COVID-19 Patient Clinical Management

UNCONTROLLED WHEN PRINTED

Introduction

This guideline is for patients ≥ 16 years of age with confirmed or strongly suspected COVID. Patients under 16 years old should be treated as per the interim guidelines.

For guidance on this, please see epidemiological criteria found here.

COVID-19 is the illness caused by infection with SARS-CoV-2. It has multisystem features, but upper and lower respiratory features are most prominent. Other clinical presentations include gastrointestinal illness, neurological dysfunction and cardiac dysfunction.

Confirmed or suspected COVID-positive patients must be fully assessed to exclude other serious conditions, particularly as the disease has the potential to cause or exacerbate other pathologies.

The Omicron variant is at high risk of becoming the dominant strain in WA. This strain is characterised by extremely high transmissibility via the airborne route and, in most patients, a milder clinical course than previous variants (although this finding may just reflect the very high vaccination rate in the community).

Clinical Presentation

Fever (≥37.5⁰C) or recent history of fever (e.g. night sweats, chills)
Acute respiratory infection (e.g. cough, shortness of breath, sore throat)
Acute loss of smell or taste
A positive or inconclusive rapid antigen test result

Other reported non-specific symptoms of COVID-19 include: fatigue, headache, runny nose, acute blocked nose (congestion), muscle pain, joint pain, diarrhoea, nausea/vomiting and loss of appetite.

Based on your assessment of the patient, they can be categorised into 4 groups:

Mild	Moderate		Severe / Critical
Symptoms	Symptoms + Lung involvement		Symptoms + Lung involvement + Hypoxia / Shock
Cough Sore throat Fever Body aches Mild tachycardia (100-120bpm) Headache Mild GI symptoms No clinical features suggestive of moderate or severe disease No new SOB or difficulty breathing on exertion If the patient has any significant risk factors (see below), they should be moved into the low risk category	Low risk SpO₂ ≥ 92% at rest Shortness of Breath (SOB): Exertional, not worsening RR 20 - 24 Extreme fatigue preventing self-care Dizziness (mild) that is momentary and self-resolving Moderate GI symptoms likely to cause future severe dehydration If the patient has any significant risk factors (see below), they should be moved into the high risk category	High risk SpO₂ ≥ 92% at rest Shortness of Breath (SOB) At rest or worsening RR 25 - 29 Exertional hypoxia Severe dehydration Syncope / severe dizziness Significant risk factors with inadequate support	SpO₂< 92% Severe Shortness of Breath RR ≥ 30 HR ≥ 120 BP < 90 Altered conscious state Confusion / drowsy Cyanosed / cold / pale / mottled skin Haemoptysis (frank) Respiratory failure
Management Advice
Self-care	Timely medical review	Emergency department review	Urgent prehospital care
Self-care advice Safety netting Refer patient to HealthyWA Website	Advise patient they require a medical review, and to call their GP as soon as possible, OR VEM Ambulance referral or Self-present to ED if possible if risks cannot be appropriately addressed, transport	VEM Ambulance referral (preferred) OR Transport Manage as per CPGs	Oxygen Normal Saline IV as per CPG Consider pre-alert facility Manage as per CPGs

Risk Factors

Shortness of breath is one of the strongest predictors of deterioration to severe illness.

Many patients with COVID-19 will have typical viral gastrointestinal symptoms such as nausea, vomiting, diarrhoea and abdominal cramping. Abdominal pain is often related to diarrhoea and is typically benign. However, maintain a high index of suspicion for a surgical or gynaecological causes co-presenting with COVID-19.

There is no specific number or type of risk factors that dictates transport vs non-transport. The greater the number of risk factors, the higher the overall risk. Where there are multiple significant risk factors present and little support available, consider transport if there is no other way to address risk.

High risk factors include:

Demographic	Comorbidities	Environmental
Elderly / frail (risk increases with age >65) Indigenous (>50 years increases risk) Obesity History of smoking Low health literacy Low digital literacy Unvaccinated or partially vaccinated Pregnant	Lungs: chronic lung disease of any cause (e.g. asthma, COPD, bronchiectasis) Heart: conditions affecting the heart or circulatory system (CVD, IHD, CCF, HTN) Immune system: any immunocompromise (e.g. diabetes, chronic kidney or liver disease, chemotherapy, steroids, other immune suppressants) Mental health conditions: serious mental health problems (e.g. schizophrenia, bipolar disorder, major depressive disorder) Disability: Significant physical or intellectual disability, down syndrome	Risk of violence, abuse or neglect Poor access to health care Remote location concerns about personal safety or care

Management considerations

Management is outline above based on specific presenting clinical condition, the following is general guidance for all patients

When approaching any scene, ensure you comply with current Personal Protective Guidelines as published in the interim guidelines
Conduct, where possible, a distanced or "From the Door" assessment as outlined in the COVID-19 Quick Reference Guide
Manage in line with COVID-19 Clinical Response and relevant Clinical Practice Guidelines
If transporting, refer to current hospital processes for assigned destination as outlined on Connect for Metropolitan Hospitals and Country Hospitals

Document Control

Directorate

Clinical Services

Responsible Manager

Head of Clinical Services

Date

Review Date

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