Coronavirus: Resources to help GPs manage high-risk and vulnerable patients

GPonline highlights information for different groups of patients and those with specific clinical conditions about the risks associated with COVID-19.

Pregnant women are not any more susceptible to complications than the general population (Photo: Mike Harrington/Getty Images)
Pregnant women are not any more susceptible to complications than the general population (Photo: Mike Harrington/Getty Images)

A number of health charities and medical organisations are producing clinical advice on COVID-19 for different patient groups and those with specific conditions. GPs may find this information useful in consultations, or to direct patients to.

This is not at exhaustive list and will be updated as further information by other organisations is produced. If you find any useful resources that you think other GPs or primary care health professionals could benefit from knowing about, please let us know by emailing gponline@haymarket.com

For details of official guidance from NHS England and Public Health England and Public Health Scotland on what GPs should do if they suspect a patient has coronavirus - see here.

Social distancing

The following groups of patients have been told to undertake social distancing (see link to guidance below):

  • Those aged 70 or older (regardless of medical conditions)
  • Pregnant women
  • Those under 70 with an underlying health condition:
    • chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
    • chronic heart disease, such as heart failure
    • chronic kidney disease
    • chronic liver disease, such as hepatitis
    • chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy
    • diabetes
    • problems with spleen – for example, patients with sickle cell disease or who have had their spleen removed
    • a weakened immune system as the result of conditions such as HIV and AIDS, or medicines such as steroid tablets or chemotherapy
    • being seriously overweight (a body mass index (BMI) of 40 or above

Full guidance on social distancing and vulnerable groups is here.

Shielding

Patients with the following conditions are at greater risk of severe complications and NHS England has advised these patients to stay at home at all times and avoid face to face contact for at least 12 weeks. Full guidance for patients is here:

  • People with a solid organ transplant such as a kidney or liver transplant
  • People with cancer who are undergoing active chemotherapy or radical
  • radiotherapy for lung cancer
  • People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
  • People having immunotherapy or other continuing antibody treatments for cancer
  • People having other targeted cancer treatments which can
  • affect the immune system, such as protein kinase inhibitors or PARP inhibitors.
  • People who have had bone marrow or stem cell transplants in the last 6
  • months, or who are still taking immunosuppression drugs.
  • People with severe respiratory conditions including all cystic fibrosis,
  • severe asthma and severe COPD.
  • People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell)
  • People on immunosuppression therapies sufficient to significantly increase risk of infection
  • People who are pregnant with significant congenital heart disease
  • All patients on the following medications: azathioprine, mycophenolate (both types), cyclosporin, sirolimus, tacrolimus

Practices are also expected to identify other patients on their list that could be deemed to be 'very high risk' and provide them with advice about shielding.

Those people most at risk have been advised to access help by visiting www.gov.uk/coronavirus-extremely-vulnerable.

Advice for pregnant women

The Royal College of Obstetricians and Gynaecologists (RCOG), along with Royal College of Midwives (RCM), Royal College of Paediatrics and Child Health (RCPCH), Public Health England and Health Protection Scotland, have published guidance for healthcare professionals on COVID-19 infection in pregnant women.

This will be regularly updated as new evidence relating to the virus emerges. The organisations have also published useful information for pregnant women and their families here.

According to the guidance, pregnant women do not appear to be more susceptible to the consequences of infection with COVID-19 than the general population. It is expected the large majority of pregnant women will experience only mild or moderate cold/flu like symptoms, if they contract the virus.

There is no evidence to suggest an increased risk of miscarriage or that the virus can pass to the baby.

The RCOG, RCM and RCPCH have reiterated that these points both remain the case, following the advice from the government on 16 March that pregnant women should self isolate. The royal colleges said the government recommendation 'is purely a precautionary measure, to reduce the theoretical risk to the baby’s growth and a risk of preterm birth should the mother become unwell'. 

Advice for patients with diabetes

Diabetes UK has produced advice about COVID-19 for patients with diabetes here. This page is being regularly updated.

The coronavirus can cause more severe symptoms and complications in patients with diabetes. The current advice for those who develop symptoms of COVID-19 is to continue to take their medication and call NHS 111. Patients who routinely monitor their blood glucose should do this more often while they are unwell.

Advice for patients with asthma and COPD

Asthma UK has produced guidance for patients with asthma here. The key advice is for patients to keep taking their preventer inhaler daily as prescribed and to carry their reliever inhaler with them every day.

The British Lung Foundation has also produced advice here. Patients should make sure they know the signs of an exacerbation and that they have a plan in place for what to do should they have a flare-up. Patients should not use a facemask due to lack of evidence of their effectiveness and because they could make breathing more difficult. The charity also advises patients who smoke to quit.

NHS England has advised that pulmonary rehabilitation courses should be suspended. It recommends directing patients to the BLF’s exercise videos here.

Advice for patients with heart or circulatory disease

The British Heart Foundation has produced this guidance for patients with heart or circulatory disease. It points out that patients who have had a heart transplant or pregnant women with a heart condition are classed as 'very high risk' and should be following the government's shielding guidance (see above). Other groups are advised to stay at home and practise social distancing.

The BHF advises patients with Brugada syndrome or Long QT syndrome who experience symptoms of coronavirus (especially a high temperature) to call 111 and tell them about their heart condition. These patients may need extra ECGs to monitor their heart, and their condition may affect what treatment they should have for COVID-19.

Advice for patients with cancer

One Cancer Voice, a group of cancer charities that includes Cancer Research UK and Macmillan Cancer Support, has produced a useful advice sheet on coronavirus for people with cancer and those who have had cancer in the past, which you can find here.

Patients with cancer are among those at higher risk of complications from COVID-19. Those most at risk of becoming seriously ill if they contract the virus are:

  • People having chemotherapy, or who have received chemotherapy in the last three months
  • People having immunotherapy or other continuing antibody treatments
  • People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors
  • People having intensive (radical) radiotherapy for lung cancer
  • People who have had bone marrow or stem cell transplants in the last six months, or who are still taking immunosuppression drugs
  • People with some types of blood cancer, even if bthey have not needed treatment

Patients may also have concerns about ongoing treatment should the UK experience a significant outbreak of COVID-19. The charities say that they are reassured that the NHS will continue to provide treatment as normal and treatment plans would only be changed if there was no alternative.

Advice for patients who don't speak English

Doctors of the World has produced advice on coronavirus in 20 languages, which were developed with the Red Cross, Migrant Help and Clear Voice. You can access these here.

Advice for patients with Addison's diseases

Addison’s Disease Self help group has some useful resources for patients and healthcare professionals including ‘sick day rules’. You can find this here.

Advice for people with liver disease

The British Liver Trust has produced information for patients with liver disease and liver transplant patients here.

Advice for patients with Crohn's disease or ulcerative colitis

Crohn's and Colitis UK has produced advice for these patients here.

Advice for patients with spinal injuries

The Spinal Injuries Association has produced advice for patients with spinal cord injuries (SCI) after being contacted by patients asking whether they should be classed as 'vulnerable' or 'at risk'. You can find this here. Patients can also call their advice line on 0800 980 0501.

The association says: 'There are no indicators that SCI adults or children are more likely to catch coronavirus, but as many SCI people have suppressed immune systems or respiratory issues, and all SCI people face the risk of additional infections and conditions related to bowel, bladder and skin, often through lack of knowledge of SCI care requirements in a hospital setting, the impact of contracting coronavirus may be more severe.'

It adds that each patient will need to make their own decision about whether they decide to undertake social distancing/self isolation or shielding.

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