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COVID-19 NICE Guidance - Managing symptoms in the community

The purpose of this guidance is to provide recommendations for managing COVID-19 symptoms for patients in the community, including at the end of life. It also includes recommendations about managing medicines for these patients and protecting staff from infection.

Communicating with patients and minimising risk

  • For patients with COVID-19 symptoms explain:
    • What the key symptoms are
    • That they and people caring for them should follow the UK guidance on self-isolation/protecting vulnerable people
    • That if their symptoms are mild they are likely to feel much better in a week
    • Who to contact if their symptoms get worse
  • Communicate with patients and support their mental wellbeing, signpost to charities and support groups, where available, to help alleviate any anxiety and fears
  • Minimise face-to-face contact by:
    • Offer telephone or video consultations
    • Cutting non-essential face-to-face follow up
    • Using electronic prescriptions rather than paper
    • Using different methods to deliver medicines to patients

Treatment and care planning

  • When possible discuss the risks, benefits and possible likely outcomes of the treatment options with patients with COVID-19 and their families and carers
  • Put treatment escalation plans in place because patients with COVID-19 may deteriorate rapidly and need urgent hospital admission
  • For patients with pre-existing advanced comorbidities, find out if they have advance care plans or advance decisions to refuse treatment, including DNACPR decisions
  • For patients who are being considered for admission to critical care – follow the critical care in adults guidance.

General advice for managing COVID-19 symptoms

  • When managing COVID-19 symptoms, take into account:
    • Not all patients will have COVID-19
    • The patients underlying health conditions, the severity of the acute illness and if they are taking multiple medicines
    • That older patients with comorbidities such as COPD, asthma, hypertension, cardiovascular disease and diabetes may have a higher risk of deteriorating and need more intensive management
    • Patients with severe symptoms of COVID-19 may deteriorate rapidly and need urgent hospital admission
  • When managing key symptoms of COVID-19 in the last hours and days of life, follow the relevant parts of the NICE guidelines on caring for dying adults.

Managing cough

  • Be aware that older patients or those with comorbidities, frailty, impaired immunity or a reduced ability to cough and clear secretions are more likely to develop severe pneumonia
  • If possible, encourage patients with a cough to avoid lying on their back because this makes coughing ineffective
  • NICE has provided a treatment table for managing coughs in adults

Managing fever

  • Be aware that, on average, fever is most common 5 days after exposure to the infection
  • Advise patients to drink fluids regularly to avoid dehydration (no more than 2 litres a day)
  • Do not use antipyretics with the sole aim of reducing the body temperature – NICE has developed a table of guidance for managing fever in adults and children
  • Advise patients to take paracetamol if they have a fever and other symptoms that antipyretics would help treat, to continue to use only while the symptoms of fever and other symptoms are present.
  • Until there is more evidence paracetamol is preferred to non-steroidal anti-inflammatory drugs such as Ibuprofen

Managing breathlessness

  • Be aware that severe breathlessness often causes anxiety, which can then increase breathlessness further:
    • Keeping the room cool
    • Encouraging relaxation and breathing techniques and changing body positioning
    • Encouraging patients who are self-isolating alone, to improve air circulation by opening a window or door (do not use a fan because this can spread infection)
    • When oxygen is available, consider a trial of oxygen therapy and asses whether breathlessness improves
  • As part of supportive care, the following may help to manage breathlessness:
  • NICE has created a table giving advice on techniques to help manage breathlessness
  • For patients with symptoms or signs of pneumonia see the NICE guidance re managing pneumonia in adults in the community
  • Identify and treat reversible causes of breathlessness, for example, pulmonary oedema
  • Consider an opioid and benzodiazepine – NICE have created a table for further guidance

Managing anxiety, delirium and agitation

  • Address reversible causes of anxiety, delirium and agitation first by:
    • Exploring the patient’s concerns and anxieties
    • Ensuring effective communication and orientation
    • Ensure adequate lighting
    • Explaining to those providing care on how they can help
  • Treat reversible causes of anxiety or delirium, with or without agitation, for example, hypoxia, urinary retention and constipation
  • Consider trying a benzodiazepine to manage anxiety or agitation

Managing medicines for patients with COVID-19

  • Follow UK government legislation on prescribing, ordering, supplying, transporting, storing and disposing of medicines
  • After a patient with COVID-19 has died, follow UK government guidance for infection prevention and control particularly if taking medicines for safe removal and destruction
  • When returning medicines, tell the community pharmacy staff that they are from a patient with COVID-19 so that infection prevention and control precautions can be taken
  • When supporting the patients with symptoms of COVID-19 who are having social care in the community – follow the NICE guidelines on managing medicines for adults receiving social care in the community

Prescribing anticipatory medicines for patients with COVID-19

  • When prescribing and supplying anticipatory medicines at the end of life:
    • Take into account potential waste, medicines shortages and lack of administration equipment by prescribing smaller quantities or be prescribed a different medicine, formulation or route of administration when appropriate
    • If there are fewer health and care staff you may need to prescribe subcutaneous, rectal or long-acting formulations
  • Consider different routes for administering medicines if the patient is unable to take or tolerate oral medicines, such as sublingual or rectal routes, or sub-cut injections

Healthcare workers

  • All healthcare workers involved in receiving, assessing and caring for patients who have known or suspected or COVID-19 should follow UK government guidance for infection prevention and control.

You can read the full NICE guidance here.

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