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How to respond to a case of COVID-19 in general practice

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A GP has been identified among 12 new coronavirus cases confirmed in Victoria, bringing the state’s total to 1732.
 
Now in isolation, the male GP is asymptomatic and reportedly contracted the virus from a close contact who also showed no symptoms.
 
He worked – while potentially infectious – across three general practices.
 
As the frontline response to the pandemic, the possibility of a positive case of COVID-19 in the team has been cause for anxiety for many general practices.
 
To help ensure they are supported, the RACGP has released a new fact sheet with easy-to-follow guidance that addresses:

• managing possible exposure to other staff and patients
• self-isolation
• consulting via telehealth during self-isolation
• practice cleaning
• communicating with patients

Dr Penny Burns, Deputy Chair of the RACGP Specific Interests Disaster Management network, told newsGP the fact sheet is an important resource that provides clear guidance which, in recent history, has been a key to practices responding effectively in a crisis situation.
 
‘Following SARS, I know that one of the issues was communication. They found staff that had accurate, up-to-date, timely, authoritative information to rely on felt much more supported and felt less stressed,’ she said.
 
‘They also felt they were then able to impart the correct information to patients as well and to other practice members.
 
‘In general practice at the moment, we are seeing changes in guidelines and recommendations constantly, and that is the nature of a pandemic. So it’s really important that we are able to access very timely, accurate, authoritative information.’
 
Community transmission in Australia remains comparatively low, with 382 active cases. But Dr Burns says it is important GPs remain vigilant.
 
‘We’re at the frontlines, so we’re out there trying to identify very early cases and we need all our practices functioning. If we’re not careful with managing it correctly, we could have a whole practice close,’ she said.
 
‘With all the cases we’re seeing in terms of chronic disease and other conditions that have not been presenting as much previously, there’s a lot of work out there for general practice to be doing.’
 
As well as providing a safe environment for patients, the fact sheet highlights the importance of having policies and procedures in place to ensure a safe working environment for practice staff. Dr Burns says the extensive consideration given to interactions between practice staff and patients, should also be given to those between staff themselves.
 
‘It’s really important to be vigilant as a practice team as to where you might be having gatherings or where you might be relaxing a little bit more,’ she said.
 
‘When this all first started happening we were doing our social distancing; we had new structures in terms of patients coming into the practice, we were checking them for symptoms and temperatures and we were isolating them if they had any of those. We had the patients sitting 1.5 metres away and we had distancing occurring at reception.
 
‘But of course, then there’s the tea room, and in the tea room you suddenly realise we feel like we’re not in the COVID environment. But you’re very much in the COVID environment.’
 
Dr Burns advises practice managers do a walk-through of the practice to contemplate how a suspected case of COVID-19 coming through the doors would impact the practice, and who would be exposed.
 
‘It’s a matter of just running through a “what if” scenario, and then looking at what your practice processes are and adjusting them appropriately to prevent that,’ she said.

 Deputy Chair of the RACGP Specific Interests Disaster Management network Dr Penny Burns.

‘One of the other things to remember is that we are still in the middle of a pandemic and overseas there are huge responses still going on; they’re still battling lots of cases with lots of hospitalisations every day.
 
‘We’re very, very lucky at the moment to not have that happening. But there is always the risk that we might get a second wave – in the Spanish flu they had a third wave – so we do need to be very vigilant and pick up all cases very early and be able to continue to function if we do.’
 
The fact sheet also includes direct contact details to government health departments in each state and territory.
 
For practices that do record a positive case of COVID-19, Dr Burns says this is an important resource and reminder that there is support available, with the intention of keeping the community safe, while ensuring practices can function and stay open.
 
‘Public health would become involved and they would look into the circumstances of the infection, but they are there to help support the practice,’ she said.
 
‘They would be doing all the contact tracing and assessing the practice. But their aim would not be to close the practice, their aim would be to support the practice in running as effectively as possible.’
 
As a disaster medicine specialist, Dr Burns says it has been impressive to see the way general practice has stepped in to support the community, especially given the unprecedented nature of a pandemic.
 
‘GPs are really standing out in this response as key players,’ she said.
 
‘General practice now does not look anything like it did a few months ago. That’s all happened very rapidly, and it’s basically being done by individual GPs supported by GP groups.
 
‘GPs constantly demonstrate their incredible ability to be adaptable and flexible, and to work with low resources. What I’d like to see is that they are very integrally involved in the future planning and policy for the next, inevitable, pandemic.’
 
The ‘Responding to a COVID-19 case in the practice team’ fact sheet is available on the RACGP website.
 
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coronavirus COVID-19 general practice

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