4 Patients with symptoms of COVID‑19 at presentation
4.1 If a patient not previously known or suspected to have COVID‑19 shows symptoms on presentation, the general advice is to follow UK government guidance on investigation and initial clinical management of possible cases. This includes information on testing and isolating patients.
4.2 Be aware that patients having systemic anticancer treatments are immunocompromised and may have atypical presentations of COVID‑19. Also, symptoms of COVID‑19, neutropenic sepsis and pneumonitis may be difficult to differentiate at initial presentation.
4.3 Advise all patients to contact their local cancer chemotherapy helpline (rather than NHS 111) if they feel unwell to ensure their symptoms are appropriately assessed.
4.4 Screen and triage all patients to assess whether they are known or suspected to have COVID‑19, or have been in contact with someone with confirmed infection.
4.5 If patients have fever (with or without respiratory symptoms), suspect neutropenic sepsis because this can be rapid and life-threatening, and follow the NICE guideline on neutropenic sepsis, which recommends:
referring patients with suspected neutropenic sepsis immediately for assessment in secondary or tertiary care
treating suspected neutropenic sepsis as an acute medical emergency and offering empiric antibiotic therapy immediately.
4.6 If COVID‑19 is later diagnosed in someone not isolated from admission or presentation, follow UK government guidance on management of exposed staff and patients in health and social care settings. [amended 26 May 2020]