COVID-19 – regular updates

See the latest updates from ANZCA on COVID-19 including messages from our president and the latest version of the PPE statement.

 

 

Plans for exams to go ahead (21 May)


ANZCA Council met on Tuesday night to discuss the completion of the anaesthesia primary and final exams in 2020 in the context of the COVID-19 pandemic. The college plans to run the exams, recognising that the situation may change and be beyond our control. We are working on a comprehensive plan including contingencies. More information in a message from ANZCA President Dr Vanessa Beavis.


 

New PPE statement released (15 May)

 

We have launched our revised ANZCA statement on PPE via ANZCA President Dr Vanessa Beavis's latest COVID-19 update. The flowchart in this statement is also available.   

We are grateful for the time and considered input of ANZCA’s COVID 19 Clinical Expert Advisory Group in reviewing the statement. 

 

Message from Dr Vanessa Beavis (11 May)

 

Hear from Dr Vanessa Beavis on the college's latest activities in relation to COVID-19 in her first message as ANZCA president. She discusses drug shortages, our revised personal protection equipment (PPE) statement, exams and training, the recent webinar in New Zealand, our commitment to overseas aid and some recent college media coverage.

 

Training updates (6 May)


Updates continue to be made to the "COVID-19 - potential impacts on training" table. There is now also now a "COVID-19 – Guidance for provisional fellows" table.

As part of our preparations for the planned delivery of the primary and final exams in the second half of 2020, the college recently wrote to trainees who would be eligible to sit the 20.2 exams or may be planning to sit in 2021 and asked them for their views on when they would like to sit the exams and why. There was a strong response, with 576 responding.  This data is now being analysed and will guide our courses of action for the remainder of 2020. 

 

NZ webinar (5 May)


More than 300 logged in to a webinar on COVID-19 and anaesthesia hosted by the New Zealand National Committee on Tuesday 5 May. The panel included a leading epidemiologist, a microbiologist, an infectious diseases specialist, the chief medical officer of the New Zealand Ministry of Health and our own CEAG and then-Safety and Quality Committee Chair, Dr Nigel Robertson. 
  
The webinar was recorded and has been added to our COVID-19 resources Library Guide. I encourage you to watch it.
  

 

ANZCA position on PPE – interim guidelines of the Infection Control Expert Group (28 April)

 

ANZCA continues to base its recommendations for protection of healthcare workers on the advice received from the Infection Control Expert Group (ICEG), the principle advisory body to the Australian chief medical officer, being equally mindful of the pronouncements from the New Zealand Ministry of Health.

The most recent ICEG interim guidance statement on PPE (24/4/2020), endorsed by the Australian Health Protection Principal Committee (AHPPC) includes new information and amendments that have implications for anaesthesia practice.
 

Our COVID-19 Clinical Expert Advisory Group (CEAG) is in the process of revising our PPE statement. This revision is being informed by the interim ICEG guidance statement and input received from CEAG and other fellows. Given the need to respond rapidly to new information as it becomes available, ANZCA has prepared this interim flowchart as a guide to PPE pending the revised statement.
 

The ICEG has advised that disease transmission from aerosolised particles, whilst possible, is highly unlikely based on epidemiological studies. Specifically:
 

“Clinical and epidemiological evidence suggest that airborne transmission is rare, but some aerosol-generating procedures (AGPs) can increase the risk. Some fine particle (<5 micron) aerosols are produced by infected patients, but the quantity of virus in these particles is significantly less than that in large droplets” 


Coupled with this, the ICEG advises that the risk of an asymptomatic patient, that is one with no triage symptoms, subsequently developing COVID-19 positivity is very low, based on the current population prevalence.


On the basis of this evidence, the ICEG has modified its guidelines to emphasise that “for clinical care of, or procedures on, patients who are NOT suspected of having COVID-19 business as usual prevention and control precautions, including PPE if required, should be observed, according to clinical circumstances”.


In addition, in regard to risk of specific procedures generating aerosolised particles, the following pronouncements are noteworthy:

  1. Bronchoscopy, tracheostomy, and ENT/sinus procedures can regarded in the same way as we manage all other AGPs. As such, there is no need to regard these procedures as requiring airborne precautions in low risk COVID-19 patients.

  2. Severe coughing is no longer regarded as an AGP.

  3. Second stage labour is no longer regarded as an AGP.
     

There are still differing opinions on whether upper GI endoscopy and colonoscopy should be considered AGPs. For now ANZCA is advising that they should be. 

 

These changes are reflected in this interim flowchart.


Please note that the ANZCA PPE statement should not supersede directives from local health authorities.


 

Training and education update (22 April)

 

We have just emailed our latest training and education information to all anaesthesia fellows, trainees and specialist international medical graduates from Dr Robert O'Brien, Executive Director, Education and Research. See the update here.


 

Update to MBS telehealth services (22 April)

 
Further to the recently announced temporary MBS telehealth items, new amendments have been announced regarding the requirement to bulk bill these services.

From 20 April 2020 specialist service providers are no longer required to bulk bill these new telehealth items.

For specialist and consultant physician item numbers and further information, please see the MBS changes fact sheet.

 

 

Recommendations relating to the introduction of an expanded scope of non-urgent surgery (21 April)


ANZCA and the Royal Australasian College of Surgeons (RACS) have been collaborating with the Australian government relating to the introduction of an expanded scope of non-urgent elective surgery.

The colleges released a joint media statement with the Minister for Health Greg Hunt, Chief Medical Officer Dr Brendan Murphy and Deputy Chief Medical Officer Dr Nick Coatsworth on the scaled resumption of elective surgery following a meeting of the National Cabinet.

ANZCA President Dr Rod Mitchell and RACS President Mr Tony Sparnon had earlier co-signed a letter to Health Minister Greg Hunt outlining three factors for consideration - patient selection, ongoing monitoring of various safety and quality variables and preparedness to immediately scale back, should that become necessary.
 

Patient selection should occur at a regional level, involving discussions between the local surgeons, anaesthetists, intensivists, and hospital administrators. In considering prioritisation of patients for elective surgery, consideration needs to include:
 

  • Preference for patients with low/no risk of COVID-19.

  • Need for use of personal protection equipment (should be low probability).

  • Need for post-operative intensive care (should be low probability).

  • Local ICU bed capacity.

  • Predicted length of stay (should be less than three days).

  • Local hospital bed capacity.

  • Ability to maintain safe social distancing.

  • Local community transmission rates.


Ongoing monitoring of various safety and quality variables needs to occur at a regional level, monitoring personal protective equipment (PPE) usage and supply; ICU bed capacity; hospital bed capacity; and community transmission.

 

Preparedness to scale back/stop non-urgent elective surgery should consider the development of hospital-based traffic light risk stratification models, with specific triggers based on measurement of PPE supplies; ICU bed capacity and community transmission. If any of these variables move into the “red zone”, all non-urgent elective surgery in that region needs to be immediately ceased.

 

Dr Mitchell and Mr Sparnon offered to facilitate discussion with relevant stakeholders to discuss and develop appropriate triggers for these traffic light risk stratification models.



ANZCA in the media (17-21 April)

 

ANZCA President Dr Rod Mitchell has featured in several broadcast and print articles responding to elective surgery and fit testing issues following the release of the college's joint statement with RACS welcoming the Australian Government's resumption of elective surgery.

He was interviewed for the ABC’s national AM program on 20 April on elective surgery and why its resumption needs to be carefully controlled and monitored. This reached an audience of 450,000 people. He was also interviewed by ABC Radio Melbourne's morning host Virginia Trioli on 21 April in a five minute interview which reached an audience of 140,000 people.

ANZCA was also referenced in several online print and online articles in News Limited publications on 21 April about our support of controlled elective surgery. This included a 
Herald Sun page one article.

News bulletins on radio stations 3AW in Melbourne, 6PR in Perth and 4BC in Brisbane and regional stations also broadcast audio grabs of Dr Mitchell  in their news bulletins on 21 April.

He was also interviewed for Channel Seven Melbourne on 19 April via zoom for a news report on elective surgery.

Other media included an article in the Weekend Australian Financial Review on 18 April (paywalled) following our joint elective surgery statement with RACS on 17 April. Dr Mitchell also featured in an online Guardian Australia article on fit testing and why it’s important.

ABC news bulletins nationally also ran audio interviews on 18 April with Dr Mitchell. The segments were broadcast on ABC news bulletins in Sydney, Melbourne, Canberra, Brisbane and Adelaide and dozens of regional ABC stations. 

 

Message from the president (17 April)


The president's message today includes information on an urgent safety alert about face masks, and updates on the resumption of elective surgery, exams, personal protective equipment, council elections, a statement on redeploying staff to intensive care, a WebAIRS initiative and a link to the new ANZCA Bulletin. 


 

Urgent safety alert: N95 face masks (17 April)

 

We have been alerted to the fact that “standard”, non-fluid resistant N95 face masks being distributed for use in operating theatres in Sydney, Melbourne and South Australia. Read more...


 

Intensive care workforce statement (9 April)

 

A “Statement on managing senior medical workforce in intensive care during the COVID-19 pandemic” has been issued by ANZCA President Dr Rod Mitchell and the presidents of five other intensive care and anaesthesia societies and colleges known as the Covid-19 Critical Care Coordination Collaborative.

The statement makes a number of recommendations in relation to managing senior medical staff in intensive care and was issued by the presidents of the College of Intensive Care Medicine of Australia and New Zealand, the Australian and New Zealand Intensive Care Society, the Australian and New Zealand College of Anaesthetists, the Australian Society of Anaesthetists, the New Zealand Society of Anaesthetists and the Australasian College for Emergency Medicine.

 

 

ANZCA statement on the use of PPE during the SARS-CoV-2 pandemic (9 April)

 

ANZCA has released a revised statement in relation to the use of personal protection equipment (PPE) during the SARS-CoV-2 pandemic.

This statement is intended to provide a single bi-national standard, informed by high level expert advice, to facilitate a safe, consistent and standardised approach to the use of PPEs across our two countries. It has been developed with the clear understanding that there will be situations where it will require modification to meet local epidemiological and resource circumstances. Such modifications should, as far as is reasonably possible, be guided by informed expert opinion. 

Read the statement here.

 

Education update (9 April)

 

Dr Robert O'Brien, Executive Director, Education and Research, gave an update on training, exams, accreditation and CPD. The communication can be accessed here.

 

 

PPE webinar (7 April)


On Monday 6 April ANZCA took part in a webinar with Dr Nick Coatsworth, Australia's Deputy Chief Medical Officer (CMO) responsible for issues relating to personal protective equipment (PPE). The Australian Society of Anaesthetists, the New Zealand Society of Anaesthetists, the College of Intensive Care Medicine and the Australian and New Zealand Intensive Care Society also participated in this webinar.

A recording of the webinar can be viewed here


 

Update to MBS telehealth services (7 April)

 
Further to the recently announced temporary MBS telehealth items, new amendments have been announced regarding the requirement to bulk bill these services:

 

  • From 6 April 2020, it is a legislative requirement that the new telehealth services must be bulk billed for Commonwealth concession card holders, children under 16 years old and patients who are more vulnerable to COVID-19. 
     

  • Health poviders may apply their usual billing practices to the telehealth items for patients who do not fit the above criteria. Providers are expected to obtain informed financial consent from patients prior to providing the service; providing details regarding their fees, including any out-of-pocket costs.


For specialist and consultant physician item numbers and further information, please see the MBS changes fact sheet.


ANZCA exams update (3 April)


ANZCA is planning for a variety of scenarios with regard to the examinations, and like all trainees and supervisors, are weighed down by how uncertain everything is. The college is working hard across many departments to develop responses to the various issues involved around training, assessment and exams. The chairs and deputy chairs of the Primary and Final Examination Sub-Committees would like to offer their support to trainees and supervisors of training at this time of uncertainty. Currently, there are several options with regard to the exams. We have compiled information which may help candidates prepare for the exams to be held later in the year.

 

AHPRA creates COVID-19 sub-register (1 April) 


The Australian Health Practitioner Regulation Agency (AHPRA) has created a new pandemic sub-register to fast track the return to the workforce of experienced and qualified health practitioners. Ahpra will be contacting over 40,000 practitioners who previously held general or specialist registration and left the Register of Practitioners, or moved to non-practising registration in the past three years to alert them that they will be added to this new sub-register. 

The temporary sub-register will operate on an opt-out basis with practitioners added automatically. They will not need to fill in forms or pay fees, nor meet the usual return to practice requirements. There is no obligation for anyone added to the sub-register to practise or remain on it. The pandemic sub-register is expected to be in place from 6 April. For more information visit the COVID-19 information page.


 

Continuing professional development (30 March)


The Medical Board of Australia will not take action if you cannot meet the CPD registration standard when you renew your medical registration this year.

They are encouraging medical practitioners to continue to do CPD that is relevant to their scope of practice. However, they say they understand that medical practitioners may have difficulty meeting CPD requirements this year as a result of withdrawn/denied leave requests, conference cancellations and the re-prioritisation necessary to meet workforce needs.

The board will keep a close watch on the situation to determine whether the 2021 renewal year is affected.

More information is available here.
 

 

ANZCA in the media COVID-19 (30 March)


ANZCA President  Dr Rod Mitchell was interviewed on ABC Radio Melbourne’s Drive program on Friday 27 March for a seven-minute segment discussing the college’s concerns about the extension of non-urgent elective surgery in private hospitals and the shortage of personal protective equipment. You can listen here, the interview starts at two hours, 24 minutes in. Dr Mitchell was also interviewed on ABC News Radio on Sunday 29 March for a seven-minute segment.

In New Zealand ANZCA fellow, Auckland anaesthetist and pain specialist Dr Leinani Aiono-le Tagaloa, was interviewed by Radio NZ about operating on patients with Covid-19.

Professor David Story, Foundation Chair of Anaesthesia, and Deputy Director, Centre for Integrated Critical Care, The University of Melbourne features in a Guardian Australia podcast on why ventilators are crucial in the fight against COVID-19.
 
Find it here.
 

 

President's Friday update (27 March)


On Friday 27 March ANZCA President Dr Rod Mitchell sent a an update to all fellows, trainees, specialist international medical graduates and staff with latest information about COVID-19 in relation to exams and training, CPD, scope of practice, ASM and events, the cessation of non-urgent elective surgery, personal protection equipment, clinical information, rural and remote communities and personal wellbeing.

See it he

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