Should suspected coronavirus patients present to general practice?

With the death toll almost doubling overnight to 17 and nearly 600 cases now confirmed, authorities in China have imposed stringent controls on the coronavirus’ city of origin, Wuhan.
 
The continued outbreak has led to the suspension of public transport networks in the city of 11 million people, while all flights and long-distance trains out of the area have been cancelled.
 
Meanwhile, biosecurity officers and border security staff at Sydney airport have screened passengers arriving in Australia from Wuhan for any signs of illness, with the flight departing only hours before the lockdown was imposed.
 
But while authorities have reported there were no ill passengers on the flight, NSW Health Protection Executive Director Dr Jeremy McAnulty has conceded measures that have been put in place are ‘not foolproof by any means’.
 
Both the Queensland and NSW health departments have told visitors who have returned from Wuhan and subsequently fallen ill to see their GP, but Gold Coast GP Dr James Courts told newsGP he is worried about the potential effect this advice could have on practices and the wider population.
 
‘My issue is if a [potential carrier] just goes straight to the GP, they may not flag it at the front desk and then there’s a chance they could infect my staff or the vulnerable population that we have here in our rooms,’ he said.
 
‘If they’re not too unwell they should be staying at home rather than going out and potentially infecting everyone else.’
 
Dr Courts, who has experience from the 2009 H1N1 swine flu pandemic in the UK, believes a better approach is to establish an information hotline or website that people can access without needing to come into contact with the general public.
 
‘Then if they’re [still] not doing well … they can arrange to be visited by either a GP or someone from public health to just check them over and do the confirmatory swabs, so they’re not exposed to the population at large,’ he said.
 
‘If they’re very unwell then that is the remit of hospitals and not us, anyway. There’s very little we can do, and at that point they should pre-warn the hospital so upon arrival they can be isolated accordingly.’
 
The fact the novel coronavirus 2019 (2019-nCoV) is already present in five countries, combined with a long incubation period and uncertainty over when symptoms begin to present, means there is a chance potential carriers will slip through the net.
 
Professor of Global Biosecurity and Head of the Biosecurity Research Program at UNSW Raina MacIntyre told newsGP that appropriate health system triage and rapid isolation of suspected carriers is key to helping control the virus.
 
‘My understanding is that potential patients have been advised to call ahead before going to the GP, and that in New South Wales GPs have been advised to immediately contact their public health unit if a patient contacts them,’ she said.
 
‘Suspected patients will then be assessed by public health and infectious diseases experts.’
 
Experts have also warned that official numbers of people affected could be severely underestimated, with researchers from Imperial College London’s MRC Centre for Global Infectious Disease Analysis telling reporters the actual figure is likely closer to 4000.
 
The Guardian has also reported that anecdotal evidence from Wuhan suggests the number of cases and deaths could be much higher than those cited in official reports.
 
Professor MacIntyre believes that, in an evolving situation where not all of the information is available, practices should be prepared.
 
‘The precautionary principal of exposing as few people as possible to potential new emerging infections is useful,’ she said.
 
‘This can be done by limiting the number of sites where potential infected people encounter the health system by having adequate isolation spaces, PPE [personal protection equipment] and infection control policies. Surgeries should make sure they have adequate respiratory protection for staff, including reception staff.
 
‘Triage is critical, and reception staff should be advised to ask a travel history of anyone with fever and respiratory symptoms. If the patient has travelled to Wuhan, or China, they should be moved to a separate room if possible, while staff contacts the public health unit or health department for further advice.’
 
The RACGP has more information on coronavirus available on its website.
 
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