6 Management: patients known or suspected to have COVID-19

6 Management: patients known or suspected to have COVID-19

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

6.2 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.

6.3 If a patient has any signs or symptoms of a possible serious illness (for example, sepsis), assess and treat the illness in line with usual care.

6.4 If other possible diagnoses have been discounted, and COVID‑19 is suspected, follow UK government guidance on investigation and initial clinical management of possible cases. This includes information on testing and isolating patients.

6.5 If a patient is diagnosed with COVID‑19 pneumonia and shows consistent radiological changes, follow the British Thoracic Society's guidance on respiratory follow up of patients with a clinico-radiological diagnosis of COVID-19 pneumonia.

Continuing and stopping treatment

6.6 Before deciding to stop or adjust any treatment, if possible, contact the patient's hospital specialist team for advice. If a medicine is stopped, ask the hospital specialist team when and how to restart it.

6.7 Continue antifibrotics if blood monitoring parameters are in an acceptable range and there is no other reason to stop, such as significant adverse effects.

6.8 If a patient is diagnosed with COVID‑19, think about temporarily stopping immunosuppressants unless the risk of aggravating their underlying lung condition outweighs the benefits of stopping. When deciding whether to stop treatment, discuss the risks and benefits with the patient.

6.9 Be aware that the half-life of some medicines means that the immunosuppressive effect will continue for some time after stopping treatment.

6.10 Advise patients on maintenance oral prednisolone that if they are diagnosed with COVID‑19, they should continue treatment because stopping it can be harmful.

6.11 Be aware that some patients on long-term oral prednisolone may be at risk of an adrenal crisis and may need a higher dose if diagnosed with COVID‑19.

6.12 Stop or adjust doses of medicines for interstitial lung disease if the patient develops acute kidney injury or deranged liver function tests because of COVID‑19, in line with the BNF and the summaries of product characteristics.