PDA Pandemic Series Update – 23 May 2020

In this issue:

• COVID-19 symptoms
• COVID-19 testing
• Update: Hydroxychloroquine and cardiovascular side effects
• Managing Medicines in community for COVID-19 Symptomatic patients
• Update: Coronavirus and your Diabetes
• Guidance: Valproate Pregnancy Prevention Programme – temporary advice for management during coronavirus (COVID-19)
• Guidance on the management of drugs requiring monitoring during COVID-19
• Influenza Season 2019/20: ending the prescribing and supply of antiviral medicines in primary care

Clinical update 

COVID-19 symptoms

Earlier this week the general clinical case definition for COVID-19 was updated to include loss of or change in smell or taste. Medically known as Anosmia. It is now:

New continuous cough OR fever OR loss of/ change in smell or taste

Everyone, including health and social care workers, should self-isolate if they develop a new continuous cough or fever or loss of/ change in smell or taste. Anyone else in the individual’s household should also self-isolate for 14 days as per the current guidelines and the individual should stay at home for 7 days, or longer if they still have symptoms other than cough or loss of sense of smell or taste.

COVID-19 testing

On Monday (18 May) the Health Secretary revealed that anyone over the age of 5 years with symptoms of COVID-19 will now be able to apply for a Swab test, also known as PCR (polymerase chain reaction) tests. This would involve using a long cotton bud and taking a swab of the back of the throat and inside of the nose. The tests can be applied for here:

The main symptoms of coronavirus are:

• high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
• new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
• loss or change to your sense of smell or taste – this means you’ve noticed you cannot smell or taste anything, or things smell or taste different to normal.

Most people with coronavirus have at least one of these symptoms. To check if you have symptoms for Coronavirus, click here.

The full list of symptoms as per the World Health Organisation (WHO) include:

Most common symptoms:

• fever
• dry cough
• tiredness.

Less common symptoms:

• aches and pains
• sore throat
• diarrhoea
• conjunctivitis
• headache
• loss of taste or smell
• a rash on skin, or discolouration of fingers or toes.

Serious symptoms:

• difficulty breathing or shortness of breath
• chest pain or pressure
• loss of speech or movement.

Update: Hydroxychloroquine and cardiovascular side effects

Recently there has been an increased interest in the use of chloroquine and hydroxychloroquine in the context of COVID-19 which is currently under evaluation in trials. There are potential cardiovascular side effects associated with their use and currently there is insufficient evidence to warrant use of this drug to treat coronavirus. The links below from the European Society of Cardiology and the British Heart Foundation provide further information on hydroxychloroquine use.

• Is hydroxychloroquine a “miracle cure” for coronavirus?
• Chloroquine and cardiovascular side effects

Managing Medicines in community for COVID-19 Symptomatic patients

Pharmacy owners and pharmacists need to ensure that they implement measures to protect staff, patients, and customers by introducing procedures to minimise the risk of coronavirus transmission. This would involve undertaking a risk assessment to ensure that any potential risk from disease or infection is eliminated or controlled.

Health and safety legislation places a legal duty on both employers and employees to ensure safety in the workplace. The purpose of this guideline is to provide recommendations about managing medicines for these patients to and protect staff from infection.

Update: Coronavirus and your Diabetes

The below link summarises and signposts to medicine-related guidance that has been produced by professional and government bodies relating to coronavirus and diabetes. This does not contain any information about specific medicines, however, the SGLT2i class of medicines has been highlighted. The following sections were updated on 19 May:

• Symptoms of coronavirus
• Staying at home
• Children and school
• Work and coronavirus.

Guidance: Valproate Pregnancy Prevention Programme – temporary advice for management during coronavirus (COVID-19)

During the coronavirus (COVID-19) pandemic, to support adherence to the pregnancy prevention requirements for girls (of any age) and women of childbearing potential taking valproate, The MHRA have published an update on managing this cohort of patients which incorporates a video virtual consultation (preferable) or telephone consultation. Other options are available which can be found on the link below.

Guidance on the management of drugs requiring monitoring during COVID-19 

This link provides advice on Warfarin, Lithium monitoring as well as DMARDS.

• Guidance on the management of drugs requiring monitoring during COVID-19
• RCGP Guidance on workload prioritisation during COVID-19

Influenza Season 2019/20: ending the prescribing and supply of antiviral medicines in primary care – issue date 18/5/20 

The most recent surveillance data from Public Health England (PHE) indicates that circulation of influenza in the community has returned to baseline levels.

GPs and other prescribers working in primary care should no longer prescribe antiviral medicines, for the prophylaxis and treatment of influenza on an FP10 prescription form. Community pharmacists should no longer supply antiviral medicines in primary care, on presentation of an FP10 prescription form.