COVID-19 (Coronavirus)

The symptoms of COVID-19 and other respiratory infections are very similar. It is not possible to tell if you have COVID-19, flu or another respiratory infection based on symptoms alone.

If you have symptoms of a respiratory infection, such as COVID-19, and you have a high temperature or you do not feel well enough to go to work or carry out normal activities, you are advised to try to stay at home and avoid contact with other people.

Symptoms of COVID-19, flu and common respiratory infections include:

• continuous cough
• high temperature, fever or chills
• loss of, or change in, your normal sense of taste or smell
• shortness of breath
• unexplained tiredness, lack of energy
• muscle aches or pains that are not due to exercise
• not wanting to eat or not feeling hungry
• headache that is unusual or longer lasting than usual
• sore throat, stuffy or runny nose
• diarrhoea, feeling sick or being sick

• The most recent government updates are available by searching “Covid” at gov.uk.
• NICE published rapid guidelines for Covid
• The government has published updated guidance for those who are defined as clinically extremely vulnerable (CEV).  Please note that this guidance suggests that there is some evidence that people who are immunocompromised may not mount the same level of immune response to the vaccine. Please bear this in mind if you consider that an immunosuppressed patient may have Covid-19.

There is no longer a legal requirement for people with respiratory infection including Covid-19 to test or to self-isolate, unless they are identified as higher risk from Covid-19.

Please see guidance for the higher risk category, this includes pregnancy, identified individuals with long term conditions who would have been previously identified with their GP at the start of the Pandemic for long term risks, including how to request Covid-19 tests.

In keeping with national guidance, BrisDoc Staff do not need to routinely test or test for Covid-19 when they have symptoms, unless they are identified as higher risk.

Please see guidance for the higher risk category, this includes pregnancy, identified individuals with long term conditions who would have been previously identified with their GP at the start of the Pandemic for long term risks. See further information here.

If you are symptomatic but have not taken a Covid-19 test

If you have symptoms of a respiratory infection and you have a high temperature or do not feel well enough to go to work or carry out normal activities, please consider staying at home.  You are not required to take a Covid-19 test and follow the guidance in this link.

Please stay off work until you no longer have a temperature (if there was one present) or until you no longer feel unwell.  The BrisDoc Sickness / Absence guidance applies and please liaise with your manager.

Working with respiratory symptoms

If you have symptoms of a respiratory infection such as cough and a cold but feel well to work consider working from home.  At BrisDoc, we see some immunosuppressed and vulnerable patients in our treatment centres.  If you do have respiratory symptoms but feel well enough to work, consider working collaboratively with colleagues and avoiding this cohort of patients, work in well-ventilated areas and practice Infection Prevention Control (IPC) measures (see IPC section). Please liaise with your line manager or shift manager to discuss options for where you work.

Please see the following government guidance for more clarity.

If you have a positive Covid-19 test

The national guidance states avoiding contact with people for 5 days after the day the test was taken.  At the end of this period, if you have a high temperature or feel unwell then follow BrisDoc Sickness / Absence guidance until you feel well enough to resume normal activities and you do not have a temperature.  Please liaise with your manager.

BrisDoc staff who have contact with a confirmed Covid-19

National guidance states that individuals are at the highest risk of becoming infected if they have had prolonged close contact with someone with Covid-19.  Please discuss ways to minimise onward transmission with your line manager and follow advice if symptomatic

Patients are seen in either the isolation or clinical rooms.  The isolation room is for people with symptoms of an infection, including Covid-19.  The other clinical rooms are for people who don’t have symptoms of an infection.

If requesting a face-to-face assessment, please ensure your triage notes are clear about whether the patient does or does not have infectious symptoms. You will be required to select the appropriate room when you press the Admin button to arrange the appointment.

For patients needing an appointment, the W&CC will ring them to confirm the appointment time and location. Patients booked to be seen in the isolation room, will be advised to wait in the car, and to ring the Host’s mobile from the car when they arrive. The Host will log the patient’s arrival over the phone, and phone the patient back when the isolation room is available and they are the next patient to be seen. Please take care to ensure that patients are not left waiting in their cars for a prolonged period.

Patients booked to be seen in the clinical rooms will be asked to phone the hosts phone on arrival and will be asked to wait in the treatment centre waiting room.

Isolation rooms and PPE for patients with infectious symptoms

Patients are asked to wear a face mask to their appointment if they are being seen in the isolation room.  Face masks are available at the entrance to the building.

PPE is available at all bases. Clinicians seeing high risk patients (including those with respiratory symptoms) should wear single use apron, gloves, face mask, and single use or re-usable eye protection (visor or goggles).

Goggles are available at each base. Please clean the goggles at the end of every consultation so they can be used again for the next patient.  Please follow latest Infection Prevention and Control guidance.

Once the patient is in the isolation room, the clinician will need to:

• Enter the case record on CLEO in their usual consulting room to start the consultation. Familiarise yourself with the previous assessments/ background clinical information.
• Don PPE and enter the isolation room to assess the patient
• Undertake a focused history and examination, seeking to add to, not repeat, the triage assessment.
• Discuss and agree the plan with the patient. If a prescription is required, agree which pharmacy this should be sent to via EPS.
• Do not login or write your notes in the isolation room to minimise the amount of time you are in there.
• Core medical equipment (sats probe, thermometer, BP machine and cuff liners, stethoscope) are provided in the room. Additional equipment, if required, can be obtained by ringing the Host (number in the room), or taken into the room with you.
• Clean the equipment, chairs and couch using Clinell wipes
• Provide directions for the patient to leave the Treatment Centre directly from your consultation. Patients should not wait in the waiting room before or after the consultation.
• Remove your PPE following the doffing guidance, and any used disposable equipment, and put it into the clinical waste bag.
• Wash your hands thoroughly and leave the isolation room
• If you need anything while you are in the isolation room, please ring the Host
• After the consultation, return to your usual consultation room to write the notes.

Consultation rooms and PPE for patients who do not have any Respiratory symptoms including Covid-19

Patients who do not have Covid-19 symptoms will be seen in clinical rooms.  Clinicians may choose whether to wear PPE when seeing patients in this room. Please clean all equipment using Clinell wipes after use.

Chaperones

The Hosts and Drivers can continue to act as chaperones when required. The chaperone must wear the same PPE as you for that consultation or more if they wish. When triaging patients who may need a chaperone for the F2F, please include this in your triaging notes and CCs will need to make this clear when they approve the F2F.

Home visits

Please consider whether the patient has any infectious symptoms and wear PPE appropriately, following guidance above for face-to-face assessments.

At the end of your consultation, clean all of the re-useable equipment using disposable wipes.  Remove your PPE and place it in a clinical waste bag and leave it at the patients home Please ensure that you do not bring any used PPE back to the car, and all equipment must have been cleaned before you return it to the car.

The Covid-19 oximetry @ Home Virtual Ward has now closed.

The following options are available on Remedy for patients with Covid-19 symptoms.

CMDU Service

• are aged 85 years and over
• have end-stage heart failure and have a long-term ventricular assistance device
• are on the organ transplant waiting list
• are aged 70 years and over, or who have a body mass index (BMI) of 35 kg/m2 or more, diabetes or heart failure, and who are resident in a care home or in hospital

The Resuscitation Council have advised we should be following the 2021 guidelines.  This involves giving breaths.  In the very rare event that you need to do CPR please use the resus masks, found in the resus boxes. The Resuscitation Council UK Guidelines 2021 state - "If you are unable or unwilling (due to the risk of COVID-19) to provide ventilations, give continuous chest compressions."

Remedy has guidance to support primary care clinicians in the diagnosis and management of Long COVID (Remedy BNSSG ICB)