GPs confused by mixed messages in coronavirus response

Matt Woodley

4/02/2020 5:19:45 PM

Equipment shortages, limited communication and conflicting advice from public health authorities is making an already difficult job even more challenging.

P2 respirator mask
P2 and N95 masks are the only masks GPs should wear when collecting specimens from potential coronavirus cases.

Since coronavirus arrived in Australia, GPs in various states have reported confusion as to where to source equipment, which suspected cases are eligible for testing, who can collect samples, and where the samples should be sent.
The response has been met with dismay by some GPs, who have appealed for more support as they attempt to help control the spread of coronavirus.
Adelaide GP and practice owner Dr Alvin Chua told newsGP he has been ‘frustrated’ with the overall public health response and the confused messaging, to the point where he sent a tweet with his concerns directly to Federal Health Minister Greg Hunt.
‘He put a tweet up saying that “we’re supporting GPs and [P2/N95] masks will be rolled out”, but if you zoom into the picture they’re actually level one surgical masks – they’re just paper, they’re … not the minimum N95/P2 masks that are required if we were to be involved with a primary contact and responsible for specimen-taking assessment collection,’ he said.
‘The very next day I rang my Primary Health Network and no one knew anything about it … there are a lot of GPs out there who don’t have the protection and yet, we’ve got the … CDBC [Communicable Disease Control Branch] directing people to see their GP.
‘It’s not that we are shirking our responsibilities, far from it. We’d like to work with public health. We’d love to be able to do the work. We’re trained for this stuff, but we also need support.’
According to The Australian, governments in NSW and Victoria are distributing some P2 masks to GPs, but South Australia, Queensland and Western Australia are not, instead relying on the Federal Government’s supply of surgical masks.
Gold Coast GP Dr Kat McLean has been collecting specimens from coronavirus suspects, but told newsGP her practice may soon have to start turning patients away due to shortages of masks, gowns and other personal protective equipment (PPE) in the state.
‘We’re finding it really difficult on the ground to actually get the equipment that we need,’ she said.
‘In Queensland, if patients meet the criteria we’ve been asked to test, and we can do that within practices if we’ve got the appropriate equipment … [but] we’ve only got a small number of P2 masks, we cannot access any more supplies [privately] and we’re not being provided new P2 masks.
‘You have to have all of your components of your PPE, so you have to have your, gown, your gloves, your mask and your goggles. And if you’re missing any one of those components, it really renders it fairly pointless.
‘Even if we’re actively turning people away, we still need to be able to keep staff safe … because even with our best attempts to potentially divert people, we’re going to likely end up with patients that make it into the clinic regardless.’
The fact that these issues have presented so soon after the first confirmed case also has Dr McLean ‘absolutely’ worried.
‘If we’re experiencing problems now, it does concern me how we’re going to actually manage this in the community,’ she said.
‘Our supplies, depending on what happens, are only going to last us a very short period of time.’
Aside from equipment shortages, Dr McLean expressed frustration at the differing messages that have come from various state and federal health departments.
‘I work on the Gold Coast, so I have patients from New South Wales and patients from Queensland. It’s been a nightmare, to be honest, in terms of the different messaging and the different advice,’ she said.
‘A really good example that we dealt with last week was Queensland’s advice when it indicated that any children with a travel history, even if they’d been in Wuhan, were okay to go back to school, and to see their GP if they got unwell.
‘New South Wales took a much more sensible approach of saying, if they’ve they have a travel history they need to be assessed before they can return.
‘[It] created so much confusion, not just with GPs advising people, but in the community where we’re hearing two different messages.’
Dr McLean also pointed out that the suspected cases that can be tested, who can test them, and where they can be tested, also differs between states and has changed several times in the past few weeks.
In New South Wales, GPs have again been advised that they are able to collect samples if in possession of appropriate PPE, having less than a week ago been told to not undertake testing unless there was no other alternative option.
NSW Health initially directed GPs to collect specimens, but only from people with a travel history to Wuhan, which has also subsequently changed to include all of mainland China.
Associate Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC), told newsGP the public health response had been ‘not a very good start at all’, but expressed optimism that it could improve.
‘The context is there are four cases in New South Wales and Victoria, two in South Australia and two on the Gold Coast,’ he said.
‘As far as we know, no one’s caught coronavirus in Australia yet. So it’s at a very early stage of what could become a pandemic, but I think we can still do some rapid planning and preparation in case it does become more severe.’
Associate Professor Morgan also said the Government should make it easier for GPs to access equipment and funding to deal with coronavirus, as GPs would likely form the backbone of any response to a mass outbreak.
‘GPs are perhaps the only workforce that could respond if coronavirus becomes more widespread in in this country,’ he said.
‘Where there are population centres, there are GPs … the ability of general practice to come to the party and be part of the solution is there, the willingness is there, but there needs to be some planning and thought around finding the opportunity.’
The RACGP has more information on coronavirus available on its website.
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Dr Peter James Strickland   5/02/2020 11:44:31 AM

There should have been no necessity for masks to prevent coronavirus within Australia.
The public health advisers got this one really wrong, and now cost the invasion of this disease into Australia, AND cost the Australian taxpayer an enormous amount of monies, frustration and concerns. How dare they blame GPs for any spread of this coronavirus. The policy from the start was NO movement out of China, or any other affected country, until full control of this disease was reached. Hard on those trapped in China etc., but very effective in preventing disease spread and deaths. Develop a vaccine, if that is possible, but don't allow people to travel and infect others whilst we have a potentially global disease similar to SARS. Human rights should be to prevent innocent people acquiring this illness, and certainly not to turn responsibility onto GPs all over Australia as a cause for any spread at this late stage in my opinion.

Dr Singh   5/02/2020 5:15:39 PM

it is impossible to get test done on yourself if you get URTI symptoms. As you know that transmisson can happen even from asymptomatic or subclinical cases and re viral behaviour is still unknown While seeing patients (even they are not from china but may be from other countries where cases has been detected )yu can catch infection and can not be tested with current guidelines even if you want to pay for test. So even you are at front line , but if you want to exclude that your sx are not from this virus ,there is no way .