COVID-19 NICE Guidance - Managing pneumonia in adults (community)

The purpose of this guideline is to ensure the best treatment for adults with suspected or confirmed pneumonia in the community during the COVID-19 pandemic.

1. Communicating with patients and minimising infection risk
  • For patients with COVID-19 explain the typical symptoms, that they should follow the UK government guidance, and who to contact if their symptoms become worse
  • Support patients mental wellbeing, signposting to charities and support groups
  • Minimise face-to-face contact
  • For patients with known of suspected COVID-19 follow appropriate UK government guidance on infection prevention and control
  • If a patient shows typical COVID-19 symptoms follow UK government guidance on investigation and initial clinical assessment of possible cases
2. Treatment and care planning
  • When possible, discuss the risks, benefits and likely outcomes of treatment options with patients with COVID-19 and their families and carers
  • Find out of patients have advanced care plans or advanced decisions to refuse treatment, including DNACPR
  • Use decision support tools where available
3. Diagnosis and assessment
  • During the COVID-19 pandemic, face-to-face examination of patients may not be possible – advice is available on how to conduct a remote consultation is available (links in the guidance)
  • Where physical examination and other ways of making an objective diagnosis are not possible, the clinical diagnosis of community-acquired pneumonia of any cause in an adult can be informed by other clinical signs and symptoms such as:
    • Temperature above 38 degrees
    • Respiratory rate above 20 breaths per minute
    • Heart rate above 100 beats per minute
    • New confusion
  • Assessing shortness of breath is important but may be difficult via remote consultation
  • Assessing severity using the follow symptoms and signs:
    • Severe shortness of breath at rest of difficulty breathing
    • Coughing up blood
    • Blue lips or face
    • Feeling cold and clammy with pale or mottled skin
    • Collapse of fainting
    • New confusion
    • Becoming difficult to rouse
    • Little or no urine output
  • Use assessment tools where possible
  • Differentiate between viral and bacterial pneumonia
  • COVID-19 viral pneumonia may be more likely if the patient:
    • Presents with a history of typical COVID-19 symptoms for about a week
    • Has severe muscle pain
    • Has loss of sense of smell
    • Is breathless but has no pleuritic pain
    • Has a history of exposure to known or suspected COVID-19, such as household or workplace contact.
  • COVID-19 bacterial pneumonia may be more likely if the patient:
    • Becomes rapidly unwell after only a few days of symptoms
    • Does not have a history of typical COVID-19 symptoms
    • Has pleuritic pain
    • Has purulent sputum
4. Managing suspected or confirmed pneumonia
  • Be aware that older people or those with comorbidities, fragility, impaired immunity or a reduced ability to cough and clear secretions are more likely to develop severe pneumonia
  • When making decisions about hospital admission, take into account:
    • The severity of the pneumonia, including symptoms and signs of severe illness
    • The benefits, risks and disadvantages of hospital admission
    • The care that can offered in hospital compared with at home
    • The patient wishes and care plans
    • Service delivery issues and local NHS resources during the COVID-19 pandemic
  • Explain that:
    • The benefits of hospital admission include improved diagnostic tests
    • The risks and disadvantages of hospital include spreading/catching COVID-19 and loss of contact with families
  • Managing breathlessness: be aware that severe breathlessness often causes anxiety which can then increase breathlessness further
  • Antibiotic treatment and oral corticosteroids – please refer to the guidance for further information

You can read the full NICE guidance here.

Stay up to date with the latest NHS COVID-19 guidance here.