Perth GP and Communicable Disease Doctor's Perspective on COVID-19 (Coronavirus)

This is a brief segue from the writing and reading I occasionally blog about.

The below is from my uncle, Dr Terry Pitsikas, a well respected GP, and also the founder of The Lindisfarne Medical Group in Perth. He now predominantly works at Royal Perth Hospital in the Department of Communicable Diseases.

Feel free to share. 

NOTE TO ME 

Can you please do whatever you want with this- facebook, pass it on. We GPs have not a voice but are at the front line; we are seeing the worried well and those with symptoms and as this disease grows we will be doing the caring- there are limited resources in the hospital system.

Please excuse the bio. I have tried to send this on but have not had response.

I have been trying to alert various people to the probable devastation that is going to come if we do not act soon or should I say “act early and act fast”.

BIO AND INFO OF TERRY PISTIKAS

My background is in General Practice, in Mt Lawley for 40 years and established what is now the Lindisfarne Medical Group. I work at RPH in the Department of Communicable Diseases and have spent considerable time in Aboriginal Health in Port Hedland and in Public Health advising the Aboriginal Health Council. From the onset of the HIV epidemic I was involved in diagnosis and management of this disease and for several years was the only GP with prescribing rights to anti-retroviral medication. 

A drug trial run by the CDC in Atlanta, Georgia, that I and RPH participated in one of the seminal trials that led to the acceptance of Triple Therapy as the standard treatment of HIV infection. My concern and suggestions are outlined below.

I have little confidence in the way the  Morrison Government has handled the Covid-19 crisis and find that the approach has been reactive and contradictory, and not consistent, changing advice from day to day. There does not appear to be an understanding of the way this disease has evolved and behaved elsewhere and of the consequences of inaction. Indeed this is a government of inaction and “none of that”.

Thank you for reading this note. I wrote it in the hope that a Lockdown will happen and that action is needed now.

PAST SUCCESS WITH FLU, ISOLATION AND QUARANTINE IN 1918/19

One of the benefits of Perth’s isolation and strict quarantine measures for and at the time was that the 1918/1919 flu epidemic was delayed by 6 months after it began on the east coast in January 1919 and the death rate was much lower than in Sydney or Melbourne. By then the onset of warmer weather, a CSL developed vaccine against secondary bacterial infection (95,000 people in Perth were vaccinated) or the natural decline of the virulence of the virus contributed to the decrease in the death rate.

LETTER

On a Lockdown for Western Australia

Introduction.

Perth people pride themselves on living in the most isolated city in the world. Its remoteness can be seen as an advantage. It is much easier to control the borders of Western Australia and access from other parts of Australia can be easily patrolled. The majority of human traffic is by plane and comparatively few people will enter by sea or road or rail. It will not be difficult to control who enters and leaves Perth and other airports in Western Australia.

The Timing of the Lockdown.

Italy has today announced that over 1,000 people have died as a result of infection with Covid-19. The region affected initially was the wealthy north; if it can happen in that part of Italy, why can’t it happen here? The country has gone into complete shutdown in response to the increasing positive diagnoses and increasing death rates. The north of Italy was to be affected but the rapid exodus resulted in the country being isolated. The question is when is a decision such as this made. How many deaths or diagnoses per head of population does it take to declare such an emergency? Should we in Western Australia wait for that to eventuate or do we go into lockdown now? It is clear we are unable to predict the spread of the virus over the next weeks and months and even the experts are quoted in the context of the likely spread of the virus in Perth as saying “it could go either way” (Professor Archie Clements, Curtin University). What we have seen in other countries is increasing numbers of people being infected with local spread being the predominant way of increasing these numbers. We talk about evidence base in modern medicine, but this is a pandemic the like of which we have never seen before in modern times; we don’t have evidence for anything we choose to do. It may be a matter of putting lives ahead of the economy which is already under stress. The economic effects of the virus are already evident- an example is the fall in tourism.

What is a Lockdown.

This means restricting people entering and leaving the parts of Western Australia that are chosen to be in Lockdown. If locals or residents need to travel then severe quarantine measures will be in place if they return. If self-quarantine is broken house arrest could be activated. There should not be a need to restrict exports or imports by whatever transport means, though transport workers will have restricted movements (and person to person interaction) once they reach their destination and will need to leave the lockdown area immediately after delivery or pickup. All meeting will have to be by remote access and this will even apply to the Federal Parliament.

Issues to do with Perth.

There is a world shortage of kits for testing for Covid-19, and there are restrictions on who can be tested. Whenever there is a shortage of pharmaceuticals it is always Perth and WA who are the last to receive supplies. It seems no different with the testing kits. It has also taken 5 full days for a patient to receive his result and that was only after he made several phone calls involving long periods of being on hold, whereas in Adelaide the result is returned in 36 hours. In Mr Dutton’s case his result was back a few hours later. There are 20% fewer GPs in Western Australia compared with other mainland states and this is also reflected in the medical workforce in general, hence the delay in the results with pressure on laboratory and other staff. If this virus gets out of control, which it has tended to do elsewhere, the medical and nursing workforce will be under unprecedented pressure. A few months reprieve which is the aim of the lockdown will allow time to source medical equipment and basic products needed for treating affected patients and protecting the rest of the population.

Summary.

A lockdown will be easier to implement in Perth and the rest of the state than in any other city in the world. It will buy time, time needed to see what treatments will work, time for a possible vaccine to be developed, time to see how other cities and countries resolved their issues whether by draconian action or by successful quarantining or by strict contact tracing and constant vigilance.

We can do this.

Terry L Pitsikas