COVID-19 — Rapid | Doctor’s Passport

Synopsis

Diagnose and manage COVID-19 from current severity, host vulnerability and illness phase, linking supportive care, antiviral eligibility, thrombosis prevention, infection control and follow-up.

COVID-19 ranges from asymptomatic infection to viral pneumonitis and multi-organ critical illness; vaccination and previous infection modify but do not remove severe risk.
Confirm current infection with a validated test when the result changes treatment, infection control or diagnosis, recognising that detection can persist after infectious illness.
Assess respiratory rate, oxygen saturation, work of breathing, mental state, hydration and trajectory; older or immunosuppressed adults may deteriorate without high fever.
High-risk non-hospitalised patients may qualify for early antiviral treatment through current NHS pathways; eligibility, ranking and preferred agent change and must be checked live.
Nirmatrelvir with ritonavir has extensive interactions and renal limits. Complete medication reconciliation and use the current product and commissioning guidance before prescribing.
Hospital treatment depends on oxygen requirement and inflammatory phase; do not use corticosteroids routinely in patients who do not require supplemental oxygen for COVID-19.
Evaluate new deterioration for bacterial pneumonia, pulmonary embolism, myocarditis, acute coronary disease and decompensated comorbidity rather than attributing everything to the positive test.

Key red flags

Viral pneumonitis

Increasing breathlessness, hypoxaemia, tachypnoea and bilateral infiltrates indicate lower-respiratory involvement and need hospital severity assessment.

High-risk early disease

Significant immune suppression, older age and specified comorbidities may meet current NHS criteria for prompt community antiviral assessment.

Alternative emergency

Pleuritic pain, unilateral swelling, focal consolidation, shock, arrhythmia or disproportionate deterioration suggests thromboembolism, bacterial infection or cardiac disease in addition to COVID-19.

Investigation priorities

Validated SARS-CoV-2 molecular or antigen testFirst step

Confirm current infection when diagnosis changes treatment, isolation or cohorting.

Management branches

Stable community illnessSupport and safety-net

COVID-19 is confirmed or likely, observations are stable and no current high-risk treatment criterion is met.

Assess duration, breathing, hydration, comorbidity, pregnancy and support; advise symptom care and current infection-control behaviour.
Explain urgent triggers including worsening breathlessness, hypoxaemia, confusion, persistent chest pain, fainting or inability to drink.
Review if symptoms fail to improve, and assess persistent functional problems rather than repeatedly testing without a clinical question.

Key medicines

Nirmatrelvir with ritonavirStart within the commissioned early-treatment window; the standard adult course is 300 mg nirmatrelvir with 100 mg ritonavir orally twice daily for 5 days when renal function permits.Use the current renal regimen and avoid in severe hepatic impairment. Ritonavir strongly inhibits CYP3A: reconcile antiarrhythmics, anticonvulsants, rifamycins, transplant medicines, anticoagulants, statins, sedatives, herbal and recreational drugs with a live interaction resource. Potent inducers and some narrow-therapeutic-index substrates make an alternative antiviral necessary; do not improvise withholding.

Remdesivir for early high-risk community treatmentWhen selected by the current commissioned pathway, give 200 mg intravenously on day 1 then 100 mg intravenously daily on days 2 and 3, starting within the eligible symptom window.Use a monitored infusion pathway; review hepatic and renal function, prothrombin time and hypersensitivity, and stop or withhold for clinically significant liver injury according to current product guidance. Pregnancy and complex organ failure require specialist benefit-risk review.

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