Risk of infecting others with COVID-19 key concern for healthcare workers

GP Dr Wendy Burton is not concerned about contracting COVID-19 herself.
 
However, the Chair of the RACGP Specific Interests Antenatal and Postnatal Care network is more worried about passing the virus on to others, especially a vulnerable member of her immediate family.
 
Dr Burton has made the difficult decision to physically distance herself from members of her household, her husband and two adult children, while she works as a GP.
 
The tipping point came on 23 March. Dr Burton had been seeing a regular patient that day, a child who had been pre-screened and had presented with a sore ear. 
 
During the consultation, Dr Burton, who was wearing protective gear, asked whether any other family members had been sick. That is when the child’s mother supplied the information that she herself had a temperature of 39°C and a sore throat.
 
‘There was that moment of potential contact,’ Dr Burton said.
 
‘I’d already been preparing my family that there would come a time when this [physical distancing] would be needed.
 
‘That was my, “I need to enact this now” thought.’
 
The fact Australia’s healthcare professionals are under considerable strain amid the coronavirus outbreak is hardly news. Working on the frontlines of pandemic takes an inevitable toll.
 
But being in such close proximity with the virus can bring an additional layer of stress.
Victorian Chief Health Officer Dr Brett Sutton announced on 1 April that more than 80 healthcare workers in Victoria had been infected with COVID-19, representing around 10% of the total number of cases in that state.
 
Dr Sutton said this information highlights the risk doctors, nurses and other hospital staff are undertaking by helping others during the pandemic. He also notes those infected were not all doctors – some were in ancillary and support roles within hospitals – and not all those infections were acquired in hospital or from patients.
 
‘But it does point to the fact our healthcare staff, across the board, really are at the frontline and we have to do everything we can to protect them,’ he said.
 
Further research supports the notion that frontline workers such as GPs are under enormous strain during the pandemic.
 
TKW Research, a research and data collection field agency specialising in large-scale data collection programs, surveyed 433 Australian healthcare professionals on 25–27 March 2020.
 
It reported 78% of healthcare professionals are concerned about contracting the virus, or passing it on to others.
 
‘While some healthcare professionals were worried for their own safety, many were really concerned about becoming infected and then passing it on to others; becoming part of the problem, not the solution,’ Drew Le Grand from TKW Research said.
 
Dr Wendy Burton has decided to practice social distancing measures within her own household to reduce the risk of passing infection on to a vulnerable family member via her work as a GP.
 
Since instigating physical distancing at home, Dr Burton ensures she keeps a 1.5 m distance between herself and family members.
 
She also limits the time spent in the same environment as her loved ones.
 
‘So if we’re watching a movie it can’t be more than two hours. I don’t want to be in the same room as them for two hours,’ she said.
 
During meals, Dr Burton positions herself at the furthest end of her dining table, while if a family member is in the kitchen, they need to leave in order for her to come in.
 
It is ‘awkward’ to move past family members in the hallway, she said.
 
Instead of sharing a bedroom with her husband, Dr Burton now sleeps in a separate room and uses a separate bathroom from the rest of her family.
 
‘I’m keeping that distance,’ she said. ‘No hugs, no cuddles, none of that.’
 
While this new arrangement has been challenging, Dr Burton said it is necessary to reduce the risks of passing the virus on to her family during this time.
 
‘I have a vulnerable member of the household,’ she said. ‘I need to do this.’
 
Dr Burton is far from the only medical professional undertaking such measures.
 
Dr Michelle Au, an anaesthetist in the US, said many doctors there are engaging in similar measures.
 
‘There is a sizeable portion of people who have already started self-isolating in the medical community,’ she said.
 
Dr Burton has also heard reports from other Australians undertaking similar measures here.
 
That includes a patient who mentioned her daughter is returning to work as a nurse and has decided to move out of the family house altogether while working.
 
Dr Burton said she would have considered moving out if her house had not been configured to allow her to have her own separate sleeping and bathroom space.
 
Fears of contracting COVID-19 or passing the infection on to others are not the only additional stresses healthcare professionals currently face.
 
TKW Research also found lack of personal protective equipment (PPE) is having a substantial impact on healthcare professionals’ ability to do their work, and is adding to their anxiety and stress about contracting or passing on the virus.
 
Dr Vicki Kotsirilos understands this concern.
 
She told newsGP the main reason she is not feeling additional stress at the moment is because she considers herself ‘extremely fortunate’ to have access to PPE. Even with that protection, however, Dr Kotsirilos said it is a ‘stressful time for GPs at the moment’.
 
‘We’re at the frontline,’ she said.
 
‘We seem to have become much busier rather than quieter because of concerned patients.’
 
The lack of PPE is stopping other GPs from engaging in work that may put them at additional risk of contracting COVID-19.
 
Melbourne-based GP Dr Vicki Nahamkes told newsGP she has decided not to work at a respiratory or COVID-19 screening clinic ‘due to higher risk of contagion due to insufficient PPE’.
 
Had she decided to work in such a clinic, Dr Nahamkes added she would have made arrangements to live elsewhere to protect her family.
 
Other concerns healthcare professionals are shouldering at the moment relate to worries about how Australia’s healthcare system will cope with the rising pandemic. TKW’s research revealed more than half of healthcare professionals are either ‘not that confident’ (41%) or ‘not at all confident’ (15%) that Australia’s healthcare system can deal with the COVID-19 pandemic.
 
‘A common sentiment was that staff are very proud of the Australian healthcare system and they consider it one of the best in the world,’ Mr Le Grand, from TKW Research, said.
 
‘However, the majority of healthcare professionals felt Australia’s healthcare system was already at capacity before the COVID-19 pandemic and that the spread of the virus will only bring further stress to the system.
 
‘Healthcare professionals are not only worried about the increase in patient numbers but also how best to deal with them given many are scared, misinformed and have expectations that often can’t be met.’
 
Dr Burton said there are further concerns relating to the pandemic.
 
‘The vicarious trauma of seeing what’s happening overseas and just constantly wondering, have we done enough? Can we flatten the curve? How is this going to pan out? How many people do I know who will die?’ she said.
 
‘And then working furiously to try to save as many as possible, while realising that won’t be everybody.’
 
Additional stresses faced by GPs include the burden of extra work and the need to work longer hours, said Dr Burton.
 
‘I’m working unsustainable hours. I need to slow down,’ she said.
 
‘This is a marathon and I’m sprinting.’
 
The RACGP has more information on coronavirus available on its website.
 
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