No PPE puts GP Clinics at risk

On the 30th January, the World Health Organisation declared a global emergency with the discovery of a new strain of coronavirus. The epicentre, the city of Huban, was the focus of the world as was their live food markets. At that point in time, most Australian General Practices were dealing with 1 in 3 people who been directly or indirectly affected by bushfire, after Australia had its worst bushfires in over 30 years. Little forethought was given to the potential need for Personal Protective Equipment (PPE) for a "worse than normal" flu season when many places were still reeling from the demand of traumatised patients and the need for masks to protect people from the smoke. The net result, many GP practices have been caught short and are now paying premium prices for PPE or not being able to source it via regular suppliers. So how does this affect the delivery of health care services?

Seasonal influenza peaks in Australia between May and September, and in 2019 we saw an unprecedented caseload as early as February in Queensland and NSW. Over 15 million influenza vaccines were given perhaps related to the early caseloads and warnings that many patients considered and acted upon. Now with the first cases of local transmission of Coronavirus, we are potentially looking at our Influenza A, B and H1N1 peaks being at the peak of CV-19 infection, resulting in a further overloaded health service. Additionally, there is no clinical way to determine the type of "flu-like" infection, so every patient with flu symptoms will have to be treated as potential coronavirus once the local person-to-person infection has been identified (as it has in NSW). This poses a massive problem for community health care services who are frequently overwhelmed during flu season from increasing patients and decreasing workforce with infected staff. As a practice owner, my primary concern must be the health of my workforce. We can not continue to deliver care to the community we serve without adequate PPE, leaving us at a loss to how to deliver services and protect patients. Having received our allocated 100 surgical masks to service our 12,000 registered patients we are struggling to implement infection control measures that would meet universal precautions of a "normal" flu season.

Primary Health Networks have been delegated the task for PPE distribution for community health providers, namely GP clinics. The recommended PPE for coronavirus is a) surgical mask and gloves for the patients b) N95 masks, gowns and gloves for medical staff. To date, most clinics have received level 2 surgical masks equating to less than 1% of their patient base, no gloves or gowns and many clinics have not received N95 masks for staff. The added burden of treating infected patients is a) the cost of staffing to "deep clean" rooms with detergent and disinfectant between symptomatic patients b) the cost of the chemicals and cloths c) disposal of PPE and cleaning equipment d) warning signs and notices e) time to triage patients by phone when they will not be attending the clinic and f) the allocation of resources and rooms specifically dedicated for isolating waiting patients.

Medical supply companies have been overwhelmed with orders from primary health services for N95, chlorhexidine, gowns and gloves, most of which have now been placed on back-order as stores have been depleted. Patients have started taking masks from clinics despite not being unwell as they cannot access them to purchase. Some clinics have resorted to shopping at hardware stores such as Bunnings and paying up to $10 per mask to protect their staff when swabbing patients. The financial burden adds to the ever-decreasing funding for primary health services. We have not seen a single case in our clinic to date yet the financial burden of over $3000 in preparation and equipment has already been invested to protect our patients and staff, yet we have no guarantee of ongoing supplies and how to fund ongoing equipment. Yesterday we were notified our overseas direct order has been blocked by the government who is not allowing N95 masks to be exported. So what happens when we no longer have PPE for staff?

Many GP clinics may be faced with limiting patients to the clinic to those without URTI or flu symptoms in order to keep their practices operational. Some may, in the height of the season, need to close their doors due to a lack of staff to run and work at the clinic, should they be infected. There have been cases of clinics being closed in the UK after staff have been diagnosed with CV-19 and the entire workforce has been put into self-quarantine until swab results are available. This is a reality for Australian GP clinics who face unwell patients without adequate protection. Once overseas travel is no longer the "risk-factor" because the virus is widespread in the community all patients will need to be treated as suspected CV-19. Heres hoping the government come to the party and either take the full burden of caseloads or provide adequate protection for staff and patients attending community clinics before privately-owned GP clinics close their doors to patients.