Clinical Assessment and Risk Stratification

This pathway is about remote clinical assessment of patients with COVID-19 aged 15 years or older who are isolating in the community, where the primary care team has accepted handover of clinical care via Public Health and the Covid Primary Response Team (CPRT). Welfare needs will be addressed by the Covid Co-ordination Hub.

1. Establish Covid-19 illness timeline 2. Assess current clinical status (Part 1 and 2) 3. Assess Clinical Risk / disease severity

4. For severe cases arrange acute COVID-19 assessment if escalation to hospital care is required, including assessment for any non-COVID condition. Consider in person assessment1 when escalating to hospital care. (See red flags below and triggers for moving patients to hospital or palliative care.) 5. Assess whether non COVID-19 health care and social supports have been addressed.

This is managed by the Covid Community Co-ordination Hub 6. Liaise with public health and secondary care as needed

Red flags for ED Assessment

• HR >110, SPO2 consistently ≤ 92%, RR >24 • Severe shortness of breath at rest (e.g. Breathlessness RR >30 despite normal O2 sats) • Difficulty in breathing (work of breathing) • Reducing O2 saturation (<92% or down 3%) • Pain or pressure in chest • Decreased oral intake or urine output (dehydrated, needing IV fluids) • Cold, clammy or pale mottled skin • New onset of confusion, becoming difficult to rouse, syncope • Blue lips or face • Coughing up blood

COVID-19 illness timeline

• Date of positive swab result • Date the patient first became unwell • Day of illness the patient is at now. If they are: • symptomatic, day 0 is date of initial symptoms. • asymptomatic, day 0 is date of test

1 In-person assessments. Based on overseas experience, in-person assessment is not usually required to decide management and is only indicated: if it will change management, or when the treating clinician is not confident, they can adequately assess the patient remotely. Consider in-person assessment when escalating to hospital care.

The key elements of an in-person assessment are: 1. taking the history by phone to limit contact, 2. preparing for in-person examination, using: space for examination with good airflow; full personal protective equipment (PPE) and infection prevention and control (IPC) measures; key equipment –pulse oximeter, a thermometer, blood pressure (BP) cuff, and stethoscope.