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Dr Merran Dyer Practice Policy regarding COVID-19

Over the weekend (14-15 March 2020) I have examined as much of the available data about COVID-19 as I could, in order to determine how to operate my medical practice as well as how to advise my patients about reducing the spread and severity of COVID-19 within the community. I have also written to the Premier and State Health Minister urging the immediate implementation of broad measures to reduce the spread via human interactions. My opinion is that a two-week, national lockdown is required immediately, but in the absence of this decision to date, I am restricting my own personal contacts and encouraging others to do so.

I have attached links to some of the key articles and comments from medical specialists and other researchers which have informed my decisions and recommendations. I encourage you to take time to consider these, as I do believe that clear information is necessary for wise decision-making. I have also attached a copy of the letter I sent to the Premier Peter Gutwein and State Health Minister Sarah Courtney yesterday.

The major public health measure to restrict the spread of a virus is social distancing. Limiting the number of personal contacts that one has, is the most effective way to “flatten the curve”, that is, delay the spread of cases over time. It has been clearly shown in both mathematical modeling and following viral spread in past epidemics and in countries overseas in the present pandemic that early measures such as lockdowns do have a significant impact on reducing both the spread and fatality rates from the virus. The impact of action or inaction is not seen for two weeks. Even a delay of one day in implementing such measures can lead to a pronounced increase in the total number of deaths. This is both due to the number of people affected as well as the overwhelm of health services trying to assist more people than can be supported at any time. This is evident in Italy now, where excruciating decisions are having to be made as to whom will be given life-support measures and to whom these are denied. As a local intensive care physician has written, this is not just something that could affect people overseas. We are not exempt and it could happen here.

In Australia, testing for COVID-19 is limited to those who have had international travel and to those who are contacts of people diagnosed with the illness. This limitation means that there are potentially cases in the community of people who have contracted the virus, especially if they have mild symptoms, and could be spreading it, but there are no effective testing protocols to make the diagnosis. If we do not test, we will not find. Looking at data from other countries, for example Hubei and Washington, by the time there were a handful of confirmed diagnoses the level of infection in the community was at least 100- or even 1000-fold higher. The low levels of diagnosed cases in Australia is leading to the conclusion from the Chief Medical Officer, Dr Brendan Murphy, to state “we are ahead of the threat” (15 March 2020). However, this is not consistent with overseas data which shows exponential increases in cases in the 1 to 2 weeks following similar numbers of cases that we have in

Australia today.

Practice Policy from 17 March 2020

  1. While there is no official directive to do so, I am choosing to offer online consultations from tomorrow (Tuesday 17 March 2020) rather than face to face appointments. This is for the ongoing care of my patients, not just for those who are concerned about symptoms which could be due to COVID-19.

  2. I have set up a Zoom account and this is accessed via email.

  3. There is a series of new item numbers from Medicare allowing a rebate to be received for certain patients. Where this can be claimed I will use these numbers, however, for other patients a private fee will be charged. This will be adjusted to be similar to the gap payment that a patient would normally pay on attending a face-to-face consultation. This is yet to be determined.

  4. For patients having a Zoom appointment, please prepare your thoughts beforehand. An email listing your reason for consultation, present concerns, present medications and supplements, and if possible, blood pressure and pulse readings, temperature, height and weight, could assist. If you hope to discuss pathology or radiology results that were requested by another doctor, please let us know as soon as possible so these can be available at the time of the appointment.

Recommendations to my patients

In my opinion, we are in the early days of the pandemic here in Australia and will be faced with lockdown at some stage soon. I would encourage you to get as much reliable information as possible to inform your own decisions. As a result of my research, I am personally doing, and recommending the following:

  1. Limit all unnecessary travel and social interactions.

  2. Apply healthy lifestyle choices – prioritise sleep, healthy diet and exercise.

  3. Stay well hydrated and drink small amounts of water frequently. Warm drinks are particularly useful.

  4. Wash hands for at least 20 seconds with soap and warm water on returning home, prior to food preparation and eating.

  5. Wipe down surfaces, particularly hard surfaces, door handles, benches, with a disinfectant. The virus can remain active on hard surfaces for a considerable time.

  6. Look out for older people or people with chronic diseases. Check on them, ensure they do not need to go out. Maybe offer to do the shopping for them.

  7. Make the most of this time to be creative, develop new skills, read a good book, connect with others by phone or online.

Final word

It is possible that those seeking to limit their social interactions and pull out of engagements will be criticised and misunderstood by others around them. I would like to encourage and affirm any decisions you make to do so. May I also encourage you to support and affirm others you know who are making difficult decisions, especially those who are financially affected by doing so. A small word of encouragement can be very powerful as we together seek to reduce the spread of COVID-19 within our communities. It could well save lives!


Why you must act now

Dr Norman Swan

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