GPs told ‘prepare now’ as new coronavirus cases arise

Matt Woodley

4/03/2020 4:37:19 PM

With one healthcare worker infected and new cases of community transmission surfacing, GPs have been warned their preparation window is closing.

Doctor taking swab
Health authorities have confirmed three cases of community transmission within Australia, but have so far been reluctant to declare that the transmission is widespread.

The confirmed infection of one doctor from North Ryde Hospital in Sydney has seen 13 of his peers, 23 nurses and four other health workers sent home for 14 days of self-isolation.
The doctor had not been overseas recently, nor possessed any of the other criteria that until 3 March were used to identify suspected coronavirus cases, meaning it appears he was infected by an unidentified patient or contact.
It is a situation many GPs have been fearing and trying to raise the alarm about, with confusion over masks and the inability to source appropriate personal protective equipment (PPE) highlighted as shortcomings in the public health response to date.
Health authorities have confirmed three cases of community transmission within Australia, but have so far been reluctant to declare that the transmission is widespread.
Dr Evan Ackermann, immediate past chair of the RACGP Expert Committee – Quality Care (REC–QC), told newsGP now is the time that practices should be considering their approach to coronavirus should it embed itself in the community, especially with cooler months generally associated with influenza on the horizon.
‘Eventually, it’s going to get a bit of a hold. Whether the coronavirus will reach the level of mortality that influenza does in Australia, I don’t know. But it’s going to pose some interesting dilemmas for general practice,’ he said.
‘You can’t say to everyone, “If you have a snotty nose go to the hospital”, so there are some big questions to be asked in the next couple of months.’
GPs have been encouraged to access RACGP resources regarding pandemic, while Dr Ackermann has also asked GPs and health authorities to consider new methods for managing the potential spread within the community, such as telehealth and clinics dedicated to respiratory illness.
‘There are clinics and GPs who could handle this well, both as a screening service and management,’ he said.
‘There would need to be some essential components – telehealth, point-of-care testing or a good collection and reporting system, capacity for a separate room, training and information management and personal protection etcetera.
‘It really would be a good time to introduce [properly funded] telehealth for this purpose. It’s all about isolation management.
‘But GPs need to start thinking about it now – what you could possibly do if it does take a hold. You’ll probably want to know and have a different system of care and in place.’

Around 10,000 people have been tested so far in Australia, but after a two-week lull, 15 new cases have emerged in the six days since 28 February and some researchers have predicted nearly 100,000 people could die in Australia in the next 12 months in a worst-case scenario.
Health authorities are now urging anyone who has returned to Australia from Iran since 19 February to self-isolate at home for 14 days, after the number of confirmed cases there surged from zero to 1501 within the space of two weeks.
At the time of publication on 4 March, Australia had had 40 confirmed coronavirus cases (including those from the Diamond Princess cruise ship) and one death.

GPs and health authorities can consider new methods for managing the potential spread within the community, including telehealth.

Gold Coast GP Dr James Courts has been advocating for at-home testing of suspected cases since coronavirus emerged. He told newsGP he still believes this is the best option for containing the virus’ spread.
‘Testing at home with a home kit or visiting team is preferable to presenting to a GP surgery or emergency department,’ he said.
‘If seriously unwell, they should be collected by ambulance to the designated fever clinic or resuscitation centre. What would need more work is on the triage of those at home, and appropriate safeguards for both patient and physician alike.
‘This would need funding from MBS and would need to involve general practice, public health, ambulance and emergency department staff as a combined effort.’
Concern over the impact coronavirus could have on healthcare systems and workers has led to the postponement of the WONCA Asia Pacific Regional Conference 2020, which was scheduled to take place in New Zealand next month.
Royal New Zealand College of General Practitioners (RNZGP) Chief Executive Lynne Hayman wrote in an email to attendees that the decision to postpone ‘has not been made lightly’, but was based on uncertainty surrounding coronavirus.
‘The college needs to act wisely and ensure our GPs and other primary care professionals, who are the key to medical care in the community, remain available where they’re needed most,’ she said.

‘We couldn’t responsibly see so many [of] New Zealand’s GPs, practice nurses, and practice managers out of circulation in late April, even for a short time, considering the evolving situation with COVID-19 [coronavirus].’
Around 10% of doctors and nurses in Italy’s hard-hit Lombardy region have been infected with coronavirus, to the point where public health officials are seeking to bring doctors out of retirement and accelerate graduation dates for nursing students.
As such, Dr Courts said while he would be ‘happy’ to work in a fever clinic or dedicated GP testing clinic, it would be dependent on having access to appropriate PPE and remuneration, as well as contingency plans should he become infected.
‘I would want payment for my time and would want sick leave coverage if infected or under demands for isolation,’ he said.
‘If under forced isolation, I would [also] be happy to work via phone, Skype or remote access – but as it currently stands that is unpaid. The only way that I could see that work was if we were provided with Queensland Health temporary contracts.
‘The question is where healthcare staff, if infected or under query of infection, are to go. Would I wish to go home with the potential of infecting loved ones?  
‘I have heard of some countries planning local isolation accommodation for healthcare staff, and maybe this would be required.’
A fever clinic has already been established in Queensland, but Dr Courts said more effort and organisation is required to take the pressure off healthcare workers.
‘We have found issues with some patients not being tested, and with findings or results not being given in a timely fashion to either the patient or to us,’ he said.
‘We [also] have very limited PPE here and just one suspect case recently required a lot of time, effort and equipment to deal with. This all needs a lot of work and co-ordination of both parties.
‘What is not appreciated are politicians and medical politicians coming out with bland statements of “we are well prepared”.
‘We are not, [but] that is okay. This is an unexpected, if not totally unpredictable event. Take ownership of that and let’s get prepared together.’
The RACGP has more information on coronavirus available on its website.
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Dr Maria Renee Boulton   5/03/2020 7:16:52 AM

Agree. We are a not due to the lack of government support for general practice. Where is the PPE? Where are the Telehealth rebates both for coronavirus and other patients who do not want to venture out. Where is the financial support to keep our doors open? Finance Telehealth? Support us if we need to close and stand staff down? Why is it the wrong information is still being given to the community, do not come to the clinic, call first. Where are the community resources (correct ones?).

Carolyn Ee   5/03/2020 7:29:24 AM

"The confirmed infection of one doctor from North Ryde Hospital in Sydney has seen 13 of his peers, 23 nurses and four other health workers sent home for 14 days of self-isolation." When this infection becomes more widespread in the community, how will primary and secondary care cope with doctors, nurses and other health workers in isolation? Moreover with the impending flu season arriving how will we deal with snotty noses indeed - isolate and test everyone? I agree that self testing at home and paid telehealth consultations are an urgent priority or our healthcare system will fall over.

SD   5/03/2020 9:58:22 AM

If it spreads, this virus is much more serious than flu. It appears quite contagious as well, spreading to almost 70 countries within 2 months. Suggestion is to have dedicated Covid 19 clinics/rooms adjacent to hospital ED for assessment and tests with PPE equipment outside those rooms. These rooms may be decontaminated at regular intervals. Exposing GP’s to infected patient is only going to take whole clinic out of workforce once patient is tested positive.

Dr Nichola Lea O'Reilly   5/03/2020 6:35:00 PM

I wholly agree with Dr Court. Alas, with the developments in the news today, an effective containment of this infection may no longer be possible. Every hospital should have a fever clinic attached to it and GPs should be staffing it in collaboration with the hospital. GPs are more time efficient , have a better grasp of complex medical patients, knowledge of social conditions in their locality and great clinical judgement. We are the perfect front line. The RACGP needs to drive the push to put us there safely and remunerated as Dr Court outlines. I feel the hare will win this race while the turtle deals with the bureaucracy.

Dr Syed Naqvi   7/03/2020 9:38:10 AM

Working as GP in Aus means access to poor MBS rebates,highest risk of contracting deadly diseases and passing on to your loved ones,highest litigation risk,responsible for whole patient care even though no supported system in place and patient not shiwing responsibilities ,to face irresponsible abusive behaviour of some people in the public.We are supposed to be the frontliner of health force and pivot in the healthcare system.E xpectation of public and organization from GPs are sky high.
Slowely GP is transforming into trash bin of the hospitals.