Last reviewed 20 April 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.
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.
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.
Covid-19 public health restrictions
The Government response throughout the Covid-19 pandemic has been to take necessary public health action to limit transmission of the virus by imposing a series of restrictions whenever the R number has grown too high and the alert level has had to be raised. These restrictions have included:
regional and national lockdowns requiring people to stay at home, including working from home wherever possible
people observing “social distancing” when they do leave home, keeping at least two metres away from others not in the same household
restrictions on travel, especially trips in and out of lockdown areas and international travel
restrictions on gatherings and closures of places such as pubs, restaurants, cafes, schools and hairdressers
“shielding” for the most vulnerable members of society.
The restrictions have been supported by legal enforcement, including spot fines for transgression. In addition, mask wearing has become mandatory in many indoor areas and on public transport and has become commonplace elsewhere as people have grown to accept the restrictions and protect themselves.
It should be noted that, while they have worked closely together throughout the pandemic, different rules have been applied in England, Northern Ireland, Scotland and Wales and the pattern of restrictions have varied from place to place.
After a brief summer respite, at the end of 2020 a “second wave” of infection swept through Europe and the UK as people moved indoors in colder weather and new more infectious Covid-19 variant strains emerged. These included a “Kent” strain (B117) and a virulent strain from South Africa.
Public Health England has stated that any resultant illness from these coronavirus mutations appears to be no more severe. However, the variants are estimated to be up to 70% more transmissible than original strains of the virus, raising the “R value” dramatically and spreading rapidly.
As the NHS came under severe pressure the national alert level was raised to Level 5 over the 2021 new year period and another strict lockdown was put in place throughout the UK to halt the spread of infection. The lockdown was considered necessary despite the hopeful sign of vaccines becoming available and being rolled out across the country.
Roadmap out of lockdown
On 24 February the Government in England published a roadmap for coming out of the January 2021 lockdown. They announced that transmission rates were once again dropping and, despite the NHS remaining under serious pressure, a very cautious relaxation can now be contemplated. The plan is based on an ambitious target for Covid vaccination which is showing signs of being effective in helping to control the virus.
Stage 1 in March saw schools and colleges reopen and people from different households were able to meet outside for recreation. The “stay at home rule” ended but people were urged to stay local as much as possible. Care home residents were allowed one nominated person to be able to visit them indoors with whom they could hold hands.
Stage 2 in April saw further restrictions lifted. Shops, hairdressers, beauty salons, gyms and spas were allowed to reopen and restaurants and pubs were allowed to serve customers sitting outdoors, including alcohol. Self-contained domestic UK holidays were permitted and sports facilities restarted. In care homes, the nominated person scheme was extended to two visitors.
In Stage 3, no earlier than 17 May:
people will be able to meet in groups of up to 30 outdoors and six people or two households can meet indoors
pubs, restaurants and other hospitality venues will be able to seat customers indoors and hotels, hostels and B&Ss will be able to reopen
indoor entertainment such as museums, theatres, cinemas and children's play areas will be able to open
adult indoor group sports and exercise classes will restart.
Lastly, in Stage 4, no earlier than 21 June, it is hoped that all legal limits on social contact will be removed and there will be no legal limits on the number of people who can attend weddings, funerals and other life events.
Details of current restrictions can be found on the GOV.UK webpage, (COVID-19) Coronavirus restrictions: what you can and cannot do.
It should be noted that the estimated dates between roadmap stages are provisional and may be subject to change as the recovery from the pandemic progresses. Full details are set out in Covid-19 Response — Spring 2021. Each stage will be a minimum of five weeks apart and will depend upon the ongoing rollout of vaccination and no surge in hospital admissions. The programme will be kept under review and adjusted as required.
There will be variations in the exact nature of timings and conditions in Scotland, Wales and Northern Ireland. However, the general direction of travel is broadly the same with an emphasis on a return to schooling for children.
Clinically “extremely vulnerable” people
At the start of the pandemic the NHS identified certain people who were considered to be “high risk” from Covid-19 due to pre-existing health conditions. These people were described as “clinically extremely vulnerable” and advised to “shield” and take special precautions to protect themselves from the virus.
Extremely vulnerable (high-risk) people includes 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.
In February 2021, following a greater understanding by doctors of the importance of factors such as age, ethnicity and deprivation, more people were written to and added to the shielding list.
As part of the general lockdown easing process, the need for the “shielding scheme” was re-evaluated and in August 2020 the scheme was paused, only to be reinstated in December with the emergence of the more transmissible coronavirus strains in the UK. At the end of March it was once again paused as part of lockdown easing. Clinically extremely vulnerable people are advised to continue to take extra precautions to protect themselves and to access their vaccinations, etc.
In care homes and in domiciliary care service users identified as being clinically extremely vulnerable or at higher risk from Covid-19 may need additional precautions, for example, avoiding contaminating surfaces that might be touched by them.
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 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.
In the latest addition, Annex K provides information on testing individuals moving from the community into a care home.
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 included in the following PHE webpages.
Key guidance is contained in the following 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. There are also posters to display in order to remind staff of the precautions they need to take.
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 also accompanied by a pair of posters demonstrating how to put PPE on and take it off in service users’ homes.
Visiting care homes
The latest guidance on care home visits in England can be found in the Department of Health and Social Care publication Guidance on care home visiting. This updated guidance was introduced as part of government measures to cautiously emerge from the January 2021 national lockdown.
DHSC state that the “default position” should be that visiting must be supported wherever and whenever it is possible and safe to do so. In this respect they state that all care homes should offer the following from the 12 April.
Every resident will be able to nominate up to two “named visitors” who will be able to enter the care home for regular visits (visiting together or separately as preferred).
In-person visits for other friends or family members should be offered using Covid-safe arrangements such as outdoor visiting, substantial screens, visiting pods, or behind windows, etc.
Visits during exceptional circumstances, such as end of life should be offered at all times.
Residents with the highest care needs should be able to nominate an “essential care giver”.
Alternatives to visiting should be facilitated, such as phone and video calls.
The DHSC state that each “named visitor” should be tested for the Covid-19 virus using rapid lateral flow tests before every visit. They must wear appropriate personal protective equipment (PPE) and follow all other infection control measures (which the care home should guide them on) during visits. The visitor may hold hands with the resident they are seeing if they wish to. However, they should keep physical contact to a minimum and at this stage there must not be close physical contact such as hugging.
The concept of “essential care givers” is that some residents have care and support needs that include tasks which cannot easily be carried out by a member of staff (or not without causing substantial distress). A family member, or another intimate person, is required instead and should be allowed to visit to provide the additional care needed. The assumption by DHSC is that there will only be one essential care giver for one resident. However, exceptions may be agreed subject to the assessment of individual circumstances.
End of life visiting should be enabled at all times (including in the event of an outbreak) and families and residents should be supported to plan visits. The guidance states that this does not only mean in the “very end” of life.
During national lockdown periods visits have typically been limited to those that could be conducted outside in the open air, wherever possible, with visitor and resident remaining at least 2 metres apart at all times. Many homes have constructed or adapted special outside visiting facilities or “pods” — outbuildings with plastic or glass barriers or screens between residents and visitors. Use of these facilities should continue as this allows residents to see a greater number of people safely. However, spaces should only be used by one resident and visiting party at a time and should be subject to regular cleaning.
All visiting must happen within a wider care home environment of robust infection prevention and control (IPC) measures and management of risks. Providers should set out their visiting arrangements in a suitable policy which has been developed in collaboration with residents and families. The policy should be based on a “dynamic” risk assessment that is regularly reviewed and informed by advice from local directors of public health and public health teams. Alternatives to visiting, such as keeping in touch through phone and online video links, should be supported wherever possible.
While the government strongly recommend that all visitors and residents take up the opportunity to be vaccinated when they are invited to do so through the national programme, the guidance states that it should not be a condition of visiting that the visitor or the resident should have been vaccinated. Critically, DHSC state that in the event of a Covid-19 outbreak in a care home, the home should immediately stop visiting.
The government has expressed a hope that by the summer of 2021 care home visiting will feel “as relaxed and normal as possible” and retaining only those infection prevention and control measures that are needed to protect the most vulnerable residents from the risk of infection.
Visitors should be tested using supplied lateral flow devices (LFD) according to government advice, Care home LFD testing of visitors guidance.
Note that the rules relating to care home visits differ in other parts of the UK.
In Scotland Open with Care — supporting meaningful contact in care homes: guidance applies. This states that routine indoor visiting of care home residents by relatives, friends and carers will be able to resume from early March with care providers supporting residents to have up to two designated visitors each and one visit a week for each visitor.
In Wales Visits to care homes: guidance for providers (Version 4) applies.
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.
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.
Government support for adult social care
The Government has developed a range of support mechanisms for the adult social care sector. The support schemes recognise the importance of the sector and the pressures that managers and staff are under.
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.
£1.6 billion in March 2021 and a further £1.6 billion in April to support providers in meeting pressures across the range of public services.
£1.3 billion Covid-19 discharge funding via the NHS to 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
Testing is a key element in identifying who is infected or is carrying the virus.
Two main types of nasal/throat swab tests are available to confirm the presence of the virus in both symptomatic and asymptomatic individuals:
Rapid lateral flow device (LFD) tests
Polymerase chain reaction (PCR) tests.
Rapid lateral flow (LFD) tests are designed to give a quick result and are usually self-administered. A swab from the mouth and nose is dipped into a special fluid and drops are placed in a plastic tray supplied in the kit. After 30 minutes the result can be read. The test is particularly helpful in screening for asymptomatic carriers of the virus.
Polymerase chain reaction (PCR) tests are more accurate and mainly for people who have symptoms. They are usually administered in test centres, such as drive through sites, or self-administered using home kits. A swab from the nose and throat is sent to a laboratory for confirmation of infection. Results can take 1 to 3 days.
Guidance for adult social care can be found in the following documents.
Additional guidance is available in Scotland, Wales and Northern Ireland.
According to the guidance all care home residents will be tested prior to admission, including on discharge from hospital. Care staff and existing residents can be tested according to the following arrangements.
• Symptomatic care home workers (and anyone with symptoms that lives in the same household as a care home worker) can arrange a PCR test at either a regional testing or mobile testing site, or choose to receive a home testing kit delivered direct to their door by visiting the online self-referral portal at https://www.gov.uk/get-coronavirus-test.
Alternatively, symptomatic staff can be referred by care home managers for a test via the employer-referral portal (a login can be obtained by emailing firstname.lastname@example.org)
Care homes can also register for a supply of routine testing kits which can be used for staff, residents and visitors. Under the scheme:
a suitable stock of LFD and PCR test kits are delivered to the home
staff are trained to administer the kits
the PCR test kits should be used to test staff members on a weekly basis and residents every 28 days
the LFD tests should be used to test staff twice a week, ideally before starting work, on the same day that they are testing using PCR tests, and mid-week between PCR tests
LFD tests should be used to test staff on their first day back to work following a period of leave that has resulted in them missing their weekly PCR test (staff should be tested before they begin their shift).
Care home workers with Covid-19 symptoms should be self-isolating and should obtain a test through the self-referral or employer portals.
LFD test kits supplied under the scheme can also be used for testing visitors and visiting professionals. See the Visiting section above.
Staff who will be conducting LFD testing on other care home staff need to complete the appropriate online training, including NHS Test and Trace training. LFD tests can also be accessed through local pharmacies and by ordering home kits online.
Where there is any suspicion of a new Covid-19 outbreak (two or more people with disease symptoms), or where it has been 28 days or longer since the last case and there are new cases, the care home manager should contact the local health protection team (HPT). The HPT will provide advice and arrange for any initial testing required.
In the community arrangements are similar. Every care worker who needs a test should be able to access one. Symptomatic staff should be self-isolating and can access testing through the self-referral or employer referral portals as above. All people admitted to hospital to receive care will be tested and the information should be shared with relevant community partners planning subsequent community care.
Both care homes and domiciliary care services must support the NHS Test and Trace system. Contact tracing is an established infection prevention technique that has long been used in combatting communicable diseases. 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.
Staff from NHS Test and Trace or other public health professionals may contact home care providers if one of their staff or service users has tested positive for coronavirus in order to alert those who have been in close contact with them. Home care providers can assist NHS Test and Trace by keeping a temporary record of their care staff and recipients of care.
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 to protect themselves against different strains of coronavirus being introduced into the country by international travellers. Government advice during the national lockdown is that people must not leave home or travel, including internationally, unless they have a legally permitted reason to do so.
Those that do travel are subject to a number of restrictions and rules.
From 18 January 2021, those who intend to travel to England, Scotland, or Wales, and UK nationals returning home from travel abroad, must provide evidence of a negative Covid-19 test result taken up to three days before departure. They must also self-isolate when they enter the UK from any foreign country except Ireland, unless they have a valid exemption.
Vaccine development and the future
Research into Covid-19 vaccines has been carried out all around the world, the hope being that successful vaccines, in combination with more effective treatments for people who are infected with the virus, is the best way to help return the world to some form of normality.
Many vaccines have now been developed. In the UK 3 vaccines have now been approved for use by the Medicines and Healthcare products Regulatory Agency (MHRA):
a vaccine developed by the drug companies Pfizer and BioNTech in the USA/Germany
a vaccine developed by Moderna in the United States
a vaccine developed jointly by Oxford University and AstraZeneca.
The Pfizer and Moderna vaccines have both been shown to be about 95% effective, effectiveness being a measure of the vaccines ability to create an immune response and confer immunity against the Covid-19 virus. The AstraZeneca (AZ) vaccine has a 70–90% effectiveness depending on the dose.
A strategy setting out priority groups for the vaccination roll-out was developed in December 2020 by the Joint Committee on Vaccination and Immunisation, Advice on priority groups for COVID-19 vaccination. The JCVI is the expert advisory group for vaccination in the UK. According to the strategy, the most vulnerable were prioritised, including care home residents and social care staff.
People on a GP register for learning disabilities were added in an update to the schedule. Also updated was the gap between jabs.
The Pfizer, AZ and Moderna vaccines all require a two-dose course. Both doses are required for full protection. The JCVI strategy was updated to place priority on the first injection with the second dose of the Pfizer/BioNTech vaccine given between 3 to 12 weeks following the first dose and the second dose of the AZ vaccine given between 4 to 12 weeks following the first dose. This change was designed to promote a more rapid uptake amongst vulnerable persons. Operationally the MHRA recommend that a consistent interval should be used for all vaccines to avoid confusion and simplify booking.
The Pfizer/BioNTech vaccine was initially delivered from a limited number of hospital hubs. This was because it needs to kept very cold. The AZ vaccine is easier to deploy and is being rolled out through hospitals, community vaccination centres, GP practices and “mass vaccination” hubs.
Adult social care staff were targeted for vaccination in the first weeks of the campaign. The majority have now been offered vaccination. Care home residents are being offered vaccines by NHS and primary care staff visiting homes. An initial government target to offer vaccines by mid-February to the over-70s, to health and social care workers and to those required to shield — about 15 million people — was met. The rest of the priority groups will follow through to the spring by which time everybody 50 and over will have been offered a jab. Vaccines will then be available for the rest of the adult population with a target for all adults to have been offered a first vaccination by July. The JCVI have stated that this second phase will start with people aged 40-49.
People will be invited to be vaccinated and should wait until they receive a letter from the NHS. More information, and access to the national booking service, can be found on the NHS Coronavirus (COVID-19) vaccine webpage.
Further information about the vaccination programme can be found in the UK COVID-19 vaccines delivery plan.
Resources to support vaccination, especially for the vaccination of care home residents and staff, can be found on the COVID-19 Vaccination Programme webpage:
COVID-19: the Green Book, Chapter 14a — containing details of 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 JCVI setting out the strategy for who should be vaccinated and when
COVID-19 vaccine product information — summary of comparative information about the Pfizer, AZ and Moderna vaccines
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.
The website includes the latest safety details on the use of the AZ vaccine. The advice follows reports of an extremely rare adverse event of concurrent thrombosis (blood clots) and thrombocytopenia (low platelet count) following vaccination with the first dose of the AZ vaccine. This dented confidence in the vaccine and led to a number of countries temporarily pausing their programmes. The UK government did not pause and the JCVI, MHRA and the WHO all concluded that the benefits of vaccination outweigh this small risk for adults aged 30 years and over.
Public health doctors have been quick to welcome the development of the vaccines as a breakthrough in the fight against Covid-19. However, they warn that achieving full vaccination is a long process. In the meantime, tried and tested methods of preventing virus transmission, such as social distancing and the wearing of masks, must continue.
At present none of the available vaccines are licensed for use on those under 16 years of age. Vaccine trials are progressing on children and improved data on clinical risk factors and vaccination in childhood is developing.
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.