COVID-19

Aims

The aim of this page is to provide links to reliable sources of information and to our local unit protocols. Given that advice is rapidly-changing, we have linked to original sources rather than replicating advice here.  We have separate patient information about COVID-19

 

Unit Protocols – start here

Almost all of the relevant guidance can be found here (much of it specific for NHS Lothian).

 

External links

Core guidance:

 

Society guidelines

 

Education & further information:

 

What to tell patients

See our page on patient information about COVID-19

The most vulnerable patients are being advised to adopt “shielding” measures.  The Renal Association have published guidance on who this should apply to.

 

Preparing for the pandemic in hospital

How can we prepare for the pandemic?  There are some important steps that every health-professional should take now:

  • familiarise yourself with PPE – make sure you know the answers to these questions – all answers can be found here:
    • what PPE should I use for routine patient contact?
    • what PPE should I use in cases with the potential for aerosolised virus?
    • how do I put PPE on and take it off?
    • what are aerosol-generating procedures?
  • familiarise yourself with guidance on CPR
  • familiarise yourself with local protocols for testing and case-escalation 
  • know what to tell patients about self-isolation, social distancing & shielding

 

Treatment of COVID-19

General principles

Early anticipatory care planning is vital for ALL patients.  (Complete NHS Lothian proforma.)

The management of patients with COVID-19 is the same as for any viral pneumonia / pneumonitis.  Follow the usual principles of good supportive care.  Avoid excessive fluid resuscitation.  Avoid nebulisers or antibiotics unless there is an alternative indication for their use (e.g. asthma or superadded bacterial infection).

Evidence base

There are no high-quality data to support the use of any potential anti-viral or immunomodulatory therapies at present.  Ideally patients should be offered enrollment in an RCT.  Similarly, there are no high-quality data to suggest that we should be avoiding any particular class of medication.  Most expert guidance advises that patients who currently take an ACEi or ARB continue to do so.  Current UK advice is that there is no strong evidence that NSAIDs are detrimental in this context but that given a degree of uncertainty, paracetamol should be used first-line.

Anecdotal evidence

Whilst it would be wise to be wary of anecdotal evidence, a few common themes are emerging from centres with experience of looking after COVID patients.  Early anticipatory planning is vital as is good communication with patients and families.  Patients can deteriorate rapidly around 7 days into hospital admission; in patients who are not expected to do well then the plan for symptomatic treatment should anticipate this.  In haemodialysis patients, aggressive fluid removal may help.

 

Acknowledgements:  The author of this page was Rob Hunter. It was first published 17 March 2020. The date it was last modified is shown in the footer.

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