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GPs call for clarity amid coronavirus confusion


Matt Woodley


29/01/2020 4:32:48 PM

Inconsistent messaging and an overall lack of coordination are hurting efforts to curtail the coronavirus, a prominent GP has said.

Collage of politicians and health officials.
Government and health authorities have been issuing sometimes conflicting messages.

UPDATED

The lessons from the 2003 SARS pandemic have been ‘forgotten’ in dealing with the new coronavirus threat, according to the Chair of the RACGP Specific Interests Disaster Management network Professor Glynn Kelly.
 
The rapidly spreading coronavirus has now infected almost 10,000 people and killed more than 210, while a shortage of test kits has led experts to warn that the real number may be higher. Australia now has nine confirmed cases, four in NSW, three in Victoria and two in Queensland.
 
Health officials from Germany, Japan and Taiwan have all recently confirmed the first human transmission of the virus outside mainland China.
 
The German man was reportedly infected by a woman who at the time had not been showing any symptoms, which could impact containment strategies if confirmed.
 
Recent reports suggesting the virus can be transmitted while patients are asymptomatic contradicts earlier advice from Chief Medical Officer Professor Brendan Murphy.
 
But Professor Kelly told newsGP the uncertainty surrounding coronavirus and how to combat it extends beyond clinical unknowns.
 
‘The biggest problem at the moment is we don’t really know [anything] and there seems to be a lack of coordination around Australia,’ he said.
 
‘We don’t know if it’s evolving or mutating. We don’t know its real incubation period because some people are getting it after 10 days, some people after five days.
 
‘At the moment people are getting one communication from one [health authority], one from another, and GPs are getting confused about which ones to follow … we really do need consistent communication across all jurisdictions.’
 
Professor Kelly pointed to public health information directing potentially infected patients to general practice clinics as ‘inappropriate’, and said uncertainty over how to access P2/N95 face masks from the national stockpile had also hindered infection control efforts.
 
‘We learnt a lot of good lessons from SARS, but I think it’s all been forgotten,’ he said.
 
‘Disaster plans, whether it be bushfires, pandemics, floods, atomic explosions, whatever, they are all hazards and [authorities] should really be able to cope.
 
‘There should be plans in place that can be activated at national, state and local level, and there just [aren’t].’
 
Earlier today RACGP President Dr Harry Nespolon moved to clarify how GPs can access the masks, having urgently lobbied the Government earlier in the week to make the stockpile available to general practice clinics across Australia.
 
‘This week I urged the Health Minister Greg Hunt to take advantage of the emergency medical mask stockpile and make them available to GPs on the frontline doing all they can to stop the spread of this virus,’ Dr Nespolon said.
 
‘It is extremely positive news that the Government has heeded that advice and acted swiftly to make these masks available.’
 
The N95 face masks, which are designed to prevent 95% of small particles from entering the nose and mouth if fitted properly, will be provided to GPs nationwide via local Primary Health Networks (PHNs).
 
Meanwhile, Prime Minister Scott Morrison has rejected suggestions state governments had issued inconsistent advice about coronavirus and defended their ability to operate autonomously.
 
Mr Morrison’s comments came after governments in NSW and Western Australia advised parents to keep children away from school if they’d visited China in the past 14 days. By contrast, Victoria’s Chief Health Officer has said only students who have been unwell or in close contact with a confirmed case need to stay home.
 
‘What the NSW Government has done has been consistent with the [federal] advice – it has gone beyond that advice and as a parent in NSW I don’t have an issue with that,’ Mr Morrison said.
 
‘The decisions made in NSW were not inconsistent with the advice that is out there, it went beyond the advice, and that’s a judgment they’re entitled to make.’
 
The Federal Education Minister Dan Tehan had earlier chastised some private schools for suggesting students stay at home for 14 days.
 
Amidst the confusion, federal health authorities are scrambling to evacuate more than 600 Australians known to still be in Hubei province, which the Chinese Government has quarantined as part of its response to the outbreak.
 
Mr Morrison has said children and elderly people in Wuhan will get priority, and be taken to Christmas Island for quarantine.
 
There is also hope some of the clinical mysteries that surround coronavirus will soon be unravelled, with scientists from The Peter Doherty Institute for Infection and Immunity (Doherty Institute) announcing they had successfully grown the virus from a patient sample.
 
The breakthrough marks the first time the virus has been grown in cell culture outside of China, and the institute’s Dr Julian Druce said the ‘significant breakthrough’ will allow accurate investigation and diagnosis of the virus globally.
 
‘Having the real virus means we now have the ability to actually validate and verify all test methods, and compare their sensitivities and specificities – it will be a game changer for diagnosis,’ Dr Druce said.
 
‘The virus will be used as positive control material for the Australian network of public health laboratories, and also shipped to expert laboratories working closely with the World Health Organization (WHO) in Europe.’
 
The RACGP has more information on coronavirus available on its website.
 
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Dr Peter James Strickland   30/01/2020 11:32:08 AM

This whole episode is nothing short of too little, too late. No cognisance was taken of the fact that the transmission of the coronavirus was unknown. There was only one decision ---- NO flights into Australia from affected countries until the transmission facts were known --no ifs or buts here! Putting responsibility onto GPs from the central health advisors is simply trying to shift their own responsibility in this saga. How many patients with respiratory symptoms come in to general practices per day? Thousands. The responsibility for the cases of coronavirus are directly related to allowing the infection into Australia, i.e. by advice which has found to be wrong, and now suggesting flying in approx. 100 extra people possibly carrying the virus to Christmas Island. It is unbelievable!


Dr Elia Botros   30/01/2020 11:49:53 PM

I've ordered the test for a sick 4y-o child whose grandmother recently arrived from China; however the pathology lab person advised that I have to call the department of health (VIC) for approval of the test
I did call twice and no one was able to help as they were unaware of the above. The test was not done yet.


A.Prof Christopher David Hogan   31/01/2020 1:10:45 AM

There are many things to take from this last 2 months, first that things can happen quickly and our jobs which seem so mundane can suddenly be anything but. Second, that coughs & colds can sometimes be deadly, not only to the patient before us, but to us.
We think our lives are routine & without warning we are exposed to bushfires that affect thousands on the fireground & their smoke that affects millions up to hundreds of kilometres away . We are stretched to the limit forced to remember long ago training & find out new things for ourselves. It is all so overwhelming.
Then we are potentially exposed to an unknown infection, with uncertain methods of transmission, unknown incubation period & unknown lethality.
Third, the uncertainty & confusion surrounding these events is to be expected & suddenly the listing of infection control measures as part of accreditation are no longer an irritating bureaucratic burden but deadly serious


Dr Aline Suan Lin Smith   31/01/2020 7:47:05 AM

GPs are again asked to step up but with what resources?
Our suppliers are out of surgical masks and P2 masks , our PPE equipment also being exhausted.
Hospitals and health direct line is directing people to GPs since early last week.
We being the front line should have been supplied necessary equipment or triage directions at least 3 weeks ago when GPs received alert about Wuhan.
Where was the response then, our practice enacted and trained staff in new triage protocol the week after ....to screen every appointment on the phone for travel overseas.
It's not enough to just ask about Wuhan or China.
The virus has broken borders, it's just not being able to be confirmed as testing not available. Dreadful management of disaster protocol which left GPS out!


Dr Merlene Lynette Thrift   3/02/2020 6:03:59 PM

A very big thank you Prof Kelly for putting the facts clearly.
GPs frequently see a dozen URTIs a day. Picking an asymptomatic corona virus without a known contact with Asia is impossible, and denying corona virus surveillance at the lab is the final mailing the coffin!
May God help everyone.
Dr Merlene Thrift