GPs ‘perfectly safe’ assessing potential coronavirus cases: ICAG

Matt Woodley

12/02/2020 4:34:22 PM

The Chair of the infection control group guiding Australia’s public health response to the virus is confident appropriate safeguards are in place.

Doctor taking swab
Some GPs have expressed confusion over updated coronavirus mask advice.

Professor Lyn Gilbert, Chair of the eight-member Infection Control Advisory Group (ICAG), believes GPs should feel ‘reassured’ by the current coronavirus situation in Australia.
‘We haven’t had transmission at this stage in Australia, apart from people who have either come directly from Wuhan or been in very close contact [with them],’ she said.
‘There’s [also] very little in countries outside mainland China. It does seem there’s been a bit of transmission in Singapore, possibly also in Hong Kong, but that’s perhaps to be expected.
‘There are a few instances … but mostly it’s been in circumstances where there’s been no precautions, no personal protective equipment [PPE] – so I think if GPs follow the recommendations correctly they should be perfectly safe.’
At least 500 medical staff have been infected with coronavirus in the outbreak’s epicentre, Wuhan, and the South China Morning Post said healthcare workers on the ground estimate that number could be much higher.
Some GPs have also expressed concerns about guidelines, recently updated by the Communicable Disease Network Australia (CDNA) on the advice of ICAG, that stipulate surgical masks are appropriate PPE when collecting samples from ‘mild cases’, rather than P2 or N95 respirators.
But Professor Gilbert said the interim guidelines, which have now been disseminated by the Australian Department of Health, are based on the best evidence currently available.
‘We genuinely believe that surgical masks are safe for the majority of clinical situations,’ she said.
‘There’s still a lot not known … [and] there are rumours about it being airborne-spread, but as far as we can tell there’s very little evidence except in extraordinary circumstances, and they’re the extraordinary circumstances where we recommended P2 and N95 respirators.’
Professor Gilbert also said the respirators can give people a ‘false sense of security’, especially if they are not fitted properly, and the potential for healthcare workers to use the respirators incorrectly means they are ‘likely to be more at risk’ than they would be if wearing a surgical mask.
‘It’s very important that they’re used properly – the reason we don’t want them used routinely is that they often aren’t,’ she said.
‘They have to be properly fitted to the face so that when you blow air in and out of your mouth, or your nose, it doesn’t leak. If you keep them on properly fitted for any length of time they become quite uncomfortable and so people often don’t wear them properly, and then they’re not effective.
‘The general experience is that, by and large, respiratory viruses are spread by droplets and contact.’
As such, Professor Gilbert said it is essential GPs exercise extreme hygiene if they have been in contact with suspected coronavirus cases.
‘When people cough and sneeze, they either contaminate their hands, or droplets fall on hard surfaces – people touching [these surfaces] is probably the major route as much as direct droplet spread,’ she said.
‘This is why we keep on emphasising hand hygiene and frequent cleaning of surfaces in rooms where patients who are infected have been. We think they’re actually more important than wearing a P2 respirator.’
Associate Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC), told newsGP he agrees with the emphasis on hand hygiene and surface wiping, and that cleaning should extend to goggles.
But he has ongoing concerns related to ‘persisting unknowns’ about how the virus spreads – for example, how to spot a super-spreader.
‘The advice seems to rest on the balance of harms between “false sense of security” from wearing a P2 or N95 mask, and the risk that expert opinion is wrong and that aerosol spread will occur in a general practice setting,’ he said.
‘For GPs who have fit-tested masks and not subsequently changed their face by growing facial hair etcetera, and for GPs who have learned how to don and doff PPE with good technique, there will be an advantage of P2 or N95 mask use if, and only if, aerosol spread is occurring.
‘I wonder if the precautionary principle is the best approach at this stage. It certainly seems to be the approach taken overseas. The last thing Australia needs if coronavirus does start spreading through our community is sick healthcare workers.’
Numerous GPs on the frontline have relayed their concerns about the sometimes conflicting and unclear coronavirus safety and containment advice from state and federal health authorities.
However, Professor Gilbert said the release of national guidelines should ensure a unified approach in the near future.
‘All of the people who are putting out guidelines have emphasised that in the early stages of an epidemic, the data that are coming are rapidly changing, sometimes contradictory, and any guidelines are provisional until we really know more about them,’ she said.
‘It takes time to catch up and everyone does it on the run, but all of the chief health officers on the AHPPC [Australian Health Protection Principal Committee], all of the representatives on the CDNA, have now accepted the guidelines.
‘Unless I’m very much mistaken, they’ve all said that they’re going to change their recommendations to conform with [the new advice]. Now, we can’t force him to do that but … I think there’ll be changes fairly quickly.’
The International Committee on Taxonomy of Viruses this week announced it had officially named the virus (SARS-CoV-2), while the World Health Organization (WHO) has dubbed the disease it causes Covid-19.
China also confirmed its highest one-day fatality total to date – 103 – which pushed the total past 1100.
At the time of publication, at least 45,000 had been infected worldwide, including 15 in Australia.
The RACGP has more information on coronavirus available on its website.
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Dr Marilyn Ann Efimoff   13/02/2020 7:42:48 AM

My husband's practice is in the middle of a huge shopping centre. Coronavirus patients may well pass through the shopping centre, cough on the fruit in the fruit store, and contaminate any number of surfaces. I think possible patients need to be directed to a dedicated area in a public hospital

Dr Ian Mark Light   13/02/2020 7:48:03 AM

General Practitioners fear that patients with coronavirus will infect busy waiting rooms full of patients
Often a empty room is not available .
So the clinic is wanting teams from the health department to home visit patients at risk eg airline staff patients from international travel and cruises .
GP’s could home visit themselves with P95 masks gloves gowns goggles and “kits “ for collection for quick turnaround say 24 hours or do a test in a car or car park but if the patient is positive for coronavirus does the GP who did the testing now isolate themselves for 14 days ?
With regards to hospital referral the ethic is to ring ahead and warn the admitting officer so he can prepare a team and room to do the test .
Nominated testing centres like with the influenza early warning clinics - that you could refer patients who have symptoms and have returned from overseas are in jobs of risk or have had contact with coronavirus is an option .

Dr Phillip Colin Hope   13/02/2020 8:04:25 AM

If patient coughs/sneezes during examination is a P2/N95 mask better than surgical mask --?? if so should we not use P2/N95 mask -- r we determining severe cases on history only before examination if we follow a different approach with them ??

Dr Roger John William Parrish   13/02/2020 9:48:12 AM

If a person who has had the virus and has recovered from it, are they still able to be a carrier for a period of time? Is the virus able to survive when it has been placed on a surface touched by an actively infected person and if so, for how long?

Dr Peter James Strickland   13/02/2020 11:00:36 AM

This advice is an indication of almost total lack of knowledge of GP practices. To say it is not spread via airborne particles from coughing to the atmosphere, and then breathed in by innumerable patients (and staff), OR left on surfaces such as counters, chairs, magazines, doors etc. is extremely naive. Why are the Chinese and other countries isolating cases ---answer---- to stop it spreading! GPs are trying to prevent this infection spreading in Australia, and it is guaranteed that any case of coronavirus sent to hospital WILL BE isolated, and for obvious reasons. The decision should have been to NOT risk any possibility of this virus entering Australia in the first place.