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At least eleven Victorians have died from coronavirus outside a hospital in the past two months.
This includes a woman in Melbourne’s northern suburbs, who was receiving at-home care under the state government’s “COVID Positive Pathways” program, before dying at home in August.
But while the state government says most of these coronavirus cases were not known to health authorities before they died, GPs are becoming increasingly concerned more people could die at home because a program monitoring thousands of patients with COVID-19 is being overwhelmed.
GP John Hodgson runs a respiratory and vaccine clinic in CoolarooCredit:Joe Armao
As the number of new coronavirus cases hits four-figure digits each day, the strain on the program is only expected to worsen and doctors, who say they are not being notified when their patients test positive, fear the system is already being stretched beyond capacity.
Of the 11 deaths outside of hospital since August 4, at least four were diagnosed with COVID-19 post-mortem, while others died shortly after they had received their positive result or had not engaged with the health services.
Despite requests from The Age, the Victorian health department did not provide a breakdown on the circumstances of these deaths, citing privacy reasons, so the exact reasons why each death occurred remains unclear.
The department would also not specify how many deaths occurred at home or how many people were signed up to the program when they died.
Under the home care program, only the most serious coronavirus cases end up in hospital. Low severity patients are triaged by community and public healthcare networks and are meant to receive daily calls from their GP to monitor their condition.
Those with mildly severe coronavirus cases receive visits from a nurse as well as telephone check-ups and are monitored by a virtual hospital emergency ward. When a person’s condition worsens, they are transferred to hospital for more intensive care.
But Hume GP John Hodgson, who runs the Coolaroo Clinic in the epicentre of the COVID-19 outbreak in Melbourne’s northern suburbs, said he was only discovering patients had tested positive to the virus days later when they called his medical practice.
“We actually have no faith in it,” he said.“The reason why people fall through the cracks is because there’s no properly organised, safe sort of setup.”
In some cases, the clinic was not alerted about coronavirus patients until a week after they returned a positive result.
“My concern is that there is a very high risk that there could be patients at home and unwell with the virus, and we just don’t know about them yet,” said Dr Hodgson. He who wants pathology labs to send positive coronavirus test results of patients directly to their nominated GP in real time.
The death of anyone with coronavirus at home has alarmed northern suburbs GP Umber Rind, who is worried people could deteriorate abruptly without realising how sick they are.
Of the more than 200 coronavirus patients at the New Leaf Medical Clinic in Melbourne’s northern suburbs, Dr Rind estimates she has only been officially notified about 5 percent of them.
The other 95 percent were discovered when the patient or a member of their family called the clinic to let them know they were infected or if they were deteriorating from the disease at home.
“If the family didn’t call us then we just wouldn’t know,” she said. “This is particularly important when we know a certain vulnerable patient has tested positive so we can ensure they are getting the care they need. It is very dangerous not to know.”
Similarly, Newport GP Sana Al-Rubaye said she had several patients, who she was unaware had coronavirus, that had quickly deteriorated at home in recent weeks.
Most were non-English speaking or from migrant backgrounds and had called the clinic breathless and distressed, unsure about whether they should call an ambulance. Some were so sick they were later admitted to hospital.
Dr Al-Rubaye said while she strongly supported a home care program to free up hospital capacity for the sickest, it was an “unreliable system” because there was no clear communication system set-up between the health department, community health networks and general practitioners to immediately alert GPs when their patients test positive.
Dr Nicole Allard, the clinical and public health lead of the cohealth COVID response said there had been “tragic” deaths of people with coronavirus across north-west Melbourne, where people had died in their homes, or had presented too late to an emergency department.
Dr Allard said about once or twice a day, staff at the assessment centre were calling an ambulance for patients who were being assessed and she was worried people were now waiting too long to be tested for the virus.
Cohealth provides a key assessment centre that connects thousands of coronavirus patients, largely in the western suburbs, with their GP and help accessing payments and medication.
Of the 550 GP practices in the west, 467 are signed to the pathways program, and some clinics are currently supporting more than 100 COVID-19 patients.
Dr Allard said every person who comes through the pathways program is sent a text on day one telling them: “if you’re sick ring us, but we also proactively tell them to call their GP.”
On the day the concerning jump in COVID-19 cases was reported last Thursday – seeing numbers go from 950 to 1438 – cohealth received 500 new referrals, bringing the number of patients in the north-west pathway to around 3500.
Asked on Friday if the system was at or beyond capacity, Dr Allard said they were scaling up and trying to minimise the risk to patients.
Dr Allard believes there needs to be a public health awareness campaign warning Victorians about the dangers of coronavirus and when to seek emergency help, much like the highly successful thunderstorm asthma campaign.
She said the warning signs to look out for included extreme lethargy (fatigue), a struggle to do usual daily tasks, shortness of breath on minimal exertion, dehydration, not being able to eat or drink, coughing up blood and confusion.
“These are all the red flags,” she said.
Dr Ines Rio, chair of the North Western Melbourne Primary Health Network, said the home-based program “works really well, except it’s at capacity”.
In NSW, at least 29 people have died at home after being infected with coronavirus, of which more than half were not known to health authorities until a postmortem examination.
In September, a Melbourne man aged in his 20s, died after contracting the virus, in his Craigieburn home. A post-mortem found he was carrying coronavirus, but it is believed the man had other serious health conditions.
Another woman, who also lived in Melbourne’s northern suburbs, died at home on August 31 after contracting the virus. It is unclear whether her diagnosis was known before her death.
A Victorian Health Department spokeswoman said every person who tests positive for COVID-19 is invited to join the COVID Positive Pathways program.
“All staff engaged in helping people with COVID-19 are providing care as part of the COVID Positive Pathways program – either as part of community-based healthcare, GPs, or in our health services,” she said.
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