Infection fears for GPs in COVID-19 hotspots

At the time of publication on Friday 17 July, there were 150 active cases of COVID-19 among healthcare workers in Victoria alone, with hundreds more in quarantine awaiting test results.
 
But it is not known how many contracted the disease in a healthcare setting, nor which hospitals they work in, as the Victorian Department of Health and Human Services (DHHS) has reportedly declined to provide this information.
 
Australia’s second-most populous state broke its own record by registering another 428 cases overnight, and potential outbreaks have occurred in at least 10 hospitals.
 
Yet despite the record-breaking run of infection, GPs say they have been ‘forgotten’ and are still struggling to access personal protective equipment (PPE) – an issue that has plagued efforts to safely manage potential coronavirus cases since the pandemic began.
 
RACGP Victoria Chair Dr Cameron Loy told newsGP the situation is putting GPs, practice staff and the wider community at risk.
 
‘GPs shouldn’t have to be scrounging around on the open market to try and buy masks,’ he said.
 
‘We’re an essential part of the healthcare service; there should be access to government supplies of PPE, otherwise GPs are going to get infected in large numbers and GPs are going to die.’
 
 Under the state’s guide to the conventional use of PPE, last updated in May, intensive care units, urgent care centres and emergency departments are deemed ‘areas of high clinical risk’ in which face masks must be worn.
 
Meanwhile, general practice clinics only require hand washing and ‘standard precautions’ when dealing with patients who do not meet the clinical criteria for COVID-19, despite the risk of pre-symptomatic or asymptomatic transmission.
 
Dr Loy says this needs to change.
 
‘I think that if we are conforming to the DHHS tiered system, where GPs really [should be] at tier one, we should be gaining access to government supplies to a much higher degree than we currently are,’ he said.
 
‘Masks need to become available to those general practices through PHNs [primary health networks] in the quantities they need to make them safe for face-to-face consultations.
 
‘[Otherwise] it will also spread to patients in our communities. None of us want to be in that circumstance – we want to protect our communities as best we can.’
 
newsGP contacted the DHHS for comment but it did not respond prior to publication.
 
Victorian Chief Health Officer Professor Brett Sutton has said the rising number of infected healthcare workers is a ‘concern’, as is the manner in which they were potentially exposed to the virus.
 
‘Some of them have been exposed because they’ve been interacting with patients and maybe those patients were not identified with coronavirus very early on because of unusual symptoms, but also there’s staff-to-staff transmission that’s occurring,’ he said.
 
‘PPE is available and it needs to be worn universally. But no one can let their guard down in terms of wearing a mask or where they’re trying to keep a distance, including with other healthcare staff.’
 
But despite his calls for full and appropriate use of PPE, Victorian GP Dr Mukesh Haikerwal – who has established his own respiratory clinic near recognised hotspots – told newsGP Professor Sutton had been ‘unaware’ of GPs struggling to access PPE as recently as two weeks ago.
 
‘We raised it with the Chief Health Officer two weeks ago ... PPE needs to be made available to make sure people are safe when they’re doing their daily care of people with COVID,’ he said.
 
‘There’s a much more fundamental problem in Victoria and in fact most states, [whereby] state governments do not recognise general practice as being part of the healthcare system.
 
‘That’s the fundamental flaw the system has. We all live and work in communities within the state and we need to be part of the healthcare system as a tier one.’
 
Associate Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC), previously told newsGP there is a major need to support GPs, who are ‘central’ to any public health response to a pandemic.
 
‘If you start losing healthcare workforce … you lose the capacity to provide primary care and patients flood into already overstretched hospital sites,’ he said
 
‘Secondly, healthcare workers tend to come in contact early on in the course of a disease spreading to the community, because people come and see us, and then we’re likely to become a source of spread of infection to patients because we see a lot of people.’
 
Dr Loy said compromised primary care services in high-risk areas would do ‘untold damage’.
 
‘A closed general practice creates enormous pressures on every other part of the healthcare system, because we are and always have carried a huge load of healthcare delivery in Australia – often unrecognised and definitely unrewarded,’ he said.
 
‘If we start losing general practice capacity it will cause enormous damage to the entire system.’
 
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