GPs ‘crying out’ for clear clinical COVID pathways

The Chair of RACGP Expert Committee – Quality Care (REC–QC), Professor Mark Morgan, has spoken out over GPs’ concerns regarding rising case numbers and unclear clinical pathways.
 
On a day the country recorded more than 70,000 COVID cases, Professor Morgan said he expects numbers to continue a sharp increase that has seen Australia’s overall numbers more than double in the past nine days.
 
And GPs, he said, want more guidance.
 
‘GPs are crying out for clear clinical pathways and guidance and knowledge about how best to help their patients and make sure their service is integrated with pharmacies, hospitals, etcetera,’ Professor Morgan told The Guardian.
 
‘It’s going to really be a quite confronting couple of months.’
 
Professor Morgan would also like to see more emphasis placed on available treatments as infections rise. He pointed to the antiviral sotrovimab as one medication that could potentially be utilised better, but said barriers are currently affecting timely access.
 
The drug needs to be taken within five days of showing symptoms to be effective; however, exploding case numbers, well documented PCR testing issues, a shortage of rapid antigen tests, unclear clinical guidelines and the need for a GP referral could result in vulnerable patients missing out.
 
‘The thing I’m most concerned about is the delays in testing capacity, delays in results, [and] lack of knowledge about the treatment options in the community, so that people will miss out on the treatments,’ Professor Morgan said.
 
‘To be effective, it has to be given in the first five days [of getting sick], and there are all sorts of problems with getting tested and finding out if your symptoms are from COVID or not.
 
‘So there are lots of difficulties finding out if you’ve got COVID, then another layer of difficulty [is] playing catch-up with the health systems as to who would access this medicine and how it would be given.’
 
The antiviral’s intravenous administration means Professor Morgan also does not think many GPs will possess the appropriate equipment to deliver the treatment themselves.
 
‘It has to be injected over half an hour, and [the patient then has to be] watched for an hour,’ he said. ‘And this is someone who’s infected.’
 
The Federal Government has ordered 81,000 units of sotrovimab, which is reportedly 79% effective against COVID in reducing serious illness, hospitalisation and death, although it is not clear how many have arrived in Australia or already been used.
 
In addition to testing positive for COVID-19, patients must have one or more risk factors to access sotrovimab, including diabetes, obesity, chronic kidney disease and moderate-to-severe asthma.
 
A series of other medications are also available to help treat patients with COVID, but Professor Morgan believes these have been somewhat overlooked.
 
Moreover, there is a ‘critical shortage’ of two of these drugs – heparin and dexamethasone – according to the Therapeutic Goods Administration. There is also a sotrovimab shortage in the US and it is unclear how long Australia’s supply will last in the face of skyrocketing case numbers.
 
‘They let [COVID] rip before they had their ducks lined up,’ Professor Morgan said.
 
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