I am a GP and have noted that the advice being given to patients in Australia and the UK with respect to going to their GPs is completely different. I am concerned that this may lead in Australia to increased adverse events and potentially fatalities if the Swine Flu is any more than mild.
In the UK my understanding is that there is a developed (and staffed and funded) network of local centres set up to be activated if needed to deal with highly predictable public health events such as the current swine flu outbreak. (see George Monbiot in relation to UK smallpox preparedness). There appears to be no such network currently in operation in Australia despite years to prepare since SARS and bird flu. Hence GPs (and their receptionists and their other patients) in suburban surgeries are being used as a stopgap. I feel that behind the assurances are many questions that need to be answered.
In my view the following should have happened today. A designated room should have been opened in every community centre/hospital/public health facility across the nation. It should be of appropriate size and easy to decontaminate and dispose of large amounts of waste such as gloves, gowns, masks etc. It should be staffed by nurses equipped with a P2 (antiviral) mask and gown etc for every patient. They would do triage, swabs, hand out Tamiflu where appropriate and take details for public health authority monitoring and follow up. All this should have been planned years ago.
This is what happened in general practice today as I experienced it: nothing. Except a variety of faxes from public health authorities which contained pie-in-the-sky advice that bears little resemblance to the realities of suburban general practice. Here’s a few comments on the NSW health fax:
- surgical face mask for patients in waiting room. Ordinary surgical face masks as I understand it are useless for control of highly infectious viral infections. My understanding is that one cough can spread enough influenza virus to contaminate a reasonable sized room.
- All staff protective measures — this means reception staff etc need to wear P2 masks, gowns, gloves etc? And is this for every person who comes in or will they, once contaminated, sit there contaminated all day? How do you decontaminate a reception desk? Or a typical suburban consulting room? Not every suburban practice has a treatment room, especially one easily decontaminated after each patient — and who will do this decontamination?
- If staff are to be protected with P2 masks what about other patients in the waiting room who may be frail /old/babies etc or are they not being considered?
- Patients should be managed in respiratory isolation — respiratory isolation does not exist at suburban GP surgeries. Most GP surgeries are air conditioned, waiting rooms are not ‘respiratory isolation’. If a consulting room cannot be genuinely decontaminated between patients (say coughing) the next patient is simply sharing the previous infection.
At an absolute minimum a truck should have arrived at every GP surgery in Australia today with a crate of P2 masks, viral standard gowns, extra gloves, waiting room signs, Tamiflu and extra viral swabs. Nothing of the sort happened so far as our surgery is concerned. No list of designated flu triage and testing centres was faxed to us. I believe this needs some explaining.
Our surgery has exactly 60 P2 masks, 75 surgical masks, 45 gowns and no Tamiflu. Most of these we bought during bird flu outbreak and several of them at that time were completely out of stock. This morning at “Discount warehouse” chemist — one of the busiest chemists for non PBS medicines in this area — there were exactly four boxes of Tamiflu in stock, all gone by 10am. From discussions I think we are one of the better prepared surgeries and all off our own bat. How long at one P2 mask per feverish/coughing patient will that last? I sometimes see 10 plus such patients a day.
If Swine Flu (or the next virus) turns out to be significant in terms of severity/deaths then if GPs and their staff are to be “the frontline” (cannon fodder??) am I supposed to go and live in a motel — or should I go home to infect my wife and children?
Bland reassurances from the bureaucrats who set up this non system are not good enough. Why aren’t we doing what the UK has done? We might stumble through swine flu if it’s not too bad — but what if it’s not? And what if the next virus is the real thing?
I wonder if the bureaucrats and medico-politicians have been reading too much Biggles and assume that GPs (and their staff and other patients) will be happy to go down with the ship?