Coronavirus testing criteria widen but roadblocks remain

Matt Woodley

26/03/2020 5:10:39 PM

While new guidelines should make it easier for people to get tested, there are still concerns over other ongoing barriers.

Doctor conducting a coronavirus test.
A shortage of personal protective equipment could hamper efforts to increase coronavirus testing.

Anyone with a fever or acute respiratory infection who works in healthcare or aged care can now be tested for the virus, as can people living in areas with an elevated risk of community transmission, or where there are two or more plausibly-linked cases.
The new criteria takes in aged and residential care, rural and remote Aboriginal and Torres Strait Islander communities, detention centres, boarding schools, and military bases that have live-in accommodation.
However, while the new criteria should make it easier to test, a lack of personal protective equipment (PPE) and testing facilities, such as respiratory clinics, could stymie efforts to scale up the program.
newsGP attempted to confirm how many primary care respiratory clinics have been set up in the two weeks since the Federal Government announced its $2.4 billion response package, but a Department of Health spokesperson declined to answer and instead pointed to the existing goal of setting up 100 sites ‘over the next four to six weeks’.
Dr Glynn Kelly, Chair of the RACGP Specific Interests Disaster Medicine network, told newsGP rural areas are likely to need more primary care respiratory clinics than those in the city, and that this would also determine the form these clinics take.
‘They should be placed in areas of greatest need. The Government has all the figures of where the caseloads are and those are the areas where they need to be established,’ he said.
‘In Queensland we’re [already] setting up two drive thru clinics in rural areas. They are going to be good but they’re simply for diagnosis – the patient drives through, you do a swab, take their details and on you go. If it turns out to be coronavirus then the patient gets contacted.
‘[Elsewhere] it may be a full diagnosis clinic, where a GP will assess them as well and if it’s a minor illness they may be able to send them home to isolation, and get them to make contact if they deteriorate.’
Associate Professor Charlotte Hespe, Chair of RACGP NSW&ACT,  told newsGP she is aware of plans to establish respiratory clinics in a number of different regions in her area, but is concerned there won’t be enough to service demand.
‘Each primary health network [PHN] in a rural setting is being encouraged to set up five clinics, and in urban areas that goes down to three. I know of about five or six that are being set up around Sydney. But those are crazy numbers, we’re going to need far more than that,’ she said.
‘Three clinics per PHN is just ridiculous. For instance, if you look at central and eastern Sydney, that’s almost 1.5 million patients and we’re being told three clinics [will be sufficient].
‘If it’s a first step, fair enough, but there’s no way that that’s going to be able to deal with what we’re about to head into.
‘There is a sense of it not being needed yet, but we’re already seeing community spread and the stories on the ground that I’m getting back are a little scary, quite honestly.’
Numerous inconsistencies across not only states and territories, but also PHNs, are also said to be hampering efforts to provide more testing.
RACGP Victoria Chair Dr Cameron Loy told newsGP ‘there is not much information’ regarding PHN-coordinated respiratory clinics and that he is ‘unlikely to see an actual expression of interest or tender for this program’, while RACGP WA Chair Dr Sean Stevens said State Government-run facilities are the only locations where testing is being undertaken in Western Australia.
Aside from establishing infrastructure and identifying areas of need, Associate Professor Hespe told newsGP putting a stop to longstanding confusion related to inconsistent testing criteria should be a high priority.
‘I’ve spent so much of my time clarifying with NSW Health what the guidelines are for testing. I go out, I tell the GPs what it is, the GPs do that and then the patients get knocked back because the people in the testing centres are using different [federal] guidelines,’ she said.
‘That’s made it extraordinarily difficult when the GPs are complying with what they’re asked to, which is that slightly broader guideline [applied by NSW Health] and the testing centres aren’t doing this.’
Regardless of testing criteria or the form of clinic, Professor Kelly told newsGP it is vital that those collecting samples are well protected and appropriately remunerated.
‘They will need full support from either the hospitals or the government, which means that they need to have full PPE supplied for everybody in the practice, not only the doctors and nurses. There’s no point giving them 10 masks to see 100 patients,’ he said.
‘They also need to have full two-way support – so, in other words, if the GP or whoever is setting up the clinic needs to talk with an infectious disease physician, there should be some direct numbers to do that.
‘They need to offer adequate reimbursement and full PPE for working in a potentially dangerous situation.’
The RACGP has more information on coronavirus available on its website.
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Dr Ian Mark Light   27/03/2020 9:59:32 AM

Many patients ought be able to self swab under instruction a nasal swab for a runny nose is easy harder is the nasopharyngeal swab through the inferior turbinate and a throat swab but under instruction the some could be trained .
In fact most general practitioners are use to the throat swabs and nasal swabs but not the nasopharyngeal swab that reaches that area a longer swab is required for that.
Also it can produce pain coughing and sneezing so you need to stand at an angle away when swabbing have good PPE and move away sometimes fast after the swab is taken .