Refer to boxes 1 and 2 for the current disease severity definitions.*
Currently, the majority of patients cared for in the community have mild illness and most will not require additional support. GPs are increasingly caring for people with mild-moderate symptoms who are at risk of more severe illness. The ability for general practices to provide care for moderately ill patients will depend on access to, and availability of, tertiary health services, clinician’s own abilities and capabilities and the patient’s willingness to be cared for in hospital.
There might be circumstances where, by choice of the patient or where access to hospital services is limited, GPs could be caring for severely ill people in the community. This guide does not provide guidance for care of severely ill patients in the community. Care of severely ill patients should be in collaboration with a hospital-led service.
*Local HealthPathways might use different criteria to define disease severity.
Box 1. Definition of disease severity for adults
|
| Mild illness |
An individual with no clinical features suggestive of moderate or more severe disease:
- no OR mild symptoms and signs (fever, cough, sore throat, malaise, headache, muscle pain, nausea, vomiting, diarrhoea, loss of taste and smell)
- no new shortness of breath or difficulty breathing on exertion
- no evidence of lower respiratory tract disease during clinical assessment or on imaging (if performed)
|
| Moderate illness |
A stable patient with evidence of lower respiratory tract disease:
- during clinical assessment, such as
- oxygen saturation 92–94% on room air at rest
- desaturation or breathlessness with mild exertion
- or on imaging
|
| Severe illness |
A patient with signs of moderate disease who is deteriorating
OR
A patient meeting any of the following criteria:
- respiratory rate ≥ 30 breaths/min
- oxygen saturation < 92% on room air at rest or requiring oxygen
- lung infiltrates > 50%
|
| Critical illness |
A patient meeting any of the following criteria:
- Respiratory failure (defined as any of)
- severe respiratory failure (PaO2/FiO2 < 200)
- respiratory distress or acute respiratory distress syndrome (ARDS)
- deteriorating despite non-invasive forms of respiratory support (i.e. non-invasive ventilation [NIV], or high-flow nasal oxygen [HFNO])
- requiring mechanical ventilation
- hypotension or shock
- impairment of consciousness
- other organ failure
|
| Reproduced with permission from National COVID-19 Clinical Evidence Taskforce. Australian guidelines for the clinical care of people with COVID-19. 2022 (version 57.1). Check for updates in the Taskforce’s Living Guidelines. |
Box 2. Definition of disease severity for children and adolescents
|
| |
Feeding/hydration/conscious state
|
Respiratory/vital signs |
Oxygen requirement
|
| Mild illness |
Normal or mildly reduced feeding |
No or mild upper respiratory tract symptoms
OR
No or mild work of breathing |
|
| Moderate illness |
Poor feeding, unable to maintain hydration without nasogastric or IV fluids
AND
Normal conscious state |
Moderate work of breathing OR
Abnormal vital signs for age (tachycardia, tachypnoea), but does not persistently breach early warning criteria (eg medical emergency team [MET])
OR
Brief self-resolving apnoea (infants) |
Requiring low-flow oxygen and/or with chest x-ray changes due to COVID-19 without other severe features |
| Severe illness |
Poor feeding, unable to maintain hydration without nasogastric or IV fluids
OR
Drowsy/tired, but easily rousable |
Moderate–severe work of breathing
OR
Abnormal vital signs for age (tachycardia, tachypnoea) with breaches of early warning criteria (eg MET)
OR
Apnoea needing support/ stimulation (infants) |
Requires high-flow oxygen or non-invasive ventilation |
Critical
illness |
Poor feeding, unable to maintain
hydration without nasogastric or
IV fluids
OR
Altered conscious state/
unconscious |
Unable to maintain breathing or
prevent apnoea without advanced
modes of support
OR
Abnormal vital signs for age
with persistent breaches of early warning criteria (eg MET)
OR
Haemodynamically unstable without inotropic or vasopressor support
OR
Other organ failure |
Requires advanced modes of
support to maintain oxygenation
Intubation and mechanical ventilation
OR
Extracorporeal membrane oxygenation |
| Reproduced with permission from National COVID-19 Clinical Evidence Taskforce. Australian guidelines for the clinical care of people with COVID-19. 2022 (version 57.1). Check for updates in the Taskforce’s Living Guidelines. |