COVID-19 Health Guidelines
The National Institute for Health and Care Excellence NICE has released guidelines on the management of patients suspected and confirmed with COVID-19. These guidelines cover recommendations for health conditions, including severe asthma, pneumonia, rheumatological disorders, and also guidelines on the management of COVID-19 related symptoms.
According to NICE, individuals with the above health conditions are at more risk of contracting the novel coronavirus and even getting critically ill. These guidelines are based on evidence and expert opinion and are aimed at maximizing the safety and care of these patients by making use of NHS treatment resources amidst this pandemic.
Severe Asthma
NICE recommends that patients with severe asthma who are either suspected or confirmed with COVID-19 should continue taking their regular medications and reduce their appointments to reduce exposure and risk of infection. The patients are also advised to maintain hygiene by regularly cleaning their medical equipment, including the mouthpieces, spacers, flow meter, and face masks using detergents and avoid sharing their inhalers with anyone else.
Clinicians are also directed to train the patients on how to self-administer the treatment at home or refer them to the nearest community clinic to reduce the number of hospital appointments. To maintain the supply chain of asthma medications, clinicians have also been advised to give prescriptions of a maximum of 30 days for each patient.
Pneumonia
As the COVID-19 continues to spread, more pneumonia cases are most likely to be caused by a virus rather than bacteria. Since viral pneumonia will not respond to any antibiotics, clinicians are advised to prescribe and administer antibiotics only when bacteria is the most likely cause, when they cannot establish whether it viral or bacterial pneumonia or when the patient exudes life-threatening symptoms with high-risk complications.
The guidelines also provide information on how to differentiate between viral and bacterial pneumonia. If the symptoms persist or worsen rapidly after or before taking the antibiotics, patients should seek medical attention immediately.
Rheumatological Disorders
Patients with rheumatological autoimmune, inflammatory, and metabolic disorders who contract COVID-19 should continue taking their medications but also seek medical intervention on which medicines are safe to continue using and which they should quit using temporarily. When dealing with such patients, clinicians should be aware that patients using immunosuppressants may develop atypical symptoms of Covid-19, like the absence of fever or cough.
If they continue feeling unwell, the patient should seek professional advice from their rheumatology team regarding the medications. If the conditions worsen despite these efforts, the patient should contact NHS 111 for advice on COVID-19.
Guideline on symptom management
NICE has also provided health professional guidelines on how to manage symptoms, including cough, fever, breathlessness, anxiety, delirium, and agitation in COVID-19 patients.
People are advised to treat mild cough using simple non-drug measures such as the use of honey and other natural remedies and by avoiding laying on the back, which can accelerate and worsen coughing. If the cough persists, clinicians should consider the use of short-term medications such as codeine linctus, codeine phosphate tablets, or morphine sulfate.
Fever should be treatable using paracetamol, while those experiencing breathlessness are advised to remain in a cool room and maintain a clear airflow by keeping their windows open. NICE also provides several guidelines on controlled breathing techniques that are effective in managing these symptoms.
Opioids and benzodiazepine combination is recommended for patients with COVID-19 experiencing mild to severe breathlessness, who are nearing the end of life. Due to the shortage of drugs, clinicians are directed to administer smaller quantities of the drugs to patients nearing the end of life.
More guidelines will be announced in due course and are likely to include advice on COPD, Cystic fibrosis, and dermatological conditions in patients receiving immunotherapy.
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