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Chief Medical Officer update on coronavirus testing


Brendan Murphy


13/03/2020 7:27:01 PM

Professor Brendan Murphy has written to GPs regarding the Communicable Diseases Network Australia National Guidelines and COVID-19 pathology testing.

Professor Brendan Murphy.
Professor Brendan Murphy.

Dear Colleagues,
 
I am writing to you again about the COVID-19 outbreak situation in Australia.
 
The Department of Health has distributed the first of our newsletters, with information about the current COVID-19 situation and the Australian Government’s health system response to manage the pandemic, including new Medicare telehealth arrangements.
 
However, there is a particular issue I want to write to you about directly, to ask for your help.
 
Unfortunately, the extreme pressure on our personal protective equipment (PPE) stocks continues, and the situation regarding pathology test kits, reagents and swabs is deteriorating rapidly, with kits no longer being available in some regions of the country.
 
Pathology collection centres have also experienced large backlogs in testing appointments in some parts of Australia, and emergency testing facilities have had to be established in some areas to ensure that urgent patients can get access to testing.
 
I am seeking your assistance in strictly applying the Communicable Diseases Network Australia (CDNA) National Guidelines in deciding whether to refer a patient for a COVID-19 pathology test.
 
The guidelines have been endorsed by the Australian Health Protection Principal Committee and recommend testing only where a patient meets both the current epidemiological and clinical criteria for testing.
 
The epidemiological criteria include:

  • international travel in the 14 days before illness onset
OR
  • close or casual contact in the 14 days before illness onset with a confirmed case of COVID-19 (this needs to be interpreted sensibly; we do not have sufficient testing kits to test everyone who attends the same large concert as a person with COVID-19).
The clinical criteria include:
 
  • fever
OR
  • acute respiratory infection (eg shortness of breath, cough, sore throat) with or without fever.
Please note that if the patient has bilateral severe community-acquired pneumonia and no other cause is identified, with or without recent international travel, they are classified as a suspect case.
 
If the patient has moderate or severe community-acquired pneumonia (hospitalised) and is a healthcare worker, with or without international travel, they are classified as a suspect case.
 
Thank you for your assistance in managing the overwhelming demands on our health system presented by this pandemic.
 
Yours sincerely,
Professor Brendan Murphy



coronavirus COVID-19 PPE tetsing



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Dr Marita Anne Carman   13/03/2020 8:48:14 PM

I have had a patient who worked in a nursing home who had a urti with no other risk factors for covid19. Her employer insisted that she get clearance from covid19 before she could return to work. Is this reasonable to test?


Dr Tawhid Mohamed Sayed Hassanien   13/03/2020 8:49:42 PM

Peter Dutton the immigration minister DID not fulfil any of the above criteria. He however did contract COVID-19 virus. Myself and any general practitioner can still contract these cover-19 outside the guidelines. We have duty to protect ourselves first. Lack of resources is not our first priority.


Dr Manal Matty Saka   13/03/2020 8:50:40 PM

In a country like Australia, why Gps do not have enough PPEs and testing kits????
And you are asking for our help!!!


Dr Cho Oo Maung   13/03/2020 8:58:54 PM

Corona Virus...
Supportive treatment. If you know the result, how much would you change the outcomes. Is this benefit enough to compare the cost ?
Monitor people with URTI symptoms
Encourage self quarantine until cough sneeze settled.
Early identification and Antibiotic treatments for Extreme age and people with chronic disease.

Practice Healthy life style ... refraining from smoking, drinking alcohol, using drugs.
Meditation ; sleep 7-9 hours ; healthy eating
Eating 1/4 of Raw Onion ; 1 cm of Ginger ; 1 clove of Garlic ; 1 G of Vit C every day.
Stay away from Crowd
Refrain Travelling to high incidence countries
Mask only for who is coughing and sneezing
That is all we should do.

Why wasting money and resources for testing so much and Outraging.
affecting down turn of our Economy.
That looks like mismanagement of this virus.


Dr Yucel Guldali   13/03/2020 9:11:03 PM

I wonder what will happen when the epidemiological criteria is no longer relevant ie when everyone with a cold is a suspected case?! This could happen in a matter of weeks.


Dr Michelle Lian Wellington   13/03/2020 9:11:04 PM

Can we please just test suspected cases as per the definition with 1 x flocked swab and 1 PCR test. We have been doing 2 nasal and 1 oral. This would seem a waste under the circumstances.


Dr Nichola Lea O'Reilly   13/03/2020 9:13:01 PM

If there is not enough PPE for our health workforce then you are going to have to lock the country down to stop the spread, morbidity, mortality and toilet paper.


Dr Jessica Wrigley   13/03/2020 9:30:26 PM

If we are expecting 1.5million cases in NSW, what is the plan for ensuring we have adequate PPE, swabs, lab testing capability? If these resources are already stretched now then how are we to contain spread and manage in the near future if we have no clear indication of numbers?
We already know there are several instances of community transmission. Keeping the testing limited to those with recent travel history or confirmed contact seems painfully optimistic at this stage.


Dr Leila Moradi   13/03/2020 9:33:27 PM

How is the situation if patient asked for home visit, with common cold symptoms and not other criteria to be a suspected case?


Dr Rifat Jahan   13/03/2020 9:35:53 PM

Before you asking for help from GP’s you should consider why the government were not prepared for this pandemic. You were asking people to be prepared for pandemic without being preparing the health system. Was it not enough to build the panic among general populations with confusing informations? There are cases diagnosed without fulfilling those 2 criteria. Is this a joke or what. You are asking us to be a gatekeeper without even protecting us.., How frustrating that could be. You want to reduce the number of cases? ask the government to go for school, University, child care closer. Make people to work from home. Go for lock down. You want us to take the burden without looking after us... come with us and see how crazy and difficult it is becoming. And the worse is yet to come.


Dr Azar Mirzaee   13/03/2020 9:45:41 PM

I assume when it gets more common we really don't need to have it exactly diagnosed as then isolation is not that necessary, we then need to qualify which patients need treatment. What is more important is to treat every single URTI the way to reduce spending, consider social distance as soon as possible to postpone, slow down community transfer and be vigilant to detect and provide conservative or experimental treatment for who they qualify.
We just need as much time as we can it takes compassion and care true leadership .


Dr George Forgan-Smith   13/03/2020 9:46:35 PM

I can’t help but think part of the problem as been the various health ministers making sweeping public statements that all who want to be swabbed will be.
On the front line we are seeing people who are scared, who are unwell and genuinely concerned. We have already had an untraced transmission in Victoria.
Can we *Please* have some sort of unified statement - not just to the doctors but to the public as well.


Dr Olga Elizabeth Scaramuzzi   13/03/2020 9:47:09 PM

If there are not enough PPE kits, use them only when absolutely necessary: on those with respiratory distress and/or with uncertainty but with serious risks factors that could lead to complications and death.
No need to confirm Dg for paper and computer statistics. Consider them as Covid19 as we record already 20 times less incidents then they are in reality( Said Dr Norman Swan).
Lighter cases should be quarantined not tested, presumed Covid19 . If deteriorate, then test for Covid19 before starting treatment ( antiviral or antibiotics or both).
Do not test only because employer or patients demands.
Travelled or not is at this stage is less relevant criterium.
Depend on symptoms and their severity. ( But tonsillitis or epiglotitis are not Covid19, please, be sensible).
Please do not ignore "octogenarians" as "too old" for your care . Many of them are productive, fit, involved and badly needed in society.


Dr Tamseela Kausar   13/03/2020 10:00:03 PM

Panic and Pandemic, that's the summary of whole situation. Deal with Pandemic by proper public education and awareness on limiting the outdoor activities and lockdown before it gets worse especially if limited resources to start with.Things getting difficult in GP practices as Triage rules seems not applicable anymore.


Dr Mohammed Muniruzzaman   13/03/2020 10:03:31 PM

It appears testing takes the centre stage than taking care of patients. Shouldn’t we keep the things simple: send the patients to the ED who look unwell with risk factors and or with co -morbidities Regardless of testing ? . Otherwise, use your discretion and act sensibly to treat and educate healthy patients with common cold symptoms and viral URTI.


A.Prof Christopher David Hogan   13/03/2020 10:32:22 PM

Thank you for your honesty & directness. We are not children & appreciate how significant the problem is.
Not that we know we do not have adequate PPE & we do not have adequate test kits this changes our therapeutic focus.
As in a flu pandemic it is now time to use clinical criteria to diagnose CoVid-19 because we do not have other criteria.
Once we have made a clinical diagnosis, the next question is How sick is the patient? If mild - self quarantine, if moderate - observe & review, if severe- hospitalise.
As has been the case in other countries & under the emergency pandemic powers can it be that all new masks & are diverted for medical use only?


Dr Sebastian Moss   13/03/2020 10:55:58 PM

It strikes me that we were being asked not to test for community transmission from unconfirmed cases on the grounds that it doesn't exist (now the reason is being shifted to more of a resource issue). But the only reason it is believed not to exist is because we are not testing for it. Maybe it is much more widespread? Would it not be sensible to have "sentinel" areas that test EVERYONE with URTI symptoms so we can get a better handle on the prevalence of this thing?


Dr Ahmad Mir   14/03/2020 12:03:30 AM

As prof Hogan mentioned , at this point clinical diagnosis is more sensible than finding cases by lab tests. Previous plan does not work now, as the number the cases is rising dramatically. Change the plan before the health professionals gets tired and our resources gets empty!


Dr Edmund Henry Olszewski   14/03/2020 12:11:25 AM

I have been made aware, that testing for frontline gps and health professionals, dreadfully sick with feverish flulike symptoms, will NOT be expedited in Perth at all, despite Urgent written on the request forms! Peter Dutton with less symptoms gets same day tests! Why can’t our tests be as quick as Peter’s?


Dr Penny Lisa Wood   14/03/2020 12:19:04 AM

The Government will be doing the best they have with the information available, and the resources that can be tasked. Attacking them wastes vital energy from the real enemy. The Government can't plan for this, no Government can.

If testing slightly unwell people makes no difference to their outcome, we need to save the limited tests for those where it does make a difference.

If people are sick, isolate. If you can avoid other people, do it. If you want to save lives, isolate. It's that simple. Testing isn't important.


Dr Monzur Murshed   14/03/2020 2:21:56 AM

After few days, this case definition won’t work. Likely, everyone will request for testing Covid 19. How will you manage then? I believe that we have to think about self samples collection and strict guidelines for managing different stages Covid 19


Dr Nicola Moll   14/03/2020 7:27:56 AM

Hi Brendan
I am most happy to help to do whatever we can to stave off this epidemic and to listen to your advice BUT you need to support US. Why are you saying yes to events under 500 people, why aren’t you advising school and university closures and closing off our borders. And most importantly why not NOW. We have no time to lose.
How can you expect us to put ourselves and our patients at risk without you motivating and the government acting to do EVERYTHING in their power to stop this epidemic?
Please...


Dr Nzimanyana Mpofu   14/03/2020 8:03:51 AM

Lack of testing kits and PPE is not a concern for the clinician. That is a political issue! Our first concern is to do no harm to our patients and ourselves! Inadequate testing of frontline staff is a recipe for rapid spread of the disease. Any symptomatic frontline clinician should be tested regardless of meeting epidemiological criteria.
The lethargic boffins at WHO wasted precious time reassuring govts that we were NOT headed for a pandemic when all the evidence pointed to the contrary!! This contributed to the lack of national preparedness in my view. Frankly, I don't think I'm in any position to reassure anyone with URT or LRT symptoms that they do not have COVID-19. The fact remains that even the CMO does not know the true extent of the spread of this condition in Australia at the moment.


Dr Irandani Anandi Ranasinghe-Markus   14/03/2020 9:03:45 AM

Totally agree with Dr Moll. What’s magical about crowds of over 500? A crowd of 50 will do for this virus which is spread via aerosol producing actions such as a sneeze or a cough. Someone who may have a sore throat and cough with no fever may we’ll be incubating the virus and very readily spread it around in those circumstances. Should we not be telling people with even mild symptoms not to attend public places but to stay away from such and get themselves better - and if it is not corona they will!! Alternatively as Dr Moll suggests - alternatively, themselves be tested.


Dr Edmund Henry Olszewski   14/03/2020 9:23:38 AM

I have been made aware, that testing for frontline gps and health professionals, dreadfully sick with feverish flulike symptoms, will NOT be expedited in Perth at all, despite Urgent written on the request forms! Peter Dutton with less symptoms gets same day tests! Why can’t our tests be as quick as Peter’s?


Dr Edmund Henry Olszewski   14/03/2020 9:29:59 AM

I neglected to mention, Perth testing is strictly 72 hours, dont bother trying to expedite matters and certainly the Covid section of PathWest is not answering there phones!


Dr Maureen Anne Fitzsimon   14/03/2020 11:06:07 AM

When the dust has settled, will the lawyers come circling and blame the GPs?
The Government has known for years that a pandemic was coming. Didn’t Rudd stockpile 4 million doses of Tamiflu ( which expired).
I realise that the situation on the ground changes every day, but why does it seem that the bones of a clear cut action plan were not in place?
GPs are being thrown under the bus.


SD   14/03/2020 11:15:12 AM

I am more worried taking infection home to my parents, partner and kid. It is impossible to know if the patient sitting in consult with/ without flu symptoms has Coronavirus. According to Chinese reports, out of 90000 infections, 3000 were of medical personnel. PPE is an absolute must for GP’s.


Dr O Gaing   14/03/2020 5:05:15 PM

We need to work together to contain the virus. We have to work as per guideline but sometimes hard to get help from the resources. I can see our GP will suffer first and sometimes we feel helpless. Simple things like not enough masks now . I felt bad that I was unable to provide surgical masks to the coughing patients last week as orders were not available. Educating the patient is very important and there are a few patients who do not want to listen at all. Australian need to show solidarity and please stop collecting toilets rolls if you have enough for 2 weeks.


Dr David Zhi Qiang Yu   14/03/2020 5:50:20 PM

Our clinic has nearly run out of masks and non of grows to work as a GPs to protect us as well as to protect our patients. If there is not enough PPE for our health workforce then you are going to have to lock the country down to stop the spread, morbidity, mortality and toilet paper.

Professor Brendan Murphy, you are out-of- touch the real world as a doctor and I better call you as a our-of-touch of politician!!!


Dr David Zhi Qiang Yu   14/03/2020 6:14:10 PM

Human to human transmission is already happening in Australian. The Guidelines for testing COVID-19 is not scientific and is not wrong. Why Mr Peter Dutton can been test according to the Guidelines??? As GPs, We should test any patients if we suspect them has Coronavirus infection in the same way other diseases. Professor Brendan Murphy, please ask the government to to get some more COVID-19 test kits from other nations as well as we need PPE to protect us in order to work effectively.

Professor Brendan Murphy, you are out-of- touch the real world as a doctor and professor!!!


Dr Mark Edwin Michael Goss   14/03/2020 6:36:39 PM

You have had 4 months to get test kits and PPE at the ready ......... and nothing was done - once again the cries from the medical intelligentsia have fallen on deaf ears.


Dr Hema Irene John   14/03/2020 7:37:07 PM

What happens if you or your GP colleague in your practice tests patient and he is Covid 19 positive, do you close the clinic and keep informing all patients who attended the clinic on that day may be exposed
Patients have to go to dedicated centres ,so that GP s can look after their routine patients and not put them at risk.


Dr Ibtihal Abdul-Amir Khalil Al-Tawil   14/03/2020 11:15:01 PM

We already having to much on our plate . Dealing with every day stress .
Blamed and shamed
I feel We are alone and isolated .
Being creative as no guideline
Questions
1-Why patients not tested in the fever clinic or corona clinic ., why tests in Gp clinic which is full of kids ,pregnant ladies and old people coming for immunisation or scripts , back pain or care plan .
We don’t have PPE , what should we wear while testing , our old white coat ?
2-what is the plan for winter
We started to have flu cases . Common cold and pneumonia cases from now .
How to differentiate , can someone tell me .
Travel history is not enough ...

My suggestion
I think we should use the media to educate the public instead of panicking them to buy toilet paper , rice and pasta
We need Simple massage
Any Travel , contact with known case and have symptoms,,,go to corona clinic , get tested and stay home in isolation
We need a simple understandable plan
1,2,3 points ,for GP AND PUBLIC , please


Dr Leila Moradi   19/03/2020 10:59:11 PM

How is the situation if patient asked for home visit, with common cold symptoms and not other criteria to be a suspected case?