Start drive-through community-based COVID-19 assessment centres provided by our Labs!
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The WHO has already declared COVID-19 as a Pandemic but we can turn this virus back while we still have low number of cases. Let's now call for drive-through community-based assessment centres for motor vehicles (mCBAC) in open carparks and fields ( not beside rest homes or schools or other densely populated areas) to be set up by the Ministry (not GPs) with nurses/HCA equipped to do this efficiently and to test & isolate more people. We need to stay ahead of the curve. This is for public safety and for business continuity. It minimizes cross infection in a very public area like a GP waiting room and does not cripple the rest of primary care. We should start preparing to have social distancing, especially for the elderly and immunocompromised and have GPs and Healthline all refer to these centres, via an electronic BPAC referral.
The UK BMJ guidelines for GPs published on 6 March 2020 also do not recommend testing in primary care. Testing should take place at the hospital, the patient’s home, or in designated receiving units according to this guidance. Setting up Community based assessment Centres (CBACs) near aged-care facilities and schools does not make public health sense and should be avoided as it risks our most vulnerable patients and allows schoolchildren to spread the disease to their families and grandparents like honey bees.
A healthcare assistant who does this everyday in a Hazmat suit and knows all the protocol, minimizes the risk of spread of the disease and reduces false negative results, which can give a false sense of security. It conserves our precious PPE & testing resources and reduces the need for time-consuming disinfecting, as patients drives through in their "own isolation room." It allows economies of scale and will divert people away from the Emergency Department.
Symptomatic people who are afraid to visit a hospital/clinic will come forward for testing to protect our families. Self-isolated sick people who stay home can infect the rest of their family who unwittingly continue to mingle within our communities. These patients will feel infinitely safer sitting in their own motor vehicle than going to a room used by another infected patient. Younger nurses/doctors can volunteer to supervise the drive-through site because a lot of the administrative work- filling out forms, taking temperature, data entry and sending swabs away- do not have to be done by a trained Senior doctor.
This can all be done in a wide open space like a carpark with plenty of ventilation. Tents should be set up on empty land/carparks away from Rest Homes and Schools and swabs can be couriered away in disposable cardboard boxes ( which virus doesn't stick on as well to). These cost-effective temporary spaces can all be easily dismantled after an outbreak and we can scale up and down with each successive epidemic wave.
Furthermore, the labs are also bulk-funded to look after the patients. Providing a drive-through service where the tests are processed, cuts out the middleman, minimizes fomite surface contamination and the need for expensive couriers to the lab. Patients should self-isolate at home while doctors decide on their case , a case number (NHI) and appointment time given to the suspect case to drive-through. This streamlines the workflow and reduces waiting time and anxiety all round.
We need to protect our doctor/nursing staff (who don't do these swabs everyday) to look after other non-COVID-19 patients during an epidemic, rather than lose them to self-isolation or illnesses. GPs are perfectly capable of handling this but we really don't need trained doctors or nurses to perform a swab or put the rest of our elderly and vulnerable patients at our practice in unnecessary danger. It is all about risk management.
To survive an outbreak , the Ministry of Health needs to protect its limited medical staff and reduce rampant absentism. This preserves our community healthcare team as an essential service because our patients do not just suffer from COVID-19 during an epidemic. Primary and tertiary care must both remain intact and continue to protect our most vulnerable. People must also feel safe visiting their GPs and the hospital.
The drive-thru MCBAC has been done successfully in South Korea, Germany, UK, Australia and many more places... including Walmart and Target in USA. This makes more public health sense and causes less disruption and economic damage than mitigating through lockdowns, closing businesses, schools and transport services.
The WHO has said " Speed trumps perfection. The greatest error is to be paralyzed by the fear of error and inertia". Dr. Maria Van Kerkhove, a WHO infectious disease epidemiologist has said “Please look for cases, please do testing and find those cases so we can turn the tide.” We can break the chains of transmission now.
China's unprecedented measures and our very own border controls have brought us precious time to prepare but we cannot be lulled into a sense of complacency. With so many more countries reporting infected cases so quickly, NZ simply cannot shut itself out from the entire world. The clock is ticking and the time to act is now because what can happen in Europe or USA can very well happen to us in Auckland, Wellington or Christchurch, with a rapid upsurge of cases suddenly. Many health authorities overseas have been caught flat-footed and were taken by surprise at how fast moving things have been. Making this change right now, before the Flu season starts, will protect everyone and save lives. Thanks.
This is what a mobile or Motor Vehicular CBAC looks like. See: https://www.youtube.com/watch?v=us-432apKFw
The below are the lessons shared by MSNBC on how to prevent family transmission and infecting other people within a clinic: https://twitter.com/MaddowBlog/status/1238279302468288512?fbclid=IwAR2KZLrr31BRKTLaWJkBCXfEFbIgQ4d-QCdmhkhERxOg9p8FjqMIksYv_l0
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