2 Patients not known to have COVID-19

2 Patients not known to have COVID-19

2.1 Minimise time in the waiting area by:

  • careful scheduling

  • encouraging patients not to arrive early

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

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

  • delivering treatment promptly

  • ensuring prescriptions are dispensed rapidly.

2.2 Be aware that worsening gastrointestinal symptoms and deteriorating liver function test results could be associated with COVID‑19.

2.3 Be aware that patients taking drugs that affect the immune response may have atypical presentations of COVID‑19. For example, patients taking corticosteroids may not develop a fever.

2.4 Be aware that patients with decompensated liver disease may be at higher risk of severe COVID‑19 when taking drugs affecting the immune response.

Treatment considerations

2.5 Balance the risks of drugs that affect the immune response with the risks of active disease.

2.6 When deciding whether to start a new treatment with a drug that affects the immune response, discuss the risks and benefits with the patient or their parents or carers, and take into account the following in the context of COVID‑19:

  • Has the patient had COVID-19 vaccination?

  • Is it essential to start this drug immediately?

  • 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?

  • Is there a route of administration that could make hospital attendance or admission less likely? [amended 9 April 2021]

2.7 If a patient is having or going to be having immunosuppressive treatments, follow the advice on COVID-19 vaccination in the Green book and the Specialist Pharmacy Service advice on using COVID-19 vaccines in patients taking immunosuppressive medicines. [9 April 2021]

2.8 For patients who are already taking drugs that affect the immune response, continue with existing courses of treatment to minimise the risk of a flare-up. Think about whether any changes are needed to minimise face-to-face contact during the COVID‑19 pandemic, including:

  • dosage

  • route of administration

  • mode of delivery.

2.9 For patients who are stable on treatment, assess whether it is safe to do less frequent blood tests for drug monitoring. Take into account the patient's age and any comorbidities.