Lack of monitoring in England for those in severe phase of coronavirus could reduce survival chances

Concerns are being raised that people isolating at home with worsening Covid-19 symptoms may not call for medical help early enough when they enter the second, more severe, phase of the virus, possibly reducing their chances of survival.

The NHS does not have a proper monitoring system for those suspected of having coronavirus, said Dr Bharat Pankhania, a senior clinical lecturer at the University of Exeter medical school.

“If a patient is developing pneumonia, it can get progressively worse very quickly and hence early admission upon the first signs of difficulty with breathing are very important,” he said.

“It is important for people recovering at home that there be a monitoring system in place too. Something that we have thus far not introduced.”

Quick guide What to do if you have coronavirus symptoms in the UK Show Hide Symptoms are defined by the NHS as either: a high temperature - you feel hot to touch on your chest or back

a new continuous cough - this means you've started coughing repeatedly NHS advice is that anyone with symptoms should stay at home for at least 7 days.

If you live with other people, they should stay at home for at least 14 days, to avoid spreading the infection outside the home. After 14 days, anyone you live with who does not have symptoms can return to their normal routine. But, if anyone in your home gets symptoms, they should stay at home for 7 days from the day their symptoms start. Even if it means they're at home for longer than 14 days. If you live with someone who is 70 or over, has a long-term condition, is pregnant or has a weakened immune system, try to find somewhere else for them to stay for 14 days. If you have to stay at home together, try to keep away from each other as much as possible. After 7 days, if you no longer have a high temperature you can return to your normal routine. If you still have a high temperature, stay at home until your temperature returns to normal. If you still have a cough after 7 days, but your temperature is normal, you do not need to continue staying at home. A cough can last for several weeks after the infection has gone.

Staying at home means you should: not go to work, school or public areas

not use public transport or taxis

not have visitors, such as friends and family, in your home

not go out to buy food or collect medicine – order them by phone or online, or ask someone else to drop them off at your home You can use your garden, if you have one. You can also leave the house to exercise – but stay at least 2 metres away from other people. If you have symptoms of coronavirus, use the NHS 111 coronavirus service to find out what to do. Source: NHS England on 23 March 2020

There is a danger that people will arrive in hospital only when their symptoms are very severe, with more of a risk that they will end up in critical care and possibly die, he said.

The early symptoms of mild disease are a persistent dry cough, a raised temperature and shortness of breath. The advice to anyone with those symptoms in England is to self-isolate at home. They are not told to inform the health service.

Most people recover within a week, but if their symptoms worsen or they still have a high temperature at the end of that time, the instruction is to fill in a form on the NHS 111 coronavirus website if they can – and to call NHS 111 only if they cannot do that. Depending on their answers, they may get a visit from a doctor or be admitted to hospital.

Play Video 3:37 Nurse offers advice on caring for those with coronavirus at home – video

Covid-19 is said to be mild to moderate in 80% of people, but can cause viral pneumonia. In the most serious cases, the immune system fighting the virus overreacts. If that happens, what is known as a cytokine storm attacks their organs. The individual will need ventilation in hospital to take over their breathing and possibly mechanical support for their heart, liver or kidneys.

People with symptoms at home will not get medical help unless they ask for it, unlike in some other countries, which have testing for people with symptoms and monitoring for them while at home.

Health authorities in the southern German city of Heidelberg have introduced a “corona taxi” service, which allows medical personnel to visit patients with the virus at home and assess their progress. This was introduced after virologists and other doctors recognised that it often comes in two waves and that typically on the eighth day, patients’ health can take a turn for the worse.

Patients with confirmed infections or suspected to have coronavirus are being called on a regular basis by student doctors manning phone lines, and based on their accounts, a taxi crew can then arrange to visit them.

Four of the taxis – small buses usually used for school runs – are constantly travelling around the city visiting patients.

“These daily phone calls and house visits would totally overwhelm the doctors here,” said Uta Merle, a medical director for gastroenterology and infections at Heidelberg University hospital, which is why medical students are being drafted in. Eight hundred have so far volunteered.

Hans-Georg Kräusslich, the head of virology at the hospital, told Frankfurter Allgemeine Zeitung the visits are necessary because “often patients don’t have the courage to ring up the clinic and don’t actually take their worsening state seriously”.

Thanks to the taxis, he said, “our colleagues have discovered quite a few patients who they were able to protect from a drastic worsening of their conditions”.

Many have been brought into hospital and put on ventilators as a result. That crucial move made just in time is believed to have saved many lives in Germany. The taxi crews have received letters of thanks from patients, crediting them with saving their lives.

Pankhania said people in the UK are no longer going to hospital for conditions other than Covid-19 in the sort of numbers that would be expected. “For whatever reason, we have frightened off the patient. Those things we should be seeing are not turning up. These people are soldiering on,” he said.

He has himself heard of cases where people were very sick with symptoms resembling those of Covid-19, but did not seek medical help and died at home.

He said it was possible that some people were put off from calling NHS 111 when their symptoms worsened or if they still had a fever after a week – which are the first clues that their condition may be becoming severe.

He also does not think it is satisfactory for people with symptoms not to be tested. “I don’t think that is good enough,” he said. “I used to be a GP. I would want to know who my patients with Covid-19 were. I would call them and ask them how they were. Unfortunately, that doesn’t happen. The GP may or may not be aware of the patient.”

The Office for National Statistics has recently begun to include deaths from Covid-19 in the community, including care homes. They show the total was more than 20% higher than the figure for hospital deaths alone.

• This article was amended on 7 April 2020 to make it clear in the headline, subheading and text that the concerns raised apply to the official advice in England only.