Patients can enter the virtual ward either via hospital discharge, community team assessment or through an assessment in primary care. All high-risk patients with covid-19 or suspected covid-19 who do not require emergency admission to hospital are held in the virtual ward.
These patients need to be monitored, with pulse oximetry, and safeguarded through care team support in case they begin to deteriorate.
Patients are classified into:
- mild (green, oxygen saturations of 95% or more
- moderate (amber, saturations of 93-94%)
- high (red, oxygen saturations of 92% or lower)
All emergency departments work to these oxygen thresholds so there is no postcode lottery.
Patients with potential covid are assessed slightly differently relative to other populations.
A new requirement of the NHS England guidance is that patients with apparently normal saturations are advised to be exercised with either the 40-step test or the 1 minute sit-to-stand test to check that they are fit for discharge and don't have hidden illness.
In addition, while NEWS2 scores continue to be important, hypoxia and low oxygen levels alone are highly predictive in covid-19. So all patients in the 93-94% oxygen saturation range should be assessed for hospital admission.
Analysis of the range of covid symptoms that most clearly predict a serious case (conducted by the Oxford covid-19 evidence service) shows that the highest predictor of severe covid illness is breathlessness/shortness of breath (and by implication its hidden equivalent, silent hypoxia).
This red-amber-green list of covid symptoms (below), from the Oxford analysis, underscores the findings by doctors in hospitals that low oxygen levels signal worse disease.
|
|
Odds ratio of predicting COVID-19 severity |
|
Breathlessness (Dyspnea + SOB combined) |
4.3 |
|
Myalgia |
2.0 |
|
Chill |
2.4 |
|
Fatigue |
1.4 |
|
Sputum |
1.3 |
|
Dizziness |
1.3 |
|
Cough |
1.1 |
|
Nausea or vomiting |
1.0 |
|
Diarrhoea |
1.0 |
|
Headache |
0.8 |
|
Sore throat |
0.8 |
|
Nasal Congestion |
0.6 |
Breathlessness (or silent hypoxia) is the most predictive symptom of a possible bad outcome from covid, followed by chills (‘shivers’ or ‘rigors’), myalgia (muscle aches) then severe fatigue.
Fever, loss of taste and smell and the other symptoms listed, while common in covid, do not confer higher mortality.
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