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Missed COVID cases highlight importance of GPs testing symptomatic patients


Matt Woodley


15/01/2021 4:03:11 PM

Three of the recent coronavirus cases in NSW presented to general practice clinics, but were not initially referred for testing.

COVID-19 testing clinic sign.
Coronavirus testing has increased in recent weeks, after dropping to its lowest point in months in early December.

RACGP NSW&ACT Faculty Chair Associate Professor Charlotte Hespe has issued an impassioned call for general practice colleagues to test every possible coronavirus case, regardless of how minor symptoms may appear.
 
‘We know that there were three cases picked up in New South Wales in the past week, all of whom had attended a general practice and not been sent off for testing,’ she told newsGP.
 
‘That’s three opportunities missed when they then had another three days each, minimum, in the community, potentially spreading the infection.
 
‘We don’t want to be blaming in any way, we just want everybody to understand the importance of why we all have to do it.’
 
The plea comes amid ongoing ‘mystery cases’ in New South Wales, along with the looming threat posed by the presence of highly infectious new COVID variants in hotel quarantine across the country, which as recently as last week shut down Greater Brisbane for three days.
 
While not wanting to criticise any of the GPs involved, Associate Professor Hespe told newsGP the circumstances created by the coronavirus pandemic require a change in mindset.
 
‘This is not our normal way of assessing people. Normally, we do a risk assessment, and we refer off if we think the risk is such that we need to,’ she said.
 
‘But this is a different scenario where really everybody has to go, despite the fact that we might think that there is absolutely no chance of them having COVID.
 
‘The Mount Druitt case that we have at present is a classic example, where in fact, they still don’t even know where the patient got it. He saw a GP twice [before getting tested].’
 
Associate Professor Hespe likens the required shift in thinking to what occurred in the 1990s, following greater awareness around the dangers of HIV.
 
‘That needed a total cultural shift in terms of thinking about what blood potentially could do. And in the same way, at the moment, we just have to … [think] that everybody is potentially harbouring COVID,’ she said.
 
‘Rather than asking a question, “Is it COVID?” Just say, “Well, potentially everyone has COVID”. And therefore that’s how you treat every consultation and interaction, and that way we won’t get into problems.
 
‘You don’t lose anything by wearing masks proactively and you don’t lose anything by having that extra bit of social distancing in the way in which we conduct our consultations.’
 
Australia appeared to experience a form of COVID-fatigue towards the end of 2020, with nationwide seven-day testing averages in December dropping to their lowest point since June, before the subsequent Northern Beaches outbreak prompted a resurgence.
 
However, the most recent FluTracking report shows there is more work to be done. Of the 96 participants who had a fever and cough, only 60% (58) sought medical advice, and less than half (47) were tested for COVID-19 – one of whom returned a positive result.
 
‘GPs play a really, really major role in getting the testing happening,’ Associate Professor Hespe said.
 
‘GPs need to understand that although there’s great public health advice out there for anybody to go and get tested, a lot of people take the view that, “I haven’t been anywhere, I’m not at risk. I don’t need to do it.”
 
‘And so we as the GP need to reinforce, “Well, actually, you do” … [because] we know that with a number of the [recent] cases, that that’s exactly how they considered themselves too.
 
‘[For example], if we hadn’t done the testing, and it hadn’t come from general practice, the Northern Beaches outbreak – which was picked up through a GP – would be even worse.
 
‘The sooner we pick them up the better.’
 
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Dr Janice Faye Sheringham   16/01/2021 1:48:24 PM

These cases may well have presented to GPs and advised to seek testing but refused! We all know how often this is happening in Brisbane, Sydney and other areas in recent times, and some “contacts” have been via Telehealth. We also are not necessarily able to believe the cases’ claims of not being tested either! The ability of some clinics to offer testing to symptomatic individuals has also been hampered by poor supplies of adequate PPE! So please, can we ensure both sides of this equation are addressed - public acceptance of the need to comply with advice for testing, and ensuring that every practice has access to the appropriate PPE for testing suspected CoVid symptoms!


Dr Lisa Meriah Fraser   16/01/2021 9:29:41 PM

agree - so much refusal of testing and not self- presenting for testing. i think perhaps we need to address a few populations - children, asthmatics and the elderly. They seem to be the most common ones not being tested.


Dr Liyana Arachchige Bandula Abeywickrama   19/01/2021 11:11:56 PM

Some people with mild respiratory symptoms comes expecting a reassurance from GP that this is not Covid. When we tell them to do the testing they would say this is not covid.


Dr Ruth Sophie Ratner   23/01/2021 8:16:41 AM

If I have taken a history from and examined a patient with some sort or respiratory symptoms (assuming they somehow got through the triage that should have redirected them to a respiratory clinic), must I then don PPE to take a nasal swab?


Dr Sameerah Nawaz   23/01/2021 11:40:57 PM

Hi Ruth,
As soon as you figure out that they do have respiratory symtoms tell them to go to resp clinic. 1 becuase it discourages others (families, friends of patients) from doing the same to you and to other GP clinics
2. Patient Taking deep breaths, peering into their mouth all would generate extra aerosol which most general practices don't have enough PPE (n95mask, gown) do deal with.
The room should then be thoroughly cleaned, ventilated.
I think a lot of the times as doctors we feel obliged to check them once they present.however, they are doing the wrong thing, and by doing so , are endangering not only your health but your other patient's health too. So send them out as soon as you notice.