Table 3

Summary of recommendations for the early identification of progressive COVID-19 in the community

Summary opinion on utility of specific symptoms and clinical parameters in identifying the progressive COVID-19 patient
SymptomsPatients who present with or develop symptoms of shortness of breath, dry cough, persistent fever, fatigue, confusion, chest tightness, diarrhoea, vomiting or abdominal pain may be at higher risk of disease progression.
Patients who present with shortness of breath, persistent fever and/or confusion require urgent clinical assessment.
The absence of shortness of breath does not exclude the presence of severe and life-threatening COVID-19 pneumonia. Other symptoms of hypoxia may be present, for example, fatigue or altered mental status.
Duration of illnessDuration of illness is not reliable for predicting disease progression. Patients with COVID-19 can deteriorate at any time.
ObservationsOxygen saturations remain the most useful observation for detecting clinical deterioration in patients with COVID-19.
Normal oxygen saturations or the absence of dyspnoea does not exclude disease progression. Consider postexertion SpO2 measurements where resting SpO2 is normal, and it is safe to do so.
Increased respiratory rate (>20 BPM) is a later sign of disease progression. HR, BP, remp and confusion screen remain useful, particularly for detecting COVID-19 mimickers/complications.
Clinical examinationThere was insufficient evidence to determine the utility of clinical examination as a tool for early identification of COVID-19 disease progression.
Generally, a clinical ‘eyeball’ assessment is of use in detecting the deteriorating patient; however, such an assessment is insufficient to rule out disease progression.
CRPCRP is of significant utility in monitoring disease progression over time.
CRP is of less use at point of first contact, or with a single measurement. If available, it should still be undertaken as a baseline.
CRP >30 mg/L should raise concern that a patient is deteriorating or at risk of deterioration (in elderly a CRP >20 mg/L).
Chest X-rayThe value of referring community COVID-19 patients for chest X-ray to determine disease progression is unknown.
  • BP, blood pressure; CRP, C reactive protein; HR, heart rate; SpO2, oxygen saturations; Temp, temperature.