‘Rapid guidance’ from NICE released on managing COVID-19 in primary care

New guidance on community management of patients with suspected and confirmed COVID-19, alongside specific advice on managing those with pneumonia, have been published by the National Institute for Health and Care Excellence (NICE).

The guidelines, released last week, are part of a series of 'rapid guidance' that NICE is developing in response to the coronavirus pandemic. The primary care guidance is accompanied by guidance for managing severe asthma and rheumatological disorders in relation to the pandemic. The recommendations are based on evidence and expert opinion, NICE said, and will be reviewed and updated as knowledge develops during the outbreak.

Community and end of life care

Amongst the clear guidance to GPs regarding managing fever, breathlessness, and other symptoms in the community, there is also advice around supporting people at the end of life. This includes the possibility of educating carers and family members to administer medicines at the end of life.

Pneumonia and respiratory infections

The new guidelines highlight those patients who are more likely to develop severe pneumonia as a result of the virus including those with comorbidities, impaired immunity or reduced ability to cough or clear secretions from the airways.

People with neurological conditions are often at risk of respiratory infection, particularly with regard to a reduced ability to clear secretions, and could be at greater risk of developing pneumonia as a result of COVID-19. The rapid guideline on managing suspected or confirmed pneumonia in adults in the community recommends remote assessment tools, as well as detailing tools not to use. This includes a tool usually recommended by NICE, the CRB65, which should not be used as it risks cross-contamination as well as relying on accurate blood pressure monitoring, harder in a remote circumstance.

NICE highlight that COVID-related pneumonia will become more common as the virus spreads. Clear guidance for GPs on assessing if pneumonia is a result of bacteria or COVID-19 virus is given, with signs of COVID-19 pneumonia listed, and clear advice to only give antibiotics if certain of bacterial pneumonia.

Hospital admissions

The same guidance also highlights various signs and symptoms to suggest possible hospital admission. Clinicians are advised to assess benefits, risks and disadvantages of hospital admission, taking into account service delivery issues and NHS resources during the pandemic.

Clinicians are also urged to discuss the benefits and risks with their patients and to find out whether patients have any established care plans or advanced decisions to refuse treatment.

Useful links:

• ‘COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community’, NICE guideline [NG163] Published date: 03 April 2020
• ‘COVID-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community’, NICE guideline [NG165] Published date: 03 April 2020
• ‘COVID-19 rapid guideline: severe asthma’, NICE guideline [NG166] Published date: 03 April 2020
• ‘COVID-19 rapid guideline: rheumatological autoimmune, inflammatory and metabolic bone disorders’, NICE guideline [NG167] Published date: 03 April 2020