COVID-19: When to refer to Infectious Diseases Team (In-patient) (Guidelines)

• Some patients who test COVID positive on PCR or LFD do not have any COVID symptoms (ie COVID is an incidental finding) or only have mild symptoms* in which case they do not necessarily need to be transferred to ward GC in Raigmore
• These patients still need to be monitored as they can potentially deteriorate particularly within the first 2 weeks of infection

Daily monitoring:

- Clinical history and examination particularly new respiratory symptoms and signs
- Regular (4 hourly) observations

• All patients should have a treatment escalation plan documented in the notes
• If a patient is end of life then transfer to Raigmore ward GC is not appropriate even if symptomatic

The following is a guide when to refer to the Infectious diseases team for consideration of moving to Raigmore ward GC for ongoing management. If ANY of the following apply please contact Raigmore ward GC:

* Symptoms include feverish, chills, sore throat, cough, shortness of breath or difficulty breathing, nausea, vomiting, diarrhoea, headache, red or watery eyes, body aches, loss of taste or smell, fatigue, loss of appetite, confusion, dizziness, pressure or tight chest, chest pain, stomach ache, rash, sneezing, sputum or phlegm, runny nose.

For patients who have hospital onset COVID/ acquire COVID whilst in hospital they may be eligible for COVID-specific therapies (neutralising monoclonal antibodies or antivirals).

Note: for full detailed guidance please see TAM.

ELIGIBILITY CRITERIA: must meet ALL criteria

• Hospitalised for indications OTHER THAN for the management of acute symptoms of SARS-CoV-2 (COVID-19)
• AND SARS-CoV-2 (COVID-19) infection confirmed by PCR
• AND Symptomatic with COVID-19* and showing no signs of clinical recovery
• AND Symptom onset within the last 7 days
• AND Underlying medical condition from ANY of the following:

• • Active malignancy including recent chemotherapy/radiotherapy
  • Transplant recipient (stem cell or any solid organ)
  • Sickle cell disease
  • CKD stage 4 or 5
  • Cirrhotic liver disease
  • Immune-mediated inflammatory disorder
  • Neurological disease including MS, MND, myasthenia gravis, Huntingtons
  • Down’s syndrome
  • Primary immune deficiency or secondary immune deficiency and eligible for immunoglobulin replacement therapy
  • HIV
  • Underlying condition or procedure for which COVID poses a material risk of destabilisation

REFER TO INFECTIOUS DISEASES TEAM ON RAIGMORE WARD GC FOR CONSIDERATION OF COVID SPECIFIC THERAPIES

* Symptoms include feverish, chills, sore throat, cough, shortness of breath or difficulty breathing, nausea, vomiting, diarrhoea, headache, red or watery eyes, body aches, loss of taste or smell, fatigue, loss of appetite, confusion, dizziness, pressure or tight chest, chest pain, stomach ache, rash, sneezing, sputum or phlegm, runny nose.