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:

MildModerateSevere / 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

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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