State of disaster, curfews, restricted movement: What do stage four restrictions mean for GPs?

Anastasia Tsirtsakis

3/08/2020 4:44:16 PM

Victoria has implemented Australia’s most stringent rules since the coronavirus pandemic began.

Victoria on the map
Australians plunged into further restrictions will now be eligible for 10 additional Medicare-subsidised psychological therapy sessions.

Victoria recorded 429 new coronavirus cases on Monday 3 August, as well as 13 deaths, eight of which are linked to known outbreaks in aged care facilities.
It comes as metropolitan Melbourne entered its first day of stage four restrictions, after a state of disaster was declared on Sunday 2 August, with stronger rules introduced to limit people’s movement in a bid to curb the spread of the coronavirus.
‘It’s understandable for somebody to be feeling depressed or anxious,’ Federal Health Minister Greg Hunt acknowledged.
‘It is difficult but there is mutual community support.’
To help people struggling with the psychological impact of the pandemic, Australians plunged into further restrictions will now be eligible for 10 additional Medicare-subsidised psychological therapy sessions under the Federal Government’s mental health program. 
‘The new items will apply to people subject to public health orders restricting their movement within the state or territory issued at any time from 1 July 2020 to 31 March 2021, and to people who are required to isolate or quarantine under public health orders,’ Minister Hunt said.
The new measure will commence on Friday 7 August and be available until 31 March 2021.
Patients are required to have a Mental Health Treatment Plan, and will need to have a review with their GP to access the additional sessions, once they have used up their initial 10.
Dr Cathy Andronis, Chair of the RACGP Specific Interests Psychological Medicine network, welcomed the initiative.
‘Under the current circumstances, which are very unprecedented … it’s very appropriate that a lot of people who may need extra counseling or extra support should be able to get it,’ she told newsGP.
‘It is targeted to areas where there is clearly a lot more stress and a lot more anxiety, and so that will be very helpful for those patients.
‘But also for GPs who are doing focused psychological strategies, they’ll also be able to do the extra sessions and therefore have the opportunity to support some of their patients more effectively, because we certainly are seeing extremely increased levels of anxiety and depression and general stress.’
The stage four restrictions, which came into effect at 6.00 pm on Sunday, apply to residents of metropolitan Melbourne:

  • A curfew, from 8.00 pm to 5.00 am. The only reasons to leave home during these hours are work, medical care and caregiving.
  • Public transport services will be reduced during curfew hours, with the Night Network suspended.  
  • Exercise is limited to a maximum of one hour per day, no more than 5 km from home. Group size is limited to a maximum of two people.
  • Shopping is limited to one person per household, once per day, no more than 5 km from home, unless the closest supermarket is further.
  • Study at TAFE and university must be done remotely.
  • All school students, including senior students and those in our specialist schools, will learn remotely from Wednesday 5 August.
  • Kinder and early childhood education services will learn remotely as of Thursday 6 August.
  • Those who can work from home, must continue to do so.
  • Face coverings continue to be compulsory while in public.
Premier Andrews has also announced almost all retail businesses in Melbourne will be closed as of 11.59pm on Wednesday 5 August. This will exclude supermarkets, grocery stores, bottle shops, pharmacies, petrol stations, banks, news agencies, post offices, and everyone involved in the frontline response.
All open businesses and services will have until 11.59pm on Friday 7 August to enact a COVIDSafe plan focused on safety, prevention and response in the event coronavirus is linked to the workplace.
The new restrictions will be in place for the next six weeks, until at least Sunday 13 September, while regional Victoria will return to stage three restrictions from Thursday 6 August.
Premier Andrews said it was the ‘hardest decision’ he has made to date since becoming premier. 
‘I’ve had the job of leading this state for almost six years – more than 2000 days. And today is by far the hardest day,’ he said.
‘But it is the decision I’ve made to keep our state safe.’

Under new restrictions, people in shopping is limited to one person per household, once per day, no more than 5 km from home, unless the closest supermarket is further. 

Dr Andronis says it is important for GPs to be mindful of vulnerable patients, such as people living alone and the elderly, and make contact to discuss their mental health.
‘They often don’t ask for any special favours or don’t particularly think that they should necessarily burden their doctor any further with mental health issues or concerns,’ she said.
‘So I think the onus is on GPs when they see these people or speak to these people about any medical concern that they should be asking them about how they are managing their anxiety or their worries in regard to the pandemic and the risk of infection, and specifically about how they’re coping with isolation, and what concerns they have around that.
‘Having a conversation about the isolation experience is not only something that will be reassuring or helpful for the patient because they feel like we’re interested, and respecting and validating their concerns.
‘It’s also an opportunity to see if there are other supports that can be made available to those people, including counseling in some cases, and that can be done via formal mental health plan if it’s appropriate, but it can also be done by regular contact with the GP.’
In addition to being mindful of patients’ mental health, Dr Andronis said the rising number of active cases has been ‘really concerning’ for GPs.
‘Not only do we have patients who are increasingly stressed and increasingly worried about going out and seeking medical care when they need it, we also have got our own stress to deal with, and that is that we are increasingly at risk of being infected ourselves and of being exposed to the virus,’ she said.
‘That is clearly a concern because we know that at least 10% of cases are healthcare workers and GPs are on the frontline, and we want to balance the risks of providing all the care that we need for our patients with the risks of the virus to us in our clinic and the staff in our clinics.
‘It means that we have to now see every patient, really strongly, as a potentially COVID risk. So that will influence how we conduct our work, and I imagine that many GPs may cut down even further on how many face-to-face appointments they can offer, and we’ll be turning more to telehealth and telephone consultations – and there’s plenty of trepidation about how that’s going for some practices.
‘So there’ll be lots of concerns on many fronts.’
South Australians will also face new restrictions, after the state recorded two new cases on Monday. From Wednesday 5 August, the number of people allowed to gather in a home will drop from 50 to 10, and pubs and restaurants will only be permitted to serve alcohol to seated patrons.
In NSW, where 13 new cases were confirmed on Monday, masks are not mandatory but they are being strongly encouraged where social distancing is not possible.
Deputy Chief Medical Officer Professor Michael Kidd said the new measures introduced in Melbourne, while harsh, are necessary and have the full support of the Australian Health Protection Principal Committee (AHPPC).
‘This is what is necessary to bring this under control,’ the past RACGP President told Sunrise on Monday.
For GPs managing patients who are waiting on a COVID-19 test result and directed to self-isolate, or who have been diagnosed with the virus, Professor Kidd outlined the directions for at-home self-isolation:
  • Anyone who has been directed to self-isolate while waiting for a test result, or is confirmed to have COVID-19, must stay at home in isolation and not leave for any reason until told that it is safe to do so by state authorities.
  • Confirmed cases who are cohabiting with others should ideally have their own room and stay in there as much as possible.
  • If they have to come out into the rest of the household, they should be wearing a mask each time. Other people in the home should also wear a mask.
  • Confirmed cases should have use of a bathroom that is not shared with other people, where possible. Alternatively, the bathroom needs a thorough clean after the person with COVID-19 has used it, each time.
If the person infected with COVID-19 is sharing a household with someone who is particularly vulnerable to COVID-19, such as an elderly family member or someone who is immunocompromised, health authorities should be informed for further assistance.
Dr Andronis encourages GPs to slow down where possible, and to practice self-care.
‘It will be a slow battle and the fatigue has set in,’ she said. ‘So we need to respect that and not feel rushed.
‘Maintain hope but proceed with caution.’
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Dr Jitendra Natverlal Parikh   4/08/2020 10:41:22 PM

Loss of ability to communicate with colleagues and elderly patients is a real worry .Patients are indirectly promoting tel health by refusing come to surgery but a tel health is inadequate for most if not many circumstances