‘We are at a critical point’: Urgent calls for people to properly self-quarantine

Doug Hendrie

22/07/2020 3:55:06 PM

The GP overseeing Victoria’s first GP-led hospital in the home for COVID-19 patients has urged people to take quarantine guidelines seriously.

Person walking out their front door.
Many people asked to quarantine in their homes after a positive test for COVID-19 are not following requirements.

Victorian GP Dr Karen Aarons estimates up to 40% of people who are asked to quarantine in their homes after a positive test for COVID-19 are not following requirements, either because they do not understand what is required or they choose not to follow the guidelines.
That estimate comes as Victoria Premier Daniel Andrews this week revealed around 50% of the state’s almost 4000 new cases confirmed between 7–21 July failed to isolate between testing and getting their results.
The Premier said he is ‘very unhappy and very sad’ at the poor response to the requirement to self-isolate, with 90% of that cohort also failing to isolate themselves between developing symptoms and getting a test.
‘People have felt sick, they’ve got symptoms, and they’ve kept going shopping, they’ve kept going to work,’ Premier Andrews said.
Dr Aarons has noticed a spate of new cases emerging due to breaches of quarantine within households in her area in Melbourne’s north-west.
She has personally seen the virus spread through at least six households, beginning with one infection and spreading to every person, with people particularly at risk in sharehouses.
‘I’ve seen partners, children, teenagers and adult siblings all get it,’ she said.
‘This says to me that there is a lack of understanding about just how contagious this virus is, and the risks of shared spaces in the home.’     
Victoria’s new wave – with a record daily high 484 new cases recorded on Wednesday 22 July – is unfolding in real time for Dr Aarons, who was notified of 12 new coronavirus cases to monitor during her interview with newsGP.
‘Twelve new positives in the last two hours demonstrates just how dynamic this pandemic is. We are at a critical point in the pandemic, and we all need to play our part to get it back under control,’ she said.
More than 70 people with milder cases in Melbourne’s north-west have gone through Dr Aaron’s novel hospital-in-the-home program based at Djerriwarrh Health Services, which relies on a combination of daily telehealth and phone consultations.
Patients are provided with thermometers and oximeters, with readings recorded and monitored to safely track their progress.
Communication lines with each patient’s regular GP are maintained through the hospital-in-the-home admission, which Dr Aarons said aids continuity of care, particular after discharge from the program. At least 30 patients in the program are currently quarantining, with more joining daily from the local community and beyond.
Almost 3000 confirmed coronavirus cases are now self-isolating at home across Victoria.
‘My major concern is the poor public understanding of what it means to isolate at home if you have a positive test and, more importantly, what it means to isolate if you are a close contact,’ Dr Aarons  said. 
‘While it’s great to see that close contacts are staying home, the main concern is that some of these people are still mingling with other household members.
‘I also know of situations where people have symptoms and are still going to work, or someone who gets swabbed but then stops at the supermarket on their way home.
‘I don’t think it is just a misunderstanding. There is a large group who just don’t seem to comprehend the gravity of the situation.
‘It’s disappointing for me and everyone in the medical profession who is working so hard to turn this around. When we hear stories like this, it’s heartbreaking.’
Some people with the virus have found it all but impossible to quarantine safely at home, particularly if they require care or have to share a bathroom or kitchen.
‘I have come across a number of people who are unable to quarantine effectively. We know that it is not possible in every situation, and the department has a provision for that, where it is genuine,’ Dr Aarons said.
In these situations, the Victorian Department of Health and Human Services (DHHS) has been able to move people to other locations to be quarantined, such as a younger woman who was fearful she would infect her vulnerable asthmatic mother. 
Dr Aarons said a lack of specific knowledge is a key problem, with some believing quarantine means simply staying home – rather than staying confined to one room, only venturing outside the room briefly in a mask to collect meals, and carrying out the rigorous cleaning required for any shared facilities likely to carry the virus.
‘For some people, this may be because it wasn’t fully explained or they misunderstood the directions,’ she said.
Dr Aarons said younger people are more likely to fail to adhere to quarantine requirements.
‘There are a few who simply find it too hard and don’t want to think about it,’ she said. ‘And others who just want to get on with life.’
DHHS protocols distinguish between close contacts of confirmed cases, who must quarantine at home, versus those who live with someone in quarantine, who are not required to change their behaviour unless the person being quarantined is found to be positive.
Dr Aarons said any patient in isolation or quarantine with questions about the rules can also consult their GP through telehealth.
‘If at any point you’re not sure what you’re meant to be doing or not doing, contact your GP – we are here to support you and to assist in keeping the community safe and healthy,’ she said.

Daniel-Andrews-article.jpgVictorian Premier Daniel Andrews said 90% of recent cases did not isolate in between developing symptoms and getting tested for COVID-19.
The news comes as The Age reports doctors at Alfred Health have been pushing for approval for hospital-led home monitoring using oximeters and thermometers. 
RACGP Victoria Chair Dr Cameron Loy told newsGP the news is concerning.
‘As Premier Andrews has said, frontline workers are not the doctors and nurses – they are everyone who sacrifices their jobs and incomes to stay at home and protect their neighbours,’ he said.
‘It is so important that we take this second lockdown seriously. We are having community transmission and we don’t know where it is coming from.
‘If we don’t follow the rules, don’t socially distance, don’t wear masks, and don’t quarantine, this will get out of hand and we will be in all sorts of trouble.
‘There will be circumstances where isolating will be very hard. The majority of the population can still do home quarantine, but for the small group of people who are going to experience undue hardship, other arrangements can be made with public health.’
Dr Loy said lockdown fatigue might be playing a role.
‘At the start of the second lockdown, it took a long time for movements to start to slow throughout the Melbourne metropolitan area, and they still haven’t slowed to the degree we saw in the first lockdown,’ he said. ‘Thankfully, movements have fallen dramatically over the last three days.
‘People are fatigued. This is actually hard. But we have to do this and we have to get through this together.
Victorians did it last time and we can do it again. We live in a community and a society, not an economy. It’s our job to look after each other.’
A DHHS spokesperson told newsGP that anyone who tests positive to coronavirus, or is identified as a close contact, is required to quarantine at home to prevent further spread of the infection.
‘This quarantine is legally enforceable and police conduct regular checks on those in quarantine to ensure they are complying. In special circumstances, the Victorian Government is able to provide temporary and emergency hotel accommodation to those who are unable to safely isolate at home,’ the spokesperson said.
‘We have seen here in Victoria how easily coronavirus can spread within families and closely connected households, which is why everyone need to follow the rules and stay at home to help reduce transmission and protect their loved ones.’ 
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Dr Bethany Reynolds   23/07/2020 8:21:30 AM

There’s poor support for isolation/quarantine. Sure stay home, but it’s impossible to distance from younger family members or those you care for. If someone is symptomatic chances are their family still has to go to work/childcare etc despite the spread risk. Not everyone has access to sick leave/supports to help them while waiting 5-7 days for a result.
We also need faster test time turnarounds - the current rate is a ridiculous burden. Not everyone can work from home while awaiting results.

Dr Ian Mark Light   23/07/2020 11:00:49 AM

This is critical in Aged Care Homes where health workers with minimal but recognisable symptoms go into work .
So all who enter an aged care facility ought have a history taken on beginning and finishing work plus a temperature check .
Vital is that all people in Aged Care have minimal PPE masks head goggles head visors and goggles and if they are attending to Residents Hygiene - gowns .
The vast majority of houses have windows and even in the cold winter at least during the day they ought be part open to allow fresh air to flow which it is believed -heavily dilutes viral load .
You can have the heating on with windows part open .

When driving in cars and taxis windows ought be part open the aircon will still work well .
Travel is safer in the older trams where windows can be part open .
With mandatory masks infection spread will drop .

Dr Peter James Strickland   23/07/2020 11:10:10 AM

The Andrews govt contracts have caused this problem. It is impractical, undemocratic and lack of insight into the practical life of everyone, and esp. preserving their mental health and well-being. Andrews has taken the "Chinese" solution--- use the govt and police to control the community. All that was needed in Victoria is NOT lockdowns, but three things ---sanitize, keep your distance in public, and test if symptoms develop. Telling people NOT to go to work, NOT to go to get food etc, and NOT send their kids to care or school has created resentment, depression and anxiety, and then threaten them with fines or gaol "smells" of communist regimes --- it is NOT going to work in Australia, and the Victorian Inquiry going on should absolutely conclude govt bungling, sacking of Ministers, and sacking or demotion of public servants involved. It is a disgrace medically, and a disaster economically, confidence -wise and from a mental health aspect. The PM should get democracy back!!