How other countries are responding to coronavirus

The Australian Department of Health recently updated its coronavirus guidelines for primary healthcare workers, including downgrading the personal protective equipment (PPE) required for collecting specimens from suspected cases.
 
But what about medical authorities in comparable countries?
 
United Kingdom
The UK recommends primary care workers ‘avoid physical examination’ of any suspected coronavirus cases.
 
It states any patient that presents at a general practice who fits the criteria as a potential carrier should be taken to an isolation room, along with their belongings, and that GPs communicate with them via phone if a clinical history needs to be obtained or completed.
 
GPs must avoid any form of-face-to-face assessment or testing with patients where coronavirus is a possibility, and instead contact their local secondary care infection specialist. Criteria for suspects is more stringent than Australia and includes travel to China, Hong Kong, Japan, Macau, Malaysia, Republic of Korea, Singapore, Taiwan, or Thailand.
 
PPE safeguards are also more robust than in Australia. Any healthcare worker that enters a room where a suspected or confirmed coronavirus patient is isolated must wear full PPE, including a P3 respirator, which offers greater protection than the P2 masks Australian healthcare workers are required to wear when collecting samples in tertiary settings from suspected cases with ‘severe respiratory symptoms’.
 
Canada
Canada has very similar case criteria and infection control management protocols to Australia. Suspected cases include people with fever, cough, or breathing difficulty who have a travel history to mainland China or have had close contact with a confirmed or suspected case.
 
The Canadian Government recommends health professionals isolate suspected cases in a designated separate waiting area, limit the visitors to only those who are essential, and exercise contact and droplet precautions. An N95 respirator need only be used when performing aerosol-generating procedures on a person under investigation.
 
United States
The US Center for Disease Control has stated it does not yet know how long coronavirus remains infectious in the air and, as such, ‘it is reasonable to apply a similar time period before entering the room without respiratory protection as used for pathogens spread by the airborne route (eg measles, tuberculosis)’.
 
Primary care physicians are not expected to collect samples from coronavirus suspects, and specimens should be collected at either clinical or public health laboratories, as diagnostic respiratory specimens, such as nasopharyngeal swabs, ‘are likely to induce coughing or sneezing’.
 
Healthcare workers collecting specimens should adhere to standard, contact, and airborne precautions, including the use of eye protection, while the use of at least N95 respirators is required before entering the patient room of a suspected or confirmed coronavirus case.
 
Singapore
Coronavirus guidelines for healthcare workers are not available on the Singapore Ministry of Health website. However, its frequently asked questions section stipulates: ‘When dealing with infectious diseases, healthcare workers are required to wear the personal protective equipment (PPE), including N95 and goggles, as they are in close contact with patients and their bodily fluids.’
 
European Union
The European Centre for Disease Control (ECDC) states all healthcare workers in contact with a confirmed or suspected coronavirus case should exercise contact, droplet and airborne protection, including eye protection, long-sleeved water-resistant gown and gloves, and a P2 or P3 respirator as a minimum.
 
‘Although airborne transmission is not considered the principal transmission route, we recommend a cautious approach due to possible transmission through aerosols,’ its guidelines state.
 
‘In the event of the need to assess a suspected case or in the management of a confirmed case, ECDC suggests the use of filtering face piece (FFP) respirators class 2 or 3 (FFP2 or FFP3). An FFP3 respirator should always be used when performing aerosol-generating procedures.’
 
New Zealand
New Zealand has established a dedicated 0800 number for health advice and information regarding coronavirus. Its advice for health professionals is similar to Australia and recommends the use of surgical masks, rather than P2 or greater respirators, for primary care clinical staff.
 
GPs can collect specimens and ‘airborne precautions should be followed when collecting specimens if there is a risk of aerosol generation’.
 
The situation at home
GPs were previously required to wear either a P2 or N95 respirator when collecting all specimens, but a recommendation from the Infection Control Advisory Group (ICAG), which advises the Australian Health Protection Principal Committee (AHPPC), downgraded this to contact and droplet precaution – ie surgical masks – in ‘mild’ cases.
 
The updated advice generated angst within the primary care community, including Gold Coast GP Kat McLean, who questioned whether the change was based on evidence or operational realities – as GPs have had issues sourcing sufficient PPE for treating suspected cases.
 
Dr McLean, who last week raised the alarm over equipment shortages and mixed messages from various health departments, told newsGP there has been little improvement since.
 
‘Many GPs I know still don’t have access to the appropriate PPE, particularly the rate-limiting components,’ she said.
 
‘We’ve been reassured by our supplier that the gloves are there and that that’s not going to be an issue … but we [still] can’t access gowns, so that’s challenging.’
 
Complicating the issue, according to Dr McLean, is new public health messaging from the Queensland Government that directs patients to ‘urgently see their doctor’ if they have concerns about coronavirus, but does not specify the need to phone ahead.
 
‘There’s this real disconnect with what our resourcing is and what the public health messaging is,’ she said.
 
‘We need to be resourced to manage potential cases that might come in the door and the messaging should be that the patients are directed to hospitals.
 
‘The variations in recommendations both internationally and between states, along with ongoing PPE supply issues, are the key concerns.’
 
The lack of PPE and inconsistent messaging has led Dr McLean to believe GPs are being taken for granted – a feeling that was reinforced when she saw news footage of asymptomatic evacuees landing in Australia from China.
 
‘All of the ground support staff that were ushering them were wearing PPE, including P2 masks,’ she said.
 
‘When you’re seeing those masks used in that situation for asymptomatic patients, and yet we’re being told that we only need a surgical mask … [when] we’re doing nasopharyngeal swabs on suspected cases – it’s a little bit disconcerting and hard to understand.’
 
Recent reports suggesting coronavirus could potentially infect people via airborne transmission would, if confirmed, impact which PPE healthcare workers don when treating and collecting samples from symptomatic patients.
 
At the time of publication, Australia had 15 confirmed coronavirus cases across Queensland, New South Wales, Victoria and South Australia, and one suspected case on Christmas Island.
 
The RACGP has more information on coronavirus available on its website.
 
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