This practice recognises the significant implications of the  Coronavirus Pandemic for our community now that we are starting to see cases diagnosed locally in Tasmania (3 so far). As yet, we haven’t seen any community transmission in Hobart, but the experts are expecting that to occur at some stage soon. The medical community is preparing for further cases with the aim of making sure there are adequate resources to manage the small proportion of people who develop serious disease if they become infected. The Tasmanian Government website provides regular updates http://www.health.tas.gov.au/. The Australian Government also has information https://www.health.gov.au/health-topics/novel-coronavirus-2019-ncov

Important measures at this stage are awareness of hygiene measures, such as hand washing and readiness to adopt “social distancing” i.e. avoiding handshakes at the stage when spread within the community starts to occur.

The contribution that this practice can make is to raise awareness about measures to reduce transmission and awareness of action individuals can take where infection is suspected, including self-quarantine.  This practice is not set up to provide diagnosis or advice about management of individuals with suspected coronavirus. The Tasmanian Government is in the process of setting up “Respiratory Assessment Clinics” around the state.  The clinic for the Hobart area is set up at the Repatriation Hospital site in lower Davey Street.  In addition, general practices who choose to be involved, are being supported to provide assessment and testing of suspected coronavirus cases.  At present there are strict guidelines about eligibility for testing for Coronavirus i.e. only people who have returned from overseas or have had contact with a known case and have respiratory symptoms are being tested due to limitations on the number of tests that can be conducted in Tasmania at present.

We are coming into the Winter “Flu” season as well which means that there will be the usual increase in respiratory infections in the community. The usual advice about having the usual flu immunisations in April and May still applies.

To reduce the risk of transmission of viral diseases (including Coronavirus) at this practice, we have adopted additional procedures. Patients of the practice who have respiratory symptoms (coughing, sneezing or shortness of breath) or fever are asked not to attend the practice but to ring and discuss appropriate alternative arrangements. In some circumstances we can offer telephone consultations.

As an occupational medicine practice, we can provide advice about workplace risks. It is important for employers and workers to understand that, at present the risk in the community and workplaces is very low, but that might change quickly. Given the restriction of testing for coronavirus, it is currently not possible to arrange testing unless the criteria above are met. While a doctor can provide some general advice about the likelihood that a worker has Coronavirus or is not likely to have the infection, the only absolute way to determine infection is by specific testing of throat / nasal swabs. Many patients with Coronavirus infection have only mild symptoms and the symptoms and a clinical examination cannot determine the presence or otherwise of coronavirus.

The US Centers for Disease Control and Prevention (CDC) provides useful advice to businesses. While this is aimed at US businesses, many of the principles apply equally in Australia. https://www.cdc.gov/coronavirus/2019-ncov/community/guidance-business-response.html

There is limited value is asking a doctor for certification that a particular worker is clear of coronavirus. If employers adopt a practice of routinely requiring medical certification of individuals in relation to fitness to work with respiratory disorders, there are concerns about the effect on limited medical resources, best deployed to diagnose and treat the condition. Employers are probably better to obtain general advice and develop policies for their particular workplace that include education about risk for their employees themselves.

We will provide further updates as appropriate.

Peter Sharman

12 March 2020