14th March 2020, Dr Chee L Khoo
I have been holding off writing about the coronavirus so far as I didn’t think that I have the expertise. I would be out of my depth. It’s been coming up to three months since the world woke up to Wuhan. It’s been 6 weeks since Australia banned all flights from China. It was only a matter of time before the virus run rampant in Australia causing mayhem. It was a matter of when rather than if. You would have thought and expect that with a lead time of 3 months that we would have a disaster plan in place by now. According to the Collins dictionary, a plan is: “a method of achieving something that you have worked out in detail beforehand”. Was there ever a plan? Or more precisely, did they plan to equip primary care to handle the crisis?
As health professionals, we received some masks at the beginning of the outbreak. I received 150 face masks 4-6 weeks ago. That was ok then as there were only 25 cases in Australia, pretty much all from either people returning from affected countries or been in contact with someone confirmed to have coronavirus. But over the last 2 weeks the numbers have increased 8-10 times to >200 now. There are increasing number of new cases in people not been overseas or been in contact with known cases. This means, the virus is now in the general community. The government have stockpiled 54 million facemasks. But each practice in south west Sydney received another 50 masks last week. Wow, I wonder how many days it will last? What is the point of holding on to the masks in secret stores when we need them in general practice.
Without masks for the patients, we are facilitating cross infection between the infected patients and our sicker patients with chronic illnesses in the waiting room, further increasing the caseloads. Without facemasks for doctors and their staff, we risk infecting staff at medical practices which will have to close, putting further strain on the medical workforce. When the doctor at Liverpool Hospital was infected, 13 other staff had to be isolated at home. We will be running very short of doctors very soon.
We have been asked to be the frontline medical staff to handle the coronavirus outbreak. But we don’t have enough masks nor personal protective equipment. Without adequate protection, we will see mortality amongst our health professional colleagues. You think that is far-fetched? Italian doctors are mourning the coronavirus-related death earlier this week of Italian physician Roberto Stella, 67, leader of the medical association in Italy’s northern Varese region, who continued to treat patients even after protective gear ran out (1). Will you consult without your face mask when seeing someone who has flu symptoms who potentially have the coronavirus? You wouldn’t send a SWAT team to a seige without their protective gear, would you? That’s exactly what the government wants us to do!
We were originally told to only swab a select few patients who had either return from certain countries or been in contact with people known to have the virus and have symptoms of the flu including fever. Of course, this represent only a small subset of patients who may have the virus. We were supposed to use our clinical skills to determine who to swab. “If you have flu symptoms, go to see your GP” was the message. How can we tell unless we swab everyone with flu symptoms. Everyone else seems to need a clearance which we can’t provide unless we swab.
We were also told that if you decided not to swab, patients should be told to self-isolate. Easy for them to give that advice but many patients can’t afford to self-isolate and need clearance to return to work. Trying to get swabs at your local pathology laboratory is increasingly harder. The time it takes to get the results is getting longer as labs are swamped by the sheer numbers. They are about to get a lot worse. Of course, if you are Peter Dutton, you can get your results in 3 hours. Our patients have to wait 5-7 days. Besides, why is he in hospital anyway? I thought all “well” patients whom we suspect may have coronavirus should first present to their GP and swabbing can then be organised. Why was he in hospital? He was reported to have said: “It is the policy of Queensland Health that anyone who tests positive is to be admitted into hospital and I have complied with their advice.” That’s not we were told. Only the unwell need admission to hospital.
Lack of leadership
Anyone who has come into contact with a confirmed case of coronavirus need to self-isolate for two weeks to prevent further spread of the virus during the incubation period. Canadian Prime Minister is self-isolating because his wife was confirmed to have coronavirus. Why is the Prime Minister, Scott Morrison not self-isolating? He is reportedly going to attend this weekend’s football match. Hardly consistent message to the public, is it? Anyone knowingly passes a disease to another person is guilty of grievous bodily harm. Without self-isolation and quarantine, the virus will spread much faster.
If you look at the rapidly escalating number of cases in South Korea before flights from Iran were banned, you would have thought that South Korea should have been banned at the same time. What was the reason why South Korea was not banned at the same time? In the week between Iran being flight banned to the time when South Korea was flight banned, at least 4000-5000 South Koreans arrived at our shores. Anyone can see from the graph that it was rapidly rising in the weeks leading up to South LKorea being banned. See Figure 1. Why was S Korea not banned when Iran was banned?
A similar case was seen with Italy. The rapid rise in the number of cases in Italy was evident when flights from South Korea were banned. It jumped from 1200 to 6000 cases before they decided to flight ban Italy. Were they waiting for a miracle to occur and see the trend reversed in the coming days or weeks? Did it have something to do with the Melbourne Grand Prix?
The Grand Prix was cancelled immediately earlier this week but football matches will only be cancelled after this weekend. Does the coronavirus take a break during the weekend? It reminds me of the case of a man arriving from Iran and told to go home and self-isolate while waiting for the swab results. He popped into the local supermarket on the way home and he was heavily reprimanded. Well, banning football matches later after this weekend is pretty similar, isn’t it? Just a couple more days doesn’t hurt, does it?
Are our leaders taking this coronavirus seriously? Is it just another “flu” epidemic, isn’t it? No big deal, really. Another media beat up? Our leaders’ attitude is emulated by the public and is making our efforts to slow down the epidemic that much harder. Where is the leadership in times of crisis?
We protect the community but who will protect us?
At my practice, I will stop seeing patients with flu symptoms when we run out of masks. They will all be instructed to go the coronavirus clinic. By the way, I would have thought that the location of these clinics would have been all sorted well before the epidemic hit Australia. Remember, we had 3 months lead time for planning. They are only beginning to decide on the locations now. After that, they have to equip the centres with PPE and other equipment, then find nursing and medical staff. I wonder how many will be up and running within the next few weeks. A reactive response is NOT called planning.
We are supposed to be frontline medical staff saving Australia. Why are we not adequately equipped? Are we dispensable? Are there any GPs on the planning committee? Oh, I forgot. Did we have disaster plan at all?