By Adjunct Assoc Prof Jared Dart BSc BA MBBS PhD FRACGP

Many of you will be worried about the novel coronavirus COVID19. This blog is the first of several to keep you informed. I hope you find this information useful. During this difficult time, we intend to use SMS and email more than we normally do – if this upsets you, please unsubscribe using the link below.

There has been some misinformation about COVID19 with many likening it to a cold or flu. It is a more serious condition with a much higher percentage dying than those who get the flu (about 10-20x more). The death rates (reflecting data from China, mostly) are shown below. If you still doubt the severity, ask yourself, why would China shut down its whole economy for a month? To learn more you can read WHO situation reports here.

To protect our patients, we have been taking proactive steps for some time. I sent a text to all our patients 27 January 2020 as part of our COVID19 triage process. We were ahead of public health advice and intend to continue to be conservative to protect our patients.

Triage

We will continue to ask patients their travel history and if they have any symptoms which may be attributed to COVID 19. Please do not be offended. We need to know if you have cold or flu like symptoms and will not turn you away. We do however, want to limit the risk of cross infection in our clinic. If our staff become infected we may infect our patients so please follow our instructions – use a mask (we will provide you one if you do not have one); wash your hands with gel on arrival and if you touch your face or blow your nose. We may ask you to sit in a dedicated waiting area. We will have home care protocols and hospital transfer protocols in place for our patients infected with COVID19.

See the World Health Organisation’s advice to health facilities below.

Preparations for COVID-19 at healthcare facilities

Dedicated ‘flu clinics’

We may begin to use dedicated rooms and times to assess patients with cold like illnesses. During these times you may only be able to see the duty doctor (not your usual GP) and they are likely to be wearing protective equipment. We will clean the rooms between patients, but you should take precautions as outlined below and avoid touching your face while you are in the clinic. I intend to make sure our practice goes above and beyond in terms of infection control in order to protect you. If you are sick it is possible we will ask you to get a nasal swab done to test for COVID19. We will support unwell patients at home – we intend to use video consults to do this. In due course I will develop a patient hand out for self-care during a cold/influenza/COVID infection. We may use Tamiflu for influenza illnesses more than we used to.

Doctor taking mans temperature

Keeping the practice viable

All of this will take time, resources and commitment on our part (I have been doing many hours of work preparing our clinic for this situation), so we ask you to be understanding during this difficult time. We may need to charge you extra for certain services and items (like masks) – this is unfortunate, but necessary. You may be aware the Federal Government froze GP Medicare rebates for 7 years and that the rebate has only increased from $34 in 2010 to $38 in 2020. This has meant many General Practices are struggling financially at a time when we are being asked to do even more for our patients (if this upsets you please contact your local Federal MP, Julian Simmonds julian.simmonds.mp@aph.gov.au).

For non-urgent matters and those which do not require your attendance at the clinic we may offer video consultations – unfortunately no Medicare rebate will apply (if this upsets you please contact your local Federal MP, Julian Simmonds julian.simmonds.mp@aph.gov.au).

We will commence influenza immunisations as soon as they arrive – look out for an email or SMS from us. We may send an email or SMS to patients over 65 or otherwise vulnerable patients to offer them a pneumonia vaccination if they have not already had one.

Objects you can pick up infected droplets from

Protecting yourself from COVID 19

It seems inevitable to me that by May 2020 the novel coronavirus COVID 19 will be endemic (widespread) in our community. With that possibility in mind, it is important we all prepare and learn ways to protect ourselves and vulnerable groups in society.

The virus spreads by droplet. This means when a person coughs, sneezes, touches their nose or eyes they can deposit virus particles called fomites on other people and surfaces. People will get infected if those particles enter their respiratory tract ie by inhalation of particles from a cough/sneeze (usually within 2 metres), or if a person touches a contaminated surface and then touches their nose, mouth or eyes. We believe the virus can live on hard surfaces for up to 9 days! These hard surfaces include anything in public spaces but could be any hard surface an infected person touches – think widely and consider disinfecting hard surfaces you believe could have been exposed to infected individuals.

This means sick people need to follow strict respiratory etiquette – something Australians are not used to (we need to learn fast!). Please encourage friends and family to follow the instructions below:

Covering mouth and nose when coughing or sneezing

To protect yourself from catching this virus I suggest the following the advice adapted from a variety of sources:

  1. STAYING HOME IF YOU ARE UNWELL!
  2. NO HANDSHAKING! Use a fist bump, slight bow, elbow bump, or wave
  3. Minimise hand contact with hard surfaces in public areas e.g. use your knuckle to touch light switches, elevator buttons, open public bathroom doors with your closed fist or hip, use disinfectant wipes at the shops to wipe the handle and child seat of supermarket trolleys etc.
  4. Wash your hands with soap for 10-20 seconds and/or use a greater than 60% alcohol-based hand sanitizer whenever you return home from any activity that involves locations where other people have been. Don’t forget to moisturise your skin as this process can make your skin very dry.
  5. Keep a bottle of sanitizer available in your handbag, school bag, at each of your home’s entrances and in your car for use after touching possibly contaminated objects.
Instructions on using hand sanitiser

Consider preparing now for widespread infections and home quarantine by getting the following:

  1. Extra 1 month supply of prescription medications, inhalers and disposable products as there may be interruptions to supply
  2. Medications like paracetamol and ibuprofen which can help make us feel less sick
  3. Alcohol-containing hand rub and soap
  4. Household cleaning agents and disinfectants – anything containing benzalkonium chloride is good for coronavirus.
  5. Making sure you get the flu vaccine when available and any other vaccinations we recommend (like Pneumovax for over 65s or those with certain chronic conditions)

Be informed, not alarmed.

We will be here to support you, as we always have.

More information will be shared in the coming weeks via email and on our website. We will reserve SMS campaigns for important information.

By Adjunct Assoc Prof Jared Dart BSc BA MBBS PhD FRACGP

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