2 Managing the underlying condition – patients not known to have COVID-19

2 Managing the underlying condition – patients not known to have COVID-19

2.1 If patients need to have face-to-face appointments:

  • ask them to attend with only 1 parent or carer to reduce the risk of contracting or spreading COVID‑19

  • advise parents not to bring their other children if possible

  • ask them to avoid using public transport if possible

  • advise them, their parent or carer to tell the team about any symptoms of COVID‑19 before the appointment. If needed, triage the patient's care as appropriate (cancel or rearrange the appointment, or ask them to attend and treat as suspected COVID‑19).

  • think about alternative face-to-face approaches, such as carrying out home visits if resources allow and follow UK government guidance for infection prevention and control.

2.2 Minimise time in the waiting area by:

  • careful scheduling

  • encouraging patients not to arrive early

  • texting or phoning 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 healthcare setting

  • delivering treatment promptly (such as having phlebotomy services or immunisations ready)

  • dispensing prescriptions rapidly.

2.3 Tell patients and their parents or carers to continue with their usual treatment and monitoring plans at home and remind them of usual safety-netting advice for their condition.

2.4 When deciding whether to start medicines that affect the immune system, discuss the risks and benefits with the patient and their parents or carers. Take into account the following in the context of COVID‑19:

  • Is it safe to delay treatment?

  • If treatment is not needed immediately, undertake watchful waiting.

  • If treatment is needed, is there an alternative with a lower overall risk for the patient?

  • 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?

2.5 For patients who are already taking medicines that affect the immune response, continue treatment to minimise the risk of graft rejection, a relapse or flare-up. Discuss the risks and benefits with the patient and their parents or carers. Reduce the risk to the patient's safety and wellbeing and minimise face-to-face contact, by reviewing:

  • dosage

  • mode of delivery

  • route of administration that could make hospital attendance or admission less likely (such as using community outreach teams if available)

  • frequency of monitoring

  • whether monitoring can be done remotely.

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