How the COVID surge is hitting GPs

There was a new, unwelcome record hit in Victoria on Tuesday, with a total of 1763 people newly confirmed with COVID-19.
 
It is the highest daily total for any state at any stage of the pandemic and is unlikely to be a record for long. While death rates remain low, the impact on health services is already acute with 517 people reportedly in hospital including 101 in intensive care.
 
These figures increased to 1535 nationwide, with 298 in ICU.
 
For RACGP Victoria Chair Dr Anita Muñoz, the hope is the trend will mirror the same pattern as New South Wales, where cases have fallen in recent days.
 
But it is the stories behind the figures that concern Dr Muñoz, particularly for GPs in the areas with the highest COVID-19 rates.
 
‘Many GPs [in those areas] are following COVID positive pathways, doing telehealth, as well as trying to continue to vaccinate,’ Dr Muñoz told newsGP.
 
‘Just those two COVID-related activities alone can take up all of the available consulting space that some clinics have.
 
‘That means that attending to non-COVID consulting can be very difficult to fit in.’
 
She warns there is likely to be a significant, delayed impact on general practice as a result, particularly for patients with health problems who cannot get treatment due to the surging case numbers.
 
‘It is really concerning for GPs to see someone who has a serious acute health problem like chest pain, or anaphylaxis, or serious asthma,’ Dr Muñoz said. ‘Sending those people into hospital to be treated is now actually a really difficult thing to do.
 
‘Hospitals are full of COVID positive patients, and in some instances ICUs are full. You may have a fully vaccinated person who has a heart attack and can’t get into ICU to get the treatment that they deserve, so the ripple effect is huge.’
 
With the vaccination rollout sitting at a crucial phase in the ‘road map’ ahead of the 70% and 80% targets, Dr Muñoz says the impact on general practice is now being felt in new ways.
 
‘There is still an ongoing struggle to get the last people vaccinate – that’s a really significant challenge,’ she said.
 
‘The other thing is that in some environments, patients are becoming quite aggressive with general practice staff over issues like mandated vaccines.
 
‘That’s really draining on all the staff and certainly has a big impact on morale.’
 
And as case numbers grow, so too do the challenges of keeping clinics open if they become exposure sites.
 
Dr Muñoz says advocating for how clinics are managed in these circumstances is a ‘vitally important piece of work’.
 
‘If the health system is to survive this challenge, we need general practice to be doing all that it can,’ she said.
 
‘And of course, it can’t do that if it’s shuttered and furloughed. We urgently need to rationalise that, and the [Victorian] Department [of Health] is very aware and they are very concerned also that we keep general practice open.’
 
On a positive note, Dr Muñoz believes vaccine uptake among young people is a cause for hope.
 
‘I would really encourage all unvaccinated Victorians to look to them as leaders and exemplars of what can be achieved if you put the good of all at the heart of your decision making, recognising that we really need to solve this problem together,’ she said.
 
The ‘very different scenario’ in Western Australia
In Western Australia, the challenges are different – for now.
 
RACGP WA Chair and member of the college’s COVID Working Group Dr Sean Stevens says the lack of visibility of the virus in the community does not always work in welcome ways.
 
‘I think there is a sense of complacency in the WA public and among some GPs, to be honest,’ he told newsGP.
 
‘It’s a very different scenario … to what my colleagues in Victoria are telling me. I’m still getting patients saying, “Look, I’m not going to get vaccinated until COVID hits, if it hits”.
 
‘There are some people who honestly think it’s not going to get here, which just staggers me. To try and convince them that it could happen any moment is at times difficult.’
 
GPs in certain parts of the state are also likely to be affected more sharply than others when the disease does finally increase in numbers, Dr Stevens warns.
 
‘Unless things change dramatically, there are going to be some areas that are going to be hit really hard,’ he said.

‘Some rural areas, and particularly some Aboriginal communities have vaccination rates under 10%, which is a major concern.
 
‘There are also certain populations within the metro area where there is significant vaccine hesitancy or vaccine refusal.’
 
In those instances, he believes the approach will have to vary in each instance.
 
‘You’ve got to have local solutions for the local issues,’ he said.
 
‘A program from Canberra or Perth encouraging people to get vaccinated is going to work for the majority of the population but there will be subsets that need respected community, elders or spokespeople to be champions of vaccination.’
 
Another of Dr Stevens’ worries is that healthcare services are already strained in many parts of the country that do not yet have any significant level of COVID-19 in the community, particularly WA.
 
‘The concerning thing is that already the hospitals are overloaded. [In WA] we’ve had elective surgery cancelled for a full month and possibly going to be extended,’ he said.
 
‘There’s record ramping at the emergency departments. Even things like obstetrics have seen the biggest demand in the state’s history.
 
‘GPs, we’ve gotten used to pivoting. Each time there’s a lockdown, we have been able to switch to telehealth and do as much as possible via telehealth with only essential appointments done face-to-face. Most practices are ready to do that again.’
 
Dr Stevens believes the inevitable spread of COVID means local practices will need to reintroduce safeguards before Christmas, but he acknowledges the onset of COVID-19 in the community is anyone’s guess.
 
‘It might not happen until next year, it could happen tomorrow. And as we’ve seen with Delta, it can just go nuts in no time,’ he said.
 
‘This is coming. We need to be ready. We need to get vaccinated. And we need to have pandemic plans well advanced.’
 
When it does finally arrive, he expects the biggest impact on vaccination to take place.
 
‘But we really need that before it comes,’ he said.
 
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COVID-19 general practice