Tutorial presented by Dr Avkash Jain, GP in CAVUHB and Community Director for PCIC.

During a telephone consultation, assess the likelihood of COVID-19 infection by the presence of the following symptoms:

• New dry cough
• Fever/chills
• Impaired sense of taste/smell
• Lethargy
• Breathlessness

Ascertain the severity of the patient’s symptoms, particularly whether they are showing signs of deterioration. Deterioration, particularly after 7-days increases the risk of mortality in patients with COVID-19, especially when they are in a high risk group.

During a telephone consultation watch out for common red flag features:

• Unable to finish a sentence due to breathlessness (note: evidence suggests that people may not present with breathlessness despite significant hypoxia)
• Breathing harder or faster than usual, or having to lean forward to support themselves to breathe
• They have an audible wheeze
• Significant deterioration in functional status – stopped doing usual daily activities
• Patient reports having blue lips

If the patient presents with any red flags, escalation to hospital may be necessary and this should be discussed with the patient.

Alternative options include:

• Escalation to video consultation where available, for a visual assessment of the patient.
• Attendance for a face-to-face consultation for a full clinical assessment of the patient.
• The patient is comfortable and coping well at home, there are no red flag symptoms and the patient is in the low risk category for COVID-19. Safety netting advice is provided to the patient and they remain at home.