‘There is airborne transmission’ – but still no sign of PPE upgrades

Matt Woodley

2/06/2021 5:29:31 PM

While the latest COVID outbreak in Australia has seen people become infected via only ‘fleeting contact’, consensus guidelines on aerosol protection remain under review.

Surgical masks and P2 respirators.
The consensus guidelines are expected to update advice related to situations in which P2 respirators should be used instead of surgical masks.

The debate that has raged since the initial stages of the pandemic – whether or not COVID can be transmitted via aerosols – appears to be over.
‘There is airborne transmission. I don’t know how much clearer I can say it,’ Australia’s Chief Medical Officer Professor Paul Kelly recently told reporters.
Professor Kelly’s unequivocal proclamation followed similar acknowledgements from the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (CDC), along with a growing groundswell of outside evidence.
It also comes after Victoria announced its snap lockdown had been extended for another week due to concerns about exposure sites remaining infectious for hours after carriers have been through, a phenomenon not witnessed in Australia until now.
However, Professor Kelly was less definitive when asked whether the Australian Health Protection Principal Committee (AHPPC) has accepted advice from the National COVID-19 Clinical Evidence Taskforce (the Taskforce) that airborne protections such as respirators are needed.
‘What that leads to in terms of protection of people that are exposed to COVID-19 has been a matter of debate, but there’s not really much debate anymore,’ he said.
‘You need to be protected as much as you need to be protected in whatever you’re doing, whether that’s in a clinical setting or in a quarantine setting.
‘We’re just working through finalising that advice at the moment, very actively, and within a very short period will be able to say more about that revised advice. But, ultimately, it’s that if you are at risk of being exposed to COVID-19, you need the protections, including the correct PPE, to protect you from that risk.’
Victorian COVID-19 testing commander Jeroen Weimar told reporters at least four of the state’s cases appear to have been transmitted via casual ‘fleeting’ contact that he described as ‘stranger-to-stranger’ transmission.
‘They’re brushing past each other in a small shop, they’re going round a display home … they’re looking at phones in a Telstra shop,’ he said.
‘And that’s very different from where we’ve been before.’
Leading occupational hygienist Kate Cole told newsGP the new variants underline the need for appropriate airborne protection, but said aerosol transmission has always been of ‘critical importance’.
‘It’s unfortunate that we haven’t had consistent national guidelines to address [the threat of airborne transmission] holistically across the country,’ she said.
‘[The new variants] reinforces how important it is that we really ramp up our efforts to address the issue of airborne transmission and use that as a prompt to remind everyone that we do need national standards, because without them, we’re going to continue to see these outbreaks across all the different states in Australia.
‘There does need to be some advice on the really simple things that people can do to mitigate against airborne transmission. It’s not scary, there are practical things that can be done.’
The Taskforce guidelines, which were drafted with the assistance of the Infection Control Expert Group (ICEG) and approved by all 32 member organisations, have been with ICEG for the past month.
Associate Professor John Ferguson, who represented ICEG on the joint Infection Prevention and Control panel (PIC) that was tasked with drafting consensus advice in the wake of last year’s high rates of infection among Victorian healthcare workers, updated newsGP on the guidelines’ progress.
‘ICEG provided consensus recommendations to AHPPC two weeks ago and there has been further work done to respond to jurisdictional concerns,’ he said.
‘AHPPC resubmission from ICEG [is expected] very soon and we believe final approval and publication will then follow.’
In the meantime, many Australian healthcare workers – including GPs – are still only advised to wear a surgical mask when dealing with confirmed COVID patients in the majority of circumstances.
Gold Coast GP Dr Kat Mclean, who works at a COVID respiratory clinic, told newsGP the current recommendations are putting healthcare workers, clinic staff, and the wider public at risk.
‘With the acknowledgement that COVID is an airborne infection, we need to really be using airborne precautions,’ she said.
‘I know a lot of GPs that have certainly gone above the guidelines and have been using appropriate airborne precautions and have out of their own pockets, organised fit-testing. But without coordination and support for general practice, I think we’re putting GPs in a really vulnerable position – especially our registrars and contractors.
‘It’s a real health-and-safety issue.’
Even though many GPs have now been vaccinated and are at reduced risk of serious complications, Dr Mclean remains frustrated at the lack of progress and believes the potential of a general practice being an exposure site is very real.
‘I worry about what lies ahead if we don’t act,’ she said. ‘[Without appropriate PPE] we may inadvertently still pose a significant risk to our patients and the un-immunised community members.
‘We certainly don’t want to have GPs as vectors of transmission. Ultimately, what general practice really needs is appropriate provision or support around PPE. It’s been an ongoing concern.
‘Nothing has moved. Honestly, it’s the same conversation I probably had 12 months ago.’
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Dr John Christopher Meegan   3/06/2021 8:46:42 AM

I am a member of RACGP and an Occupational Physician with AFOEM(RACP). There is a long-standing principal in the hazard control hierarchy of OHS known as ALARA meaning any hazardous exposure should be minimized to as low as reasonably achievable. It should have been assumed from day one that aerosol transmission was occurring. The very minimum protection is fit tested P2. Even better a powered air purifying P2 respirator helmet with positive pressure to the face where fit testing is not needed and negative pressure of respiration does not draw the hazard in through any leaks. The lack of proper attention and guidelines about this potientially lethal hazard to HCWs for so long into this pandemic would not be accepted in any other industry. It is completely outrageous.

Dr Dileep Singh   3/06/2021 7:37:40 PM

Many of General practitioners and doctors and other health professionals are not vaccinated They are already at high risk As there is a blitz for aged care workers and disability workers it should be for doctors and nurses snd other health professionals .South Australia and Queensland premier announced to give 2 doses if pfizer so they get vaccinated in 3 weeks What about doctors who are at very high risk especially general practitioners who if infectious can pass on to their patients. RACGP should make this as priority.