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Pharmacy technician Vicky is talking to dispensing assistant Farida, who has just arrived for her shift.

“Farida, I need you to go on the counter please – Sam is off today,” says Vicky.

“Oh OK,” replies Farida. “Umm, just one thing though. We’ve been so busy recently that I’ve barely set foot outside the dispensary in weeks. If someone comes in and says they need something for someone who has coronavirus symptoms, what do I say? Obviously, I know to advise them to seek medical help if things look really bad, but is there anything in particular around managing things like cough and fever when it’s thought to be due to Covid-19?”

Answer

This is a really sensible question for Farida to ask, and the following explanations comprise recommendations made by the National Institute for Health and Care Excellence (NICE) in recently published “rapid guidelines” on managing Covid-19 symptoms in the community. Note that the usual care should be taken in terms of checking individual circumstances, such as concurrent conditions, other medication, risk factors for side effects, complications and so on, as well as adhering to product licensing restrictions.

Cough

For mild symptoms, it is best to try non-drug measures such as a teaspoon of honey in a hot drink, and avoiding lying on the back as this renders coughing – which is the body’s way of trying to clear secretions from the respiratory tract – ineffective. If the cough is causing distress, codeine linctus 15mg/5ml can be used, at a dose of 5-10ml every four hours. The addiction potential of codeine linctus should be taken into consideration, and the patient advised on the potential for side effects, including constipation.

Fever

Avoiding dehydration by drinking fluid regularly, albeit no more than two litres per day, should be observed by all patients. Antipyretics may be taken, but are not advised if the sole aim is to reduce body temperature; instead, they only have a place if there is fever plus other symptoms that antipyretics, such as paracetamol or ibuprofen, would help with. The use of ibuprofen for Covid-19 patients has been contentious due to reports of it causing a worsening of symptoms, but the Commission on Human Medidinces Expert Working Group on coronavirus has stated that there is no scientific evidence supporting this and hence NICE highlights it as an option. As is the case for all NSAIDs, care should still be taken to ensure the lowest effective dose is used for the shortest period of time.

Breathlessness

Keeping the room cool and aiding air circulation by opening a window or door can all help, although fans are not advised. Patients can also be encouraged to try relaxation and breathing techniques, as anxiety can worsen this symptom, as well as altering body positioning – for example, by relaxing the shoulders, sitting up rather than lying down, and leaning forward – as appropriate.

The bigger picture

There are measures beyond those outlined above in the NICE document, both in terms of the symptoms that can be managed in the community and the treatments that can be provided, but these involve specialist advice or prescription medicines so are not detailed here.

It is worth bearing in mind that not all patients with the above symptoms will have Covid-19, but without testing, it is difficult to tell. Other symptoms that may point towards Covid-19 include aching muscles, sore throat, headache and loss of sense of smell, but the virus seems to be able to cause a wide range of symptoms, so pharmacy staff should advise customers seeking advice or product recommendations for their loved ones to use information from the NHS website and the NHS 111 online coronavirus service. Caution is needed, as individuals can deteriorate quickly and need urgent admission to hospital in order to manage the pneumonia that can develop.

Extend your learning

• Read the brief evidence summary published by NICE on the use of NSAIDs for people with or at risk of Covid-19
• Get to grips with the body positions that can help ease breathlessness by reading information from NICE
• NICE has published several rapid guidelines relating to Covid-19. Others that may be of interest to pharmacy staff include those on severe asthma, COPD and immunocompromised children. The full list is regularly updated.