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.
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.
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.
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
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?
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 :)
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!
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 ...
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
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
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!