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Covid-19 Primary Care Resources


Covid-19 Primary Care Reference Guide



A continually updated synthesis of all relevant guidance for GPs on managing acute Covid

This information is sourced from NHS London clinical networks, the BMJ, the Centre for Evidence Based Medicine (CEBM)PHE, NHSE, the MHRA and the PCDS:

1. Review a patient’s notes before calling them. Consider conditions/medications which put someone at increased risk for serious illness or which need active management during their acute illness with Covid:

2. Screen for symptoms of Covid-19 infection and severity of illness

Focus on change. A clear story of deterioration is more important than whether the patient currently feels short of breath

Ask date of first symptoms (Covid-19 can produce rapid deterioration in respiratory function, especially in the second week)

Suggested questions:

  •  “How is your breathing today?”
  •  “Do you have an oximeter at home or have you noticed any blue discolouration of your lips?”
  •  “Are you more breathless than usual on walking or climbing stairs?”
  •  “When was the last time you went to the toilet and passed urine?”

Serious differential diagnoses such as bacterial pneumonia, meningitis, or sepsis should be considered

Covid-19 can trigger new-onset diabetes in previously healthy people

3. Categorise symptoms and assess risk for patients with likely Covid 19

CategorySymptoms Risk Assessment  Action
Mild symptomsNo moderate or severe symptomsSats ≥ 94%
HR ≤ 90
RR ≤ 20
– Add to practice list of known/suspected Covid 19 patients
– Self management/PCR testing/isolation advice & safety netting
– Consider eligibility for inhaled budesonide if over 50
Moderate symptoms
MEDIUM RISK
New breathlessness on walking
Dizzy/faint on walking
Severe headache
Not passing urine
Moderate tight chest/wheezy
MEDIUM RISK SIGNS
No desaturation with exertion on desaturation test or ≤ 2% from resting values
Sats = 93-94
HR =91-130
RR=21-24
Speaking full sentences
Deteriorating symptoms
– Currently medium risk
– Consider trial of treatment at home
– Consider eligibility for inhaled budesonide if over 50
– Consider treatment to prevent secondary bacterial pneumonia (the MHRA have advised that azithromycin and doxycycline should no longer be used in the management Covid-19 infection within primary care, unless otherwise indicated)
– Treat an exacerbation of asthma or COPD IF known steroid responsive
– Consider high dose bronchodilators (4-8 puffs salbutamol via large volume spacer (or nebuliser)
Self management/ PCR testing/ isolation advice & safety netting
– Arrange daily follow up call to assess breathlessness at rest/with usual activity and daily pulse oximetry
– Follow up until 48 hours of improvement in symptoms and O2 Saturations
– Refer to secondary care if deteriorating saturations 
– Patient to call 999 if deteriorating
Moderate symptoms
HIGH RISK
New breathlessness on walking
Dizzy/faint on walking
Severe headache
Not passing urine
Moderate tight chest/wheezy
HIGH RISK SIGN
Sats ≤ 92%
HR ≥ 131
RR ≥ 25
Unable to speak full sentences
Signs of sepsis
Other emergency signs
– 999 Hospital Admission unless
Advance Care Plan/plan on CMC
SEVERENew breathlessness on walking
Dizzy/faint on walking
Severe headache
Not passing urine
Moderate tight chest/wheezy
– 999 Hospital Admission unless Advance Care Plan/plan on CMC

Written by Dr Poppy Freeman