GPs’ PPE must match aerosol reality

5 minute read

Australia’s guidelines for protecting frontline workers against covid-19 is expected to undergo a long-overdue change in the coming weeks.

Australia’s guidelines for protecting frontline workers against covid-19 is expected to undergo a long-overdue change in the coming weeks.

While the move could bring down the hotel quarantine house of cards, GPs could finally benefit – if they get PPE that fits the new reality.

On 30 April, the World Health Organisation formally recognised that covid is spread via aerosols, which can travel farther and remain in the air longer than larger respiratory droplets.

Medical experts welcomed the update, with high-profile members of the RACGP and AMA having long called for the recognition of airborne spread.

“We do have an airborne pandemic response protocol, which has never been activated,” Dr Andrew Miller, president of the AMA WA, told our sister magazine The Medical Republic.

“[The government] could activate that and the two main things that would be changed is an appreciation of indoor ventilation and the provision of airborne-level PPE.”

Dr Miller said any update to PPE requirements should extend to GPs.

“For primary care, the rules have to be exactly the same,” he told TMR.

“And what we’ve done is we’ve treated GPs and their staff as if they’re disposable items, which clearly they’re not.

“And we’ve pretended they’re not on the front line, we didn’t even put them in 1a for vaccination.

“We have to do an assessment of the facilities they work in to see whether they’re suitable for patients with covid to attend.”

The reason it has taken so long for aerosol transmission to be recognised, according to Dr Miller, could be grounded in human nature, rather than science.

“People don’t like being contradicted when they have many years of authority and expertise in their own specialty,” he said.

“Also, when they’re the appointed and chosen government advisors, it’s very embarrassing for them to turn around to the government and say, ‘Listen, we were wrong, and actually we’ve caused a lot of damage’.

“Victoria has had 4000 healthcare worker infections and 800 deaths in aged care facilities, many of which could have been prevented if we had focussed on how this virus actually spreads.”

Essentially, addressing airborne spread in a meaningful way would not only require admitting fault, but also committing to redesigning airflow in virtually all buildings.

While countries like the UK have remained tight-lipped, others are starting to up the ante on PPE.

New Zealand’s Ministry of Health has put processes in place to ensure primary and urgent care clinics have access to fit-tested n95 respirators.

Across the pond, America’s Centers for Disease Control and Prevention updated its advice to reflect aerosol transmission as one of the “principal ways” covid was spread.

Australia’s Infection Control Expert Group, however, has remained silent on the topic and has not updated its guidance on face masks and respirators since March.

While it does acknowledge that fit-tested respirators in all clinical care involving close patient contact is “increasingly being considered or implemented”, the ICEG guidance still says there is “no robust clinical or epidemiological evidence” to support the use of airborne precautions.

This stance is expected to change within the coming weeks, as ICEG considers new recommendations on face and eye protection from the National Covid-19 Clinical Evidence Taskforce.

Although the specifics of these proposed guidelines will only be published when ICEG makes a formal response, they are expected to recommend n95 masks, goggles, gowns and gloves for anyone encountering suspect covid cases.

National Chief Medical Officer Professor Paul Kelly seemed to confirm as much at a press conference over the weekend.

“There is airborne transmission of covid-19 – I’ve known that for a long time, I’ve said it many times here,” Professor Kelly said.

“What that leads to in terms of protection of people that are exposed to covid-19 has been a matter of debate, but there’s not really much debate any more.

“You need to be protected in whatever you’re doing, whether that’s in a clinical setting or in a quarantine setting.”

He ended the conference by reiterating that the Clinical Evidence Taskforce’s proposed guidelines were under active review. ICEG has so far declined to provide a firm date for its response.

Dr Miller said he knew of multiple GPs who had purchased respirators with their own money, but were unable to use them due to trouble accessing fit-testing.

“I think there’s a lot of pressure on, because clearly the National Covid Evidence Task Force team have come down on the side of needing airborne protection,” Dr Miller said.

“Even if ICEG hold out against it, that will still come out as being a National Covid Evidence Task Force guideline.

“And then the days of allowing people anywhere near a covid-positive person in a surgical mask will hopefully be over.”

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