It’s crazy to think that a whole year has passed since the UK went into its first lockdown in response to the COVID-19 pandemic. During the early stages of the pandemic, medical efforts were focused on treating the acute viral infection and accompanying severe respiratory disease. Methods for treating the acute infection are now better understood, but the wider and longer-term impacts of the COVID-19 pandemic are now emerging and, as such, the focus is shifting.

‘Long COVID’ is a term that is used to describe the signs and symptoms that continue or develop after acute COVID-19. The symptoms are many and varied, affecting a range of systems in the body and fluctuating in severity. Collectively, these symptoms can leave people severely debilitated. NICE, Scottish Intercollegiate Guidelines Network, and the Royal College of General Practitioners collaborated to produce COVID-19 rapid guideline: managing the long-term effects of COVID-19, which was published in December 2020. Dr Claire Davies identifies six key learning points from the guideline, including how to recognise the symptoms of long COVID, tailoring investigations to the patient’s symptoms, and using shared decision making to develop plans for care and management. There is still much to learn about diagnosing and managing this new and emerging condition; the guideline has been developed using a ‘living’ approach, which means it will be continuously reviewed and updated in response to new evidence.

One of the hidden impacts of the COVID-19 pandemic is the rise in domestic abuse. The National Domestic Abuse Helpline experienced a significant increase in demand during lockdown, with an average increase of around 50% in calls and over 400% in visits to its website.Dr Vasumathy Sivarajasingam shares 10 top tips for recognising and responding to domestic abuse in primary care. There are many forms of domestic abuse and they can have an enormous impact on the wellbeing of victims and their families. Domestic abuse can happen to anyone, however, there are some population groups who are at higher risk. When discussing domestic abuse with patients, GPs should adopt an open, non-judgemental approach; the article includes practical advice for doing this, including questions that can help to open up a conversation about domestic abuse with patients. The article also advocates the use of simple screening questions that can help identify patients who may be experiencing domestic abuse, so that appropriate support can be offered. After reading the article, test your updated knowledge using the multiple-choice questions. 

Domestic abuse_web

Top tips: identifying domestic abuse

Dr Vasumathy Sivarajasingam

Putting COVID-19 aside for just a moment, this issue of Guidelines in Practice also features an article about antimicrobial prescribing for bites and stings. Last year, NICE published two guidelines about antimicrobial prescribing for insect bites and stings, and human and animal bites. The guidelines aim to optimise antibiotic use and reduce antibiotic resistance. Dr Caroline Ward summarises the recommendations, highlighting common themes and important differences in management. It can be challenging to differentiate between inflammation and infection as both may present with erythema and swelling—Dr Ward describes important differences to look out for that can help to distinguish between inflammation or infection. The article also includes useful tables that summarise the assessment and management for insect bites and stings, and antibiotic prophylaxis and treatment for human and animal bites. Use the hypothetical patient scenarios to guide your reflections on how you would manage patients in line with NICE’s recommendations.

Lastly, in this month’s View from the ground article, Dr Sandesh Gulhane draws parallels between the COVID-19 pandemic and the film Snakes on a plane and shares his frustrations about some of the myths that are circulating about the COVID-19 vaccines.

References

  1. Refuge website. Refuge response to Home Affairs Select Committee report on domestic abuse during Covid-19. Refuge, April 2021. www.refuge.org.uk/refuge-response-to-home-affairs-select-committee-report-on-domestic-abuse-during-covid-19