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Has the coronavirus shown the need for better public health responses?


Doug Hendrie


7/02/2020 3:21:52 PM

Fragmented messaging has led GPs on the ground to call for a more centralised response.

Australia and the coronavirus
Inconsistent messages from state and federal health agencies and unpredictable availability of personal protective equipment are among the chief concerns.

GPs across the nation have been confused amid the coronavirus response.
 
Inconsistent messages from state and federal health agencies, and unpredictable availability of personal protective equipment (PPE), including confusion about the types of masks needed, are among the chief concerns. 
 
RACGP President Dr Harry Nespolon told newsGP the situation has demonstrated the need for a ‘single centralised body dispensing authoritative information’, rather than differing advice from multiple health agencies.
 
‘Australia needs a national plan for dealing with potential pandemics like this virus. This isn’t the first and won’t be the last,’ he said.
 
‘Let’s use what this virus has shown us to be well prepared into the future. GP involvement in planning and early access to resourcing must be a given in the future.’
 
Dr Nespolon said GPs are well prepared for challenges such as the coronavirus.
 
‘We’re at the coal face and patients will inevitably present to their general practices in these situations,’ he said. 
 
‘We are fortunate that so far there have not been very large numbers of infected people, because hospitals would not be able to cope without the assistance of general practice.
 
‘We just need the right information, the right resourcing and the right financial support.’
 
Earlier this week, Dr Nespolon called for a more unified national response to the virus when speaking on ABC radio.
 
‘Each of the states is getting different advice [which] can be relatively contradictory … [I]t would be better if it was all consistent,’ he said. ‘We’d be in a much better position to provide advice to our patients and, for us as a college, to our members.’  
 
Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC– QC), told newsGP that GP involvement is key.
 
‘What both the bushfire crises … and this potential pandemic have demonstrated is that GPs have not been adequately part of the co-design of the emergency response and that effective channels to GPs and from GPs are a bit piecemeal,’ he said.
 
The calls come after Professor Glynn Kelly, Chair of the RACGP Disaster Management Specific Interests network, warned that the lessons from the SARS pandemic of 2003 had been forgotten.
 
‘At the moment, people are getting one communication from one [health authority], one from another, and GPs are getting confused about which ones to follow … we really do need consistent communication across all jurisdictions,’ he told newsGP last week.  
 
‘Communication has often been conflicting and often not timely. We need one simple source that has clear concise timely accurate information.
 
‘GPs also need to be involved in all planning, because we have to respond [to these crises] but we’re not involved on any formal basis.’
 
GPs on the ground who are responding to potential cases have backed calls for a unified approach. 
 
Speaking on Channel 10 news this week, Adelaide GP Dr Alvin Chua called for a ‘united national approach’ and suggested specialised ‘fever clinics’ could also be needed.
 
Dr Chua told newsGP he is concerned about the lack of consistent messaging between federal and state health authorities, as well as the challenges in getting access to high-protection P2/N95 masks.
 
‘We are capable … [but] we need the support, we need proper PPE and we need to protect our healthcare workers, doctors, nurses, receptionists and, most importantly, other sick patients in the waiting room,’ he said.
 
Dr Karen Price, Deputy Chair of RACGP Victoria, told newsGP that official information flows around the coronavirus could be improved.
 
‘We need a central source of information that’s funded by government, but independent of government, for outbreaks like this,’ she said. ‘The communications channels are not well set up. Each health department is putting out webinars that contradict other states.
 
‘In emergency departments, they run simulations of major disaster responses to find out where their weakest links are. We can’t afford for this to be the test run that shows us where our weaknesses are. We need to be pre-emptive.’
 
Kangaroo Island GP Dr Tim Leeuwenberg told newsGP the coronavirus response has demonstrated the need for primary care to be actively involved in emergency planning.
 
‘Primary care needs to be considered … whether public health or mass casualties and disaster, at every level in preparation and planning as well as response,’ he said.
 
‘We can do so much to help if we have a seat at the table.’
 
Issues of coordination, PPE availability and mixed messages are not unique to Australia’s response, with GPs in Ireland expressing very similar concerns, while a paper in the British Journal of General Practice has called for GPs to be involved in planning for outbreaks, stating that ‘strong primary care systems form the foundation of any emergency response’.
 
Earlier efforts to create a centralised response to public health disasters have not gained traction.
 
Calls in 2017 by the Australian Medical Association for an Australian equivalent to the US Centre for Disease Control were rebuffed.
 
In 2013, a Federal Government inquiry into Australia’s response to the threat of globalised infectious disease heard from experts that fragmentation was a major concern.
 
Professor Peter McIntyre from the National Centre for Immunisation Research and Surveillance of Vaccine-Preventable Diseases told the inquiry that Australia had very strong response capacity in many areas, let down by fragmentation.
 
‘[T]here tends to be fragmentation both at the national level and in our capacity to respond regionally and more broadly, because we lack the sort of coordination that would achieve that,’ he said.
 
The RACGP has more information on coronavirus available on its website.
 
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Dr Peter James Strickland   8/02/2020 4:23:35 PM

This coronavirus episode is an illustration of how NOT to manage such an emergency of of a possible serious outbreak of disease. I n 1973/74 there was a threatened outbreak of cerebral malaria from falciparum malaria in Darwin into the whole community. I immediately placed 2000= odd personnel numbers in the services and their dependants on prophylactic medications (incl infants). The local Health boss got a kick in the backside for no action, and the Commonwealth released to me vehicles and spraying equipment for anopheles mosquito eradication in Larrakeyah Barracks, and aircraft for aerial spraying of swamps. Outcome --no spread of falciparum malaria in Darwin. There should have been an immediate stoppage of people coming from China on the threat of this coronavirus, and NOT this flying of people all over the place into quarantine. One case of a person in quarantine getting the symptoms and pathology of the coronavirus, and the "horse has bolted" again. Incompetence, or not?


Dr Yogesh Kumar Rathod   9/02/2020 12:31:57 PM

suggestion:

Setup assessment & Investigation at specialisedcamps/centres - to refer patient to.
Let these centres be equiped & staffed with specifically trained people - with relevant protective gear, as required.
Have team to expedite & monitor self - isolation as required
Facilitate case register & notifications.
Streamlined FU & admission as necessary
GP's can provide the necessary collat, history - if/as required .
this frees the GP centres to get on with other GP work, and minimises risk spread of inadvertent in the clinic waiting rooms.


Dr Edward Thomas Wu   10/02/2020 10:35:23 PM

Writing from China(Shenzhen) where the 2019-nCoV epidemic is making a more than traumatic impact to every single person across the whole social spectrum. The glimpses on Weixin of crashes of horrified people with symptoms of URTI overwhelming hospitals in the locked down city of Wuhan with 11 million people conveying frames of scenery more in keeping with a horror movie set than reality. As I reminiscent on what would happen to my primary care surgery back in Sydney if this outbreak descends there. The problems we face in Australia is only a far cry from the reality in China where "primary care" only cater for the unworthy "little" ailments of life and primary care plays practically no role in this national calamity. I hope we in the RACGP being the largest group of health care professionals can focus our minds and be more than ready to contribute to the care of residents facing evolving diseases with unknown expressions and methods of care at the very front line .