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Health departments expand coronavirus testing

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The updated testing advice from health authorities in Queensland and NSW comes after an eight-year-old boy was confirmed as the 13th confirmed case in Australia.
 
Efforts to boost testing have increased recently, with NSW Health announcing last week it would begin screening patients with milder symptoms, while Western Australia has stopped reporting the number of suspected cases due to shifting parameters on what constitutes a suspected case.
 
Primary Health Networks (PHNs) in Queensland also announced recently that a number of private pathology services are equipped and prepared to collect samples.
 
Meanwhile, NSW Health first updated and then removed information for GPs that stated ‘testing of specimens for 2019-nCoV is now available through private pathology providers’.
 
newsGP contacted NSW Health for clarification and was told the advice, which had been live for less than two days, was removed so it could be updated.
 
Gold Coast GP Dr Kat McLean, who recently spoke to newsGP about difficulties sourcing appropriate personal protective equipment (PPE) for conducting coronavirus swabs, has ‘considerable concerns’ about sending suspected cases for specimen collection at private pathology clinics.
 
‘We’re sending potential cases into shopping centres, to sit in small community pathology labs and to then get testing done, which is really concerning,’ she said.
 
‘I’ve already heard feedback from a GP this morning that the technician at the pathology lab was using just a mask, not the full PPE, so I’m not sure what’s happening in the community, but that’s worrying GPs.’
 
But Associate Professor Ian Mackay, a virologist at the Australian Infectious Diseases Research Centre, told newsGP professional specimen collection centres are ‘aware of’ and ‘should be expert at’ the safe collection of human samples, including for coronavirus.
 
‘Given what we know about this respiratory virus, specimen collection according to current guidelines should pose no more of an infection risk to health workers than would collecting a sample for influenza virus,’ he said.
 
However, he was less certain of the risk posed by suspected cases presenting in crowded areas like shopping centres while potentially infectious.
 
Current Australian Department of Health advice states close contact with a coronavirus case – which would constitute the need for self-isolation – is defined as:

• greater than 15 minutes face-to-face contact in any setting with a confirmed case in the period extending from 24 hours before onset of symptoms in the confirmed case
• sharing of a closed space with a confirmed case for a prolonged period (eg more than two hours) in the period extending from 24 hours before onset of symptoms in the confirmed case.  

The same advice states there is evidence of human-to-human transmission, including among healthcare workers and that asymptomatic and pre-symptomatic people are also able to transmit the virus.
 
Professor of Global Biosecurity and Head of the Biosecurity Research Program at UNSW Raina MacIntyre has previously told newsGP it is important to expose ‘as few people as possible’ to potential new emerging infections, including by limiting ‘the number of sites where potential infected people encounter the health system’.
 
However, Dr Evan Ackermann, past chair of the RACGP Expert Committee – Quality Care, told newsGP he believes the response, including expansion into private pathology, has been ‘pretty well organised’ so far.
 
‘The private pathology labs set up to do this are actually selected by the company as they have the particular facilities to manage [and] they are especially trained with regard to safeguards,’ he said.
 
Dr Ackermann acknowledged there have been different experiences in different parts of Australia, but overall he believes the response has gone ‘reasonably well’ so far.
 
‘The lucky thing is it’s not that common [in Australia] at the moment, it’s actually rare,’ he said.
 
‘In general practice we’re seeing a lot of people, but it’s not much of a concern to be honest on an individual basis.’
 
He also said shortages of P2 and N95 masks should not pose a major problem for most clinics, unless there is a need for specimen collection.
 
‘Most practices and PHNs have adopted systems to ensure people are properly managed. This may include screening questions when phoning for appointments, or notices in the waiting area,’ he said.
 
‘Being informed, alert and organised is the best defence … no personal protection program is ever perfect – but good care systems, isolation rooms and handwashing are good starts.’
 
Singapore, which has 24 confirmed cases, recorded its first cases of local coronavirus transmission, after four women who had not travelled to Wuhan became infected. According to the World Health Organization (WHO), there are currently 27 cases in nine countries with possible or confirmed transmission outside of China.
 
Cases of the virus are doubling every five days and WHO Director-General Dr Tedros Adhanom Ghebreyesus has said the world still has ‘a window of opportunity’ to contain the virus and called for more cooperation globally.
 
‘Of the 176 cases reported outside China so far, WHO has received complete case report forms for only 38 per cent of cases,’ Dr Ghebreyesus said.
 
‘Some high-income countries are well behind in sharing this vital data with WHO. I don’t think it’s because they lack capacity.
 
‘Without better data, it’s very hard for us to assess how the outbreak is evolving, or what impact it could have, and to ensure we are providing the most appropriate recommendations.’
 
The global number of cases, including China, has reached more than 24,000, while the death toll is quickly approaching 500. There have been at least 176 cases in 24 other countries and regions outside China, including two deaths.
 
The RACGP has more information on coronavirus available on its website.
 
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coronavirus general practice pandemic pathology specimen collection

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