Feature

GPs at the forefront of South Australia’s successful efforts to tackle coronavirus


Doug Hendrie


25/05/2020 11:59:48 AM

The state has been among the nation’s leaders in controlling the virus – here’s how.

SA map
Of SA’s 439 cases, 334 were cared for by GPs in the state’s COVID-19 GP assessment team.

Three quarters of all coronavirus patients managed by GPs in the community.
 
The creation of a GP rapid response team within a week to care for patients with mild SARS-CoV-2 symptoms at home through telehealth.
 
Training and protocols created in a matter of days to allow GPs in the response team to care safely for patients.
 
GPs embedded in decision-making about the COVID-19 pandemic, working alongside the state health department, Primary Health Networks (PHNs), the RACGP and the Australian Medical Association (AMA).
 
Tests created rapidly by a state-owned pathology organisation, allowing GPs to test for the new virus alongside the flu in early February – using the same swab to conserve scarce resources.
 
Fantasy? Hardly.
 
Welcome to South Australia’s conquering of the coronavirus, with GPs very much at the forefront.
 
Of the state’s 439 cases, 334 were cared for by GPs in the state’s COVID-19 GP assessment team, run by GenWise.
 
SA Health GP liaison officer Dr Emily Kirkpatrick – who is also the Deputy Chair of RACGP SA&NT –told newsGP she was surprised and pleased at how well her state dealt with the virus. 
 
‘Having three quarters of our patients managed here in the community has been key. It’s quite a big difference from the other states,’ she said. ‘We haven’t really talked about it, but it’s quite remarkable.
 
‘It was an entirely GP-run model.
 
‘I am pleasantly surprised with how well it’s gone and how much we’ve been able to achieve in South Australia. I don’t think we could have expected such a positive outcome with such high-level collaboration.’  
 
The last patient in South Australia who had COVID-19 left hospital last week to applause from medical staff at the Royal Adelaide Hospital.
 
A week earlier, on 15 May, SA Health declared there were no active cases remaining in the state of 1.7 million people, with no new cases since 7 May.
 
The state is now beginning to reopen – ahead of schedule – with Premier Steven Marshall claiming his state had led the nation in its response to the virus.
 
Here’s how South Australia did it.
 
COVID-19 GP assessment team
The state’s chief public health officer, Professor Nicola Spurrier, decided early that it was important to have a GP liaison in order to engage directly with GPs on the community frontline.
 
‘It’s because of that we could set up the assessment team – we couldn’t have achieved it without that [GP liaison] role,’ Dr Kirkpatrick said.
 
‘We’ve put forward our intention to continue greater GP engagement at SA Health even after the pandemic, which is great.’
 
The assessment team was launched on 24 March, after just seven days of intense preparation.
 
The team was initially set up to help each patient’s usual GP manage the virus. But as numbers started to rise, it became clear that additional training was needed due to the complexity of the situation. The assessment team began conducting all coronavirus community care by 30 April.
 
Potential coronavirus patients were tested either in a drive-thru clinic by SA Pathology nurses, or in a hospital COVID-19 clinic.
 
‘That was the only time they would come out of the house if they had mild symptoms. The rest of the time they were at home and GPs and nurses checked on them every day,’ Dr Kirkpatrick said.
 
If a person was found to be carrying the virus, the GP assessment team – in conjunction with the SA Health public health unit – determined if it was safe to treat the patient in the community.
 
‘We had a team of 35 GPs, and we had quite a number of positive patients at the time,’ Dr Kirkpatrick said. ‘We assessed all of them, regularly reviewed them, and cleared them at the end.
 
‘GPs decided if they could stay home or had to go to hospital, supervised by the SA public health team.’  
 
GPs helped coronavirus patients access food, social supports and mental health services while maintaining strict home isolation. Patients were asked to stay in their own separate area within the home, if they lived with other people, and avoid any contact.
 
‘It was all done virtually, after a very extensive risk assessment,’ Dr Kirkpatrick said. ‘Children had to be seen face-to-face or by video with a paediatrician, with adults receiving a phone call or video.’
 
Strong connections with hospitals led to processes for escalation of care in the event the disease progressed. Only two patients in the community had to be escalated to hospital.
 
‘It was remarkable how well people did in their own home,’ Dr Kirkpatrick said.
 
Testing started early, with tests created in-house
South Australia had its first two cases early on, after a couple arrived from Wuhan in January.
 
The cases were confirmed by 1 February.
 
‘We had a couple who were travellers from Wuhan. They were admitted to the Royal Adelaide Hospital – and that made us really think about the testing platform and our capabilities,’ Dr Kirkpatrick said.
 
‘That was one reason we moved so quickly.’
 
SA Pathology had created its own tests by 6 February, allowing GPs to test for the coronavirus alongside the flu.
 
‘Novel coronavirus testing will become part of routine respiratory infection testing, resulting in a more efficient and streamlined process for GPs,’ SA Health said in a statement at the time.
 
‘While it will result in more South Australians being tested, it will mean more people will be able to rule out any links to novel coronavirus.’
 
That made South Australia the first state to allow GPs to routinely test for the coronavirus – even as other states grappled with shortages of swabs, requiring GPs to only test patients who fit a narrow set of criteria.  
 
‘We didn’t have to rely on tests from interstate. It was done in-house so we could very quickly add that on to the respiratory panel and allow GPs to order it,’ Dr Kirkpatrick said.
 
The fact that SA Pathology was government-owned made it easier to respond rapidly.
 
‘They have been the sole provider of COVID-19 testing until the last couple of weeks. They carried us for three months,’ Dr Kirkpatrick explained.
 
How could they respond so quickly? Because South Australia had been ramping up its flu testing capabilities in recent years.
 
‘SA Pathology has been heavily involved in the respiratory pathogen space previously, involved in the Australian Sentinel Practices Research Network [ASPREN] based at the University of Adelaide, so they had the expertise in-house to be able to develop the COVID-19 platform, while other pathology companies had to rely on buying kits,’ Dr Kirkpatrick said.
 
‘While many other labs were struggling with swab supply, we could run the respiratory viral pathogen PCR and SARS-CoV-2 PCR tests off the same swab, which was a real advantage. It meant we could conserve our swabs.’
 
South Australia’s rate of testing is the third highest in the nation, with 46,000 tests per million population.

Emily-Kirkpatrick-article.jpg
Dr Emily Kirkpatrick in the SA Health state control centre.

Centralised information
SA Health ran weekly webinars with their own experts – as well as RACGP, AMA and PHN input – where cases could be discussed.
 
Dr Kirkpatrick sent newsletters to the state’s GPs from Monday to Friday, with the latest information and GP-relevant tips. Her work has been hailed by her peers, including her predecessor in the liaison role, former RACGP SA&NT Chair Dr Danny Byrne.
 
Dr Byrne told newsGP Dr Kirkpatrick successfully connected the public health unit to private general practice.
 
‘This [newsletter] service has been highly regarded by GPs on the ground,’ Dr Byrne said.
 
‘SA Health realised early on they needed a GP in the COVID-19 space to work alongside [its own] staff. Emily has done amazing work.’ 
 
In addition, SA Health set up two coronavirus dashboards – one public and one for medical use.
 
‘The medical dashboard had really accurate data on how long patients had been infectious for, how long their symptoms lasted and when they were cleared,’ Dr Kirkpatrick said.
 
‘We could see hospital capacity – every bed in the state – as well as how many tests had been done that day, how many new cases, as well as maps of where testing was being done, so you could see any gaps.’
 
Into the future
GPs have been calling for more input into disaster management and planning for years.
 
In the aftermath of this summer’s bushfires – and as the current pandemic continues – South Australia may be showing the way.
 
‘When it comes to disaster planning, we really need to refocus on what primary care can deliver,’ Dr Kirkpatrick said.
 
‘Some people thought GPs wouldn’t want to manage the coronavirus, but it was the opposite – we had too many. There was so much interest from GPs who wanted to be part of the process, it was remarkable.
 
‘Having such high-level collaboration, with the RACGP, PHNs, AMA and SA Health working as one cohesive group, it hasn’t been achieved before.
 
‘We can’t waste this opportunity. We have to take forward all these lessons learned and take it all with us.’
 
How did the response unfold?
An SA Health spokeswoman provided newsGP with a brief timeline of the state’s response to the coronavirus:

  • 22 January – First Public Health Alert disseminated to GPs
  • 1 February – First two positive cases
  • 6 Feb – First local testing at SA Pathology
  • 10 March – Announcement of nation’s first drive-thru COVID-19 test collection centre
  • 17 March – Announcement of South Australia’s first regional COVID-19 clinic
  • 22 March – Border closure announcement 
  • 24 March – First community transmission
  • 25 March – First ICU cases
  • 26 March – Biggest increase in cases (38 cases)
  • 28 March – Announcement of further measures to reduce the spread
  • 1 April – Announcement of additional staff for contact tracing
  • 7–12 April – All four deaths
  • 15 April – Announcement of testing blitz
  • 17 April – Announcement of rapid COVID-19 testing
  • 17 April – Announcement of wastewater testing
  • 23 April – Announcement of home hospital program
  • 24 April – Announcement of digital prescriptions
  • 30 April – Announcement of COVID-dedicated teams of GPs and nurses for people self-isolating
  • 6 May – 14 days of no cases
  • 7 May – One new case
  • 18 May – Announcement of asymptomatic testing
  • 21 May – Last COVID-19 patient leaves ICU
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COVID-19 pandemic response South Australia



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SD   26/05/2020 7:22:42 AM

COVID 19 teams/ clinics, respiratory assessment clinics and fever clinics has been a major contribution to keeping the clusters at bay and keeping COVID patients away from general public in hospitals and GP medical centres.


Dr Daniel Thomas Byrne   26/05/2020 8:08:21 AM

Great work Emily and SA Health. Early in the pandemic SA had not only the highest testing rate in Australia but the one of the highest rates in the world. An engaged, keen, well informed GP community were a huge part of the testing success along with SA Pathology.


Dr Matthew Laurence Byrne   26/05/2020 8:22:10 AM

Congratulations to SA ! This is the model we should have had in Victoria. We in general practice could have done so much more but were locked out by rigid inefficient systems which I am sure missed many low level cases . Fortunately the social isolation has probably contained many of these but using primary care better would have been far more efficient .


Dr Deborah Susan McKay   26/05/2020 8:37:42 AM

Inspiring


Dr Wasan Haider Maghazaji   26/05/2020 9:07:45 AM

Well done SA .


Dr Myint Zaw   26/05/2020 1:03:57 PM

Well done SA


Prof Max Kamien, AM   26/05/2020 1:39:09 PM

Bravo to GPs in SA. Also showing the way on how to avoid triumphant hype: "South Australia may be showing the way". Liked that.


Dr Susan Margaret McDonald   30/05/2020 7:54:39 PM

Fantastic work SA. Great to see public health engaging with GP's and achieving so much for your community. We are a statewide network who can mobilise instantly if we are given a few basic tools.
We felt useless in the first few weeks in Queensland with no PPE, inability to test, and conflicting messages coming from all directions.
Finally we got a daily communique from Cairns Hospital giving us the positive case data which was excellent as up until then we only had rumours and the local newspaper for information. We have an excellent public health unit but they couldn't help us.
A lot can be learned from the experience of other states who are at the frontline.
A wake up call for the future.