NHS national bodies advise identifying patients with possible COVID-19 based on travel history, isolating and testing them

NHS England and Improvement, Department of Health and Social Care, Public Health England

NHS organisations – specifically primary care practices and acute trusts

Letter on 24 January 2020, updated on 31 January, 7 February, 25 February

To identify possible cases as soon as possible and prevent transmission to other patients and staff. Follow-up guidance to update NHS organisations following spread of the virus, with same stated aims

NHS national bodies provide advice to NHS organisations on identifying people with possible COVID-19 based on travel history and isolating and testing possible cases. The advice is to obtain a travel history from all patients with acute respiratory infections, as COVID-19 is most likely to be seen in recent visitors to Wuhan in China. There is advice on isolating and testing possible cases: avoiding direct physical contact unless wearing personal protective equipment (PPE) and getting specialist advice from a local microbiologist, virologist or infectious disease physician. The letter links to Public Health England (PHE) guidance for the NHS on:

• initial assessment and investigation
• infection prevention and control
• guidance on diagnostics
• guidance for primary care.

Key changes in the second version of the advice are expansion of geography for the clinical case definition to cover all of mainland China and inclusion of fever and removal of sore throat from the clinical case definition.

Key changes in the third version of the advice are:

• expansion of geography for the clinical case definition to cover mainland China, Thailand, Japan, Republic of Korea, Hong Kong, Taiwan, Singapore, Malaysia and Macau
• modification of the clinical case definition so that fever without any other symptoms is a sufficient criterion for testing (if the patient has also travelled through relevant countries in the previous 14 days)
• alternative clinical diagnosis for fever in a returning traveller should be considered and tests performed at local NHS laboratories, according to PHE guidance.

The key change in the fourth version of the advice is further expansion of geography for the clinical case definition.