It’s the end … of the week at The Medical Republic‘s live COVID-19 blog.
This week has had more ups and downs than a tired preschooler. Thanks for sticking with us, and stay healthy.
- Electronic prescribing has been fast-tracked: doctors can now send electronic prescriptions direct to pharmacies.
- ACT is stepping up its COVID-19 testing to look for community transmission.
- Concerns for healthcare workers on the COVID-19 frontline, as infection rates increase.
- The ACT is stepping up its COVID-19 testing program to include
randosrandomly selected individuals who don’t otherwise meet the criteria for testing.
The goal is to look for evidence of community transmission, the ACT Health department said in a statement.
“Given the recent drop in demand for testing from returned travellers and close contacts of already confirmed cases we are now able to expand our surveillance,” said ACT Chief Health Officer Dr Kerryn Coleman.
The testing will be done at the Weston Creek Walk-in-Centre and at the drive-through testing station at EPIC.
- Electronic prescribing is here! In a new, fast-tracked initiative, GPs will be allowed to send electronic prescriptions direct to the patient’s pharmacy to be filled.
The federal health department just announced the interim arrangements (with some stealth, we might add), and the RACGP has welcomed the move.
“This is a vital part of the puzzle to enable GPs to continue providing the same quality care to their patients via telehealth as they do face-to-face,” said RACGP President Dr Harry Nespolon.
Under the new system, prescribers will still create a paper prescription during the telehealth consultation, which will be signed either electronically or as normal. The doctor can then scan or photograph the prescription, and send to the pharmacy by email, text or fax. They may also be able to send the prescription direct to the patient, but we’re still trying to confirm that with the Department of Health.
Doctors must still send the paper prescription to the pharmacy as soon as possible or, if that’s not possible, retain the paper prescription for at least two years. Patients can also now choose to have their medication delivered directly to them.
4.15pm, 3 April
- The AMA has started a regular series of evidence-based fact files on COVID-19, designed to “reflect the reality of life for doctors working daily to help all Australians survive and maintain their health in the time of COVID-19.” The first file is on transmission and personal protective equipment, with AMA Vice President Dr Chris Zappala.
1.50pm, 3 April
Infectious diseases physician Dr Peter Collignon is giving us a welcome dose of (cautious) optimism this afternoon:
Latest epidemic curve from NSW. Still looks like very good news. The curve is better than flattening- its falling. Peaked about March 25, so main effect is what we did about 5 days before that and earlier. Means at the moment Ro is likely less than 1. pic.twitter.com/BulvLd91yK
— Peter Collignon (@CollignonPeter) April 2, 2020
- The Medical Republic’s survey on the financial impact of the COVID-19 pandemic on GPs has generated some strong responses. The survey of 175 GPs found 54% have lost more than 30% of their revenue compared with this time last year, with one 100%-bulk-billing clinic reporting a 50%-70% loss in income.
RACGP President Dr Harry Nespolon said the survey also underlines the RACGP’s push to allow telephone consultations to be included – something that was initially resisted.
“This is one time where we need to emphasize to the public that it is not just about telehealth, something they might not understand, but is available over the telephone,” he said.
GP and former AMA President Dr Mukesh Haikerwal AC said telephone calls to his practice were incessant – about ten times what would normally be experienced – but all of them were for referrals.
“Our staff are literally being fried on the line, therefore we need to put on more frontline staff on the desks,” he told TMR. “We are also having to triage the little numbers of people away from the practice because of having respiratory symptoms, being elderly, or vulnerable.”
- Western Australia has expressly prohibited the use of serology tests for COVID-19 except for research purposes, and the Royal College of Pathologists of Australasia has also advised against their use for diagnosis or screening.
“Given the serious limitations and risks associated with the COVID-19 point of Care (POC) serology tests for acute detection and diagnostic purposes, the Chief Health Officer deemed them an unacceptable risk to be used in that way and has prohibited them under the Public Health Act 2016,” the WA Department of Health said in a statement.
The RCPA emphasised that the current PCR test is the primary testing method for COVID-19.
“The IgG/IgM tests have a fundamental limitation; they rely on the detection of antibodies made by the patient in response to SARS-COV-2, they do not detect the virus,” RCPA president Dr Michael Dray said. “Patients may only make antibodies to COVID-19 infection a week to 12 days after they first become sick, therefore, if doctors rely on these rapid tests early in the disease, their diagnosis will be wrong.”
- There are increasing concerns for the welfare of healthcare workers on the frontline of the COVID-19 pandemic.
As Australian Doctor reports, GPs make up one-third of COVID-19 cases in healthcare personnel in Italy – who account for 10% of cases in total – and the US and UK have both recorded their first fatalities among doctors. In Victoria, 10% of all coronavirus cases are in healthcare workers, the RACGP says.
The organisation is concerned and fearful that Australia could soon see fatalities in doctors, particularly with the push to return tens of thousands of non-practising healthcare staff to the frontline.
“I don’t want to be in a position where I’m writing condolence letters to 30, 40, 60 of my colleagues’ families throughout this year,” said RACGP Victoria Chair Dr Cameron Loy.
- With all the telehealth announcements, the absence of detail on non-bulk-billing telehealth services has many clinicians and clinics worried about their financial futures.
In the original announcement, Federal Health Minister Greg Hunt flagged that “further changes will be introduced during the week that will allow GPs and other providers to apply their usual billing practices to telehealth consultations.”
A TMR survey has found that general practices are losing significant revenue in this pandemic, and many are wondering if they will even be able to stay in business (check out our podcast interview with Dr Nathan Pinskier – GP and eHealth expert). The Australian General Practice Alliance has also raised concerns about the viability of general practice, and called on the government to remove requirements for bulk billing of telehealth consults.
Given it’s the end of this week, we’re waiting with bated breath for those details from the health minister, and will bring them to you as soon as we find out.
- Yesterday was a relatively quiet day, but there were still a few big COVID-19 stories that landed. The Grattan Institute researchers gave us reason to hope by suggesting that if our infection rate continues to slow – as it appears to have been doing over the past few days – there’s a chance our hospital system will be able to cope with the pandemic.
The PM declared that Australia was leading the world with testing rates, as the first country to exceed 1000 tests per 100,000 population. Parents working through COVID-19 can now access free childcare, as the federal government threw a financial lifeline to the childcare sector.
And in a sign that we’re all struggling psychologically, the Black Dog Institute reported more than double the usual number of visitors to its website last week; with 40% of these visitors looking at materials relating specifically to COVID-19.
- Here are the latest infection figures to 6am this morning:
National – 5,224 (up 248 since 6am yesterday) and 23 deaths.
ACT – 88
NSW – 2389
NT – 20
QLD – 835
SA – 385
TAS – 71
VIC – 1036
WA – 400
And for NSW folks, NSW Health has a heat map showing cases by local government area. If you want to really drill down into the data, you can look at COVID-19 cases by notification date and postcode, local health district, and local government area.