3 Managing the underlying condition – patients known or suspected to have COVID-19

3 Managing the underlying condition – patients known or suspected to have COVID-19

3.1 Be aware that:

  • children and young people often show no or mild symptoms of COVID‑19 and very few will develop severe or life-threatening disease, but those who are immunocompromised may be more vulnerable to COVID‑19

  • COVID‑19 can be difficult to diagnose and the symptoms can overlap with symptoms of other diseases

  • patients taking medicines that affect the immune response might have atypical presentations of COVID‑19; for example, those taking prednisolone may not develop a fever

  • COVID‑19 affects children and young people differently to adults so there may be less risk in starting or continuing with medicines that affect the immune system.

3.2 If a patient has any red flag signs or symptoms of a possible serious illness (for example, sepsis, meningitis or febrile neutropenia), assess and treat them in line with usual care for these infections.

3.3 If a patient does not have any red flag signs or symptoms suggesting an alternative diagnosis, follow UK government guidance on investigation and initial clinical management of possible cases. This includes information on testing and isolating patients.

3.4 When patients with symptoms of COVID‑19 have been identified, follow appropriate UK government guidance on infection prevention and control. This includes recommendations on using personal protective equipment (PPE), patient transfers, and options for outpatient settings.

3.5 If COVID‑19 is later diagnosed in a patient not isolated from admission or presentation, follow UK government guidance on management of exposed healthcare workers and patients in hospital settings.

3.6 If thinking about whether to stop usual treatment when a patient has symptoms of COVID‑19, contact the specialist team for urgent advice before stopping any medicines. Discuss the risks and benefits with the patient and their parents or carers, and take into account:

  • the severity of the underlying condition

  • the risks and benefits of stopping or continuing treatment

  • the effect of stopping treatment on other conditions

  • whether COVID‑19 is confirmed

  • the severity of the COVID‑19 symptoms

  • other risk factors such as age and comorbidities, for example, diabetes or severe respiratory, cardiac or inflammatory disease.