3 Patients not known to have COVID-19

3 Patients not known to have COVID-19

3.1 If patients need to attend hospital appointments, minimise their potential exposure to the virus by:

  • encouraging them not to arrive early

  • texting them when staff are ready to see them, so that they can wait outside the building, for example in their car

  • providing a 'clean route' through the hospital to the department

  • reducing, and ideally eliminating, the time they spend in waiting areas through careful scheduling

  • delivering investigations, procedures and treatment promptly and in 1 stop when feasible

  • ensuring prescriptions are dispensed rapidly and ideally without visiting hospital pharmacies, for example by use of home delivery or NHS volunteers, where available.

Treatment considerations

3.2 When deciding whether to start or continue treatment with a drug that affects the immune system, discuss the risks and benefits with the patient, their parents or carer, and take into account the following in the context of COVID‑19.

  • Is it essential to start this drug immediately?

  • Is it essential to continue this drug?

  • If treatment is needed, is there an alternative with a better risk profile?

  • Is the required monitoring and review feasible?

  • Can monitoring be done remotely or at a frequency that minimises the risk to the patient's safety and wellbeing?

  • Are there any changes to the dose, route of administration or mode of delivery that could make hospital attendance or admission less likely?

    The British Association of Dermatologists has published a risk stratification grid. It includes a list of drugs affecting the immune response that could put patients at risk of severe infection.

3.3 Assess whether it is safe to increase the time interval between blood tests for drug monitoring in patients who are stable on treatment. Take into account the patient's age and any comorbidities.

3.4 Encourage and support shared care, by helping patients carry out elements of their own care.