What is coronavirus and what can care providers do to keep their service users and staff safe?
What is coronavirus?
The World Health Organisation 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 between 2 and 14 days. This means that if a person remains well 14 days after contact with someone with confirmed coronavirus, they have 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 (37.8 ºC 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 7 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 7 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 7 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 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. This includes visits from friends and family.
The lockdown measures were considered essential to halt the spread of the virus between people and prevent illness, thus reducing pressure on hard pressed NHS and social care services. They were supported by changes to the law and enforced by the police who were given powers to impose fines on people breaking the movement restrictions.
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, restrictions may vary between England, Northern Ireland, Scotland and Wales where different roadmaps apply. Regional variations may also exist as different parts of the UK are affected at different times by the virus.
It should also be noted that the gradual exit from lockdown depends on the transmission rate of the virus, referred to as the “R” value, remaining low. The lockdown will be re-imposed if a second wave of the virus is considered a risk and it is likely that, in the absence of a viable vaccine, some form of restrictions based on social distancing will become the “new normal” in countries all over the world.
“Moderate-risk” and “high-risk” individuals
Certain people of all ages are considered to be more at risk of serious illness from COVID-19 infection than others. Public Health England recognise two categories, those who are at moderate risk (vulnerable) and those who are at high risk (extremely vulnerable).
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.
Those in the “moderate risk” (vulnerable) category are advised to 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.
Those in the “high-risk” (extremely vulnerable) category are subject to special “shielding” arrangements set out in Guidance on Shielding and Protecting People Defined on Medical Grounds as Extremely Vulnerable from COVID-19. They have been advised to self-isolate and not leave home for any reason for at least 12 weeks (until the end of June).
Care home guidance
Admission and Care of Residents during COVID-19 Incident in a Care Home 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.
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.
A number of annexes contain further details on areas such as receiving people discharged from hospital and isolating residents. Annex F on personal protective equipment (PPE) includes a list of social care distributers. It also provides contact details for a National Supply Disruption Line to support managers who are having difficulties in sourcing appropriate PPE.
A detailed annex on isolation 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.
Note that Admission and Care of Residents is being reviewed.
Home care guidance
COVID-19: guidance on home care provision was produced by PHE in March and has been kept updated.
Home care providers are advised to:
review their list of clients and support needs
work with local authorities to establish plans for mutual aid.
The guidance states that if neither the care worker nor the individual receiving support is symptomatic, then no personal protective equipment is required above and beyond normal good hygiene practices. If the individual receiving care and support has symptoms of COVID-19, then the risk of transmission should be minimised through safe working procedures, including wearing PPE for any procedures that involve physical contact.
If the individual being cared for does not have symptoms but is part of a household that is self-isolating, the guidance states that additional precautions may not be necessary if the service user and the care worker can remain at a safe distance from the symptomatic member of the household. If this is not possible then appropriate PPE should be worn.
PHE acknowledge that exact requirements will vary on a case by case basis and should be subject to risk assessment.
Guidance on the wearing and management of personal protective equipment (PPE) is contained in the following PHE documents.
COVID-19: Personal protective equipment (PPE) — resource for care workers delivering home care (domiciliary care) during sustained COVID-19 transmission in England.
The guidance covers periods of “sustained transmission” when the COVID-19 virus is considered to be common in the community and likely to be encountered by staff.
How to work safely 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 surgical mask.
PHE state 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.
The document contains a flow chart to help guide care home managers on when PPE is recommended. It 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 state 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.
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.
Considerations for acute personal protective equipment (PPE) shortages provides Health & Safety Executive approved guidance on optimising PPE use during periods of short-term lack of availability.
Visiting care homes
Admission and Care of Residents states that family and friends should be advised not to visit care homes at the present time, except next of kin in exceptional situations such as end of life.
The guidance recommends that alternatives to in-person visiting should be explored, including the use of telephones or video calls.
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.
Tests can be performed in regional drive-through centres or using home testing kits. For staff both self-referral and employer-referral test booking routes are available.
In England care homes can also order testing kits through a special portal. At present the option is only available when a home looks after older people or people with dementia. The application must be made by the manager registered with the Care Quality Commission (CQC).
The portal can be found here.
Coronavirus (COVID-19): getting tested provides details of how to book tests.
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 the Care Quality Commission (CQC) announced a stop to all inspections in England for the duration of the crisis. However, the CQC has since developed an Emergency Support Framework (ESF) to respond to the changing needs of the health and social care system during this period. This went live at the beginning of May. Although not an inspection, adult social care providers are likely to have a one-hour video call from CQC where they will be asked questions covering the areas of:
safe care and treatment
protection from abuse
assurance processes, monitoring, and risk management.
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. People travelling from the Republic of Ireland are exempt. If a person does not have suitable accommodation to go to they will be required to stay in facilities arranged by the Government.
The arrangements will be reviewed every three weeks and relaxed when safe to do so.
Vaccine development and the future
Research into a COVID-19 vaccine is being carried out as a priority around the world, although how successful such a vaccine will be and how it may be made available and rolled out is not yet known.
Whether a vaccine is developed or not, with the world entering a financial crisis after the pandemic and the ongoing threat of virus transmission remaining, ways of life may be significantly changed for good after the pandemic has passed.
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.
Last reviewed 26 May 2020