Last reviewed 5 January 2021
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 10 days. This means that if a person remains well 10 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?
Self-isolating is a key element in fighting the pandemic. It is understood that most people will no longer be likely to transmit the virus 10 days after the onset of symptoms. Self-isolation is therefore designed to slow down the spread of the virus and protect others whilst someone may be infectious.
People should stay at home and self-isolate as follows:
those 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 — they should arrange for a test to confirm that they have Covid-19
those who test positive for coronavirus should continue to self-isolate for 10 days from onset of symptoms, or 10 days from point of taking a positive test if they are asymptomatic — those who test negative can stop self-isolating as long as they are well
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 have been in contact of a person who has had a positive test result must self-isolate at home for 10 days from the date of their last contact
those who return from countries which are not on the “safe” travel corridor list should also self-isolate for 10 days.
People who are contacted by NHS Test and Trace must follow isolation guidance provided by contact tracers.
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.
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.
Stay at Home: Guidance for Households with Possible or Confirmed Coronavirus (COVID-19) Infection, published by Public Health England, contains further advice.
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.
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.
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. 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 was 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. 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. This was followed by the reallocation of local tiers.
A proposed Christmas easing was abandoned amid a surge of transmission rates in London and South East counties driven by the emergence of a new more infectious Covid-19 variant strain, B117. Instead, further restrictions were announced, including a Tier 4 “stay at home” order for affected areas.
Despite being easier to catch than the standard Covid-19 virus, Public Health England has stated that any resultant illness from the new coronavirus mutation appears to be no more severe. However, the variant is estimated to be up to 70 per cent more transmissible than original strains of the virus, raising the “R value” dramatically and spreading rapidly. It is therefore viewed the variant as a very significant threat.
Another more contagious variant emerged at the end of 2020 in South Africa, rapidly spreading to other countries, including the UK.
Over the new year period, the Government warned that the NHS was under serious pressure from rising transmission rates in many regions and, after a brief increase to Tier 3 and 4 across the whole country, the prime minister announced on 4 January that a third national lockdown was being implemented in order to combat the spread of the new Covid-19 variants. The national alert level was raised to Level 5.
The lockdown will be kept under review but is expected to remain in place for the foreseeable future while Covid-19 vaccines are rolled out. Restrictions are similar to the 2020 March lockdown. People are asked to stay at home wherever possible. They can go out to buy food, to obtain medicine, to care for others and to exercise but they must stay local and must observe social distancing. People can still go to work, if they cannot work from home, but should not meet with others except for those in their support bubble. Schools and higher education will remain closed until February although early years childcare will remain open.
National Lockdown: Stay at Home lists the full range of restrictions.
“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.
During November, high-risk individuals in England were made subject to the same lockdown restrictions as everyone else. However, with the emergence of the more transmissible coronavirus strain in the UK, in December shielding was reinstated in areas subject to “tier 4” restrictions.
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.
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 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 most recent update was produced in December 2020 and included new guidance on isolation and testing.
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.
A 14-day period of isolation is being recommended for residential settings as older care home residents are a particularly vulnerable group and their immune response may differ from younger, normally healthier individuals.
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.
Annex G covers decontamination and cleaning processes for care homes with possible or confirmed cases of Covid-19. Annex I details the use of the NHS Capacity Tracker, a tool which provides an England-wide portal for publishing vacancies in care homes.
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 was 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 republished for the November national lockdown and revised again during December. Visiting Care Homes During COVID-19 supersedes previous advice.
The updated guidance states that visiting should be enabled wherever it is possible to do so safely. It acknowledges that visiting is a central part of care home life but that welcoming visitors into homes from the community inevitably brings infection risk.
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.
A key element in supporting visiting is the distribution of rapid (lateral flow) tests to care homes across the country to be used for visitors. The Government aim is to provide sufficient quantities to test up to two visitors per resident, twice a week. Visitors will need to arrange visiting with the care home in advance and be mindful of the additional workload for staff.
While rapid testing can reduce the risks around visiting, PHE acknowledge that it does not completely remove the risk of infection. In addition to using testing, care homes must use robust infection prevention and control (IPC) measures.
The guidance states that:
all care homes should seek to enable outdoor visiting and “screened” visits
all care homes in Tiers 1, 2 and 3 — except in the event of an active outbreak — should also seek to enable indoor visits where the visitor has been tested and returned a negative result
visits in exceptional circumstances — including end of life — should always be enabled
in the event of an outbreak the care home concerned should immediately stop visiting.
Section 2.1 of the guidance covers the management of safe indoor visiting supported by testing. It states that, for indoor visits:
all visitors should be tested
every visitor must return a negative test before each visit
if a visitor has a negative test, is wearing appropriate PPE and following other infection control measures, then it may be possible for them to have physical contact with their loved one, such as providing personal care, holding hands and a hug
contact should be “limited” to reduce the risk of transmission.
Before receiving and testing visitors, the guidance states that care providers must consider the practicalities of implementing a visitor testing regime and put in place relevant safeguards. Managers have discretion to set up their own testing areas. They should be clear to communicate to visitors the purpose of testing.
Section 2.2 states that indoor visiting without testing may only go ahead in Tier 1 areas where visitor tests are unavailable.
Section 2.3 of the guidance covers the use of outdoor visiting. The guidance states that outdoor visits can be made available to visitors who have not been tested in order to provide opportunities for more visits than the available testing capacity in the care home might enable. Use may be made of communal garden or outdoor areas, or specially adapted outbuildings with plastic or glass barriers between residents and visitors. Spaces should only be used by one resident and visiting party at a time and should be subject to regular cleaning.
The guidance recommends the following measures in all cases.
Visitor numbers should be limited to a maximum of two constant visitors wherever possible. This, for example, means the same family member visiting each time to limit the number of different individuals coming into contact.
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 appropriate PPE and 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.
Guidance on the January 2021 restrictions, National Lockdown: Stay at Home, states that visits to care homes can still take place with appropriate mitigation arrangements, such as substantial screens, visiting pods, or behind windows, etc. Close-contact indoor visits are not allowed.
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 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.
Two types of test kits are delivered to care homes:
polymerase chain reaction (PCR) test kits (Kingfisher kits)
lateral flow device (LFD) test kits.
The guidance states that PCR test kits should be used to test staff members weekly and residents every 28 days. LFD tests should be used to test staff on their first day back to work following a period of leave that has resulted in someone missing their weekly PCR test. In this case staff should be tested before they begin their shift.
LFD tests should also be used to test visitors and visiting professionals.
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 10 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. In December 2020, the self-quarantine requirement was reduced to 10 days instead of 14.
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.
In November it was announced that a vaccine created in partnership by Pfizer and BioNTech had completed its trials and would be available by the end of 2020. The two-dose vaccine had proved 95% effective in producing an immune response and protecting people from infection. In December this was followed by AstraZeneca who announced that their vaccine, developed in collaboration with Oxford University, had also completed its trials with a 70–90% effectiveness rate depending on dose.
During December both vaccines were approved for use in the UK by the Medicines and Healthcare products Regulatory Agency and urgent plans for a national vaccination rollout were devised.
Details of the COVID-19 Vaccination Programme have been set out on the GOV.UK website. The webpage contains links to relevant documents such as:
COVID-19: the Green Book, Chapter 14a — containing details of both vaccines, precautions for use, side-effects, etc
COVID-19 Vaccination: Information for Healthcare Practitioners — containing details on the programme for GPs and other healthcare practitioners
COVID-19 Vaccination: Consent Forms and Letters for Care Home Residents
COVID-19 Vaccination: Guide for Older Adults — a public information leaflet
COVID-19 Vaccination: a Guide for Social care Staff – an information leaflet for staff
COVID-19 Vaccination: Care Home and Healthcare Settings Posters — including a poster for care homes
Priority Groups for Coronavirus (COVID-19) Vaccination — advice from the Joint Committee on Vaccination and Immunisation (JCVI) setting out the strategy for who should be vaccinated first
COVID-19 Vaccinations and Care Homes: Programme Launch — a letter to care home managers in England setting out how they should prepare for vaccinating their staff and residents
Training materials for staff involved in supporting the vaccination programme.
Care home managers should refer to the webpage for the latest versions of documents.
Priority Groups for Coronavirus (COVID-19) Vaccination: Advice from the JCVI, was updated on 30 December 2020, replacing earlier versions. The guidance states that the most vulnerable groups should be prioritised, along with those that care for them. This includes care home residents and staff.
The Pfizer/BioNTech vaccine was available in December but, due to requirements to keep it very cold, it could only be administered from specially equipped hospital hubs. This meant that it was impractical to use it in care homes and the initial campaign had to start with care home staff, the over 80s and healthcare workers. The AstraZeneca vaccine only requires standard vaccine fridge storage and thus is easier to deploy through community hubs and via GP surgeries. This should include deployment in care homes for residents from the start of January 2021.
NHS England has written to GPs, general practice teams and Clinical Commissioning Groups to establish a Covid-19 vaccination service which will be based on the flu-vaccination model. Each primary care network will deliver vaccines through a national booking service with individual practices working alongside nominated centres.
Both of the currently available vaccines require a two-dose course for maximum effectiveness against the virus. However, the JCVI strategy has been updated to place priority on promoting rapid, high levels of vaccine uptake amongst vulnerable persons. The JCVI thus state that delivery of the first dose to as many eligible individuals as possible should be initially prioritised over delivery of a second vaccine dose. JCVI therefore recommend that the second dose of the Pfizer/BioNTech vaccine may be given between 3 to 12 weeks following the first dose and the second dose of the AstraZeneca vaccine may be given between 4 to 12 weeks following the first dose.
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.