Ongoing Assessment

Establish what day this is in the course of the patient's COVID-19 illness and continue the clinical review cycle until at least day 10. See the Covid-19 illness timeline.

For vaccinated cases, the isolation time is 10 days, provided the previous 72 hours were symptom free.

Unvaccinated cases, the isolation time is 14 days provided the previous 72 hours were symptom free.

Clinical review cycle

• Patients in COVID-19 Care 1 are reviewed by a suitable clinical practitioner on alternate days (including weekends) or as clinically appropriate, unless escalated to COVID-19 Care 2. This can be a nurse, NP or GP (if this is provided by a nurse, then NP or GP support must be available if required). • At COVID-19 Care 2:

• higher risk patients are reviewed by a suitable clinician daily (including weekends), with additional checks as clinically indicated. Patients should have access to a pulse oximeter if they have personal risk factors for

COVID-19 Care 2.

• lower-risk patients self-monitor symptoms daily and may receive lower frequency of clinical assessment, but the household is contacted frequently.

Self-monitoring

• Advise the patient to: • record symptoms and observations 3 times a day. • watch for worsening symptoms. • only seek medical care outside the home on the advice of their medical care team. • what to do if their condition deteriorates.

What to do if their condition deteriorates

Advise the patient to call 111 if acute care is consistent with their wishes and they experience any of the following:

• Severe trouble breathing or severe chest pain

• Confusion or not thinking clearly • Feeling faint or passing out (losing consciousness) • Haemoptysis

Advise the patient to inform the ambulance service that they are COVID-19 positive. Reassure them they will still receive care.

If acute admission is not consistent with the patient's wishes, advise them to contact their clinical team.

Advise the patient to contact their clinical team if they experience any of the following:

• New or worse trouble breathing • Symptoms getting worse • Start getting better and then get worse • Symptoms of severe hydration, e.g.:

• having a very dry mouth • passing only a little urine • feeling very light-headed

The likely time course of the illness.

How to seek help for unwell household members

Advise to seek medical advice:

• Between 8 am and 5 pm, contact the household member's usual general practice clinic. • After hours, contact the COVID-19 Healthline – phone 0800358545 or (09) 3585453.

Advise not to self-present to any medical clinic or emergency department.

If they need to call an ambulance, ensure they inform the ambulance service of COVID cases in the house. Assure them the service will still be provided if appropriate.

Review symptoms and perform remote examination

Monitor trends over time and take account of the full clinical picture. The symptom complexity and changes in features over time may be more significant than isolated responses.

• Assess breathing and general symptoms. See Daily Checklist. • Include video observations, if available.

• To minimise exposure, only perform an in-person examination if it will change clinical management or when you are not confident that remote assessment is adequate. • Consider important acute complications of COVID-19. • Ask about mood and mental wellbeing. • Consider whether symptoms are due to a different new diagnosis or a preexisting condition.

Symptom relief

• Provide medications for symptomatic relief if required, e.g. paracetamol, antiemetic, antidiarrhoeal, electrolyte replacement. • Ask about allergies before providing any medications.

Triggers for moving from COVID-19 Care 1 to 2

Escalate care if the patient develops features indicating moderate severity: • worsening pattern of general symptoms. • mild symptoms with one or more of: • constant fatigue • worsening headaches • worsening cough • becoming short of breath with effort • constant aches

• diarrhoea (frequent loose bowel motions) • chills, fever

• abdominal pain • vomiting • rashes, swelling, or blistering of toes • Fever greater than 38°C • Rising heart rate from normal baseline • Arrange delivery of a pulse oximeter with instructions to the patient or caregiver on how to use. Reassess the patient when the pulse oximeter is available later in