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

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