable frontline primary care workers, a retired Australian GP currently on the ground has claimed.
Dr Edward Wu, who practised in Sydney for more than 40 years, told newsGP that China’s overreliance on hospitals and an outdated perception of GPs has led to an ‘uncontrolled crush’ of people with symptoms of upper respiratory tract infections at large government hospitals.
Dr Wu is presently training GPs in China and has paid close attention to the government’s response.
According to Dr Wu, the consequences have been dire – particularly in Hubei province, the outbreak’s epicentre.
‘Teams of medical personnel have been dispatched from cities all over China to “rescue” hospitals in the province crumbling under the pressure of patient numbers, as well as hospital staff acquiring the infection themselves,’ he said.
‘It is like sending armies to the frontline.
‘If a system of clinically competent and appropriately supported general practitioners could operate effectively at the community level at dispersed locations, the rapidity of cross infections might not be so extreme and dramatic, thus allowing the hospitals to only take care of patients who require more intensive interventions.
‘[Instead], the whole population has gone to large teaching hospitals, depleting their human and material resources … risking the collapse of the entire health service.’
The situation has become so dire that the Chinese Government has deployed 2600 additional People’s Liberation Army medical personnel to reinforce exhausted healthcare workers struggling with massive patient numbers and a limited supply of personal protective equipment.
More than 3000 doctors and nurses have been infected by the virus, while at least eight have died – including the director of Wuhan Wuchang Hospital, Dr Liu Zhiming.
Overall more than 30,000 medical staff have been dispatched to Wuhan, according to Minister of the Chinese Embassy Wang Xining, who this week told the ABC’s Q&A that the reinforcements and other extreme interventions have helped contain the spread of the virus.
However, while the number of recorded cases within Hubei province and the Chinese mainland appears to be slowing, some epidemiologists have said multiple changes to the way case numbers are calculated have made it difficult to track.
Dr Wu believes China needs to change its perception of general practice, which has been in decline since generalists were replaced with various clinical disciplines in hospitals and largely non-clinical public health worker ‘bare foot doctors’ in the community.
‘I hope this epidemic assists the national government in China to develop a clinically competent primary care profession … by ensuring the effective establishment of a clinically competent system of general practitioners,’ he said.
Chinese President Xi Jinping announced a plan in late 2018 to train 500,000 new GPs in an effort to decentralise its health system and shift patients away from overcrowded hospitals, and the RACGP is ready and keen to assist and play a role in the 11-year program.
While Hubei is still ‘bearing the brunt’ of infections and deaths, Dr Wu said the impacts of the crisis are being felt throughout the country, even though the number of new cases appears to be slowing.
‘Public facilities are being conscripted for care of low-dependency patients. Strict enforcement through residential precincts and villages are [is] being carried out to “flush out” fever patients all over China,’ he said.
‘The rate of increase in new cases has slowed and an increasing number of recovered people are being discharged from hospital and released from the mandatory 14 days of isolation.
‘A push is now starting to get people back to work, but a lot of people are reluctant even to go out of their home. There is a feeling of eeriness, considering one is so used to seeing crowded streets everywhere in China.’
Dr Wu is hopeful new tests and potential treatments will help turn the tide.
‘The main problem with this epidemic is the “unknowns”, especially with regard to [how] human-to-human transmission [occurs], as well as the infectivity during the prodromal period among carriers,’ he said.
‘As rapid point-of-care diagnostic tests – such as immunoglobin IgM and IgG, and possibly more ready availability of reverse transcription PCR [polymerase chain reaction] for the virus’ RNA [ribonucleic acid] – are being quickly developed and effective antivirals [Chloroquine, Favipiravir and Remdesivir] are going through clinical randomised controlled trials, this epidemic may go as fast as it came.’
However, Dr Wu also warned Australian public health authorities must heed the lessons from what has occurred in China. 
‘The disquiet in Australia raised by clinically competent general practitioners is a good example of our system of primary care’s function in epidemic control. We just need to make sure public health authorities recognise the importance of our usefulness by being more receptive to the alarms we raise,’ he said.
‘The apparent lack of public health preparedness by both [some] individual practitioners and public health authorities has fortunately only caused criticisms and uneasiness, without significant harmful effect but a lot of soul searching.
‘I am sure improvements will result from this experience – including the setup of adequate consulting rooms in general practices and readiness in the provision of support to general practitioners by public health authorities.’
The RACGP has more information on coronavirus available on its website.
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Dr Anna Lindsay   26/02/2020 6:46:36 AM

Many GP practices in Australia do not have the capacity to isolate or protect other patients and themselves from infection. It was of great concern that GP's were suggested to be the first contact in Australia. The UK have had a much more effective model in place to avoid cross infection.

Dr Ian Mark Light   26/02/2020 8:16:04 AM

Personal Protection Equipment and Kits for testing for Covid 19 with rapid turn around diagnosis are going to be essential plus the ability to do house calls or see patients outside the surgery and do examinations and testing on site.
Some clinics have the capacity to isolate patients in a room and designated testing centres will be valuable .
Self testing kits eg by nasal swabs are possible and health care workers could have them to detect asymptomatic viral shedding in contacts.
Co-infection with influenza A and B means vaccinations for all eligible people as early as possible treatment in high risk patients at least and chemoprophylaxis.

Dr Dileep Singh   26/02/2020 9:03:29 AM

blueprint for pandemic in news today Looks will need lots of resources Why can’t we close borders completely at this stage to stop getting people carrying infections and everybody goes through quarantine before they enter Australia to avoid infection spreading . Isn’t better to spend money on quarantine and prevention than spending money on treating .??

Dr Elias Youssef Samaha   26/02/2020 12:59:59 PM

It would be nice to have a team go out and see suspected Covina patients in their home or have designated clinics patients can rock up to with appropriate isolation facilities. both can be equipped with PPE, diagnostic kits etc, proper funding to account for risks/ decontamination etc
These doctors can be supported by infectious diseases specialists .

This would reduce chances of cross infection that we will invariably get at GP practices where some are under equipped

It would also be interesting to see whether GPS can be litigated against for OH&S breaches if their staff get infected while working e.g. for not taking adequate infection control precautions/ having required PPE isolation rooms etc, I suspect some GPS without this may turn away patients to try and mitigate that risk . Also It’s just not worth the 38$, there should be another item number for dealing with coranovirus patients , as area needs to be disinfected after seeing such patient, which will impact workflow

Dr Edward Thomas Wu   28/02/2020 2:52:51 PM

Following drastic and determined actions of isolating as well as tracing cases and contacts as well intensive public health campaigns on personal preventive practices, zero new infection has now been achieved in most areas of China (excluding Hubei Province - still under lock down) allowing people to return to their employments. Maybe as diagnostic tests and effective primary treatment options become more readily available at the general practitioners level, adding to the building up of "herd immunity" among the population, Covid19 will recede just like the H1N1 influenza to coexist with the human species. However, for an immunologically "virgin" population like Australia, great care need to be exercised both at the individual as well as population levels.