As a community transmission-fuelled outbreak threatens to get out of control and suburbs are locked down, newsGP explores containment efforts and general practice’s role in stopping the spread.
The spate of new cases in Victoria – more than 400 over the past fortnight – has forced health authorities to apply drastic new measures to bring the situation under control, including four weeks of targeted lockdowns.
A mass testing campaign has seen more than 93,000 samples collected in the past three days, while federal health authorities are reportedly working with the Victorian Government to ‘ring fence’ suburbs in the 10 postcodes that will go into stage three lockdown from 11.59 pm on 1 July.
As occurred during the height of Australia’s nationwide response to the pandemic, residents in these areas will only be able to leave home to work, provide care, exercise or buy groceries.
All international flights will also be diverted from Melbourne for the next two weeks and police will have the power to impose on-the-spot fines on people found to be breaking lockdown.
The Australian Health Protection Principal Committee (AHPPC) advocated for the suburb-by-suburb restrictions, and 800 federal workers have been sent to assist with community engagement, door-knocking, and testing at fixed and mobile sites in coronavirus hotspots.
Victorian Premier Daniel Andrews has said police will be active in ensuring residents abide by the restrictions, including via coordinated traffic stops similar to random breath testing.
Dr Glynn Kelly, Chair of the RACGP Specific Interests Emergency Medicine network, told newsGP complacency has been a major driver of the spike in transmission. He believes general practice should be better utilised to support public health messaging and testing.
‘We should be involved in it at ground level, particularly in the affected areas,’ he said.
‘That will take better communication – which is often the way in disasters and pandemics – but we need better communication to GPs, and we probably need better communication from GPs.
‘GPs shouldn’t have to wait to find information in the medical media, but that’s what’s happening. It should be through official medical channels.’
Victorian GP and RACGP Life Fellow Dr Mukesh Haikerwal, who has established a coronavirus testing facility that offers a ‘full clinical service’, recently told 9News that GPs have been forgotten, even though he is currently seeing more potential cases than at any other time during the pandemic.
‘My biggest concern is the people on the ground. GPs in every practice around this area have been ignored and neglected from this whole process,’ he said.
‘What’s happened in Victoria could happen anywhere in the country. It’s unfortunate that it started with us first. I think it is important we hang tough, but they need to involve the local GPs who work in the area if they want to go to communities.
‘We can talk to people to give them the confidence to come and get tested. It is a scary thing.’
Melbourne continued its two-week streak of double-digit case numbers when it was revealed another 64 new cases had been recorded overnight, with the majority locally acquired across 10 suburbs.
The situation has become such that Dr Kelly believes the suburban lockdowns, which have been compared to those seen in parts of China, are necessary.
A targeted approach has also been backed by UNSW epidemiologist and World Health Organization advisor Professor Mary-Louise McLaws, who told the ABC it would still be possible to contain the virus while easing restrictions elsewhere by locking down hotspot areas.
Such an approach would involve ordering people to not leave designated zones without special exemptions, but Associate Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC), told newsGP he has reservations about the effectiveness of this strategy if it involves the creation of ‘enforced borders’ around hotspots.
‘This is a very problematic approach and very difficult to implement. People need mobility for essential workplaces and to access supplies and to fulfill carer responsibilities,’ he said.
But Associate Professor Morgan agrees with the assessment that GPs’ unique skillset is currently being overlooked in public health efforts to contain the spike.
‘It has been one of the recurring features of emergency responses, that GPs are not part of the co-design,’ he said.
‘GPs know their communities. They have clinical information systems that can identify the vulnerable [and] GPs can support and help interpret and personalise public health messaging.
‘GPs can also help manage some of the secondary consequences of the pandemic by identifying people with unstable chronic disease, mental health concerns or people at risk of domestic violence.
‘These are vital roles that should be recognised as essential during any outbreaks of COVID-19.’
Like Dr Kelly, Associate Professor Morgan believes complacency has been a major driver of coronavirus’ resurgence and says more needs to be done to reinforce social-distancing messages that complement other containment efforts.
‘Most respiratory infections are spread in the same way as COVID-19 – through droplets and touching infected surfaces – so every time a person catches a cold, something has slipped through the cracks,’ he said.
‘As a GP, I have seen an increase in coughs and colds since the reopening of childcare centres and schools. In my opinion, this is a marker that we have collectively allowed the conditions to exist for the rapid spread of COVID-19.
‘The sooner spread is stopped in its tracks by people staying away from each other, the shorter the period of lockdown needs to be. It makes sense to go hard and go soon.’
In announcing the new stage three lockdowns for select suburbs, Premier Andrews revealed hundreds of residents had refused to provide samples. He urged anyone to get tested if they feel unwell or are approached by health officials carrying out door-to-door testing.
‘If you are sick, you cannot go out. The only thing you should be doing if you are sick is getting tested,’ he said.
‘Please get the test because the results, the data, the information, the certainty that we get from those tests is in many respects the most powerful tool that we have.’
However, while acknowledging the importance of mass testing, Associate Professor Morgan believes more nuanced messaging regarding how people should respond when they receive their results is required.
‘There seems to be an over-reliance on the value of a negative test,’ he said.
‘I have people contacting me in general practice who are developing flu-like symptoms who are quite convinced their negative COVID-19 test means that they don’t need to self-isolate.
‘In an attempt to encourage more people to get tested, we seem to have over simplified the messaging. Negative tests are only an indicator that makes it less likely that you have COVID-19.’
Both Associate Professor Morgan and Dr Kelly believe GPs are best placed to have this type of informed discussion with patients, and Dr Kelly encouraged practitioners to discuss COVID-19 as often as possible.
‘Every one of my consultations now, if I’ve not seen somebody for a while I talk about COVID,’ he said.
‘It’s becoming more and more important, because we’ve been at this for months and people are getting complacent. They think, “Oh well, we’ve been there, we’ve done that”.
‘But this is far from over, and as GPs we need to amplify that message as much as we can.’
Melbourne postcodes that will be under stage three lockdown conditions:
3012 – Brooklyn, Kingsville, Maidstone, Tottenham, West Footscray
3021 – Albanvale, Kealba, Kings Park, St Albans
3032 – Ascot Vale, Highpoint City, Maribyrnong, Travancore
3038 – Keilor Downs, Keilor Lodge, Taylors Lakes, Watergardens
3042 – Airport West, Keilor Park, Niddrie
3046 – Glenroy, Hadfield, Oak Park
3047 – Broadmeadows, Dallas, Jacana
3055 – Brunswick South, Brunswick West, Moonee Vale, Moreland West
3060 – Fawkner
3064 – Craigieburn, Donnybrook, Mickelham, Roxburgh Park, Kalkallo
The article was originally published by newsGP and is reproduced with its permission.
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