COVID-19 NICE Guidance - Managing pneumonia in adults (community)

The purpose of this guideline is to ensure the best treatment for adults with suspected or confirmed pneumonia in the community during the COVID-19 pandemic.

1. Communicating with patients and minimising infection risk
  • For patients with COVID-19 explain the typical symptoms, that they should follow the UK government guidance, and who to contact if their symptoms become worse
  • Support patients mental wellbeing, signposting to charities and support groups
  • Minimise face-to-face contact
  • For patients with known of suspected COVID-19 follow appropriate UK government guidance on infection prevention and control
  • If a patient shows typical COVID-19 symptoms follow UK government guidance on investigation and initial clinical assessment of possible cases
2. Treatment and care planning
  • When possible, discuss the risks, benefits and likely outcomes of treatment options with patients with COVID-19 and their families and carers
  • Find out of patients have advanced care plans or advanced decisions to refuse treatment, including DNACPR
  • Use decision support tools where available
3. Diagnosis and assessment
  • During the COVID-19 pandemic, face-to-face examination of patients may not be possible – advice is available on how to conduct a remote consultation is available (links in the guidance)
  • Where physical examination and other ways of making an objective diagnosis are not possible, the clinical diagnosis of community-acquired pneumonia of any cause in an adult can be informed by other clinical signs and symptoms such as:
    • Temperature above 38 degrees
    • Respiratory rate above 20 breaths per minute
    • Heart rate above 100 beats per minute
    • New confusion
  • Assessing shortness of breath is important but may be difficult via remote consultation
  • Assessing severity using the follow symptoms and signs:
    • Severe shortness of breath at rest of difficulty breathing
    • Coughing up blood
    • Blue lips or face
    • Feeling cold and clammy with pale or mottled skin
    • Collapse of fainting
    • New confusion
    • Becoming difficult to rouse
    • Little or no output
  • Use assessment tools where possible
  • Differentiate between viral and bacterial pneumonia
  • COVID-19 viral pneumonia may be more likely if the patient:
    • Presents with a history of typical COVID-19 symptoms for about a week
    • Has severe muscle pain
    • Has loss of sense of smell
    • Is breathless but has no pleuritic pain
    • Has a history of exposure to known or suspected COVID-19, such as household or workplace contact.
  • COVID-19 bacterial pneumonia may be more likely if the patient:
    • Becomes rapidly unwell after only a few days of symptoms
    • Does not have a history of typical COVID-19 symptoms
    • Has pleuritic pain
    • Has purulent sputum
4. Managing suspected or confirmed pneumonia
  • Be aware that older people or those with comorbidities, fragility, impaired immunity or a reduced ability to cough and clear secretions are more likely to develop severe pneumonia
  • When making decisions about hospital admission, take into account:
    • The severity of the pneumonia, including symptoms and signs of severe illness
    • The benefits, risks and disadvantages of hospital admission
    • The care that can offered in hospital compared with at home
    • The patient wishes and care plans
    • Service delivery issues and local NHS resources during the COVID-19 pandemic
  • Explain that:
    • The benefits of hospital admission include improved diagnostic tests
    • The risks and disadvantages of hospital include spreading/catching COVID-19 and loss of contact with families
  • Managing breathlessness: be aware that severe breathlessness often causes anxiety which can then increase breathlessness further
  • Antibiotic treatment and corticosteroids – please refer to the guidance for further information

You can read the full NICE guidance here.

Stay up to date with the latest NHS advice here.

Stay up to date with the latest HSE advice here.