Rules on isolation rooms for suspected covid-19 cases in GP surgeries to be relaxed

GPs seeing patients who might have covid-19 can give them a face mask and ask them to sit two metres away from other people in the surgery if no spare room is available, new guidance is expected to say.

Peter Holden, a GP in Derbyshire and a clinical adviser to NHS England on covid-19, said that the advice to use isolation rooms to limit the potential spread of the virus was being updated to reflect “operational reality.”

He told The BMJ that members of the public who thought they might have covid-19 were being signed off by NHS 111 as unlikely to have the virus and sent back to their GP for other unmet healthcare problems, such as a possible chest infection of a more conventional nature. But many were turning up at surgeries still concerned that they had covid-19.

“The patients being sent to see their GP from NHS 111 may not have coronavirus, but they still have a healthcare need. However, practices and patients are presuming they are still dealing with a case of possible coronavirus, which is unlikely,” said Holden.

“Doctors and other health professionals need to get isolation into perspective. At the moment a lot of the guidance is based on academic practice, and this has to be tempered by operational reality. The risk of someone having a positive test result is nine in 4500—the cases and tests in the UK so far. The risk is tiny.”

New advice due to be issued by NHS England in the next week to 10 days would make the procedures needed much clearer, said Holden. “GPs think these patients need to have a separate room, but space is limited in GP surgeries, and my understanding is that the new guidance will advise giving patients a face mask and a seat 2 m from anyone else if there is no room in which to isolate them.”

Holden’s comments follow an article in the Guardian by an anonymous “lead clinician at an urban walk-in health centre in the south of England” who called for a public information campaign “because misinformation is spreading undue alarm and hysteria.”1

The clinician reported how patients who have been told they do not have the virus by NHS 111 are arriving at the centre worried about being infected, leading to the limited rooms being taken up as isolation suites, time spent disinfecting public areas, and telephone calls to Public Health England and hospitals to try to arrange tests.

The clinician also reported waiting overnight with a patient who needed an ambulance to transfer them to hospital for a test, resulting in a 19 hour shift. Meanwhile, staff are sent home as a precaution, and queues of other patients are getting longer.

Bharat Pankhania, a senior consultant in communicable disease control at Exeter University, told The BMJ that the public was not getting the message that covid-19 is not circulating in the UK and that this was causing “mayhem.” He said that 99.9% of people turning up at surgeries would not have covid-19. “During this containment phase, there is a lot of stress, but the virus is not circulating in the UK and there needs to be calm,” he said.

As of 21 February, there have been 76 767 cases of covid-19 recorded worldwide and 2247 deaths. The largest increase in cases on 21 February outside China occurred in South Korea, which registered 52 new cases, 39 among people who had attended the same church service in the city of Daegu. There has been one death in South Korea.