COVID-19 Information for primary, community and integrated care teams

The Coronavirus pandemic is creating a particularly challenging environment for primary, community and integrated teams to deliver care to patients with respiratory disease. The situation is evolving creating constant change.

PCRS has drawn together the following sources of information which will be updated regularly, which you can find on our website. Please also share any useful resources you have below.

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  • To kick things off, I thought I'd share a message from a GP that was sent to a community pharmacy WhatsApp group.

    The GP working in London where he is inundated with calls from patients with suspected COVID 19.

    (not sure if all factually correct but like the manner in which the patients were reassured and the amazing NHS team work).

    It would be great to hear other people's thoughts during these testing times.

    Darush

     

    It has been very interesting to take calls from the 111 covid -19 queue. I was able to talk to people from Hackney , Newham, Tower hamlets and Waltham Forest.

    I was impressed that all cases passed from 111 were very likely to have the virus. I only spoke to 12 cases but some common themes emerged. All the calls were happy to accept telephone advice. The calls took longer than other out of hours calls, mainly due to most  patient’s high level of anxiety.

     

    Common symptoms were:

    Fever , cough, breathlessness and fatigue and aches in muscle and joints. No runny noses and only 1 sore throat.

    The fever was usually high (over 38c and in some cases 40c) and persistent over more than 4 days.

    The cough was generally dry and developed several days after the fever. (3 or 4 days)

    The breathlessness varied from one person to another and in some was intermittent chest tightness like an asthma attack.

    Fatigue and muscle aches seemed worse in the first 4 days with cough and breathlessness after that.

    The cough and breathlessness  persisted in 2 people beyond 2 weeks.

     

    The main anxieties were:

     

    1.Why is the fever so high?

    2.Why is the fever not settling after 4 days?

    3.Why is the cough not settling after 2 weeks?

    4.Why am I breathless and when will I need to go to hospital?

    5.Can I have a swab to be sure it is coronavirus?

    6. Can I come to the hospital for treatment?

     

    Being able to answer these questions is the key to giving the reassurance that will allow the patient to stay at home confident that they know what to do to get through the illness.

     

    My answers to the questions are:

     

    1.      The fever is your body’s way to fight the infection, we have no medicine to treat this virus but your immune system will fight it, the fever is part of that process. If the fever makes you too uncomfortable of stops you taking food drink use paracetamol to reduce the fever for a few hours.

    2.      The fever can go on for 7 days with this infection if you are still feverish after that we should talk again.

    3.      The cough can go on for 3 weeks if you are not too breathless and able to eat and drink the dry cough will settle over time.

    4.      Breathlessness is a feature of this illness due to irritation and inflammation of the lungs if the breathlessness is severe you may need to have oxygen support or ventilation in hospital. This is likely if you are too breathless to climb the stairs or to hold a conversation or to eat and drink.

    5.      You will only be swabbed if you are so sick that you need to be admitted to hospital, the swab takes 3 or 4 days to get a result so we treat you on the presenting symptoms of this illness.

    6.      This virus has no specific treatment. You will come into the hospital if the inflammation in the lungs is so severe that you need oxygen support or ventilation. Less than 1 in 10 people will need this support.

     

    People felt very anxious and wanted to come to the hospital for reassurance.

    I tried to reassure them that it was safe to stay at home unless the breathlessness became severe and the other symptoms could be managed well in their own home. I focused on the importance of helping their own immune system with rest, fluids, fruit and nourishing foods, keeping warm and avoiding stress.

    Like 5
  • That's really helpful in getting a clearer picture of not only the symptoms people present with but the questions they want answering and where their anxiety lay. Thanks for posting darush attar-zadeh

    Like 1
  • Whilst everyone is working flat out there has been a level of support offered with free drinks etc. Headspace (via its app) is offering a section of use free to anyone so staff and worried patients called Weathering The Storm. 

    10 minutes of guided mindfulness for your mental health. 

    Like 3
  • Thanks for that Darush, it is reassuring to know that the advice I have been giving is in line with others. Despite following guidelines with something as new and as anxiety producing (in patients) as this it's easy to start to doubt yourself!

    Like 1
  • Great information thankyou. 

    I have another question - couple of GP's asking for advice about COPD pts with rescue packs and the use of prednisolone in the current situation given the advice about not avoiding ibuprofen.  The differentiation between a copd exacerbation and COVID 19 ? obviously temperature is a key distinguisher and the dry cough - any thoughts 

    Thanks Sally

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  • Salbutamol requests due to Covid-19- we are receiving many requests from patients  with a history of asthma but no episodes for years. I am concerned that 1-  patients will be treating them selves inappropriately - for cough due to coryza not asthma, 2- not treating asthma appropriately if asthma relapses, 3- there will be a shortage of salbutamol. 

    How are others responding- would a peak flow with asthma action plan be a more appropriate response?

    Like 1
    • Stephen Lytton I'm currently doing a few telephone consultations and would treat it similarly to a face to face session. I'd want to explore several things including how the diagnosis was initially made prior to issuing as we wouldn't want others who need it without (list not exhaustive). 

      History of previous attacks

      Family history

      Past medical history

      Courses of Oral Corticosteroids (OCS)

      Adherence to ICS treatment

      Current SABA use (Ratio of SABA to ICS)

      Asthma Control Test score or RCP 3 questions

      Inhaler technique - use http://www.rightbreathe.com to coach patient via phone/video call

      Asthma Plan

      Exposure to triggers including smoking & second hand smoke, pets. Exploring COVID 19 related stress

      Multi-morbidity - including hay fever

      Issue of peak flow diary and monitor patient after 2 weeks to assess variability.

      Alternative diagnosis? I'd be worried if the patient is treated unnecessarily with SABA they could develop:

      Rapid ꞵ2 receptor tolerance

      Rebound bronchoconstriction

      Increased inflammation

      Increased response to allergens

      1.Papi A, et al. Asthma. Lancet. 2018;391:783-800.

      I refer to these useful PCRS documents:

      https://www.pcrs-uk.org/resource/good-asthma-review

      https://www.pcrs-uk.org/sites/pcrs-uk.org/files/AsthmaGuidelinesInPractice_FINAL_0.pdf

      Like 1
  • Having the same problem - pharmacy cannot keep up with the demand for salbutamol. Being very strict with only issuing 1 salbutamol. Conversation and written needs to go with each script. 

    Like 1
  • Accessing risk of staff - apologies for yet another post - risk assessment of staff with respiratory conditions who have required oral steroids' over the past year. I would rate them at higher risk just as I would have heightened alert if they came to see me before all of this. Management are removing from face to face contact duties but is this enough and should they be self isolating ??? Any thoughts.

    Sun is shining in Suffolk this morning :) 

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  • Hi everyone,

    Can you tell me if anyone has sent out advice to Primary Care to ensure a consistent approach to requests for rescue packs and those wanting to restart inhalers for asthma after many years?

    Ive been on holiday for a week and am trying to catch up, so would like to pinch with pride!

    Medway CCG has sent something out but any direction from elsewhere for comparison would be good at the moment!

    KR Lisa

    Like 1
  • Hi Lisa. The NHSE/I London Respiratory team is currently working on this. There are various pathways being developed across London and lots of great ideas but herding the amazing clinician passion into a once for London version is the challenge!  . Once there is an agreed London version I will share ...

    Like 3
  • Lisa Chandler Here is the version for Knowsley which is using the Oxford Covid 19 evidence service approach to assessing breathlessness over the phone and something that most pathways I have seen are now including https://www.dropbox.com/s/wkoivw1rlqnpgo8/Knowsley%20Community%20and%20Primary%20Care%20Pathway.pptx?dl=0

    Like 1
    • Noel  Thanks that is really useful

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    • Noel Hi again, do you have a modifiable version please? or a contact for one? We would like to use it locally, with a couple of tweaks to meet our local provision. Thanks in advance

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    • Lisa Chandler its from Sarah Sibley at Liverpool Heart and Chest 

      Like 1
  • Vince Mak  can you "follow" this page and keep people updated about development of London version ?

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  • Yes sure - but may not be immediate!

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  • This discussion piece from Bergamo clinicians about shifting to community centred care for the outbreak. Deliver pulse oximeters to those we try to keep at home? https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0080

    Like 1
  • Hello,

    It was suggested that I could share this piece of my work with you. I collected a few pharmacy/meds Covid19 related topics that were on social media about 2 weeks ago and shared my analysis/thoughts with my own practice. Some are respiratory related. It is meant to be a short, concise document so that it is easy and quick to read. This may be useful for other colleagues.

    Colleagues can change links to inhaler videos to their preferred ones and update other info to reflect their own local guidance....

    Keep up the good work everyone!

    Dany

    Like 4
      • Heather Oliver
      • PCRS Operations Team
      • Heather_Oliver
      • 3 mths ago
      • Reported - view

      Thank you for sharing Dany Ros We've now included those on our COVID-19 Shared Resource page on the PCRS website: https://www.pcrs-uk.org/resource/covid-19-shared-resources-healthcare-professionals We'd like to credit you on the resource. Are you happy for me to include your name? Or we could include your practice if you'd prefer.

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      • Dany Ros
      • Dany_Ros
      • 3 mths ago
      • 2
      • Reported - view

      Heather Oliver I am glad that this resource may be useful to other colleagues and am happy for my name to be attached to it. Thank you.

      Like 2
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