GPs rise to the COVID-19 surveillance challenge - more help needed

coronavirus image

20 March 2020

Professor Simon de Lusignan, Director, RCGP Research and Surveillance Centre

The RCGP Research and Surveillance Centre (RSC), based at the University of Oxford, has adapted its disease surveillance to meet the challenges of COVID-19 surveillance, to support primary care, patients and the wider population during these trialling times. The additional activities include an extension of the current virological surveillance and testing of people with influenza-like illness (ILI) or lower respiratory tract infections (LRTI) and serology sample collection across all age groups.

Three key activities in primary care surveillance

Data quality – high quality records so we know when COVID-19 peaks

It would be most beneficial if practices can ensure to code for ‘problems’ and the disease when coding. The RCGP RSC needs to track three disease areas to accurately monitor the rise and peak in COVID-19. It is important, even during phone triage, to code as a problem and the disease NOT symptoms. If possible, add the “episode type”, is this a first or new or follow-up?

To accurately track what patients are presenting with, it is important that practices code for any COVID-19 related diagnosis [see printable template here] as well as for the following disease codes:

  • Upper respiratory infections.  Please code otitis media, sinusitis, tonsillitis etc. with what you think – on a balance of probabilities – the likely diagnosis is.
  • Lower respiratory infections.  Again, if the clinician taking the call thinks this is a chest infection, please code this appropriately.
  • Influenza-like-illness (ILI). The RCGP RSC definition is: An acute respiratory illness with a temperature measured/reported/plausibly ≥ 38 °C and cough, with onset within the past 10 days.  ILI cases should not have another more plausible diagnosis. ILI cases have a sudden onset, and there are often symptoms suggestive of systemic upset – myalgia, fatigue, malaise, headache etc. 

When these, especially ILI peaks, it is likely we will have reached the peak of transmission, though like flu there may be more than a single peak. 

The codes used for COVID-19 are:

  • Exposure to 2019-nCov (Wuhan) infection               
  • Suspected  2019-nCov (Wuhan) infection                 
  • Tested for  2019-nCov (Wuhan) infection               
  • Confirmed 2019-nCov (Wuhan) infection
  • Excluded  2019-nCov (Wuhan) infection      

Virological and serological surveillance

We need to treble the number of virology practices in the RCGP RSC network to make sure we can reliably report the spread of the virus, and background levels of (herd) immunity.

In the rapidly changing environment practices are dealing with on a daily basis, the advice to limit non-urgent contact has led us to evolve our virological surveillance by offering self-swabbing to people presenting with ILI or LRTI. These samples will be sent directly to the PHE labs and patients and the practice will be advised of the outcomes.

The serological sampling involves taking additional blood samples of patients already presenting to practice. This surveillance will contribute directly to Public Health England’s Serosurveillance activities, identifying any trends of COVID-19 in immunity the population to report the level of “herd immunity.”  

PHE is committed to keeping a larger number of virological samples long term, as more virology practices will enable us to better differentiate.

Trials of interventions that may mitigate the impact of COVID-19

The practices that are part of the network will be able to contribute to potential future trials of medicines that might modulate the course of the disease, opportunities of which will be communicated throughout the network. We are looking to start some as early as next week!

Want to join the RCGP RSC in COVID-19 surveillance?

Since the outbreak of COVID-19, the RCGP Research and Surveillance Centre has extended its over 50-year collaboration with Public Health England to incorporate COVID-19 into its surveillance.

The College is also working with other national bodies to closely monitor and plan to deal with any potential outcome that may develop in the UK. A vital part of that work will be to monitor the number of suspected COVID-19 cases in the community in a timely way.

The RCGP RSC currently has around 100 practices that contribute to the additional surveillance, and these opportunities will be offered to them. The RCGP RSC always welcomes new practices to become members.

Being a member of the RCGP RSC provides practices the fantastic opportunity for collaboration across primary care to create an observatory of testing and confirmed cases in the network of 4 million. The COVID-19 observatory provides a near real-time update on the cases across the network and the activity within primary care nationally and locally.

In addition to taking part in the current pandemic surveillance, member practices can be involved in research projects, which include funding for practice time. The RCGP RSC offers learning and development opportunities, such as eligibility for RCGP Research Ready accreditation and quality improvement using our practice dashboards. To become part of a bottom-up professionally led network of like-minded practices, please download and complete our data request form [Word] and send it to MedicalDirectorRSC@rcgp.org.uk. If you would like further information please email: practiceenquiries@phc.ox.ac.uk.

 

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