OPINION: What's coming down the tracks? Preparing for the next wave of Covid-19 management

Dr. Lucia Gannon writes...

 Dr. Lucia Gannon

Reporter:

Dr. Lucia Gannon

Tipperary

File photo

Community Assessment Hubs
What are they and why are they necessary?
Easter weekend brought glorious sunshine. For those of us who were not working, and who are lucky enough to have a garden, it was a chance to slow down and spend some time in nature. But behind the scenes, healthcare workers, policymakers, politicians and HSE administrative staff have been busy putting plans in place for the next wave of COVID management.
Coronavirus Community Assessment Hubs (CAHs) have already opened in some parts of the country, and the HSE plans to establish up to a total of forty centers in the coming weeks.
General practitioners will work with HSE nursing and administrative staff, to provide timely, efficient and safe care for patients. The hubs are to be situated in repurposed buildings, within, or close to, existing HSE facilities. Their purpose is to provide an area where patients with confirmed or presumed COVID infection, can be assessed by a doctor. These are patients who feel that their condition is deteriorating, or who have COVID and have developed a second, coincidental illness and need a clinical examination. Under normal circumstances, these patients would ring their GP and ask for an appointment. But as it is no longer safe for health care workers to see such patients without full personal protective equipment (PPE), all of these examinations will be carried out in the local assessment hub. Based on the result of the review, a patient will be advised to return home and continue self-isolation or will be referred to the hospital, for more intensive treatment.

There are good reasons for the establishment of CAHs. Patients can be examined by personnel who are trained in the correct use of personal protective equipment (PPE). Most GPs have never had to wear PPE to protect themselves from infection and need training and practice if they are to do it correctly.
If all COVID positive patients are treated in a separate centre, the risk of transmitting infection in GP surgeries is reduced. General practice is still open and needs to remain so. Vaccinations, antenatal checks and the management of acute and chronic diseases are some of the services that GPs need to continue to provide. It is important to tell your GP if you or anyone in your household has any respiratory symptoms before you arrange a face to face appointment.

The doctors and nurses that work in the hubs will become more expert at assessing COVID patients. These doctors and nurses will be able to decide quickly, who can be discharged to the care of the GP and who needs admission to a hospital. By reducing the number of patients who present to hospital for assessment and treatment, hospital staff can concentrate on the most serious cases, which is what they do best.

It is important to remember that if you are ill from any cause, you should ring your GP or out of hours provider just as you always did. The doctor will decide how best to help you. They may offer you a telephone or video appointment, give you a surgery appointment, refer you to a CAH, a hospital, or call the emergency services. When you do call your doctor, you should let them know if you have been tested for COVID and the result of the test, if you know it. Ring your GP early if you are feeling unwell from any cause so that you can receive the best possible treatment.

Community hubs are not COVID testing centers. Testing is organized through a separate system and can only be requested by a GP or a hospital doctor. All consultations at a CAH are by appointment only. They cannot operate as walk-in centers. When a patient rings a GP, the doctor will send an electronic referral to a central location. On arrival at the center, the patient’s details will be taken by telephone while they wait in the car. Once the doctor has the relevant information, the patient will be escorted into the hub for an examination. The assessment will be brief and may only involve checking the pulse, blood pressure, oxygen saturation, respiratory rate and a brief chest examination. After the examination the patient leaves the building, and further directions given by telephone.

As I write, it is intended that the hubs will be open for twelve hours a day, seven days a week. Two doctors will work at any one time, for shifts of between four and eight hours. These doctors will return to their practices when they not working in the hubs where they will continue to provide the usual GP services. This plan may change with time.
Regardless of any changes, however, the first point of contact for all patients is the GP.
Some GPs will contract the virus and become ill. GPs in South Tipperary hold a Zoom meeting every week and keep in contact by social media, to share information and support each other. If your GP is ill, please continue to ring the usual number to receive an alternative source of medical care.

Meanwhile, it is encouraging to know that physical distancing is having a beneficial effect. Ireland has not experienced a huge surge of positive patients, as has happened in Spain, Italy, the US and UK. The most obvious explanation for this is that we practiced social distancing at an earlier stage of the pandemic than other countries.
Another positive sign is that admissions to intensive care units stabilized last week and hopefully they will start to fall over the next ten days. Some of the patients who were on ventilators have made a full recovery. Medical professionals have saved lives because so many people have followed the advice to stay at home and not spread the virus.

When testing began, every positive person had twenty close contacts that also needed to be tested. The additional tests created a huge workload for public health specialists and laboratories. Since the introduction of social distancing the number of close contacts has decreased to five for every positive person. Reducing the number of contacts makes tests available for high risk and vulnerable people allowing them to get the medical care that they require.

Social distancing has prevented a tidal wave of illness which buys everybody time until we have a vaccine, a treatment or until a significant number of people develop immunity.
As the restrictions are relaxed, and it is impossible to say at this stage when that may be, we will see smaller waves of illness but this should be mild disease in an otherwise healthy group of people who do not require medical care.

In the meantime, we should not become complacent about this illness. It is still present. It still has the potential to cause serious illness and death. It is important that we continue to be vigilant. We need to wash our hands, cough into a tissue or our elbow, keep our hands away from our face and keep our distance from others. Our reward is knowing that by being vigilant about these simple measures, we are saving lives.