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This short video is the first of two aimed at healthcare workers caring for patients with suspected or proven COVID-19, to provide guidance on the clinical assessment of such patients.
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It is important at all times to minimise your contact with potential Covid 19 patients. And to wear personal protective equipment, known as PPE, when doing so. Maintaining your own health is critical, not just for you and your family, but also for your health institution. As previously outlined, your patient should have come through a screening process at entry to a separate location from other patients. They should have washed their hands, and have a garment, mask, or paper towelling available to cover their mouth if coughing.
The majority of your decision-making comes from the history of the illness which should be taken from a distance of 1 to 2 m, and ideally to the side of the patient. The clinical area should be well ventilated and as bare as possible, apart from a chair for the patient, and a table for necessary clinical equipment which should remain in this room for all clinicians to use. Writing of notes should ideally take place in a separate location. Key equipment items are pulse oximeter and thermometer. Consider not measuring blood pressure or auscultating the chest unless crucial to your decision-making as it will significantly lengthen contact time, thus increasing your risk of contracting Covid 19. The most common symptoms of Covid 19 are fever, cough, fatigue, anorexia, dyspnoea, sputum and muscle aching.
It is important to establish any non- communicable diseases the patient may also suffer from, either treated or untreated. And to consider other conditions which may mimic Covid 19, or may be exacerbated by Covid 19, such as asthma, anaemia or heart failure.
In the same way, a pregnant patient may be breathless because she is pregnant. Or may have a fever because of a pregnancy complication. The elderly and immunosuppressed, may present with atypical symptoms, including confusion or gastrointestinal symptoms, and may not develop fever.
So, who is most at risk of developing severe illness, or not surviving Covid 19?
Age and comorbidities are the major risk factors. Patients under 55 years of age have a fatality rate of less than 1%, while those in their 70s have a fatality rate of 8%. Cardiovascular and respiratory disease, cancer and diabetes are the major comorbidities associated with severe disease. It appears at present, that children and pregnant women are no more likely to get severe infection than the general population.
Many patients, especially younger patients, without underlying NCDs have relatively mild symptoms and recover fully and quickly. Deterioration most commonly occurs from day 5 to 13 with a peak at 8 or 9 days. New progressive breathlessness is the key clinical feature, indicating a deterioration. Or acute onset of confusion in older people. Patients discharged to self- isolate at home should be advised to return if they deteriorate.
With further deterioration the following may be noted. Severe breathlessness or difficulty breathing, chest pain, cyanosis, history suggestive of shock such as cold or clammy with mottled skin, new onset of confusion, increasing lethargy or significantly reduced urine output.
No treatment has been found to improve Covid 19 pneumonia, so management is largely supportive care, especially respiratory care. More detailed advice on management and decision-making in Covid 19 will be discussed in the next podcast.
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