Box 1.

Illustrative examples of cases assigned to different traffic light categories

Case 1
A man in his 50s with potential contact with COVID-19 2 weeks prior to presentation was admitted with 7 days of swinging fever, nausea, poor oral intake and shortness of breath. His temperature was 38.9°C on admission and he required 1L of oxygen to maintain an oxygen saturation of 96%. Examination revealed sparse crackles only. Chest radiograph (CXR) demonstrated patchy consolidation in both bases. Admission bloods showed lymphopenia with lymphocytes at 0.56 × 109/L.
Assessment:With possible exposure, congruent clinical picture, classic CXR and lymphopenia, he was classed as ‘red’ and later tested positive for SARS-CoV-2 by rt-PCR on an upper respiratory tract (URT) swab.
Case 2
A man in his late 80s with multiple comorbidities, including known prostate malignancy, who had moved into a care home shortly prior to presentation with increasing confusion, was admitted. He was apyrexial with normal oxygen saturation on admission. Examination revealed a tense, palpable bladder, and urinary retention was confirmed by bladder scan. He was found to have a cough, although CXR and bloods were unremarkable. Collateral history revealed that he has been having a cough for ‘years’.
Assessment: He was classed as ‘green’ and later tested negative for SARS-CoV-2 by rt-PCR on an URT swab.
Case 3
A female in her 70s with a background history of COPD presented with 4 days of cough productive of creamy sputum, shortness of breath and reduced exercise tolerance. She was apyrexic on admission and had an oxygen saturation of 94% on room air. Examination revealed a wheezy chest. Admission bloods showed a neutrophil count of 6.46 × 109/L, lymphocytes of 1.09 × 109/L and CRP <4 mg/L. Bi-basal atelectasis was seen on CXR. Whilst SARS-CoV-2 is a plausible cause for this episode of COPD exacerbation, the trigger could also be a variety of infective or non-infective insults.
Assessment: She was classed as ‘amber’ and was subsequently tested negative for SARS-CoV-2 by rt-PCR on an URT swab.
Case 4
A female in her mid-80s who lives alone with early dementia was found to be more confused by her carers. On admission she was febrile at 38.6°C. Oxygen saturation was 96% on room air. A thorough examination did not reveal any positive findings. Her bloods showed total WCC of 3.9 × 109/L, neutrophils 2.37 × 109/L, lymphocytes 0.98 × 109/L, CRP 34 mg/L, and normal liver function tests. CXR was also normal.
Assessment: With an undifferentiated fever and no other clinical findings to point towards a diagnosis, she was initially classed as ‘amber’. On day 2 of admission she had increasing dyspnoea, and desaturated to require 2L of oxygen for maintenance of 94% oxygen saturations. Repeat bloods showed more marked lymphopenia at 0.74 × 109/L, without a concurrent rise in neutrophils. She was reclassed as ‘red’ and was later tested positive for SARS-CoV-2 by rt-PCR on an URT swab.