Assessment, Monitoring, and Management of Symptomatic COVID-19 Patients in the Community

Overview

This updated Guidelines summary provides key information for primary care on the assessment, monitoring, and treatment of patients who present to general practice with symptomatic COVID-19.

Reflecting on Your Learnings

Reflection is important for continuous learning and development, and a critical part of the revalidation process for UK healthcare professionals. Click here to access the Guidelines Reflection Record.

Adult Primary Care COVID-19 Assessment Pathway

Algorithm 1: Adult Primary Care COVID-19 Assessment Pathway

COVID-19 Oximetry @home Monitoring

• As per Algorithm 1 in the section, Adult Primary Care COVID-19 Assessment Pathway, patients who are at higher risk and are well enough to be managed at home should be considered for COVID Oximetry @home (CO@h)
• The CO@h pathway should be available to people who are:
  • diagnosed with COVID-19: either clinically or positive test result and
  • symptomatic and either
  • aged 65 years or older or
  • under 65 years of age and at higher risk from COVID-19, or where clinical judgement applies considering individual risk factors such as pregnancy, vaccination status, learning disability, caring responsibilities, and/or deprivation
• Pregnant women being referred to a CO@h service should also be asked to contact their maternity team for specific advice around pregnancy and COVID-19
• CO@h is a self-monitored and self-escalated pathway, with optional check-in calls for some patients. Patients are provided with a pulse oximeter, a supporting pack including instructions on self-monitoring, and clear guidance on safety netting and escalation
• For those patients in whom a self-monitored pathway is not clinically deemed to be sufficient, a referral to local CO@h services providing proactive telephone calls to support patient monitoring should be considered
• All patients who are eligible for COVID-19therapies should also be considered for CO@h monitoring, as they are in high-risk groups.

COVID-19 Treatments

• As per Algorithm 1 in the section, Adult Primary Care COVID-19 Assessment Pathway, the highest risk patients with mild-to-moderate symptoms should be considered for treatment with new antibody and antiviral treatments if they are within 5 days of symptom onset
• Two types of COVID-19 treatments are available:
  • neutralising monoclonal antibodies usually given by infusion or injection in a local hospital or health centre
  • oral antiviral treatment—currently molnupiravir (Lagevrio) in capsule form that can be taken at home
• Patients who are eligible for these treatments should be referred to COVID-19 medicines delivery units (CMDUs)
• Patients who are not eligible for COVID-19 treatments could be eligible for the PANORAMIC trial.

COVID-19 Medicines Delivery Units

• GP practice teams can still refer potentially eligible patients if they have tested positive for COVID-19. COVID-19 treatments must be delivered quickly following symptom onset. Practices and 111 should use the clinical policy document to help identify if a symptomatic patient is potentially eligible. GP teams should check the patient meets the criteria for referral. The CMDU will confirm eligibility and discuss treatment options
• Therefore, if you are assessing a patient who is at highest risk (for the full list of eligible patient criteria, see Table 1), has not been contacted by a CMDU, and meets the following referral criteria, you should refer to a CMDU. If your area is using e-Referral Service (eRS) to refer patients to CMDUs, the NHS has asked commissioners that their CMDU services are listed in the infectious diseases specialty, under a nonspecific ('not otherwise specified') clinic type, but to include in the service name, the words ‘COVID-19 medicine delivery unit (CMDU)’. Some services may have been established with the service name ‘COVID MABS delivery unit (CMDU)’.
• Referral criteria for CMDU:
  • positive test for COVID-19 and
  • symptomatic with COVID-19 and showing no signs of clinical recovery and
  • onset of COVID-19 symptoms within the last 5 days and
  • patient is a member of the highest-risk cohort
  • NOT requiring hospitalisation or oxygen for COVID-19
  • NOT under 12 years old
  • NOT a child weighing less than 40 kg
  • NOT been contacted by the CMDU directly within 24 hours of their test result
• The main message for everyone is that vaccination is key and is still the mainstay of protecting people against COVID-19.

Table 1: Eligibility for COVID-19 Medicines Delivery Unit Referral

For information on eligibility for the PANORAMIC study, refer to the full guideline.

For further information on CMDUs, refer to the full guideline.

COVID-19 Treatment Pathway—Overview for GPs

Algorithm 2: COVID-19 Treatment Pathway—Overview for GPs/111

For information on the PANORAMIC study and additional resources, refer to the full guideline.