New government support welcomed but PPE concerns remain

Matt Woodley

31/03/2020 4:58:07 PM

How are different regions coping with the coronavirus? RACGP state and territory faculty chairs report in.

Map of Australia.
Access to personal protective equipment remains the chief concern in many areas.

An inability to consistently access adequate supplies of personal protective equipment (PPE) remains the chief concern for GPs across Australia, according to RACGP state and territory chairs.
Expanding Medicare-funded telehealth consultations is expected to ease the burden somewhat, as are the standalone respiratory and testing clinics being rolled out.  
But the consensus among the RACGP leaders is that many GPs are being forced to source their own supply of PPE, find creative workarounds, or simply go without.
RACGP Queensland Chair Dr Bruce Willett told newsGP accessing PPE is ‘still the biggest concern’ for GPs in his state, both from a personal safety standpoint and also in terms of limiting the spread of the virus.
‘Health professionals all across the country know that the infection rate has been very high amongst health professionals in all the countries previously affected,’ he said.
‘Masks have been reaching practices but in very small numbers ... [and] practices remain concerned as the COVID-19 tsunami looms ever closer.
‘We know that our personal risk is higher, but I remain impressed with the ongoing commitment and professionalism of our fellow GPs, practice nurses and staff.’
Tasmania appears to be one of the few areas where the shortages are not reaching a critical stage – by virtue of being ‘two or three weeks behind the mainland’, according to RACGP Tasmania Chair Dr Tim Jackson. Even so, supplies there are limited as well.
RACGP SA&NT Chair Dr Zakaria Baig is mostly pleased with the local response to the crisis, especially the high rate of testing being done. But he told newsGP that PPE shortages have forced some general practices to band together to find their own consistent supply.
‘Different practices have formed a sort of syndicate and they’re actually buying or importing PPE stock from overseas,’ he said.
‘The masks and PPE are not arriving at PHNs [Primary Health Networks], so they’ve given up on that and started to be self-sufficient and order from the manufacturer directly.’
Dr Baig said this solution had cut out the ‘middle man’ and allowed the practices so secure a consistent supply at a lower cost.
However, in areas where these solutions do not exist or are not possible, GPs are having to make difficult choices.
RACGP Victoria Chair Dr Cameron Loy told newsGP there is a PPE shortage across all healthcare providers in the state, and he is ‘incredibly concerned’ that some GPs are choosing to assess and sometimes swab suspected coronavirus cases regardless of whether they have appropriate PPE.
‘It is unreasonable to have GPs making these choices,’ he said.
‘There is no doubt that the primary care workforce is at significant exposure risk in the COVID-19 pandemic. We saw this in Italy in recent times and I do not want this repeated here.
‘If we cannot swab because we have no PPE, then someone else has to do it who does. I can’t see any other way around that.’
In Western Australia, where the State Government has established COVID-19 clinics that are the only venues allowed to perform coronavirus swabbing, RACGP WA Chair Dr Sean Stevens says the situation is not as dire – but concerns remain.
‘There aren’t enough masks to fully deal with the volume of patients, [even though] the demand has eased off a little since many practices are going to telehealth,’ he said.

‘Gowns and disposable goggles are in short supply, but most clinics have enough gloves for now.’
Instead, Dr Stevens told newsGP a lack of clear messaging is the greatest challenge facing GPs in Western Australia, although recent efforts – such as the RACGP coronavirus page – have helped.
‘The WA Health Department is [also] working on a decision support tool that will provide clear guidance to GPs on how to manage suspected COVID-19 cases and their close contacts, and I think this will be invaluable,’ he said.
Confusion about testing is also challenging coronavirus containment efforts in ACT and NSW, RACGP NSW&ACT Chair Associate Professor Charlotte Hespe said.
‘I’ve spent so much of my time clarifying with NSW Health what the guidelines are for testing,’ she said.
‘I tell the GPs what it is, the GPs do that and then the patients get knocked back because the people in the testing centres are using different [federal] guidelines from what New South Wales Health has said we’re testing on.
‘That’s made it extraordinarily difficult when the GPs are complying with what they’re asked to do, which is that slightly broader [NSW Health] guideline and the testing centres aren’t.’
Like Dr Willett and Dr Loy, Associate Professor Hespe believes more could be done to protect health workers and stop them from spreading the coronavirus among vulnerable patient groups.
‘We’ve set up a specific drive-thru healthcare worker testing centre in my region,’ she said.

‘[A number of colleagues] went off to be tested and all three of them were sent home because the person who was testing wasn’t using the actual guidelines; they were using the federal guidelines.
‘You’ve got anxious healthcare workers who can’t work because they’ve got symptoms of a cold. We’re appropriately sending them off to be tested, and then the specimen collector says, “no, no, no, no, you don’t have a high enough temperature”.
‘They decided the temperature of the cut-off was 37.5°C, but the person had a temperature at the time of presentation of 37.4°C so they got sent home. From a clinical perspective, that’s a load of nonsense, especially if the patient’s taking Panadol
‘So [my colleagues] had to go back the next day to be tested again, wasting everybody’s time and exposure and resources. It’s crazy.’
One state that appears to have been testing differently to others from the beginning is South Australia.
Dr Baig told newsGP thatat the time of publication on Tuesday 31 March, there were only three coronavirus cases in the state without a known source of transmission – compared with more than 150 in NSW – and he believes this is partly due to SA Health’s early decision to test all suspected flu-like-cases for coronavirus as well.
‘Let’s say the doctor is suspecting the patient has the flu – when they order a test for flu testing, the coronavirus was added to the panel. No other state was doing that as a routine,’ he said.
‘By doing that, South Australia was able to track down cases even if someone didn’t suspect coronavirus, but then returned a positive test. By the time other states started doing it, South Australia had already carried out 10,000 tests.
‘South Australia was also the first state to start home testing. They were the first one to set up drive-thru testing.’
Despite ongoing challenges, there is also hope among the college’s state and territory chairs that Australia’s public health system is adapting and responding to the unprecedented coronavirus pandemic.
Associate Professor Hespe is hopeful telehealth, new point-of-care testing kits, and the establishment of dedicated respiratory clinics will reduce the huge demand on PPE supplies.
‘It’s really about being creative and being able to say, “look, we have to do this testing – how do we minimise the wastage that’s happening under the current testing system’s framework?”,’ she said.
‘The good news is, we have been heard. [For example] the telehealth package came out but it wasn’t what we wanted so they broadened it.’
Meanwhile, Dr Willett is aware of a number of practices in Queensland that have been approached by PHNs to establish dedicated respiratory clinics, and that it ‘appears to be progressing as quickly as can reasonably be expected’.
Likewise, he said information ‘is gradually becoming more consistent’ – a sentiment shared by most state and territory faculty chairs contacted by newsGP.
Dr Jackson also said recent government support would help practices in Tasmania stay afloat as they deal with the impact coronavirus has on patient volumes.
‘Basically we’ve all become … bulk-billing practices now. Traditionally in Tasmania we had a lesser rate than on the mainland, so incomes have dropped by probably 20–25%,’ he said.
‘But the MBS [telehealth expansion] has been really good. That’s enabled us to work as usual without seeing people [who otherwise might pose a risk to staff and other patients].
‘We’re just having to adapt. Some of the some of the increase in the PIP [Practice Incentives Program] payment will help counteract that and has been good as well.
‘Government is listening – both State Government and Federal Government – to the RACGP and the other medical groups, so I think that’s really good. They’re pretty well giving us what we need.’
However, while acknowledging the challenges and the need for everyone to adapt, Victoria’s Dr Loy believes governments at all levels could better assist GPs and help the community ‘understand the risk we face and their role in averting a tragedy’, by being more transparent.
‘We need consistent advice and we know where we are heading,’ he said.
‘We need to know what the chief health officers and chief medical officers are actually recommending to government and explanations of why they take or reject advice.
‘Lay out the path, lay out the triggers.

‘Lead, do not preside.’
The RACGP has more information on coronavirus available on its website.
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Dr Ian Mark Light   1/04/2020 8:26:14 AM

You can buy masks from pharmacies at high prices the more ethical sell 10 flat surgical masks for $ 24.50
Duckbill masks are sold for $12.95 a mask prices with prices up to $23.00 a mask .
At Nebraska hospitals they use UV light to
Sterilise masks for reuse .
Stanford University has published that Low Heat baking of masks at 70C or 158 F for half an hour is effective as is exposure to the vapour of boiling water for 10 minutes .(Web MD health news March 24 2020-)these are the rapid innovation trials to ameliorate shortages
If supply is not improved only a percentage of general practitioners with the masks gloves gowns and eye protection will be safely be able to see the URTI’S and LRTI’s and Viral Intelligence Testing Centres will need to forewarn of the Covid 19 positive percentages by area and by clinical presentations .

Dr Neil Warren Donovan   1/04/2020 11:42:47 AM

As A GP it is very frustrating to send patients with viral symptoms away and not tested. Is everyone sticking to the guidelines?
Can we not move to testing febrile coughing patients with flu like symptoms, outside the strict guidelines (in NSW) . Can we have transparency about how many kits there are ?
Surely it is time for the Influenza vaccine to be delivered faster . Patients are desparate, practices are ready, the minister says NOW. But distribution is in dribs and drabs, not sure when? There will be patients fighting to go first . Distribution is now the weakest link, in 2 weeks the landscape could be very different. I spoke with NSW distribution setting this morning, its just business as usual. " its the same every year ". Pls tell me in vaccines are not just sitting in a warehouse. Can we have more information, every patient wants to know.
Do we have to decide who goes first, of those eligible? Aged Vs Asthmatic ?

A.Prof Christopher David Hogan   1/04/2020 9:47:35 PM

The lack of PPE is a source of great concern across the whole world with the possible exception of China

Dr Harneet Verma   9/04/2020 8:16:25 AM

i work in northwest tasmania. asymptomatic patients are likely to be around. the mandatory patients coming in are being offered masks to protect us. how long can we survive without normal masks for patients especially in the flu season