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​Standard clinical assessment and risk of deterioration assessment

This document is to be used with Caring for adults and children in the community with COVID-19: Flow chart and care protocols. It is for use by all clinicians or other staff involved in the care of COVID-positive patients in the community in NSW, including local health districts, specialty health networks, primary care providers, Healthdirect and third-party providers.

On this page

1. Clinical assessment
2. Risk of deterioration
3. Document information

Clinical assessment

Asymptomatic/Mild

Adult symptoms and signs

Patient has no symptoms OR: 

• Mild cough or upper respiratory tract symptoms (incl. sore throat) 
• Nausea, loss of appetite, vomiting but tolerating fluids/food 
• Loss of smell/taste
• Headache, body ache

Child symptoms and signs

Patient has no symptoms OR: 

• Mild upper respiratory tract infection or cough
• Mildly reduced fluid/oral intake
• Mild vomiting or diarrhoea 
• Mild headache, body aches, fatigue

Moderate

Adult symptoms and sign

• Persistent fever >39 C 
• Marked cough 
• Haemoptysis 
• Mild breathlessness 
•  Mild chest pain 
•  Diarrhoea 
•  Abdominal pain 
•  Vomiting 
•  Reduced fluid intake but >50% normal 
• Dizziness on standing up

Child symptoms and signs

• Persistent fever >39 C and not responding to treatment 
• Mild breathlessness 
• Coughing up blood 
• Reduced fluid intake, but >50% normal over last 24 hours 
• Reduced urine output but >50% normal normal over last 24 hours 
• Moderate vomiting and/or diarrhoea 
• Unable to stand or walk

Severe

Adult symptoms and signs

• Shortness of breath / difficulty breathing Confused or drowsy 
• Unable to stand 
• Fluid intake <50% normal 
• Chest pain lasting >10 mins 
• Pale, clammy, mottled skin

Child symptoms and signs

• Moderate to severe breathlessness / difficulty breathing 
• Severely reduced fluid intake (<50% normal over last 24 hours) 
• Severely reduced urine output (<50% normal over last 24 hours)
• Reduced level of consciousness (including drowsiness, confusion, floppiness), seizures 
• Age under 1 month (corrected) with temperature over 38 degrees
• Any other severe symptom

Risk of deterioration

High-risk medical history

• Chronic lung disease
• Cardiovascular disease, including hypertension
• Active cancer
• Immunosuppression
• Chronic kidney disease
• Transplant
• Diabetes
• Liver disease
• Frailty
• Disability (physical or intellectual)
• Significant mental illness
• Significant drug and alcohol dependence
• Pregnancy
• Obesity − BMI >30 in adults − >95th centile for age and sex in children
• Aboriginal and/or Torres Strait Islander
• Pasifika background
• Age under 3 months (corrected)

Note: stable intermittent/episodic asthma or mild developmental delay are considered low risk.

High-risk social factors

• Geographical remoteness from higher level care
• Concerns about access to housing, food, medication or other care at home
• Concerns about personal safety at home, including violence, abuse and neglect
• Caring for other household members
• Financial concerns

Additional social risk factors for children

• Parent/carer at high social risk (domestic abuse and family violence, neglect, abuse, drug or alcohol use)
• No identified carer
• Parent/carer has a major medical or mental illness

Document information

Developed by

 NSW Agency for Clinical Innovation

Endorsed by

Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning, NSW Ministry of Health.

Consultation

COVID Care in the Community Subject Matter Expert Reference Group

For use by

NSW Health local health districts, specialty health networks and primary health care