Emerging infectious diseases: giving GPs the right tools

“IF you have any health concerns about [insert emerging infectious disease] we urge you to speak with your GP” is a sentiment echoed by spokespeople in the early stages of an epidemic. It is sound advice, and speaks to the critical role GPs play in the frontline of our health system. It invokes a fundamental, comforting belief we hold as a community – when we need answers to our health concerns, our GP is there for us. However, it is also advice that firmly establishes an expectation that GPs will be able to provide evidence-based information on the new disease, and address, or alleviate, health concerns. Herein lies the issue: at the start of an epidemic there is a significant mismatch between the certainty sought by citizens and the certainty that GPs may be able to provide.

This places GPs in a difficult position. Often without rapid access to emerging information regarding the new disease, GPs are expected to not only provide general counsel to patients but also provide very concrete clinical advice; for example, to test or not to test, or what to prescribe to alleviate symptoms. Although GPs are often right at the coalface of epidemics, they are often not privy to early information when an epidemic first becomes a concern.

Of course, some degree of clinical uncertainty is inevitable and unavoidable in the early stages of an epidemic. Information changes rapidly and ultimately, we don’t know what we don’t know. This uncertainty can be exacerbated when there is inconsistent or conflicting advice and public health legislation between states and territories. But it begs the question: how can the Australian health system better support GPs in navigating the uncertainty that accompanies emerging diseases so that patients benefit from the best available knowledge?

As the world consolidates the lessons learnt from recent epidemics, a number of potential solutions to this issue are being explored.

For example, it is known that early clarity on the common symptoms, risk factors and health complications of an emerging infectious disease is vital for frontline health care staff. It helps to make decisions such as who to test, and which patients require closer follow-up. In addition, the earlier these clinical aspects of the disease are characterised, the sooner robust clinical guidelines can be produced and evidence-based health care can be delivered.

This first starts with research to better understand the disease. The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) presents an example of a coordinated and collaborative approach to clinical characterisation.

In 2012, ISARIC, in collaboration with the World Health Organization, launched a pre-approved research protocol and associated adaptable uniform case report forms in “peace time” in preparation for the next epidemic and with a harmonised approach to minimise duplication of effort.

Recently, ISARIC’s research readiness and established peer-to-peer network played an important role in identifying COVID-19 symptoms, risk factors and complications – and Australian hospitals contributed significantly to this international agenda.

Australia has also had considerable success with translating research findings into standardised evidence-based clinical guidelines during COVID-19 with the development of nationally endorsed living evidence guidelines. Continued commitment to these approaches will again assist with clarity for clinicians treating patients in future epidemics, as is becoming apparent with the rise of monkeypox.

Rapid initiation of well designed, large national clinical trials offers another potential approach to supporting outpatient care during emerging infectious disease outbreaks. These trials are capable of producing definitive results. These in turn allow clinicians to provide evidence-based information to patients faster and confidently apply robust evidence when making clinical decisions.

An example of a recent large clinical trial is the RECOVERY trial that aims to identify treatments that may be beneficial for adults admitted to hospital with confirmed COVID-19. This UK-led trial has enrolled over 45 000 participants at over 200 hospital sites and, importantly, provided the evidence for ten treatment decisions. Clinical trials conducted in the outpatient setting are equally important to ensure evidence-based medicine at every level of care.

Specific to the Australian context, one proposal that may assist with collaborative efforts is the establishment of an independent authority for communicable disease coordination. Currently, Australia is the only member country of the Organisation for Economic Co-operation and Development without a recognised and independent body for such a purpose. The establishment of an Australian authority, which is part of the current government’s plans, would perhaps be most comparable with Canada’s Public Health Agency. This proposed Australian agency would signal a commitment to a “single source of truth” to guide evidence-based decisions.

GPs face the considerable task during the early stages of any outbreak of being expected to provide counsel to their patients and make actionable decisions about patient care for diseases of which little is known. It is, therefore, of paramount importance that GPs are included as active partners in the research and policy agenda for emerging infectious diseases, and recognised for their leadership in this area.

Benjamin Jones is a DPhil student with the Health Systems Collaborative at the University of Oxford. He previously completed his MD and post-graduate studies in Health Leadership and Management at UNSW Sydney. He is a research assistant for ISARIC.

Amy Paterson is a clinician-researcher and was involved in the frontline response to COVID-19 in South Africa. She is currently reading for a DPhil in global maternal and child health at the University of Oxford. She is a research assistant for ISARIC.

Amanda Rojek is a visiting research fellow at the Pandemic Sciences Institute at the University of Oxford and an Emergency Medicine Registrar at the Royal Melbourne Hospital. She is an advisor to ISARIC and an investigator on a treatment trial for monkeypox.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.

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