Calling all GPs - Here's how to prep your practice for Covid-19

Simple steps you can take to protect your practice and your patients from the coronavirus (Covid-19), from an expert at the National Institute for Communicable Diseases (NICD).

Cases of the new coronavirus, dubbed SARS-CoV-2, have surpassed 100 in South Africa, Health Minister Zweli Mkhize announced on Tuesday. There are now also 14 locally-transmitted cases.

For many people suspecting they've been infected with the new coronavirus, general practitioners (GPs) will be the first people they turn to. If you're one of these doctors, here's what you need to know.

We interviewed Cheryl Cohen, the head of the NICD's Centre for Respiratory Diseases and Meningitis.

1. Is it safe to have patients who believe they might have the new coronavirus come to their GP's practice?

As a GP you should be thinking about what you will do when a patient who thinks they might be sick with Covid-19 comes to your practice.

You could, for example, get your receptionist to ask people whether they have the symptoms of the infection such as a cough, fever and shortness of breath, or whether they have travelled recently. If patients say yes, those people could be directed to a separate room to be tested.

A person is not placing the whole facility at risk if they walk into a facility and don't touch anyone, cover their mouth when they cough and immediately identify themselves to reception without coming close to them.

The risk really comes in when people who might have Covid-19 are sitting there in a queue for hours.

So it's okay for patients to go to the facility while understanding the principles about how the virus is spread: It's really important not to have close contact with people and to stay at least one metre away from everyone.

2. Does my receptionist need to wear protective equipment, like a mask?

No. The new coronavirus is transmitted through droplets released when we talk, cough or sneeze. Those droplets can only travel through the air for about one metre. The other way it spreads is through contact with the droplets on a surface, and then bringing those droplets up to your face with your hands. As long as you wash your hands, you break that chain.

So, if your receptionist is staying a metre away from patients, doesn't greet them by shaking hands and is regularly washing hands and cleaning her desk, there is no need for protective gear.

3. The NICD runs a special hotline just for doctors. Previously, doctors were told to phone this number before testing patients for Covid-19. Is this still true?

No. The NICD no longer requires you to phone the hotline. Patients can be tested as long as they have flu-like symptoms such as a cough, sore throat, shortness of breath or fever and meet one of the following criteria:

 - Been in close contact with someone who has Covid-19. That means someone who has been within one metre of the patient for a period of 15 minutes.

 - Have travelled to a country where you have a high risk of getting infected. The NICD currently lists the following countries as high risk: China, Hong Kong, Japan, South Korea, Singapore, Vietnam, Taiwan, Italy and Iran, but this list is updated regularly. For the most recent information, go here.

 - Have worked in or been to a healthcare facility treating people with Covid-19.

 - Have a severe case of pneumonia with an unknown cause.

Doctors still need to submit the correct documentation available on the NICD's website to the private or public laboratory they use. These labs can arrange to collect samples.

4. One of my patients has tested positive for Covid-19. Should I self-isolate?

No – if you have taken all the proper precautions, including wearing special protective masks. Once we identify a positive case of the new coronavirus, the first thing we do is find all the people who have been in close contact with that person. You have to get pretty close to patients to take the throat swab, but if a doctor has taken all the required precautions they would not need to self-isolate.

In cases where the doctor was not aware their patient was infected with Covid-19, and was, for example, not wearing a protective mask, they would have to self-isolate for 14 days.

We don't want the entire healthcare workforce to be off for 14 days. This is why it's so important that doctors prepare and have the correct systems in place at their practices and to make sure they have the correct protective gear available.

The protective gear

 - Doctors should wear surgical masks, gloves and aprons while doing a brief examination.

 - An N95 or respirator mask is only needed if you are performing aerosol-generating procedures, such as asking patients to cough up sputum.

If you know that you don't have masks and protective equipment, you need to make sure you can refer patients properly to somewhere they can get testing.

Editor's note: Doctors can also refer patients to private labs for testing, according to the deputy director general for communicable and non-communicable diseases at the health department, Yogan Pillay.

Who should get tested and where, are likely to change as the new coronavirus continues to spread in South Africa. Check the NICD's website to stay in the loop.

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