Big drop in endocrinology tests during pandemic

COVID-19 restrictions have had a significant impact on the use of pathology testing with researchers in South Australia reporting a drop in the number of endocrinology tests requested during the state’s first lockdown compared to earlier in the year.

According to the analysis of records from SA Pathology falling test rates were seen across community and ED settings – the ratio of number of pathology tests pre-lockdown and post-lockdown vs. baseline period decreased from 1.02 to 0.53 respectively.

The decrease was most pronounced for haematology, general chemistry and endocrinology tests, whereas the exception was microbiology molecular tests, which includes virology PCR testing, which were three times higher during the lock down period compared to earlier in the year.

The number of troponin tests, as an indicator of urgent care, decreased in the lockdown period compared to the baseline period and researchers said an inverse association between patient age and numbers of troponin tests in lockdown may suggest that possible avoidance behaviour was more pronounced in older age groups who are at increased risk of suffering severe effects associated with COVID-19.

“In South Australia the health care system was not overburdened by COVID-19 cases during the study period and as such did not represent a barrier to patient presentations at ED. The behaviour of not seeking treatment for urgent care conditions needs to be addressed in preparation for further possible COVID-19 restrictions and other pandemics.”

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Mandatory COVID-19 vaccination for all healthcare staff: AMA

The AMA has called for a national mandatory vaccination regulation against COVID-19 for all healthcare staff after NSW led the way for staff in public and private hospitals.

Under a new Public Health Order, NSW health staff must have a first dose of vaccine by 30 September 2021 and be fully vaccinated by 30 November 2021, or at least have their second appointment booked or they will be excluded from the workplace.

Health Minister Brad Hazzard said 80% of staff were already vaccinated and the new requirement was similar to existing mandatory vaccination requirements for frontline health staff for influenza, chicken pox, measles and pertussis.

“National Cabinet agreed in June to mandate COVID-19 vaccination for aged care workers, and NSW will now ensure the same protections exist for all our health workers,” he said.

“It will also ease pressure on our health system during this challenging time. More than 1,200 healthcare workers have been in isolation each day over the past seven days and we cannot afford that right now. Vaccinations will help ensure our fantastic staff can continue to care for patients.”

The AMA said mandatory vaccination rules should be put in place nationally for the workforce of the entire health care system including support staff.

With worrying numbers of COVID-19-infected frontline workers furloughed and unable to work, as well as several clusters being linked to hospitals,  AMA President Dr Omar Khorshid said mandatory vaccines for health care workers are needed to sustain the health system into the future as Australia learns to live with COVID-19.

“We’ve said plans to reopen Australia will be a disaster unless our health sector is ready, and that will mean having a fully protected medical workforce,” he said.

“There is widespread uncertainty as to whether other occupations and workplaces can also mandate vaccinations. The law needs clarity to give employers and employees certainty.

“AMA proposes nationally consistent public health orders be issued by state and territory governments to provide legal protection to any employer who can also reasonably establish worker safety would benefit from a workplace vaccine mandate. Longer term, statutory coverage may be required.”

Diabetes screening impetus needed to tackle stagnation in care

The US Preventive Services Task Force (USPSTF) has lowered of the age threshold for screening for diabetes from 40 to 35 years in updated recommendations. The task force now recommends that adults aged 35 to 70 years who are overweight or obese be screened for prediabetes and type 2 diabetes and that clinicians “offer or refer patients with prediabetes to effective prevention interventions”. The update also adds metformin to diabetes prevention interventions.

The new recommendation coincides with a report published in JAMA suggesting there has been stagnation in of diabetes care and outcomes in the US. A study showed the total age-standardized diabetes prevalence was 14% in 2015-2018 and there had been no consistent improvements in glycemic control and risk factor management for 10 years.

“These findings provide important context to the new USPSTF recommendation and warrant a closer look at where the biggest missed opportunities lie and what could be gained with the new screening guidelines,” an accompanying commentary said.