PPE, hotline needed for GPs

Transcript: AMA Queensland Council of General Practice Chair Dr Maria Boulton, ABC Radio Brisbane, Breakfast with Mike van Acker, Monday 3 January 2022

Subjects: COVID preparedness, PPE for GPs, GP hotline, children’s vaccine rollout

MIKE VAN ACKER:    I didn't know anyone locally with COVID a week ago. Now I know of around 10 cases. I've got friends in isolation, quite a few of them, people that I know. And with the increasing case numbers escalating at a rapid pace, doctors say they want to be properly equipped. Dr Maria Boulton is the chair of the Australian Medical Association of Queensland’s Council of General Practice. And she joins me on the phone right now. Good morning, Dr Maria Boulton.

MARIA BOULTON:     Good morning, Mike.

MIKE VAN ACKER:    Do GPs have enough resources to support COVID-positive patients?

MARIA BOULTON:      No, no. And it's really sad, because for us to come out of this, to look after patients properly, all areas of health care need to be resourced. So not only just the hospitals, but also GP clinics. And GPs in Queensland are amazing. They work all over, including rural and remote regions. And often in those areas, you'll find one GP working in a small clinic, looking after the entire community, and that GP needs to be resourced so that they can continue to work and they can continue to provide those services to that community.

MIKE VAN ACKER:     And what kind of resources are we talking about?

MARIA BOULTON:      Yeah, I guess, in terms of keeping GPs and GPs’ staff working, we know that Omicron is extremely contagious, and we know that if people get sick, they get isolated, which means they can't work. GPs needs to be protected. And what they need is a fit tested N95 mask, goggles, gowns, gloves, hand sanitiser, face shields, and we've been pushing for GPs to be offered fit testing.

What fit testing does is that it'll test that particular GP on different models of mask and find the mask that fits that GP, because we know that Omicron is airborne, so that that airborne particle doesn't enter that mask and make that GP sick. And this is really important, because GPs are also looking after vulnerable people. And the last thing we want is a GP not knowing they have COVID infecting their vulnerable patients.

And to their credit, Queensland Health did open up some fit testing for GPs in Brisbane over the weekend, at very short notice. And many, many GPs landed on the service and the service was quickly overwhelmed. But it shows how much GPs want to do the right thing and how much they need it. So that would be a really good start.

MIKE VAN ACKER:     You know what, Dr Boulton, you've just educated me, I had no idea that one size doesn't fit all. I had no idea about such a thing as fit testing. And we're all walking around with those white and blue masks that we’ve bought at Woolies, and they might not be entirely appropriate. I know we're not talking about the general public here, we're talking about GPs. But at the same time, the principle remains the same, doesn't it?

MARIA BOULTON:      Yeah, correct. And look, for the general public, surgical masks, if that's all you can get, that's fine. But for a health professional who's in a room with someone who may or may not have COVID, they need that adequate protection. And this is where that that N95 mask comes in. And the N95 mask needs to fit adequately.

MIKE VAN ACKER:      Yeah. So they opened up a fit service for them. And how long did that last before they ran out and it was overwhelmed?

MARIA BOULTON:       Yeah, it lasted a few hours before they had to start turning people away. And they are booked out for the next two days. And I know that Queensland Health is working hard to make sure that they can service those GPs that turned up and are calling to get the service. There are some Primary Health Networks, for example, the Gold Coast and Darling Downs, who have had similar services for GPs. But as far as I know, the rest of the state hasn't been as lucky. I don't care what it takes, I don’t care who does it. But I think it's important that those GPs get access to this service.

For example, if you're in New South Wales, and you work in a New South Wales coal mine, every three years those coal miners get fit tested. So it is something that can be done and it can be done on a larger scale. So there's no excuses, and it is something we've been calling for since - well from for me, I've been calling for it since March 2020.

But that's how to keep the workforce working. There's a lot more that needs to be done in terms of planning to look after COVID positive patients in the community, which should have been done already. And we're calling for the State Government to just step in and make sure that those plans are in place because at the moment, there are some patients that are falling in between the cracks.

MIKE VAN ACKER:      So what sort of planning are you calling for?

MARIA BOULTON:        Yesterday I had a conversation with a doctor from the Gold Coast. She was looking after a few patients who had been diagnosed with COVID. She had a couple of patients who were considered high risk, who hadn't been contacted by Queensland Health after they were notified that they had a positive result. One of them was very unwell, was having trouble breathing. They were confused as to who to call. She was actually on her day off, she called all her patients with COVID. And she found out that this patient was really struggling and had to send this patient to emergency.

We've been told that every patient who’s been diagnosed with COVID should receive a call from Queensland Health, and that call is to make sure that that patient is low risk. If that patient is medium risk or high risk, for example, if they have a chronic illness or if they're immunosuppressed, or if they're pregnant, then they should be placed in a higher risk model of care. And this isn't happening consistently, and patients just don't know who to call. Patients don't know what signs to look out for. So for example, if you are diagnosed with COVID, and you start having trouble breathing, chest pain, you've become faint, or you've had any concerns, that care needs to be escalated. And it needs to be made very clear to patients as to who to call.

With doctors, for example, us GPs, GP specialists, we manage respiratory illness all the time. But we are calling for a dedicated GP hotline that we can call in case we have a patient like my friend had yesterday, who needs that care to be escalated. Or in case we need to ask someone a question or in case we need to get our hands on medication. And that hasn't happened yet. And we need to be given a phone line that we can access quickly because things happen quickly. Patients deteriorate quickly. And it's important that we have that 24/7 hotline that we can call.

MIKE VAN ACKER:       I have no medical training, as a man on the street, just an average citizen, it just seems like such a failure to plan across each level of government really. And that's been brought home, particularly for me anecdotally, when I see how many people have been driving around trying to find rapid antigen tests at a chemist. I'm seeing Facebook friends go, ‘we had to get to 10 different chemists to get one’. Apparently there's an electrical retailer that selling them, which makes no sense to me. There just seems to be major flaws in the planning. But this is not a surprise that Omicron was coming, we're going to open the borders. Well, I beg your pardon, Omicron arriving is a surprise. But the fact that we would need additional testing once we opened the borders, that's not new, is it?

MARIA BOULTON:        No, that was predictable. And you're right, Omicron’s been a special beast, but we knew the date of the borders opening. We knew that we had that deadline and we knew we should have gotten ready. And it's really interesting, I was listening to the press conference when this announcement of rapid antigen testing for close contacts was announced. And the trouble with that announcement was that they should have ensured that they had adequate stockpiles before they made such an announcement because, at the moment, people can't find rapid antigen tests. And the advice there for example, if you're a close contact, and you need to have that day six rapid antigen test, and you can't find one, then you need to go and line up for a PCR test. But once again, the system is overwhelmed. And once again, that's predictable. We knew that there were going to be more tests needed. And that should have been better prepared for.

MIKE VAN ACKER:         Now, moving back a step, I guess sideways, to the vaccine rollout. It's been extended for children aged five to 11 from January 10. Given that they've also bought forward the booster program for adults as well, do we have enough supply?

MARIA BOULTON:         We don't. At the moment in my fridge, I have no supply of vaccines for 5-11 year olds. I'm still waiting for them to arrive. It is a different vaccine - the vaccine for 5-11s is a lower dose, and it needs to be diluted differently, so it comes in different vials. We can't use the adult ones, we have to use the special paediatric vials. And those vials have yet to arrive in my clinic. We've been told that they'll arrive possibly the 7th of January, possibly the 10th of January. But once again, it's something that we're holding our breath for. We hope they arrive when they tell us they’ll arrive because in the past, there have been delays. And I know that there's a lot of GP clinics that are waiting for those vaccine vials to land in our fridges before we can open bookings. There's many of us that are planning to have some very big vaccination clinics before school starts so that we can get as many children vaccinated as possible, because it's in all our best interests to vaccinate as many as possible. And then there are many, many, many parents who want their kids done before they start school. But that will all depend on the numbers of vials we get into our fridges.

MIKE VAN ACKER:         Okay, Dr Maria Boulton, Chair of the AMA Queensland Council of General Practice. It's a little bit terrifying, a little bit concerning is probably a better word. But thank you very much for your time this morning for explaining all of that. Like I said, I don't know if I'm reassured or even more frightened than I was. But thank you very much.

MARIA BOULTON:         Thank you, Mike.