General practice is prepared to tackle coronavirus – but we cannot do it alone

Harry Nespolon

28/01/2020 3:58:52 PM

RACGP President Dr Harry Nespolon outlines what GPs need to know amid the current outbreak.

Dr Harry Nespolon
RACGP President Dr Harry Nespolon believes GPs need to be ‘vigilant in order to detect and isolate any cases that may present over the coming days and weeks’.

When faced with any public health emergency, including an infectious disease outbreak, the community will inevitably turn to general practice.
GPs are vital for both disease control and the essential health services for which patients rely on us every day. Our position as trusted authority figures means we must offer informed reassurance, guidance and comfort to concerned patients and community members.
Alert, but not alarmed.
It is important to remember that our experience dealing with more common contagious viral infections, such as measles and influenza, means we are well placed to fulfil our role in the wider healthcare response to the ongoing coronavirus outbreak.
At this stage, we know human-to-human transmission can occur, and some of the early cases have been severe. But, we do not yet know how transmissible this infection is, nor how many people get mild infection.
In a letter to Australian health practitioners, Chief Medical Officer Professor Brendan Murphy stressed the critical nature of early detection ‘to enable diagnosis, isolation and appropriate contact tracing’ in order to ensure there is no human-to-human transmission in Australia.
He’s right.
This means we must take a cautious approach and be vigilant in order to detect and isolate any cases that may present over the coming days and weeks.
Clinically, nearly all cases have had fever, associated with other respiratory symptoms including cough and shortness of breath. It is estimated that about 25% of cases so far have severe symptoms with significant pulmonary involvement.
While the virus’ exact incubation period is yet to be determined, all reports suggest an average of around seven days, with an upper limit of 14 days.
Combining an awareness of these factors with any potential travel history a patient or a contact may have should help in our goal of dramatically reducing any exposure the Australian population has to this virus.
Should a wider outbreak occur, every accredited general practice has an infection control plan, which includes pandemics. As such, I have the utmost faith Australia’s GPs will be ready to protect the community from this threat, along with any other potential harms that might afflict our patients.
But in order to ensure best practice is employed in surgeries and clinics across the country, we must be given the appropriate information, tools and support from public health authorities.
To this end, I have sought assurances from Professor Murphy. He has confirmed GPs and practice staff should wear face masks when consulting potential coronavirus cases, and that clinics with supply issues can access the national stockpile via their local Primary Health Network.
While it is not recommended people in the community wear face masks, we have been advised that patients suspected of having coronavirus should be isolated and managed in contact/droplet precautions:

  • Place a single-use surgical mask on the patient
  • Isolate the patient in a single room with door closed
  • Any person entering the room should use appropriate droplet and contact precautions personal protective equipment (PPE), ie single-use surgical face mask, eye protection, gown and gloves
Practices should already have around a month’s supply of PPE should a pandemic event occur, so they will be able to cope in the short term. However, if coronavirus spreads – as many fear it will – we could be looking at a prolonged period where these measures need to be applied.
In this case, the Australian Government must consider how it manages the nation’s emergency reserves and how it will distribute PPE across the country.
Federal Health Minister Greg Hunt has already announced the national medical stockpile of 12 million masks will be made available as needed, while other PPE such as gloves, gowns, and protective eye wear will also need to be sourced and made ready.
Aside from physical equipment, effective public health messaging is needed to inform patients of their responsibilities with regard to infection control – in particular, calling ahead of time, informing reception staff of relevant prior travel, and wearing appropriate PPE such as a face mask.
Communication is key in situations such as these. So long as we have the most up-to-date information in a timely fashion and are able to work hand-in-glove with other emergency services and healthcare sectors, I see no reason why we will not be able to meet this challenge as we have others before.
The Government has promised it will do all it can to have the right information, support structures and preparations in place.
The rest is up to us.
The RACGP has more information on coronavirus available on its website.
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A.Prof Ralph Gustav Audehm   29/01/2020 7:28:23 AM

Have not received any communication from Govt - all information I have gathered has been on RACGP/AMA and ausdoc. I got more information from the public news than the Govt. They need to get their act together.

Dr James Courts   29/01/2020 8:06:00 AM

Unanswered questions include;

1.) Funding for telephone calls
2.) Lack of space for isolation - I imagine a lot of practices can not immediately call on a spare room - how long should this room be left unoccupied/deep clean?
3.) Lack of free appointments
4.) Support for (self employed) GPs off sick / funding - avoiding transmission to their own family

With many years of a Medicare freeze I can imagine a fair few GP surgeries will be using all available space and have limited on the day appointments.

Our role is for recognition of those that have not self triaged to public health/hospital services.

Dr Noela Catherine Whitby, AM   29/01/2020 9:25:00 AM

Advice at odds with that given to the community and GPs many days ago by the NHS UK. Basically phone the GP practice for advice . DO NOT just turn up. Patients with likely symptoms told to attend the hospital which has procedures and equipment in place to deal with cases.

Dr Ian Mark Light   29/01/2020 10:45:12 AM

General Practice can do it .
As for phone calls not being rebated - we have just had bushfires fought by many volunteers at risk to their lives - take the phone calls .

Dr MD Shahadot Hossain   29/01/2020 11:23:30 AM

Proper education is important to public especially who is at risk. Those who recently travelled even any country other than China developed URTI infection become panic and presented to GP. Can get information from GP practice via even phone.

Dr David Zhi Qiang Yu   29/01/2020 11:31:33 AM

We are based in Sydney and have large Chinese speaking patients in our practice. We have one confirmed Coronavirus from our practice. We have many patients who fever, cough and other respiratory symptoms from China, Hong Kong or other countries. When we organised the Coronavirus tests for those patients, we need to call the Public Health Nurse from Public Health Unit, who only approved to do the Coronavirus test for the patients from Wuhan, but not others who have traveled from other part of Chinese, Hong Kong or other part of the world. We have not options but we have to send those patients to the Emergency Department at the Public Hospitals to exclude Coronavirus infection!!! Under the current Health Policy from NSW, we may miss many many cases undiagnosed. We need our college to act immediately to pressure the NSW government and Federal Government to change the policy to allow GPs have autonomic to decide whether the patients to need to do the Coronavirus tests!!!

Dr David George Maxwell Welsh   29/01/2020 6:52:36 PM

The two PHN's we have contacted today know nothing about the masks! Can you ask Professor Murphy to ensure they all have the masks!

Dr Peter James Strickland   30/01/2020 11:22:28 AM

This has been badly managed by government and their advisers.
What was absolutely required was to STOP flights coming into Australia from affected areas from the start, and not be talking about having 100 or so people evacuated from Wuhan Province to Christmas Island. Inadequate and wrong decisions have allowed this coronavirus into Australia, and when little previous cognisance taken of its incubation and infectious ability. As stated above there has been virtually no concerted pragmatic effort to contact and assist GPs here ---all talk and blame onto GPs, and no responsibility taken for these bungles in my opinion from these central health advisers. If it had been done properly there would not be the present risk of spread into the Australian community. Sometimes hard decisions have to be made to prevent infections spreading, and this has NOT happened here soon enough here in Australia. Past lessons not learnt!