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GPs call for action as WHO declares coronavirus pandemic


Matt Woodley


12/03/2020 4:06:50 PM

A number of Australian doctors have said mass gatherings, such as major sporting events, should be cancelled or held behind closed doors in a bid to avoid ‘catastrophe medicine’.

Empty soccer stadium
Champions League matches have been played in empty stadiums because of the coronavirus outbreak. (Image: AAP)

On the morning of 23 February, Italy had recorded 79 confirmed cases of coronavirus – nearly 50 fewer than Australia’s current total.
 
Less than three weeks later, the entire country of more than 60 million people has been placed into ‘lockdown’ in an attempt ease pressure on a crumbling healthcare system that has subsequently been overwhelmed by more than 12,000 cases.
 
The situation has gotten so dire that the Italian College of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has published guidelines advising doctors to undertake the type of wartime triage usually reserved for ‘catastrophe medicine’ undertaken on the battlefield.
 
According to The Atlantic, the guidelines state a lack of equipment, doctors and facilities needed to tend the huge number of patients swamping hospitals and intensive cares units has meant medical staff are now prioritising treatment of ‘patients with the highest chance of therapeutic success’.
 
The guidelines also indicate that ‘it may become necessary to establish an age limit for access to intensive care’ and that patients who are too old to have a high likelihood of recovery, or who have too low a number of ‘life-years’ left even if they should survive, will not be treated.
 
Nearly 830 people have died in Italy since the outbreak began and Australian doctors have begun advocating for enhanced efforts to ‘flatten the curve’ and avoid the fate of other countries such as Italy and Iran.
 
Melbourne-based GP Dr Vyom Sharma told newsGP he believes Australia must ‘immediately’ begin social distancing, even if only in incremental stages, beginning with planned mass gatherings.
 
‘Physical attendance by spectators at the Formula One Grand Prix, [and] NRL and AFL games should be prohibited,’ he said.
 
‘Beyond this, social distancing policies need to be expanded in line with available epidemiological data.’
 
Overseas, athletes have tested positive, major football matches have been postponed or held behind closed doors, schools have closed, and the NBA has suspended the rest of its season.

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An elderly patient is attended in one of the emergency structures set up to ease procedures outside the hospital of Brescia, Northern Italy. (Image: AAP)

Dr Sharma said if appropriate containment measures are not implemented and Australia’s healthcare system is overrun, the consequences could be dire.
 
‘Many patients will be harmed and possibly die, and not just those at most risk from COVID-19 [coronavirus],’ he said.
 
‘Young, healthy people will be affected if they have unexpected illnesses, due to needed resources [such as] ICU beds and medical and nursing staff being occupied by COVID-19 patients.
 
‘Doctors will [also] get sick, worsening the mismatch of ill patients to available health services.’
 
GP Dr Brad McKay also told newsGP Australia needs to look at public health responses in other countries around the world to avoid mistakes that have led to mass outbreaks elsewhere.
 
‘We’ve seen in China that social distancing has been helpful in decreasing the spread of [coronavirus],’ he said. ‘We’re learning valuable lessons from our colleagues in Italy by observing how bad things can get.
 
‘Hospitals over capacity, doctors working around the clock, patients ventilated in corridors, medical equipment in short supply, and health professionals choosing who lives and who dies because there aren’t enough resources to treat everyone.
 
‘It’s better to be over-prepared and wrong, than underprepared and totally screwed.’
 
The number of cases of coronavirus outside of China has increased 13-fold in the past two weeks, with the number of affected countries tripling in that time, leading the World Health Organization (WHO) to declare a global pandemic.
 
WHO Director-General Dr Tedros Adhanom Ghebreyesus said he expects to see cases, deaths, affected countries continue to rise in coming weeks, especially if containment efforts do not increase.
 
‘WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction,’ he said.
 
‘We cannot say this loudly enough, or clearly enough, or often enough: all countries can still change the course of this pandemic.
 
‘If countries detect, test, treat, isolate, trace, and mobilise their people in the response, those with a handful of cases can prevent those cases becoming clusters, and those clusters becoming community transmission.’
 
The Australian Government has announced a $2.4 billion response package, including new Medicare item numbers for telehealth and 100 dedicated respiratory illness clinics.
 
However, Dr Sharma said GPs could be better utilised than collecting samples at pop-up clinics. He also questioned the wisdom of directing potential cases to general practices.
 
‘Using GPs and potentially even nurses to swab patients and collect basic epidemiological data, while a high standard of care, might be something we will find locks up a valuable and versatile workforce which may be best utilised in another capacity. Pathology collectors and DIY kits might be good substitutes here,’ he told newsGP.
 
‘Many people will opt not to be tested at pop-up clinics due to delays or concerns of being exposed to infection in queue. Unlike the NHS in the UK, we do not have a policy to prevent presentations to general practice [in these cases], so this will pose a huge burden on time, resources and risk.
 
‘GPs will be at great risk of exposure to [coronavirus], which poses an exceptional risk to availability of medical labour.’
 
At the time of publication on Thursday 12 March, Australia had had 127 confirmed cases of coronavirus, including at least four instances where the source of infection was not known.
 
NSW Chief Medical Officer Dr Kerry Chant responded to questions regarding bans on mass gatherings by indicating it is a matter for Council of Australian Governments (COAG) health ministers.
 
The RACGP has more information on coronavirus available on its website.
 
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Dr Nicholas John Brodie Page   13/03/2020 6:51:12 AM

Another peculiarly dangerous Australian thing is that people with an URTI are required to see their GP for a medical certificate to be off work.
This can spread the virus round the waiting room and give it to the staff and close the clinic.
Can we please stop issuing “sick notes”.


Dr Kuljit Kaur Singh   13/03/2020 7:49:31 AM

We are at the crossroad now- we can either follow the path of countries like Italy, Iran and South Korea where the virus seems to be winning, or choose to curb its exponential rise successfully like Singapore, Japan, Hong Kong. Yes, it may be inconvenient for the community to have drastic (draconian) measures likea “lockdown”, with public event cancellation, closure of educational institutions, work-from-home, restricted local travel and more social distancing imposed now, but a few weeks of this slight imposition could potentially save our country from this “catastrophe medicine” and significantly limit numbers of infected cases and fatalities. If we miss the boat now, it may be too late - let’s be proactive not reactive! come on team Australia, let’s beat this war before it beats us.....


Dr Ian Mark Light   13/03/2020 10:07:55 AM

Health Workers have to have good PPE - N95 masks eye protection gloves gowns in some cases face shields plus hand sanitisers with 20 second washing after each visit .
When the flu and coughs and cold season hits need tests of full viral screening either as a drive in or home visit - hopefully covid 19 tests will be available then.
Catastrophic medicine means the bulk of elective surgery is stopped - cosmetic screening endoscopy joint replacement and all equipment theatres and medical staff redeployed to urgent care and emergency care that does not need ICU with mechanical ventilation .
ICU staffing can be multiplied for some tasks like observing PPE put on and taken off and relief in some tasks eg vital signs to ameliorate fatigue .
Also those who have recovered from mild COVID 19 may be immune after weeks though RNA shedding is the dilemma .
To help is telemedicine conference calls and smart phone videos .


Dr Dileep Singh   13/03/2020 10:26:45 AM

There had been few calls to close borders completely and any one coming should go to 14 days quarantine ( not self isolation) but leaders don’t listen Only time they will listen is when it is out of control which will be too late.


A.Prof Christopher David Hogan   15/03/2020 7:05:32 PM

Our decisions must be evidence based as some actions are counterintuitive. For example mass closures of schools is not helpful. First, children are at low risk of severe illness from coronavirus & second keeping children at home necessitates them being cared for. Removing the people who are caring for children from the workforce removes people from critical infrastructure occupations leading to more damage than would occur from coronavirus infection..
Australia has had experience of quarantine from the Spanish Flu & various other significant infections. We have had infrastructure failures from loss of electricity supply & loss of natural gas from the Longford gas plant failure .
Disaster management is complex, difficult & the situation often changes rapidly.
There is a lot of experience in disaster management in Australia - second guessing every decision made by government is unfair & unhelpful