GPs largely unscathed by surge of COVID infections among healthcare workers

The small number of infections linked to general practice should be considered a success story, according to RACGP Victoria Chair Dr Cameron Loy.
 
‘There has not been a major outbreak of COVID-19 associated with any general practice clinic in Victoria. That’s because general practice did all of its practice infrastructure changes during the first wave,’ he told newsGP.
 
‘We shifted to telehealth, reduced waiting room occupancy, triaged in cars, set up respiratory clinics and some GPs isolated sections of their clinics.
 
‘There are cases in general practice, but no outbreaks. That’s actually a really important distinction.
 
‘It happened differently in general practice because we stepped in and made changes – and we were very lucky as well, that public health actions prevented widespread morbidity and mortality from COVID-19.
 
‘People say [GPs] don’t see acute COVID, but it’s the surprises where GPs can come unstuck. In other countries, it’s been far worse in primary care.’
 
Figures from Victoria’s Department of Health and Human Services (DHHS)from early September seen by newsGP show that 68 staff members from general practices have been infected with the coronavirus to date, including 38 medical practitioners in one clinic, 21 nurses and nine other healthcare workers.
 
These figures include both those who were infected at work and as those who acquired it in the community.
 
By contrast, healthcare worker infections have been much higher in other areas of the profession, with more than 1000 hospital workers and almost 2000 aged care workers contracting the virus according to Victorian Government figures. Nurses and aged care workers account for 2808 of a total of 3408 cases.
 
While those statistics now show that 85% of all healthcare worker infections are acquired at work, Dr Loy believes that rate is likely to be lower in general practice, though that data is not available.
 
The Federal Government’s major telehealth rollout may also have played a key role in keeping GPs and patients safe from the coronavirus. Health Minister Greg Hunt flagged patient and staff safety as a key rationale for the rapid introduction of telephone and video call consultations in March.
 
Earlier in the pandemic, GPs such as Dr Rob Hosking reported that patients were hiding their symptoms until they were in the consultation room – potentially placing them and their staff at risk.
 
Dr Loy said GPs have also been helped by the lockdown public health response, which had suppressed case numbers.
 
‘Lots of GPs have worked in respiratory clinics and testing stations and carried a huge load during this pandemic. Let’s not underestimate what has gone on. General practice is not a benign setting,’ he said. 
 
‘But I feel for our colleagues in major teaching hospitals with major COVID caseloads – it’s a scary and challenging world to be in.’ 
 
The healthcare worker infection rate outside of general practice has triggered a major debate over whether the provision of personal protective equipment (PPE) has been adequate, as well as whether procedures like donning and doffing and common areas are major causes of infection.
 
The Age and the ABC have reported that stocks of N95 respirators fell to alarmingly low levels in Victoria during the second wave, forcing rationing.
 
On Friday 18 September, the Victorian Government announced an expansion of N95 fit-testing – which ensures the respirators provide protection – out to all COVID wards in a response to pressure from doctors and medical organisations. 
 
An estimated 7000 healthcare workers have died from the disease globally during the course of the pandemic, according to an Amnesty International report, with Mexico the worst hit with 1320 deaths, followed by 1077 deaths in the US.
 
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