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Covid-19 Primary Care Resources


Comorbidities GPs need to actively manage



A quick reference guide for when patients with comorbidities are unwell with Covid-19

This information is sourced from NHS London clinical networks, the BMJ and the PCDS:

COPD 

  • Mild deterioration = up to 2% below their baseline O2 pulse oximetry sats
  • Moderate deterioration = between 3-4% below their baseline O2 pulse oximetry sats
  • Severe deterioration = 4% or more below their baseline O2 pulse oximetry sats

If on Long Term Oxygen Therapy (LTOT) discuss ceiling of care and consider admission if sats <88% on their standard dose of LTOT

Interstitial Lung Disease

  • Mild deterioration = up to 2% below their baseline O2 pulse oximetry sats
  • Moderate deterioration = between 3-4% below their baseline O2 pulse oximetry sats
  • Severe deterioration = 5% or more below their baseline
  • If on Long Term Oxygen Therapy (LTOT) discuss ceiling of care and consider admission if sats <88% on their standard dose of LTOT

    Asthma

    • Remember to manage asthma actively with usual management. The risk of inadequately treating an asthma attack is highly likely to be worse than the risk from Covid-19 (which can trigger an asthma attack)

    Diabetes

    • Consider SICK day rules in people with diabetes who are unwell with Covid 

    Other medications

    • Remember SADMAN rules for medications that you should think of stopping in people with intercurrent illness that could cause AKI or DKA

    Older/immunocompromised people

    • Covid can present with atypical symptoms, such as delirium and reduced mobility

    Patients with adrenal insufficiency: primary (eg Addisons) or secondary (eg previous high dose steroid treatment)

    Sources