Victorian GPs urgently call for coronavirus location data as state braces for fresh surge

Doug Hendrie

22/06/2020 4:22:40 PM

GPs want as much data as possible to help protect their patients and themselves as the state braces for a second wave.

Victoria on the map
Health officials have warned Victoria is ‘absolutely at risk of a second peak’ following five straight days of double-digit growth in new COVID-19 cases.

The state has seen more than 100 new cases in the past week, emerging in clusters across the Hume, Casey, Brimbank, Moreland, Cardinia and Darebin local government areas (LGAs), with most cases linked to community transmission.
But details are sparse on where, exactly, the cases are occurring, given the six LGAs cover large areas of Melbourne’s north-west and south-east.
RACGP Victoria Chair Dr Cameron Loy has called on the Department of Health and Human Services (DHHS) to give GPs more geographic detail so they can protect themselves and conserve still-scarce supplies of personal protective equipment (PPE).
‘GPs would change their protocols very quickly if they knew there was an outbreak around them,’ he told newsGP.
‘If we had that geographic data, we would implement much stricter controls while patients are being assessed. Unless we know the prevalence in our towns and suburbs, we cannot appropriately implement PPE guidance.
‘We simply cannot do 100% universal protection for every person walking in – the infrastructure and funding are simply are not there. We need to appropriately target what we’re doing based on what’s happening in our communities.
‘It’s only with this information that we have a chance of protecting ourselves.’
The DHHS already supplies geographic data down to the affected street and suburb for outbreaks of some other diseases.
‘We get the suburb and street for Legionnaires [disease], but with COVID we get only a very large geographic area,’ Dr Loy said.
‘If there was a COVID-positive case in the town I work in it would help us enormously to know that, and it would help the community by protecting the patients who come to our clinic and the staff who work here.’ 
Privacy and anonymity would have to be protected in making more specific location information available, Dr Loy said.
Recently detected clusters include families in Coburg and Keilor Downs, as well as an outbreak linked to the Stamford Plaza Hotel, where returned travellers have been quarantined. The family-linked outbreaks span many different households, however.
Dr Loy said Commonwealth-level issues regarding the availability of PPE have also not been resolved.
‘In Victoria, as in other states, GPs are in the firing line. Even after all these months, we still have issues with PPE,’ he said.
‘My fear is that if it does get out of hand, we will once again be in a situation where GPs may be seeing the first patients in outbreaks without enough PPE supplies.
‘We’re expected to fend for ourselves [on PPE]. We are an important part of public health and this still remains an issue.’ 

The local council areas have been identified as coronavirus hotspots based on figures showing more than 83% of the new COVID-19 cases in Australia in the past seven days were recorded in Victoria.

The calls come as top health officials warn that the surge in new cases is a sign that infection-control principles, namely social distancing, are not being properly maintained.  
Many of the clusters have been associated with large family gatherings, leading Australia’s Chief Medical Officer Professor Brendan Murphy to warn that some Victorians have not been taking social distancing seriously.
The Australian Health Protection Principal Committee ‘strongly discourages’ travel to and from the six affected LGAs for non-essential reasons until the Victorian Government can suppress the spread of community transmission in those municipalities.
Victoria’s new cases are the highest they have been in more than two months. The state’s Chief Health Officer Professor Brett Sutton said that more than half of the new cases are linked to transmission within families.
‘People have not followed our advice around physical distancing, hygiene and limiting the number of people you invite into your home,’ he said.
In response, the State Government has clamped down on home gatherings, with the maximum number of guests cut to five, and 10 for outdoor gatherings.
The planned boost to restaurant, café and pub patron limits has been suspended, meaning the limit remains at 20.
The planned reopening of gyms, cinemas, indoor sports centres and concert venues has still gone ahead, with a 20-person limit.
Dr Loy said that at the start of the first wave of the pandemic he had fully expected he would have to write dozens of condolence letters to the families of frontline GPs who had died, given how dangerous the virus has been to doctors in other countries.
‘The actions that the Chief Health Officer and his unit took meant that I don’t have to do that. Public health control of this pandemic has been exceptional. It has saved lives,’ he said. 
‘Victoria has had a more conservative and restrictive approach to COVID than other states. It’s my expectation that they are going to do everything they can to continue that trend.’
In response to the possible second wave, Dr Loy quoted top US medico Dr Anthony Fauci: ‘Outside is better than inside, no crowds are better than crowds, and small crowds are better than large crowds.’ 
‘Family gatherings count as a crowd,’ Dr Loy said.
The latest figures have prompted the Victorian Government to extend the state of emergency until 19 July. State Health Minister Jenny Mikakos said she has concerns around people paying visits even though they have mild symptoms.
‘We have had particularly some concerns around family gatherings, extended family members across many households visiting each other even when they have been exhibiting mild symptoms,’ she said.
Police will once again be monitoring social restrictions in force.
Queensland will now require any visiting Victorian to undergo 14 days of self-quarantine, while South Australia has not ruled out keeping its borders closed.
The DHHS did not respond to requests for comment.
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Dr Mukesh Chandra Haikerwal, AC   23/06/2020 6:53:50 AM

Dreadful state of affairs:now “no go” areas in Melbourne. As GPs we have taken every protection to exclude anyone with respiratory conditions, temperature or with exposure to people infected by or tested for COVID in the last 7 days. This is with a “triage” protocol. We have people waiting in their cars in our car park or at home. Using phone & video consults helps but there are times you need hands on review and eye-balling patients. We insist on max numbers sitting in our waiting room and corridors of the building. We have been running a federal DoH GP Respiratory Clinic. That initiative is slated to end on 30.6.2020. This allows our areas - indeed beyond our area GPs - to send their patients for a clinical review, treatment and a swab. We send a secure notification to 95% of GPs if nominated by the patient using HealthLink direct to your practice software “inbox” like a path or radiology reply. This service is free to GPs to receive AND SEND. All services are paid for by DoH.

Dr Mukesh Chandra Haikerwal, AC   23/06/2020 6:59:27 AM

Part 2: The vast majority of the 3000 or so passing through the facility Respiratory Clinic have been charming and compliant. There are some who have been rude, defiant and violent. Having on site security helps this but is very expensive. If we had no access to the RDC we would have to send more folks to hospital - unnecessary- and access to care would be a huge problem. We need to share our collective experience as we head into “Living with Covid phase: post-Covid is NOT with us for a while.

Dr Ian Mark Light   23/06/2020 8:36:06 AM

More Clinics can develop the Capacity to Triage some patients with respiratory symptoms safely .
They need a well ventilated space in a room say where windows can be opened and airflow isolated from other areas in the clinic.
The PPE of Head Visors with a certified mask a gown and gloves have to become available to at least a significant percentage of clinics or to a few designated people in a clinic on rotation .
House and Aged Care Visits by General Practice Teams of three with PPE and Testing Equipment can start there is a work force some General .
Practice clinics are seeing many less patients .
In Aged Care homes on sunny days Health Teams and Relatives can visit patients in outside areas even in Melbourne there are several sunny though cool days a month .
There is no reason doctors and Relatives cannot meet the Elderly and those with moderate respiratory complaints in outside or well ventilated indoor spaces .

Dr Nicholas John Brodie Page   23/06/2020 10:28:37 AM

The powers that be in VIC seem to have a very low opinion of GPs. They keep us in the dark about the position of clusters. They are even flabberghastly abusive at times with no apologies. They should ask their counterparts in South Australia how to mount a GP/Public Health integrated response that works effectively.

Dr Peter James Strickland   23/06/2020 11:24:50 AM

Victoria as a whole is a disaster with respect to controlling this whole pandemic. The govt there condoned the recent protests, and now we have the consequences of widespread Covid 19. There will be those who argue that this is not the cause --- what other large gatherings have occurred in Victoria within the incubation period? As a consequence the whole of Australia is affected with respect to borders re-opening and we now have serious economic and health problems again. Incompetence due to political stupidity and bias!

Dr Jennifer Anne Anderson   23/06/2020 11:32:58 AM

Thanks Mukesh for the service you offer. as an inner city GP with no car park and strictly no respiratory symptoms though our door, we appreciate that your service not only provides the swabs but a clinical assessment that we can then follow up on. services that only provide a swab are oly useful for simply URTIS that are unlikley to be covid.

Dr Tatiana Cimpoesu   23/06/2020 11:38:32 PM

I don’t see why public gatherings in country Victoria, especially outdoors, have to be limited to 10 people. All new cases are in Melbourne and we didn’t have a case in SW Victoria for three months, despite a massive testing blitz in May. An outdoor gathering in the country, out in open space and fresh air, with more than 1.5 m distance between people is far less risky than shopping in a large shopping centre where people are in close proximity and air conditioners are circulating droplets for hours!

Dr Jan Leslie Forsten Hanson   25/06/2020 3:43:05 PM

Allowing the protest gatherings may not have been the source of infection, but it seems they have been part of the mixed messages people are receiving, so it is harder to make sense of ongoing recommendations made around physical distancing and restrictions. I suspect loosening restrictions has parallels with following a very strict weight loss diet
- it is easier to adhere to really strict rules, and less easy to make healthy choices when options open up.