On March 23, 2020, the UK Government enforced a country-wide lockdown in response
to the COVID-19 pandemic to limit transmission of severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2). Although spread of the virus has been reduced, the lockdown
has created new challenges for primary care practitioners who manage patients with
chronic respiratory diseases (CRDs). However, there have also been opportunities for
innovation, especially in terms of digital and remote working, and these solutions
could be maintained and developed further to improve primary health-care services
as we recover from the pandemic.
The threat of COVID-19 is a serious concern for patients with CRDs and their primary
care providers. Challenges that these patients already face related to their illness
include an increased risk of depression, and feelings of isolation and loneliness,
which might have been amplified during lockdown, without the usual support from health-care
providers, family, and friends. Although the virus might have acted as a catalyst
for patients with CRDs to access online support groups and self-management tools to
reduce feelings of isolation, and to improve their knowledge about their illness.
Improved adherence to preventer medications for those with asthma and COPD has been
reported, to the extent that inhaled corticosteroid inhalers were in short supply
at one point during lockdown in the UK. This shift in patient behaviour provides an
opportunity for primary care providers to actively promote self-management and online
Confused messaging about whether patients with CRDs were at increased risk of infection
with SARS-CoV-2, or development of severe disease, might also have contributed to
increased levels of patient anxiety. Primary care providers, a key source of advice,
might themselves have been unsure of the best guidance as concerns about increased
risk were somewhat eased by emerging, reassuring data. Patient communication must
be clear and efficient to help avoid misinformation and unnecessary panic, and can
be difficult to convey. Efforts to ensure guidance reflects the available evidence,
is up to date, and is communicated through appropriate channels is therefore essential
in these unprecedented times.
Routine check-ups were disrupted by lockdown restrictions; primary care providers
had to adapt quickly to maintain care for chronically ill patients and respond to
acute presentations and potential COVID-19 cases. Overnight, remote consultations
(telephone, video, or online) widely replaced face-to-face appointments in the UK
to allow for physical distancing and to prevent spread of infection. 97% of practices
now offer video consultations and 75% offer online consultations compared with just
25% offering remote consultations last year. This move towards a digital era will
likely continue for non-urgent cases as lockdown restrictions are lifted, and care
providers can then prioritise face-to-face consultations for patients who need them.
Ideally, in the future, patients—in collaboration with their clinician—will have a
choice in the mode of appointment that's most suitable. Some primary care practices
have adopted strategies to enable patients to safely visit the facility—eg, with designated
shielded sites reserved for vulnerable patients, in which physical distancing is strictly
observed, or red sites where people with suspected COVID-19 can attend. Now that the
peak of the pandemic might have passed, and demand for face-to-face appointments is
increasing, health-care providers can adapt these measures to reflect the reducing
threat of infection.
Potential misdiagnosis of patients with CRDs being infected with COVID-19 has been
a challenge for primary care physicians owing to overlapping symptoms and the initial
lack of widespread testing available in primary care facilities. Physicians have to
decide whether an appointment in person is necessary and worth the risk of exposing
the patient to infection. Policy makers must learn from this experience for future
pandemic preparedness, to manage any second waves, and to ensure sufficient and efficient
testing is readily available in primary health-care facilities. This will not only
allow improved management of individual suspected cases, but can also help physicians
make key decisions about patients with respiratory illnesses, as well as identifying
the risk to the general population as lockdown measures are eased.
Although the pandemic is far from over in many countries, it is time to reflect on
what we have learned from a primary health-care perspective in the management of CRDs.
The shift towards increased self-management and use of digital tools could help initiate
a new era in primary care—one of improved health for patients together with the flexible
and comprehensive use of all available resources.
© 2020 Collanges/BSIP/Science Photo Library
Since January 2020 Elsevier has created a COVID-19 resource centre with free information
in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre
is hosted on Elsevier Connect, the company's public news and information website.
Elsevier hereby grants permission to make all its COVID-19-related research that is
available on the COVID-19 resource centre - including this research content - immediately
available in PubMed Central and other publicly funded repositories, such as the WHO
COVID database with rights for unrestricted research re-use and analyses in any form
or by any means with acknowledgement of the original source. These permissions are
granted for free by Elsevier for as long as the COVID-19 resource centre remains active.