Last reviewed 24 November 2020
What is coronavirus and what can care providers do to keep their service users and staff safe? This article provides a round-up of essential information for care settings, including PPE, testing, high-risk individuals, visiting and social distancing.
What is coronavirus?
The World Health Organization (WHO) defines coronaviruses as a family of viruses that cause infectious illness ranging from very mild to very severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). Covid-19 is a new strain which originated in China at the end of 2019. It has since spread worldwide, initiating a global pandemic public health emergency.
How does coronavirus spread?
People can catch Covid-19 from others who are infected.
The virus moves from person-to-person in droplets from the nose or mouth which are spread when a person with Covid-19 coughs or exhales. In addition, the virus can survive for up to 72 hours out of the body on surfaces. People can become infected if they breathe in the droplets or touch infected surfaces and then touch their eyes, nose or mouth.
The incubation period of Covid-19 is believed to be between 2 and 14 days. This means that if a person remains well 14 days after contact with someone with confirmed coronavirus, they have likely not been infected.
What are the symptoms?
The NHS recognise the main symptoms of coronavirus as:
fever and high temperature — people will feel “hot to touch” on their chest or back (37.8ºC or above)
new, continuous dry cough — the NHS define this as coughing a lot for more than an hour, or three or more coughing episodes in 24 hours (someone with an existing cough may find that it is worse than usual)
loss or change to the sense of smell or taste — the NHS defines this as someone noticing that they cannot smell or taste anything, or things smell or taste different to normal.
Most people with coronavirus have at least one of these symptoms. Other less common symptoms include aches and pains, nasal congestion, headache, conjunctivitis, sore throat, diarrhoea, or a skin rash or discolouration of fingers or toes.
Symptoms begin gradually and are usually mild. Most people (about 80%) recover from the disease without needing special treatment. A small percentage can become seriously ill and develop difficulty breathing. This is particularly dangerous for people with weakened immune systems, for older people, and for those with long-term conditions such as diabetes, cancer and chronic lung disease.
How can people protect themselves?
Public Health England (PHE) recommends that the following general “handwashing and respiratory hygiene” precautions are taken to help prevent spreading coronavirus.
Cover the mouth and nose with a tissue or sleeve (not hands) when coughing or sneezing (Catch it. Bin it. Kill it).
Put used tissues in the bin straight away.
Wash hands regularly with soap and water for at least 20 seconds — use hand sanitiser gel if soap and water are not available.
Try to avoid close contact with people who are unwell.
Clean and disinfect frequently touched objects and surfaces.
Do not touch eyes, nose or mouth if hands are not clean.
In addition, the Government is asking people to “self-isolate” if they have symptoms of Covid-19, to stay at home whenever possible and to “socially distance” themselves.
What is self-isolation?
People who think they may have coronavirus symptoms should stay at home if the following apply.
People who have symptoms of infection and live alone should self-isolate by staying at home and not leaving their house for 10 days from when the symptoms started.
Those who live with others and one person has symptoms should self-isolate as a household for 14 days from the day when the first person in the house became ill (if anyone else in the household starts displaying symptoms, they need to stay at home for 10 days from when the symptom appeared, regardless of what day they are on in the original 14-day isolation period).
Those who are symptomatic are advised to:
stay at least two metres (about three steps) away from other people in the home whenever possible
sleep alone, if possible
wash hands regularly for 20 seconds, each time using soap and water
stay away from vulnerable individuals, such as the elderly and those with underlying health conditions as much as possible
keep hydrated and use over the counter medications, such as paracetamol, to help with the symptoms.
If symptoms worsen during home isolation, or if they are no better after seven days, they should contact NHS 111 online. If without internet access, they should call NHS 111. For a medical emergency they should dial 999. Those who are worried about their symptoms should avoid going directly to their GP, to a pharmacy or to a hospital.
Testing for coronavirus is not needed for people self-isolating and staying at home.
People should plan ahead and ask others for help to ensure that they can successfully stay at home. Where necessary, they should ask employers, friends and family to help them get the things they need.
Self-isolating is designed to slow down the spread of the virus and protect others in the community whilst someone is infectious. It is understood that most people will no longer be likely to transmit the virus 10 days after the onset of symptoms. In a household situation, it is likely that people will infect each other. This is the reason for the 14-day self-isolation.
Staying at home and social distancing
In March, the Government announced a countrywide “lockdown” with the temporary closure of places where people gather and meet, such as pubs, clubs, restaurants, cafes, non-food shops, gyms, cinemas, churches and leisure centres. Schools and early years childcare were also closed with a partial service remaining open to support certain children. People were urged not to travel and to stay at home. They were permitted to go outside only when shopping for necessities, such as food and medicine, for medical or care needs, for example, to help a vulnerable person, and to exercise once a day.
Essential workers, such as doctors, nurses, care staff and those involved in food production and supply, were allowed to travel to work. Non-essential workers were asked to stay at home. Those that could run their businesses from home were encouraged to.
People staying home were advised to not have visitors, not even from friends or family. Those that did venture out were asked to do so for only short periods and to go straight home afterwards. While out they were asked to observe “social distancing” rules. This involves keeping a safe distance of at least two metres from others not in the same household.
Vulnerable people, including those aged 70 and over, were advised to be particularly stringent in staying at home and following social distancing measures when outside. They are far more vulnerable than younger people if they contract the virus. Their best defence is to keep away from others and stay at home.
National alert levels
The lockdown and requirement for social distancing has been informed by an alert level system introduced by the Government in May.
There are five levels.
Level five (red) signifies a "material risk of healthcare services being overwhelmed" and requires extremely strict social distancing.
Level four signifies “a high or rising level of transmission” and requires enforced social distancing.
Level three (amber) describes the virus as being “in general circulation” but no longer high or rising exponentially — as a result social distancing can be relaxed.
Level two describes the number of cases and transmission as being low — minimal social distancing is required.
Level one (green) will describe a situation where Covid-19 is no longer present in the UK and social distancing will no longer be required.
The Joint Biosecurity Centre (JBC) has the task of recommending what the alert level should be.
Estimating the alert level involves calculation of an “R” value by public health experts. This value reflects the average number of people that a single person might infect on a daily basis.
The R value is typically expressed as a range. Therefore an R number between 1.1 and 1.3 means that on average every 10 people infected will infect between 11 and 13 other people. A growth rate between +2% and +4% means the number of new infections is growing by 2% to 4% every day.
The Government has stated that it wishes to keep the R value as close to 1 as possible. This means that the virus is not spreading and has been effectively suppressed.
On 10 May, the Prime Minister announced that the measures had been successful enough to consider a phased easing of the lockdown. It was announced that, in England only, people should continue to stay at home for most of the time but that they could start to gradually do more exercise and outdoor activities. Garden centres were reopened and people could start to meet again in parks and open spaces, albeit not in groups. People were warned to “stay alert” when outside, to maintain social distancing and to continue washing their hands more often.
The announcement to ease the lockdown restrictions was followed by publication of a “roadmap” to eventually return to “as near normal” as possible. A key feature of this is the gradual return of people to work when safe to do so and the development of “Covid secure” workplaces and services.
It should be noted that, while they have worked closely together throughout the pandemic, different roadmaps out of lockdown were applied in England, Northern Ireland, Scotland and Wales and the pattern of restrictions has varied from place to place.
In June, shops reopened and the rules for meeting up with people from outside of a household were changed.
People were able to meet outdoors in a group of up to six people.
Single adult households could form a “support bubble” with one other household — members of the bubble were allowed to spend time in each other’s homes and stay overnight.
Further relaxations followed as the national alert level was reduced from four to three and the national R value was reduced to close to 1.
For instance, in July people were allowed to meet in groups of up to two households and businesses such as hairdressers, pubs, restaurants, hotels and cafes reopened with strict safety guidelines in place. Where it was not possible to stay two metres apart a new social distancing rule of “one metre plus” was introduced. This involved staying one metre apart while observing “additional mitigation” precautions such as wearing a mask. Mask wearing was also made compulsory in many indoor spaces and when using public transport.
During the summer people resumed holiday flights abroad to safe destinations and in September children and young people returned to schools and higher education.
Despite all efforts to suppress virus transmission a widely anticipated increase in infection rates occurred throughout Europe and the UK in the autumn of 2020. This “second wave” seems to be caused by a number of factors, including people moving indoors in colder weather and what is referred to as “compliance fatigue” as populations grow tired of restrictions.
In the UK local and regional transmission rates were closely monitored and “hotspot” areas identified. Lockdown restrictions were subsequently reintroduced on a locality basis. Scotland, Wales and Northern Ireland imposed so-called “circuit break” lockdowns while England developed a strategy based on a three tier system of local restrictions which were applied according to transmission rates in different areas.
By November it was clear that the regional restrictions were proving insufficient to stem the second wave surge and a four-week lockdown was reimposed.
Details are set out in the online government document New National Restrictions from 5 November.
The Government has stated that after the circuit break lockdown each area or region will be allocated a tier of 1–3, each with its own set of rules about what is permitted. It has been proposed that the regional tiered approach will last until March 2021 with allocations reviewed every 14 days. During this period it is expected that Covid-19 vaccines will be rolled out.
In the UK, a difficult 2020–21 winter is predicted with the effects of the Covid-19 virus complicated by “flu season” and annual seasonal pressures on health and social care systems.
“Moderate-risk” and “high-risk” individuals
Since the start of the pandemic, Public Health England has recognised two categories of people who are considered to be more at risk of serious illness from Covid-19 infection than others, those who are at moderate risk (vulnerable) and those who are at high risk (extremely vulnerable).
NHS guidance is available here.
Vulnerable (moderate-risk) people include those who:
are 70 or older
have a lung condition such as asthma, COPD, emphysema or bronchitis (not severe)
have heart disease, diabetes, chronic kidney disease or liver disease (such as hepatitis)
are taking medicine that can affect the immune system (such as low doses of steroids)
are very obese.
Extremely vulnerable (high-risk) people include those who:
have had an organ transplant
are having chemotherapy for cancer, including immunotherapy
are having an intense course of radiotherapy for lung cancer
have a severe lung condition (such as severe asthma or severe COPD)
are taking medicine that makes them much more likely to get infections (such as high doses of steroids)
have a serious heart condition and are pregnant.
Since the start of the pandemic, those in the “moderate-risk” (vulnerable) category have been advised to be cautious and stay at home as much as possible. They can go to work if they cannot work from home but should be very careful to comply with social distancing and handwashing advice.
During the height of the pandemic those in the “high-risk” (extremely vulnerable) category were made subject to special “shielding” arrangements. This involved people being advised to self-isolate and not to leave home for any reason wherever possible.
As part of the general lockdown easing process the need for shielding was re-evaluated and in August the scheme was paused. As with people at moderate risk, shielded individuals were free to return to a Covid-safe workplace, if they could not work from home, and to go out for shopping and exercise. However, they were advised to be careful in taking precautions.
The Government webpage Guidance on Shielding and Protecting People Defined on Medical Grounds as Extremely Vulnerable from COVID-19 has been kept updated as the pandemic has progressed.
During November high-risk individuals in England were made subject to the same lockdown restrictions as everyone else. After November regional tiered restrictions will apply.
Care home guidance
Admission and Care of Residents in a Care Home During COVID-19 was published by PHE in collaboration with the Care Quality Commission at the start of April. This replaced the earlier COVID-19: Guidance on Residential Care Provision. Version 2 was published in June and has been kept updated. The guidance is currently being reviewed following the implementation of the new national restrictions in November.
The guidance covers:
admitting new residents
caring for residents with Covid-19
reporting Covid-19 cases
providing care after death
resilience, including advice on staff self-isolation and staffing shortage
supporting existing residents who may require hospital care.
The guidance states that care providers should follow all relevant government guidance for everyone in a care home. For example, wherever possible, care homes should be implementing social distancing measures and supporting individuals to follow the shielding guidance for the clinically extremely vulnerable group.
Any resident presenting with symptoms of Covid-19 should be promptly isolated and tested. Staff should immediately instigate full infection control measures to care for the resident.
PHE advises that all residents being discharged from hospital or interim care facilities to a care home, and new residents admitted from the community, should be isolated for 14 days within their own room. This should be the case unless they have already undergone isolation for a 14-day period in another setting. Even then, PHE states a care home may wish to isolate new residents for a further 14 days.
Advice for staff contains the strong recommendation that, given evidence of the chances of asymptomatic transmission, care homes should do all they can to restrict staff movement wherever feasible. This includes ensuring that members of staff work in only one care home, wherever possible. Providers are also advised to consider “cohorting” staff to individual groups of patients or floors/wings.
A number of annexes contain further details for providers on minimising risks.
For example, Annex D describes standard infection prevention and control (IPC) procedures and Annex E covers restrictions for workforce movement. Annex F covers the availability and use of personal protective equipment (PPE). It includes links to further PPE information. Annex I describes the use of the “Capacity Tracker” which is used to support discharge planning by tracking care home vacancies.
A detailed annex on isolation (Annex C) states that all symptomatic residents should be immediately isolated for 14 days from onset of symptoms. Wherever possible they should be looked after in single occupancy rooms with en-suite facilities. Where this is not practical, symptomatic residents may be cared for together in multi-occupancy rooms. The guidance specifies that residents with suspected Covid-19 should be cohorted only with other residents with suspected Covid-19. They should not be cohorted with confirmed cases.
Signage should be displayed to prevent unnecessary entry into any isolation room. Doors should be kept closed. Staff should immediately instigate full infection control measures and wear appropriate PPE to care for any resident with symptoms.
Finally, Annex J provides detailed guidance on Covid-19 waste management measures. The guidance states that non-healthcare waste, eg recycling, domestic type waste, packaging, etc must continue to be handled and managed as normal. It also advises the following options for personal contact or “respiratory intervention” waste from someone with suspected or confirmed Covid-19 infection.
Place in a “tiger bag” — a yellow bag with a black stripe — and store securely for 72 hours before placing in usual waste collection.
If not possible to store securely for 72 hours, place in an orange bag and dispose of as infectious clinical waste.
Home care guidance
Coronavirus (COVID-19): Provision of Home Care was published by PHE on 22 May to replace earlier guidance.
The guidance states that if anyone being cared for by a home care provider reports developing Covid-19 symptoms they should be supported to contact NHS 111 via telephone, or online. Home care workers are advised to report suspected cases of Covid-19 to their managers who should work with community partners, commissioners and the person involved to review their care needs.
A considerable part of the PHE guidance concerns advice on dividing service users into “care groups” where a specific staff team is allocated to provide care to each. Thus “high-risk” shielded service users might be placed in one group and their care provided by a certain cohort of staff, reducing the risk of virus transmission to a minimum.
The guidance states that home care providers should be working with other agencies to reduce the risks for shielded individuals still further. This might be through identifying priority needs and coordinating care packages.
Where it is not possible to allocate specific care groups to specific staff subgroups, PHE suggests that it may be possible to schedule for shielded and at-risk individuals to be seen before people from other categories. PHE states that risks can also be reduced by reducing contact between staff, including replacing face-to-face meetings with remote communications, and by staggering times of entry to community bases.
The guidance provides further advice on:
hospital discharge and testing — including testing for home care workers and individuals receiving home care and testing for patients being discharged from hospital into the community
trusted assessor schemes — schemes to aid safe and timely discharges to care homes and care at home services
government and NHS support for social care
steps for local authorities to support home care provision.
Separate guidance covers personal assistants employed using direct payments from personal health budgets. This can be found here.
Guidance on the wearing and management of personal protective equipment (PPE) is contained in the following PHE documents.
The guidance covers periods of “sustained transmission” when the Covid-19 virus is considered to be widespread in the community and likely to be encountered. It describes safe ways for working for all adult social care workers and includes helpful FAQs to cover most situations that staff will face.
The resource for workers in care homes states that, when providing personal care which requires staff to be in direct contact with residents (eg touching, bathing, washing, etc) or requires them to be within two metres of any resident who is coughing, staff should use:
single-use disposable gloves
a single-use disposable plastic apron
a fluid-repellent (type IIR) surgical mask.
PHE states that eye protection may also be needed where there is risk of contamination to the eyes from respiratory droplets or from splashing of secretions. They state that single-use items should be changed between each episode of care, but that masks and eye protectors can be used “continuously” while providing care until the member of staff takes a break from their duties.
When within two metres of a resident, but not delivering personal care or needing to touch them, and where there is no one within two metres who has a cough, PHE recommends that only a type II surgical mask is required. A fluid-repellent mask is not needed. However, if one is already being worn during a given session, there is no need for it to be replaced.
The guidance was updated in July when a recommendation was added for staff in any other situation when in a care home to wear a mask. It applies to staff in any role working in staff only areas, such as staff common rooms, offices, laundry rooms, kitchens, etc. Staff working alone in a private area are exempt. However, they are required to wear a mask if they leave the private work area to move through the care home building, eg on an errand, or for meal breaks.
The document is accompanied by a video guide, Putting on and Removing PPE — a Guide for Care Homes.
The PPE resource for domiciliary care workers sets out similar guidance to that provided for care homes.
Home care workers are advised to wear disposable gloves, a disposable plastic apron and a fluid-repellent surgical mask whenever providing personal care which requires them to be in direct contact with a client (eg touching) or where they are within two metres of anyone in a household who is coughing. The recommendations apply whether the client being cared for has symptoms or not, and includes all clients, including those in the “extremely vulnerable” group. PHE states that the principles are also suitable for extra-care housing schemes and live-in home care.
Eye protection may also be needed for care of some clients where there is risk of droplets or secretions from the client’s mouth, nose, lungs or from body fluids reaching the eyes (eg caring for someone who is repeatedly coughing or who may be vomiting).
When a visit does not require staff to touch a client but does need them to be within two metres of the client, the guidance states that they only need wear a surgical mask. Household members with respiratory symptoms should remain outside the room or rooms where the care worker is working.
As with care homes, staff working in any other work situation when in a client’s home are advised to wear a mask. This also applies to staff in any role when in premises such as domiciliary care offices or when working with other staff members. Care workers do not have to wear a mask when in their car alone.
In all cases the use of PPE should be supported by effective hand hygiene.
The guidance is accompanied by a pair of posters demonstrating how to put PPE on and take it off in service users’ homes.
Visiting care homes
In the early stages of the pandemic care homes were advised to carry out risk assessments and review existing visiting policies. As the pandemic spread providers were told to suspend all visiting except in end of life situations. This was effective in reducing the risk of visitors bringing infection into homes. However, it was acknowledged that it was hard on residents as being cut off from visits from friends and family has a considerable psychological impact.
As virus transmission rates decreased and the first lockdown was eased, new guidance for care homes relaxed the “no visits” position but on the basis that the first priority is still to prevent infections from entering homes. Public Health England advised that visits should still be restricted and alternatives, such as keeping in touch through online video links, should be pursued wherever possible. However, to these alternatives a limited number of face-to-face visits could be added as long as appropriate risk mitigation arrangements were in place based upon “dynamic” risk assessments and advice about local transmission rates from directors of public health.
The guidance for England was revised again and republished for the November national lockdown as Visiting Arrangements in Care Homes for the Period of National Restrictions.
All providers should have a visiting policy which has been developed in collaboration with residents and their families. Care home providers, families and local professionals are advised by PHE to work together to find the right balance between the benefits of visiting on wellbeing and quality of life, and the risk of transmission of Covid-19 to social care staff and vulnerable residents.
Suggested risk reduction measures include the following.
Visitors should be limited to a single constant visitor per resident, wherever possible, with an absolute maximum of two constant visitors per resident.
Homes should have an arrangement for booking appointments for visitors – ad hoc visits should not be allowed.
In line with NHS Test and Trace guidance, providers should maintain a record of any visitors as well as the person and/or people they interact with.
Visitors should have no contact with other residents and minimal contact with care home staff.
Visitors should be reminded to wash their hands for 20 seconds or use hand sanitiser on entering and leaving the home.
All visitors should be supported to wear a face covering when visiting.
Visitors should be encouraged to follow social distancing as much as possible while on-site and to keep personal interaction to a minimum.
All visitors should be screened for symptoms of acute respiratory infection before entering.
To further reduce risks providers are advised to consider additional measures, such as visits taking place in a communal garden or outdoor area, or the use of plastic or glass barriers between residents and visitors.
Risk assessments should be kept under regular review and any changes in visiting policies and arrangements communicated to residents and their families.
Where risk is considered to be heightened the guidance states that providers may adopt a general policy that visits will only be permitted in exceptional circumstances. In such cases, alternative means of maintaining contact between residents and their loved ones should be clearly set out.
In the event of an outbreak in a care home and/or evidence of community hotspots or outbreaks leading to a local lockdowns, the guidance states that care homes should rapidly impose visiting restrictions to protect vulnerable residents, staff and visitors.
In both residential care and home care, any member of staff who is concerned that they may have Covid-19 should stay at home and follow government advice for self-isolation. They should not attend for work or see service users.
Staff health and wellbeing
Health and Wellbeing of the Adult Social Care Workforce was published by the Department for Health and Social Care on 11 May. The document recognises the “dedication and commitment” shown by care workers and care organisations during the Covid pandemic. It also recognises the costs, especially for staff who may also have families to support and high-risk dependents. Examples of costs include worry and anxiety.
The guidance includes tips, advice and toolkits that social care employers and managers can use to help build the resilience of their teams and address any concerns their staff may have.
The social care action plan
The Government has developed an action plan for adult social care that acknowledges the pressures the care sector is under and makes a number of proposals.
COVID-19: Our Action Plan for Adult Social Care recognises difficulties in obtaining enough PPE and sets out action to tackle this. It also promises more support to tackle outbreaks in care homes and a safer system of discharge from hospitals. Lastly, to support those working in the sector, the plan refers to an expansion in Covid-19 testing for adult social care staff and care home residents.
The action plan is backed by a support package for care homes which includes the following.
Infection control training — including “train-the-trainers” courses from infection control nurses.
A number of schemes to improve the supply of PPE — including PPE distributed specifically for care homes through Local Resilience Forums.
An infection control fund intended to help providers pay for additional staff and /or maintain the normal wages of staff who, in order to reduce the spread of infection need to reduce the number of establishments in which they work, reduce the number of hours they work, or self-isolate.
£1.3 billion Covid-19 discharge funding via the NHS which will support local authorities to provide alternative accommodation to quarantine and isolate residents before their return to their care home, if required.
Increased clinical support from local primary care and community health services — including a named clinical lead for every care home, weekly “check-ins” and support for the use of key medical equipment such as pulse oximeters.
Details are published in Coronavirus (COVID-19): Care Home Support Package.
Testing, tracing and tracking
A nasal/throat swab test is available to confirm the presence of the virus. Such testing is seen as a key element in combatting the virus and keeping people safe.
In the early stages of the pandemic, tests were restricted to those in hospital. However, testing capacity has been drastically scaled up to enable tests to be conducted of all essential workers, including NHS and social care staff, and of symptomatic and asymptomatic care home residents. In addition, the Government have confirmed that all people discharged from hospitals to care homes will be tested.
Latest details can be found in the online government document, Coronavirus (COVID-19): Getting Tested.
The guidance states that the following groups are eligible for testing through the NHS.
Anyone in England and Wales who has symptoms of coronavirus, whatever their age.
Anyone in Scotland and Northern Ireland aged five and over who has symptoms of coronavirus.
The following groups can access priority testing.
Essential workers in England, Scotland, Wales and Northern Ireland.
Anyone in England, Scotland, Wales and Northern Ireland over five years old who has symptoms of coronavirus and lives with an essential worker.
Children under five years old in England and Wales who have symptoms of coronavirus and live with an essential worker.
Care staff are regarded as essential workers throughout the UK.
Tests can be arranged through the NHS website using one of the following routes.
A staff self-referral route.
An employer referral route for staff who are self-isolating.
A “whole home” referrals route which allows care home managers to arrange testing for all of their staff and residents.
Tests for staff and their families can be performed in regional drive-through centres or using home testing kits. “Whole home” tests use kits sent to the home and collected by a courier. Details of the online referral portals and the exact application and referral processes involved can be found in the guidance.
In the event of a suspected outbreak of Covid-19 in a care home, the manager concerned should contact their local health protection team who will arrange any action required, including testing.
Contact tracing is an established infection prevention technique that has long been used in combatting communicable diseases such as coronavirus. It involves identifying and isolating people who are infected and then tracing those who may have been in contact with them. These people can then be tested and isolated as required.
Contact tracing during the Covid-19 pandemic has already proved effective in countries such as China, South Korea and Germany. The Government has stated that it is developing its own system based on location tracking mobile phone apps which it hopes will be in operation in England sometime in June. An NHS tracking app is currently being trialled, as are apps in Scotland, Wales and Northern Ireland.
In March, during the initial crisis stage of the Covid-19 pandemic, the Care Quality Commission (CQC) announced a temporary pause to inspections in England. An Emergency Support Framework (ESF) was developed to respond to the changing needs of the health and social care system during the pandemic period. This went live at the beginning of May and was designed to help the CQC identify problem areas and target support.
In September, the CQC announced that it was turning its attention to how it would regulate the health and social care sectors during the next phase of the Covid-19 pandemic. They have stated that they are not returning to any fixed timetable of regular scheduled inspections yet. Instead they will be using their “insight” model to monitor providers during a “transitional” period and reinstate targeted inspections for higher risk services. Where site visits are needed inspectors will adopt a “balanced” approach to limit any risk of spreading infection.
In addition to their regulatory activity the CQC has also conducted a review of infection prevention and control (IPC) systems in residential social care. To support this review the CQC have developed a new IPC inspection tool with updated and expanded key lines of enquiry. The tool can be used by providers who wish to strengthen their IPC processes and arrangements. It can be found on the CQC website.
Travelling is now much reduced due to countries around the world closing their borders. Government advice is to avoid any unnecessary international travel.
At the start of the pandemic, people flying back to the UK from certain “specified countries” where outbreaks had been reported were required to self-isolate for 14 days. However, this has been extended with the introduction of new quarantine rules for UK arrivals applicable from 8 June. These require any passengers arriving in the UK by plane, ferry or train to provide Border Force officials with an address where they must self-isolate for two weeks. If a person does not have suitable accommodation to go to, they will be required to stay in facilities arranged by the Government.
Vaccine development and the future
Research into Covid-19 vaccines is being carried out as a priority all around the world, the hope being that a successful vaccine, in combination with more effective treatments for people who are infected with the virus, will be the quickest way to help return the world to some form of normality.
On 9 November it was announced by Pfizer and BioNTech that one of its vaccines had proved successful in its initial trials in the US and in Germany and could be made available for use by the end of 2020. Research data suggests that the vaccine is up to 95% effective in producing an immune response when given as two doses, three weeks apart. The announcement was followed by similar news from the US company Moderna who also reported a 95% effectiveness rate for their vaccine.
Later in November, in a further boost to hopes for a successful vaccine, researchers at Oxford University announced that the vaccine they have been developing with the drug company AstraZeneca was also finishing its phase III trials. They reported that it had been shown to be safe to use and has a 70–90% effectiveness rate depending on the dose.
In the UK, the NHS has announced that it is developing urgent plans for a national vaccination rollout if one or more of the vaccines can be successfully licensed with the Medicines and Healthcare products Regulatory Agency. NHS England has written to GPs, general practice teams and Clinical Commissioning Groups to establish a Covid-19 vaccination service which it is anticipated will operate from December.
According to NHS England the services will:
be rolled out in a similar way to flu vaccination with GPs and general practice staff staffing designated vaccination centres in each primary care network area
utilise a national call and recall/booking system alongside local GP practice booking systems.
Alongside the general practice-led service, other providers such as NHS Trusts will be commissioned to provide the programme through other means. Care homes or housebound people will be covered through on-site or home visits.
Full details of the vaccination programme will be finalised when final trial results and vaccine licensing has occurred. The Joint Committee on Vaccination and Immunisation (JCVI) will then finalise details of who will be prioritised and have access to the vaccine first. This is likely to include older people, health workers and care staff.
Scientists believe that a variety of vaccines will be required to effectively suppress the virus in all populations and age groups.
Public health doctors have been quick to welcome the development of the new vaccines as an exciting breakthrough in the fight against Covid-19. However, they warn that there is still a long way to go. A national vaccination roll-out during 2021 on the scale that will be needed is a huge undertaking and will take many months. In the meantime, tried and tested methods of preventing virus transmission, such as social distancing and the wearing of masks, must continue.
As well as planning for a future rollout of a Covid-19 vaccination, adult social care providers should also ensure that their flu immunisation policies are in place and that they have made all necessary arrangements to implement them.
With the UK entering the annual “flu season” it is vitally important that all adult social care staff and eligible service users are vaccinated. Every winter the NHS and social care systems come under great pressure as people become unwell with flu, some suffering serious illness and even dying. In 2020–21 the winter is expected to be particularly difficult with influenza viruses and the Covid-19 virus co-circulating.
This year the key priority groups eligible for the flu vaccine include:
people aged 65 years or over
those aged 6 months to under 65 years in clinical risk groups, such as those with chronic (long-term) respiratory disease, liver or heart disease
people living in long-stay residential care homes or other long-stay care facilities where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality
those who are in receipt of a carer’s allowance, or who are the main carer of an older or disabled person whose welfare may be at risk if the carer falls ill
household contacts of those on the NHS Shielded Patient List for the coronavirus
health and social care workers employed through Direct Payment (personal budgets) and/or Personal Health Budgets, such as Personal Assistants, delivering domiciliary care to patients and service users
health and social care staff.
NHS England state that they aim to further extend the vaccine programme in November and December to include the 50–64-year-old age group subject to vaccine supply.
Public Health England point out that those most at risk from flu are also among the most vulnerable to Covid-19, and if people get flu and coronavirus at the same time, they are more likely to be seriously ill.
See Flu Vaccination Guidance for Social Care Workers for more information.
The overall strategy is set out in the Government’s Coronavirus Action Plan: A Guide to What you Can Expect Across the UK, published on 3 March. This sets out a plan for trying to contain the virus and slow person-to-person spread while research continues into a vaccine.
Where can the latest information be found?
Care providers and managers should keep as up to date as possible and ensure that staff, service users and their relatives are kept informed.
The following official sources can be used.
People are warned to avoid misinformation and out-of-date information. Guidance has changed rapidly throughout the outbreak. It may also vary according to where in the UK people live. Always refer to the latest official Government information.
The National Institute for Health and Care Excellence (NICE) have published the first of a series of “rapid” coronavirus guidelines. Further guidelines are in development and will be published on the Covid-19 section of the NICE website.