GPs must help aged care prepare for the coronavirus – now

Ken McCroary

17/03/2020 2:04:11 PM

GPs working in aged care should immediately work to help facilities get ready for a worsening outbreak, GP and lecturer Dr Ken McCroary writes.

House being protected from virus
Aged care facilities need to plan now about what they will do if coronavirus gets in, Dr Ken McCroary stresses.

I’m a GP who regularly sees patients in residential aged care facilities.
That’s why I’m speaking out now.
Our patients in aged care are the most at risk from the new coronavirus.
That’s not hyperbole. Of the five Australians who have died so far from the coronavirus, three are linked to the outbreak in the Dorothy Henderson Lodge aged care facility in Sydney.
The disease associated with the virus, COVID-19, is particularly dangerous for people over 60. People over 80 are at the most risk.
Federal and state authorities have called on aged care to get ready. The WA Health Minister has even called on people to avoid visiting loved ones if they have flu-like symptoms.
The Aged Care Quality and Safety Commission is calling on providers to undertake a self-assessment in order to ensure readiness for a possible outbreak.
And Prime Minister Scott Morrison has said the Government is prepared to ‘lock down’ aged care facilities if needed.
I personally believe it is now time to lock down aged care. That means no more visitors and good screening for staff. 
While we wait for an official move, I believe GPs who regularly visit aged care facilities can play a direct role in change.
We can ask managers about their plans. We can let them know of any issues.
Having a GP ask them directly can help make the issue real, shifting the pandemic from abstract to reality. 
After I finished visiting one of my regular aged care facilities last week, I went to use their hand sanitiser. None there. I tried the sinks, and the soap dispensers were broken. There were no options.
I usually bring my own for situations like this because, sadly, it’s not uncommon.
In the year of the coronavirus, however, it’s not going to be nearly enough.
It is a matter of when, not if. We must make this a priority.
We read about 1–2% mortality overall rate, but aged care facilities could see much higher mortalities if the virus spreads unchecked.
Far better to do our best to ensure the virus never gets access to those most vulnerable. 
If we are serious about protecting our most vulnerable patients – someone’s mum, someone’s dad – then we need to prepare properly.
That means monitoring patients and visitors for signs of ill health. It means asking loved ones not to attend if they are unwell or have been in close proximity to someone with the virus.
It means laying in stores of soap and hand sanitiser and personal protective equipment (PPE). It means enforcing sneezing and cough hygiene. It even means introducing or enforcing staff logs to help with breach control.
All staff will need training in what to do – not just clinical, but dining and cleaning staff too.
Nursing staff will have to be trained regarding what to do if there are suspected cases, contact and droplet precautions, gowns, P2 masks and goggles as necessary.
Prevention is our main course of action. But aged care facilities will also need to plan now about what they will do if the virus does get in.
They will need to prepare isolation rooms with separate toilets – and do so now, so it’s there if needed.
Collecting stores of PPE should be done now, not later.
And forging connections with local medical staff and pathology labs – government or private – ahead of time will be vital.
Most aged care facilities have dealt with other outbreaks, such as influenza or norovirus. From my experience, though, many facilities struggle to contain a virus as common as influenza – even after widespread vaccinations.
That means this virus should not be underestimated.
Several Asian nations seem to have gotten on top of the virus with strong public health measures. But health systems in other nations are now overwhelmed.
If the coronavirus does spread in aged care homes, even our world-class hospital system may struggle with admissions – and that’s to say nothing of the ICUs.
With advanced care directives and mortality risks, it may not be appropriate to transfer every resident with the disease into a hospital – especially if they’re not going to be accepted into intensive care anyway.
That means aged care facilities need to be prepared to manage patients themselves.
GPs, if you work regularly in an aged care facility, talk to them about their plans.
We have to prepare now – or risk the tragic alternative.
The RACGP has more information on coronavirus available on its website.
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Dr Michelle Anne Ledbury   18/03/2020 7:39:30 AM

This is not a very helpful article for people who do work in aged care. Perhaps more practical tips of what to do - how to get a swab / protect those who collect the swab, how do we administer the seasonal flu vaccine. Who is responsible for talking to public health. When doctors should stop visiting in person...etc etc
. Of course we are trying to talk to management already, but usually they are not very forthcoming with the GPS - have to specifically ask for a copy of their protocol and directives.

SD   18/03/2020 10:32:11 PM

I believe we will need lot more doctors to deal with Coronavirus epidemic in next 6 months. As Italians have expedited their 10000 doctors in the last year of medical degree without exams to work at intern level, in same way our specialist colleges need to expedite assessments of doctors in training programs to fellowship so that all can concentrate on dealing with this. This is specially for those in Emergency, Intensive care and GP training programs. We will need more doctors and nurses in coming time.

Dr Kenneth McCroary   19/03/2020 12:11:40 PM

Thanks for the constructive feedback, always appreciated. As you are aware the answers to those points are freely found particularly on websites of RACGP, Health, both Federally and state, phns and public health units. All frontline GPs are no doubt all over that information already and therefore the purpose of the article was not so much a cut and paste exercise in procedures but a stimulus for discussion hopefully to encourage reflection and enact change on behalf of one of our most vulnerable patient cohorts. Pleasingly later that day the Prime Minister et al have put in place some initial measures.