ࡱ>  "bjbj}} 5`` C>>>$bbbPdbKp2 4f f f ):*1* KKKKKKK$vM(Ph+K>=*)")"=*=*+Kf f 9 @Km-m-m-=*8f >f Km-=*Km-m-A&Bf lYJ+vAJVK0KA6P+P,BBpP>eE=*=*m-=*=*=*=*=*+K+Km-=*=*=*K=*=*=*=*P=*=*=*=*=*=*=*=*=* :  Support for management of the post-Covid patient in general practice Appendix A shows a suggested investigative pathway for general practice in the form of a flow chart Advice and Guidance services for professionals are available to support community management: Telephone advice about medical patients is available from the Severnside GP team 8am-6.30pm Monday-Friday (via the BrisDoc Professional Line 0117 244 ) The  HYPERLINK "https://remedy.bnssgccg.nhs.uk/adults/respiratory/advice-guidance-respiratory/" community respiratory specialist team offers advice and guidance for all patients with respiratory problems, irrespective of whether they have Covid or not (to try to offset acute referrals). It is operational 7 days a week, 0800-18.30. Dial 0333 230 1471. This service can escalate cases for consultant advice on a daily call, Monday to Friday, with on-call support at weekends, as required The British Lung Foundation and the Asthma Society have created a joint, on-line post-covid hub with resources for patients, researchers and professionals  HYPERLINK "https://www.post-covid.org.uk/" https://www.post-covid.org.uk/ In addition, the NHS has launched a new, national web based resource to support patients in their recovery  HYPERLINK "https://www.yourcovidrecovery.nhs.uk" https://www.yourcovidrecovery.nhs.uk and some patients may find that useful in managing their recovery. This section will be amended to reflect any decisions about the Community covid follow up rehabilitation service. Wellbeing and mental health AWP has launched new resources to support wellbeing during the pandemic. Please note these resources are accessible to everyone, not just patients who are receiving care from mental health services: The HYPERLINK "http://www.awp.nhs.uk/news-publications/trust-news/2020/may/covid-19-wellbeing-guides/" AWP Covid-19 Wellbeing Guideprovides lots of useful resources to support wellbeing, including ways to wellbeing, apps, mindfulness, local and national helplines and strategies for coping with Covid-19, so please do share this resource with patients. The AWP Response Line (0300 303 1320) is open 24/7/365 to provide advice, guidance and support over the phone to patients, families and carers, as well as members of the public who may be worried about their own or someone elses mental health. Support for patients who have experienced long-term mental health difficulties or if primary concern is of anxiety/depression then VitaMinds is likely to support best. They offer a range of short-term psychological therapies for a range of mental health difficulties.  HYPERLINK "http://www.vitahealthgroup.co.uk/nhs-services/nhs-mentalhealth/bristol-north-somerset-south-gloucestershire" www.vitahealthgroup.co.uk/nhs-services/nhs-mentalhealth/bristol-north-somerset-south-gloucestershire. Phone: 0333 200 1893 Support services across Bristol, North Somerset and South Gloucestershire.  HYPERLINK "http://www.imhn.org/coronavirus/guide" www.imhn.org/coronavirus/guide.      SHAPE \* MERGEFORMAT   PAGE   PAGE 2 Primary care assessment and management of adults with persistent symptoms following COVID-like illness All patients should be managed remotely wherever possible; we support you to be courageous Remember to consider/ explore non-COVID serious differentials and red flags  COVID-19: BNSSG Primary Care guidance If critically/ severely ill, check ceiling of care/ ReSPECT/ DNAR status. If admission appropriate, call/advise 999 (ensure SWASFT aware if current Covid-19 suspected) Frail and/ or multimorbid patients - palliative care in the community may be the most appropriate management for many as unlikely to benefit from hospital treatment CPR Call 999, defibrillation if indicated. Airway manoeuvres/ interventions are aerosol generating so avoid in primary care.COVID-19 complications: Consider these differentials when assessing patients presenting with persistent or worsening symptoms after a COVID-like illness. The clinical picture is not yet fully understood so this is not a definitive list but will be updated as more guidance and evidence emerges. Usual recovery from Covid-19. Many people who have COVID-19 are asymptomatic or have mild disease and recover quickly over a period of 7- 14 days with variable upper respiratory tract symptoms. 4 weeks: muscle aches, chest pain and sputum production should have substantially reduced (significant sputum production is less common). 6 weeks: cough and breathlessness should have substantially reduced. 3 months: most symptoms should have resolved but fatigue might still be present. 6 months: symptoms should have fully resolved unless the patient has had a complicated ITU stay. Patients with more severe disease (managed in hospital or the community), will likely have a longer recovery particularly if they had additional acute complications or required intensive care. Clinical features which might suggest more concerning complications: PE: breathlessness, pleuritic chest pain Pericarditis: breathlessness, chest pain Myocarditis: breathlessness, chest pain Pulmonary fibrosis: breathlessness, dry cough, inspiratory crepitations on auscultation. Restrictive spirometry (FVC<80%), desaturation on exertion Cardiomyopathy: Persisting breathlessness, ankle swelling Early (< 4 weeks)Later (up to 12 weeks)Late (12 weeks+)CardiovascularPericarditis, myocarditis, PE, DVTPE (acute or chronic)Cardiomyopathy, Pulmonary hypertensionRespiratorySecondary bacterial infectionInterstitial lung diseaseMental healthAnxiety, low mood, guilt, flashbacks, hyperventilation Anxiety, low mood, hyperventilationAnxiety, low mood, hyperventilationGastrointestinalAcute diarrhoeal illness, derangement in LFTs Suggest referral for ongoing diarrhoea > 6 weeks. Post-covid liver fibrosis no clear signals that this existsSystemicPersistent fevers, fatigue, loss of strength, breathlessnessPost viral fatigue, deconditioningPost viral fatigueManagement < 12 weeks after COVID-19 illness Red flags for serious complication or acutely/ seriously unwell, manage according to the most likely differential If frail, consider/ review advanced care plans and whether symptomatic community management most appropriate Psychological comorbidity is significant, explore carefully particularly considering whether SOB could be due to hyperventilation Management > 12 weeks after COVID-19 illness Recognise challenge of non-specific symptoms, unknown true trajectory of disease Consider face to face assessment if not improving in anticipated trajectory (see usual recovery section) See flow chart in Appendix A Advice and guidance services may be able to advise about additional / alternative community management options.  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