Covid: Behind the Scenes at a General Practice
Updated: Feb 12
General practice is usually the first point of contact people have with the health care system. GP teams are very much a part of the local community. We know the community well and most of us live in the very same community we work in. The first we heard about the “novel coronavirus” was an innocent fax which came from the public health department early in 2020. Then news reports emerged about this new virus affecting parts of China and then regions in South East Asia. Restrictions were imposed on flights coming in from China, then Australia quickly joined the world entering a period of lockdown to contain the spread of the virus.
At our practice, the developments were met with varying degrees of concern and alarm. COVID was a new virus and we did not know how infectious the virus was or how dangerous. There are doctors and staff who are vulnerable and at high risk if they become infected. All General Practices would need to find a way to safely care for patients who may be potentially infectious with COVID. The physical layout of our practice would become a key factor in how we managed the pandemic - we operate from a cottage with the benefit of having a small outdoor carpark. Having access to that outdoor space has been very valuable. Procedures had to change rapidly. The Commonwealth funded Primary Health Network sent us supplies of masks as personal protective equipment (PPE). The Commonwealth quickly developed and rolled out Telehealth consultations to allow patients to access health care from home. At the practice, we appointed a clinical lead doctor for COVID. We used Telehealth and stopped seeing patients face to face unless necessary.
We took advantage of the outdoor carpark to set up a tent clinic, with the doctor wearing full PPE (mask, gloves, gown, face shield) and with a nurse to scribe for them. Evidence is that the risk of spreading the virus outdoors is much less than within an enclosed room. We have used this outdoor clinic in all seasons – initially for all face to face patients, but now for all those with respiratory or infectious symptoms. The doctors and nurses clean the seats and surfaces between each patient. Procedures were changing on a daily basis as we got more information from the health authorities. Our administration staff valiantly had to keep track of daily changes and manage worried patients while also worrying about whether they themselves may be at risk.
We felt we were in a war – and in reality, we are. We are fighting a virus which is sneaky and potentially deadly. People infected with the COVID virus may be infectious without showing symptoms. For most people the symptoms seem to be mild, but a significant proportion need to go to hospital and in Australia the case fatality rate is 2.7% (Australian Bureau of Statistics). The risk for each person increases with age to approximately 8% in the 70s age group and 26% in the 80s age group. Because the virus is so infectious, it can spread rapidly if not kept in check and cause many deaths due to the number of people it can infect. In London, where COVID is out of control, the Mayor has declared a major incident because of the surge in COVID cases, the ambulance service has been overwhelmed and firefighters are transporting people to hospitals which are filled to bursting.
Australia has been lucky compared with the rest of the world. As an island and with quarantine, we have been able to better control our borders and keep COVID at bay more than many countries. We have been able to act quickly to contain outbreaks and have developed a COVID safe way of living our lives. We have lost lives and our economy has been battered, but so far have done better than most countries. Perhaps the biggest risk in Australia is complacency. COVID will be with us for years to come, despite the hope of a vaccine. It is important we continue into 2021 with physical distancing, hand sanitizing, masks to reduce spread, and if sick - staying home and getting a COVID test.