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The waiting game

Referrals: Criteria for referring potential Covid-19 patients to secondary care

Public Health England guidance

First published on Public Health England website

Case definitions: possible case, as of 13 March 2020

  • requiring admission to hospital (a hospital practitioner has decided that admission to hospital is required with an expectation that the patient will need to stay at least one night)


  • have either clinical or radiological evidence of pneumonia


  • acute respiratory distress syndrome


  • influenza like illness (fever ≥37.8°C and at least one of the following respiratory symptoms, which must be of acute onset: persistent cough (with or without sputum), hoarseness, nasal discharge or congestion, shortness of breath, sore throat, wheezing, sneezing

Note: Clinicians should consider testing inpatients with new respiratory symptoms or fever without another cause or worsening of a pre-existing respiratory condition.


Patients who meet the following criteria and are well enough to remain in the community

  • new continuous cough and/or
  • high temperature

Individuals with cough or fever should now stay at home.


Clinicians should be alert to the possibility of atypical presentations in patients who are immunocompromised.


Alternative clinical diagnoses and epidemiological risk factors should be considered.


Action to take if inpatient definition is met




Ensure the patient is placed in respiratory isolation or within a specified cohort bay and the PPE described in the infection prevention and control guidance is worn by any person entering the room. 


Ensure that the patient, potentially contaminated areas, and waste are managed as per the infection control guidance.


Sampling and testing


Arrange diagnostic sampling for individuals meeting the inpatient definiton. Do not wait for results of local testing for other pathogens before sending samples for SARS-CoV-2 testing.


Testing should be organised through the local hospital. See how to arrange laboratory testing and the guidance for sampling and diagnostic laboratories that includes an overview of laboratory investigations and sample requirements.


Designated PHE regional laboratories, in addition to the Respiratory virus unit (RVU) Reference laboratory at PHE Colindale, are able to carry out testing. See how to arrange laboratory testing.


Source: Public Health England


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