Within a few months the global coronavirus pandemic (COVID-19) has spread to almost every country in the world. In the UK at its peak, the number of patients in intensive care was estimated to be doubling every 3-4 days. Now numbers of new cases are beginning to decline in most affected countries. Deborah Bellamy reviews current the information available about the virus and what the public health concerns are for the UK.

Current position on Coronavirus (COVID-19)

Since it was first identified late last year as a novel coronavirus (COVID-19) strain in individuals from the city of Wuhan in Hubei province, China, Covid-19 has spread rapidly around the world.

From the beginning of the lockdown process in the UK, the Government has been guided by science to contain, delay, and mitigate the outbreak and uses research to inform policy development.

In an epidemic, one of the most important numbers is R – the reproduction number. Recent adjustments to guidance that have been made are influenced by the ‘R’ which, if this is below one, on average each infected person will infect fewer than one other person. Therefore the number of new infections will decrease and as this reduces further,as will the number of new infections. The R is now below 1 - currently between 0.5 and 0.9 and ventilated bed capacity reduced and deaths in the community are also falling.

By optimising the social distancing measures as the R number changes, processes can be modified to continue to suppress the epidemic spread, whilst aiming to minimise economic and social effects longer term.

There is still a real concern for a second peak of COVID-19, so progress to ease lockdown has necessarily been slow, but after more than 7 weeks, restrictions have begun to be diminished in England. However, if the R number rises then this will need to be reviewed. It is not an easy balance and previous viral outbreaks showed morbidity and mortality related to decreased access to care may be of equivalent, if not increased significance than the effects of the outbreak longer term.

Scotland, Wales, and Northern Ireland are devising their own guidance on the easing of restrictions. Moving forward, significant global challenges remain on the operational support required for managing the virus.

Guidance has been updated by Public Health England (PHE) and Health Protection Scotland (HPS) to provide healthcare providers in all settings with information around assessment and management of suspected UK cases, and specific guidance for primary care, social and residential settings.Such guidance is reviewed and updated constantly and should be referred to on a regular basis as the situation is still evolving.

All healthcare workers managing possible and confirmed cases must adhere to updated national infection and prevention (IPC) guidance. A key priority remains in ensuring healthcare workers are protected in all work environments and that hospitals remain safe. As a consequence, different personal protective equipment (PPE) and mask and respirator combinations are being recommended for varying clinical situations and areas which take into consideration the infection status of confirmed cases versus possible cases and the risk of exposure to aerosols containing the virus.

There have been reports of issues with obtaining adequate PPE, but these largely seem to have been resolved.

What is a coronavirus?

A novel coronavirus is a new coronavirus, not previously identified. The virus causing coronavirus disease 2019 (COVID-19) is different from other coronaviruses that commonly circulate.

How is it spread?

The current advice remains the disease can only be spread between close contacts – defined as spending more than 15 minutes within 2m of an infected person. According to PHE, coronaviruses are essentially transmitted by large respiratory droplets and direct or indirect contact with infected secretions. They have been detected in blood, faeces and urine and, under certain circumstances, airborne transmission is thought to have occurred from aerosolised respiratory secretions and faecal material. In addition, the virus can survive for a certain amount of time out of the body on surfaces (up to 72 hours).

Respiratory secretions produced when an infected person coughs or sneezes containing the virus are thought to be the main cause of transmission when there is close contact of within two metres or less with an infected person. This risk is liable to increase the longer the contact period with an infected person and for longer than 15 minutes.

Individuals can catch COVID-19 if they breathe in the droplets or touch infected surfaces and then touch their eyes, nose or mouth.

The incubation period for COVID-19 and onset of symptoms is estimated between 0 and 14 days. The estimated average is 5–6 days. Most patients are usually considered infectious while they have symptoms and how infectious they are dependent on the severity of their symptoms and stage of their illness.

The median time from symptom onset to clinical recovery for mild cases is approximately two weeks and 3–6 weeks for more severe or critical cases. There have been reports of infectivity during the asymptomatic period and some patients may be completely asymptomatic, rendering infection control more complex.

Current guidance is based on knowledge gained from experience in responding to coronaviruses with significant epidemic potential such as Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV). Both prompted global collaboration to reduce spread between people and to protect healthcare workers.

It has been found that Covid-19 differs from other coronaviruses as spectrum of disease is broad and estimated approximately 80 per cent of cases have so far led to a mild infection with around 20 per cent of Covid-19 cases have been classed as "severe" with the death rate between 0.7 per cent and 3.4 %.

Updated case definition

Public Health England (PHE) updated possible COVID-19 case definition, guidance on testing and which cases should be reported to local health protection teams.

The Government guidance to stay at home where a member of a household meets the possible case definition should be adhered to.

Staff who meet the possible COVID-19 case definition will need to stay at home but can work remotely if well enough to do so.

Testing

Testing in England and Scotland had previously been limited to those with symptoms who are key workers and their families, hospital patients, care home residents, over-65s and those who need to leave home to go to work.

The testing capacity in the UK has been increasing and anyone aged five and over in the UK with symptoms can now be tested for coronavirus

However, some health professionals have raised concerns about the accuracy of some tests as well as the time it takes for results to be returned to patients with the average test return was five days but some reports are up to 13 days.

Priority for testing remains with NHS staff and care home workers and service users to protect the most vulnerable. Essential workers can apply online with the recommendation to apply within the first 3 days of having symptoms as the test is best taken within 5 days of symptoms starting. Option of taking the test at home or at a drive-through testing site are given and involves taking a swab of the inside of the nose and the back of the throat, using a long cotton bud.

There have been advances with regard to Covid-19 antibody tests and a test developed was approved for use by PHE.

There have also been developments in tracking and tracing which is another key component for the next stage of easing lockdown restrictions on 1 June. This system enables someone who has come into contact with another with the virus are able to be tracked and potentially asked to self-isolate. A pilot of the tracking app is ongoing on the Isle of Wight, however as it currently only lets someone know if a contact has symptoms and not if they have tested positive, it may need further refining.

Detailed information on case definition can be found at https://www.gov.uk/government/publications/wuhan-novel-coronavirus-initial-investigation-of-possible-cases.

Is there a cure for the coronavirus?

Clinical trials are ongoing and a combination of three anti-viral drugs: interferon beta-1b, lopinavir-ritonavir, and ribavirin have been found to be successful in reducing the duration of hospital stay and treating mild or moderate cases of COVID-19, but are not a cure.

Longer term the treatment of COVID-19 lies with a vaccine or drug-based treatment. The UK government has invested heavily into finding a vaccine for the virus, which is undergoing clinical testing currently.

However, a mass vaccine or treatment may still be more than a year away and it is still possible an effective vaccine may not be found.

Which patients are at more at risk?

Generally, elderly patients and those with weakened immune systems or underlying health conditions, such as hypertension, diabetes, cardiovascular disease, chronic respiratory disease and cancer are considered to be more at increased risk developing severe symptoms.

Recent statistics have shown, one in three (approximately 32%) of those who died in hospital with Covid-19 also had type 1 or type 2 diabetes. More analysis of data is needed but currently patients with diabetes are being urged to contact practices for delayed reviews and advice to ensure that their condition is as well controlled as possible. Ensuring they have adequate medication or insulin supplies, plus testing equipment so that they can monitor regularly if they become unwell, is also advisable.

NHS England had published a clinical guide for diabetes teams (hospital and community) during COVID-19. The clinical guide for the management of people with diabetes during the coronavirus pandemic provides a framework for considerations and priorities. Further guidance is likely to be forthcoming.

Other prevalent co-morbidities were dementia, respiratory difficulties, chronic renal disease, and ischemic heart disease.

There have also been much publicised information about the high number of care home deaths and with approximately 70% of care home service users having dementia, this may be a causal factor.

Increased capacity for testing, adequate provision of PPE and additional funding has been provided via the Government in a support package for care home staff and service users. Whilst the number of deaths in care homes now seems to be falling, they continue to make up a significant proportion of coronavirus related deaths. The ONS also disclosed that care workers as being twice as likely to die of COVID-19 than NHS workers and the general population.

The death rate among British black Africans and British Pakistanis from coronavirus in hospitals in England has been found to be more than 2.5 times that of the white population.

ONS statistics in England and Wales have also shown that men have been twice as likely as women to die from COVID-19.

There has been a link between morbidity rates and poverty which associated with poor health, increased levels of disability poor housing and diet. The Office for National Statistics (ONS) released new statistics on deaths involving COVID-19 by local geographical areas and socio-economic deprivation. Death rates in 30% of the most deprived areas were seen to be more than twice as high as in the more affluent areas.

How to protect those at high risk

For the elderly or those in vulnerable category, and therefore at increased risk of becoming seriously ill from coronavirus, additional precautions, at least until the end of June include:

  • stay at home at all times – do not leave home to buy food, collect medicine or exercise

  • stay at least 2 metres (3 steps) away from other people in the home as much as possible

  • get food and medicine delivered and left outside the door – ask friends and family to help or register to get coronavirus support on GOV.UK

  • prepare a hospital bag, including a list of current medicines, in case they need to go into hospital

  • wash hands with soap and water often

  • make sure anyone who comes into the home washes their hands with soap and water for 20 seconds or use hand sanitiser gel if soap and water are not available

  • clean objects and surfaces regularly touched, such as door handles, kettles and phones, using your normal cleaning products

  • clean a shared bathroom each time it is used by wiping surfaces.

If help is needed getting deliveries of essential supplies, elderly or vulnerable patients should be signposted to local charities and schemes. The NHS Volunteer responders are also able to take referrals either by calling 0808 196 3382 or online.

What should everyone do?

New guidance is to: Stay Alert, Control the Virus, Save Lives. This has been criticised by some as being confusing, but generally means:

  • stay at home as much as possible

  • work from home if possible

  • limit contact with other people

  • keep your distance when out of the home (2m)

  • wash hands regularly

  • stay home if you or anyone in the household has symptoms.

There is no longer any limit to the amount of exercise, or "open-air recreation" outside in England and individuals can play outdoor sports such as golf or tennis with members of their household or with one other person from another household.

Individuals can now meet one other person from another household, outdoors remaining 2m apart. They cannot gather in a larger group with people not from their household, except for funerals. Individuals cannot visit friends or relatives in their houses or in gardens. Relevant authorities, including police, have powers to enforce restrictions via fines and dispersal of gatherings larger than 2 people.

Households can also drive any distance in England to destinations such as parks and beaches, bearing in mind many facilities are not open, but they should not travel to Wales, Scotland or Northern Ireland, where guidance remains to avoid any non-essential travel.

People who can work from home in England should continue to do so "for the foreseeable future". Those unable to do so, should travel to their workplace by walking cycling or driving to avoid overcrowding on public transport. Those who have to access public transport will experience socially distanced queuing and should wear face coverings.

Workplace guidance has been issued and incorporates more cleaning, staggered working shifts and no hot-desking.

The goal is for primary school children in England to return to school prior to the summer break if feasible, and for pupils in Reception and Years 1 and 6 to return from 1 June. Currently teachers unions are requesting further scientific evidence this is safe so remains contentious. The BMA is opposing the decision to begin to return children to school, urging for the prioritisation of testing and caution as they feel there is conflicting advice from scientific case studies.

In the UK, the NHS advice still states anyone with symptoms should self-isolate and stay at home for at least 7 days. If they live with others, they should stay at home for at least 14 days, to avoid spreading the infection outside the home.

Patients should be directed toward the dedicated coronavirus NHS 111 website for information. The advice is if their condition worsens or symptoms last longer than seven days, they should call NHS 111.

Decisions on easing lockdown in Wales, Scotland and Northern Ireland are the responsibility of each national government.

Symptoms to look out for

A recent addition to the commonly listed symptoms of Covid-19 is that loss of smell and taste can occur suddenly and without an accompanying blocked nose.

This may be the first symptom to appear or may start at the same time as other symptoms and in some cases, may be the only symptom. Perception of flavour is dependent on the sense of smell so patients who cannot smell may stop enjoying food.

The other most common symptoms are fever ≥37.8°C and at least one of the following respiratory symptoms, which must be of acute onset.

  • Persistent cough (with or without sputum).

  • Shortness of breath or difficulty breathing.

  • Chills

  • Muscle pain.

  • Sore throat.

  • Tiredness.

Some may also have generalised aches and pains and diarrhoea.

Advice in other parts of the UK includes the following.

  • Check your symptoms in Scotland.

  • Check your symptoms in Wales.

  • Northern Ireland: call 111.

If patients do not have no internet access, they should call NHS 111 or for a medical emergency dial 999.

For region specific information and advice in:

  • England visit nhs.uk

  • Wales visit phw.nhs.wales

  • Scotland visit nhsinform.scot

  • Northern Ireland visit HSC

  • Ireland visit HSE.

Information for Primary Care

Under the GMS contract, practices have a responsibility to provide services to their registered patients and how best to do this. COVID-19 does not invalidate this requirement.

General practices have an important role to play on ensuring patients are clear there is safe access to care and that they will be able to be seen where clinically necessary in the most appropriate clinical setting. Physical examinations will still be undertaken where this could inform the diagnosis of an acute condition or risk of further deterioration.

As many practices have been aware, there seems to have been a temporary reduction in customary clinical activity, however this was replaced by considerable work on system modification. This is now reversing early indications show patients are beginning to contact practices more often. This will be particularly important for chronic disease management, particularly those with diabetes as the need to ensure their condition is well controlled due to additional risks of severe Covid-19.

Many practices have been working collaboratively and some areas designating branch surgeries or a specific practice as a COVID hub and establishing locality “hot, cold, respiratory and remote” advice hubs.

All organisations involved need to be aware of the staffing implications and agree the most appropriate way forward in collaboration with staff. This may also involve the PCN, CCG and other primary care providers where necessary.

Temporary movement of staff may be a necessary part of business continuity for all health care areas, but employers are expected to be flexible and any decision to change work patterns should be clinically led and reasonable.

Staff members should raise any concerns with regards to their personal safety with their manager and if they have underlying health concerns, or vulnerable family members that should be taken into consideration.

Adherence to high standards of infection prevention and control, as well as complying with social distancing rules are the best way to prevent the person-to-person spread of pathogens, such as coronavirus.

All patients should be remotely triaged to assess whether a face-to-face appointment is deemed clinically necessary or whether follow up care and advice can be given using remote consultation methods.

To protect staff and patients and enable effective social distancing, practices can indicate recommended distances by way of signs or tape on floors placed at least two metres apart.

To achieve effective infection control, infection control policies and procedures must be implemented in full, especially those related to effective use of PPE, hand hygiene, sanitisation and environmental cleaning.

There may be additional country specific guidance to each in the United Kingdom, as this guidance was written by Public Health England primarily for an English health professional audience. Managers are advised to check if country specific information is available as necessary and should please refer to Health Protection Scotland, Public Health Wales, or Public Health Agency in Northern Ireland.

To find local Health Protection Teams (HPTs) on www.gov.uk/health-protection-team, practices can type in their postcode to access further local advice/support.

Further information, in other parts of the UK may be accessed from:

  • Public Health Wales

  • Health Protection Scotland

  • Public Health Agency (Northern Ireland).

Interim guidance for Primary Care has been withdrawn and replaced with the following:

  • information about use of personal protective equipment (PPE) in primary care

  • primary care guidance and standard operating procedures for COVID-19 are now provided by NHS England

  • posters to support safe putting on and taking off PPE

Which may be accessed from the PHE website. Patients posters should be displayed so that they can be seen prior to patients enter the practice premises.

NHS 111

NHS 111 has an online coronavirus service that can advise those who need medical help. They will ask some questions and check the patients location so they can find services to help.

Current advice is not to leave home if anyone thinks they have coronavirus symptoms and to protect others by doing the following.

  • Do not go to places such as the GP surgery, pharmacy or hospital. Stay at home.

  • Use the 111 online coronavirus service to find out what to do.

  • Only call 111 if you cannot get help online.

Staff should refer to Guidance to assist professionals in advising the general public published by Public Health England and available at www.gov.uk.

Main principles

The (COVID-19) Standard Operating Procedure (SOP) outlined key principles for general practice in the context of coronavirus which are:

  • All patients should be triaged remotely

  • Remote consultations should be used when possible with video consultations when appropriate

  • Practices should work together to safely separate different patient cohorts: patients with symptoms of COVID-19; shielded patients; and the wider population.

  • Staff should be allocated to either patients with symptoms of COVID-19 or other patient groups, where possible.

  • In order to protect our workforce, staff should be risk assessed to identify those at increased risk from COVID-19 and the shielded group which includes those at highest risk from COVID-19.

  • Dedicated home visiting services should be considered for shielded patients.

  • Access to urgent care and essential routine care should be maintained for all patients.

  • All patients without symptoms of COVID-19 booked for any face-to-face contact should be advised to inform staff if they develop symptoms, and rescreened prior to consultation

  • Patients with symptoms of COVID-19 will be directed to NHS 111 (online, telephone if necessary) in the first instance, or may make direct contact with general practice or be referred by NHS 111/the COVID-19 Clinical Assessment Service (CCAS).

  • Avoid redirecting patients to NHS 111 if they present to general practice either because they cannot get through to NHS 111 online/by telephone, or because an NHS 111 clinician has directed them to their GP.

  • For any face-to-face assessment, patients living with someone with symptoms of COVID-19, even if they do not themselves have relevant symptoms, should follow the pathways for patients with symptoms of COVID19

  • For all face-to-face consultations, infection prevention and control measures should be followed.

Practice operating model

According to the Standard Operating Procedure (SOP), local areas will need to consider, with their CCG, the operating model that best suits their local context and arrangements. This should be flexible to adapt to changing circumstances, for example if a practice needs to close due to workforce issues.

The pandemic has led to increased patient need, reduced staff numbers and the need to separate face-to face consultations for patients with symptoms of COVID-19 from other patients necessitating in new ways of working within community settings.

As well as isolating services for patients with symptoms of COVID-19, and shielded patients, some practices may wish to separate services for patients without symptoms of COVID-19 into those with urgent care needs and those for essential routine care, such as childhood immunisations.

Where possible, staff should be allocated to either patients with symptoms of COVID-19 and those living in a household with someone who has symptoms, or patients who do not have symptoms of COVID-19.

Patients, communities and local systems (including NHS 111, directory of services leads, pharmacies, community and secondary care services) will need to be kept up to date with changes to the configuration of general practice.

Reference to the SOP for community pharmacy and community services (when published) may also be helpful to ensure joined up working

Practices should also:

  • have clear guidance for their staff based up national information and guidance available and updated as necessary.

  • ensure bank staff are kept up to date with local policies on COVID-19 in case they are needed to provide cover at short notice. Flexibility is needed within the Rota to allow for childcare or self-isolation to be taken into consideration.

There are other practical elements practices can put in place, these include the following.

  • Displaying posters at all entry points to the practice and prominent notice on practice website and online booking systems.

  • Messages recorded on practice phone systems.

  • Sending patients SMS (text) messages.

  • If a patient presents at reception, not previously being triaged, the receptionist should ask “do you have a high temperature or cough or breathlessness?” or “have you been in close contact with someone with coronavirus infection?” – if so the patients should immediately isolated.

  • Alcohol-based hand gel for use on entry to and exit from the practice.

  • Ensure all staff know where the designated isolation room or area is and have access to contact numbers for HPE.

  • Laminated effective handwashing posters in the toilet areas.

  • If there is likely to be a delay with repeat prescriptions or routine appointments due to additional work pressure publicise this.

Patient information posters should be displayed in the practice. Suggested wording for practice websites and other communications channels as well as materials to display in practices are available from: https://www.england.nhs.uk/coronavirus/primary-care/.

Patient transfers to secondary care

If the patient is critically ill and requires an urgent ambulance transfer to a hospital, practice staff must ensure they inform the ambulance call handler of the concerns about COVID-19.

In all other instances, the case must be discussed with the hospital initially so that they are aware that COVID-19 is being considered and the method of transport to secondary care agreed.

Anyone with suspected COVID-19 should be instructed not to use public transport or taxis to get to hospital.

It is recommended for patients with suspected or confirmed COVID-19 that they wear a surgical face mask if this can be tolerated for clinical areas, communal waiting areas and during transportation, The aim of this is to minimise the dispersal of respiratory secretions, reduce both direct transmission risk and environmental contamination. A face mask should not however be worn by patients if it is likely their clinical care to be compromised, such as when receiving oxygen therapy via a mask. A face mask can be worn until damp or uncomfortable.

Following the patient transfer from the practice, the room should be closed and should not be used again until appropriately cleaned. Detailed information is available on PHE website and includes waste disposal.

Personal protective equipment for COVID-19 in primary care

Preventing transmission of COVID-19 requires both droplet and contact precautions. If an aerosol generating procedure is being undertaken then airborne precautions are required in addition to contact precautions, whilst this is unlikely in primary care, additional guidance should be sought.

PHE has published guidance on putting on and removing PPE which should be followed and PPE kit for general practice staff should be available.

If there concerns around the availability of PPE, the practice should contact the NHS National Supply Disruption line on 0800 915 9964 or email supplydisruptionservice@nhsbsa.nhs.uk which should be answered within an hour.

All contact precautions need to be used to prevent and control infection transmission via direct contact or indirectly from the immediate care environment (including care equipment).

If there is any unavoidable contact with the patient, staff must minimise time spent with the patients, wear PPE in line with the standard infection control precautions, such as gloves, apron, and a standard fluid resistant surgical mask.

All staff should have access to and be trained in the proper use of PPE which should be disposed in the clinical waste after being removed. Hands must be washed with soap and water after all PPE has been removed and disposed of.

Updated guidance from PHE suggests in general practice PPE use may be necessary depending on 'local risk assessment'.

The guidance says primary care professionals should use PPE when coming within two metres of a possible or confirmed case of Covid-19 which should include a fluid-resistant (Type IIR) surgical mask; plastic apron; eye protection; and gloves.

Eye/face protection should be worn when there is a risk of contamination to the eyes from splashing of secretions (including respiratory secretions), blood, body fluids or excretions.

Staff who have had and recovered from COVID-19 should continue to follow infection control precautions, including the PPE recommended.

Guidance for infection prevention and control in healthcare settings, adapted from Pandemic Influenza: Guidance for Infection prevention and control in healthcare settings 2020.

Are face masks recommended for practice support staff and patients?

Guidance recommends that reception staff should keep two metres from patients, but where this is not practical, they should wear a fluid-resistant facemask. Some practices have also installed screens for added protection.

Patients are increasingly wearing face coverings as government guidance in England recommends that people should aim to wear face coverings in other "enclosed spaces where social distancing is not always possible, and they come into contact with others that they do not normally meet". Face coverings should be worn and not surgical masks.

Environmental cleaning following a possible case

The minimum PPE to be worn for cleaning an area where a person with possible or confirmed coronavirus (COVID-19) is disposable gloves and an apron. Hands should be washed with soap and water for 20 seconds after all PPE has been removed.

If a risk assessment indicates that a higher level of virus may be present then the need for additional PPE to protect the cleaner’s eyes, mouth and nose might be necessary. The local Public Health England (PHE) Health Protection Team (HPT) can advise on this.

Non-healthcare workers should be trained in the correct use of a surgical mask, to protect them against potentially infectious respiratory droplets when within 2 metres, and the mask use and supply of masks would need to be equivalent to that in healthcare environments.

Once the patient has been transferred, the room where the patient was should not be used, the room door should remain shut, with windows opened and the air conditioning switched off until it has been cleaned with detergent and disinfectant. Once this procedure has been completed, the room can be used again.

Dedicated or disposable equipment (such as mop heads, cloths) must be used for environmental decontamination. Any reusable equipment (such as mop handles, buckets) must be decontaminated after use with a chlorine-based disinfectant, as per current guidance. Communal cleaning trollies should not enter the room.

Day to day cleansing and disinfection of the practice environment will be increased in frequency, especially in areas such as treatment rooms, waiting rooms (where in use) and toilets. Where re-useable equipment is used it should be decontaminated according to the manufacturer’s instructions.

Infection control

Hand hygiene is essential to reduce the transmission of infection in health and other care settings remains the critical element of standard infection control precautions (SICPs) for both health care professionals and the public. All staff, patients and visitors should decontaminate their hands with alcohol-based hand rub (ABHR) when entering and leaving practices.

Infection prevention and control recommendations are being constantly reviewed as the outbreak evolves and the country moves through the phases described in the coronavirus action plan.

Effective infection prevention and control measures, including transmission-based precautions (airborne, droplet and contact precautions) with the recommended personal protective equipment (PPE) is essential to minimise risks but cannot eliminate it.

Are children and pregnant women at risk of infection?

Two reports have been published on illness among pregnant women after COVID-19 infection but suggested more evidence is needed. Pregnant women do not currently appear more likely to contract the infection than the general population.

Children can catch coronavirus but remain unlikely to have severe symptoms but their role in the spread of the virus is not yet fully understood.

Emerging scientific literature will continue to be scrutinised and it is suggested pregnant women follow the same precautions for the prevention of COVID-19, including regular handwashing, avoiding individuals who are unwell and self-isolating and to consult a healthcare provider by telephone for advice if concerned especially those with other underlying health conditions.

CQC Inspections/Emergency Support Framework

The CQC wrote to all registered providers outlining changes to their regulatory approach in response to the coronavirus (COVID-19) outbreak. This included stopping routine inspections and provider information collections (PIC).

The CQC acknowledge the coronavirus (COVID-19) pandemic continues to present immense challenges on how care is delivered across health and social care. There are increased risks for service users, both with coronavirus or without it, whose treatment and care is being affected either directly or indirectly as a result.

To enable the CQC to identify such risks and respond appropriately, they have developed an Emergency Support Framework (ESF). This has been designed to be flexible and facilitate the CQC to respond to the changing needs of the health and social care system during this period.

The ESF underpins the CQCs regulatory approach during the coronavirus (COVID-19) pandemic period, but this does not constitute an inspection. This process will be rolled out sector by sector to all regulated health and social care services and implemented in general practice from the 18 May 2020.

Practices are encouraged to continue to submit statutory notifications and are encouraged to maintain inspector relationship through this period.

Information Governance

Information governance is key to ensure data is managed and shared appropriately.

Covid-19 Information Governance Advice is available on the NHS website.

  • Advice for health and care professionals.

  • Advice for the social care sector.

  • Advice for IG professionals.

NHSX is developing information governance resources and information which will become available.

In the interim, if the practices Data Protection Officer or Caldicott Guardian is unsure of appropriate action to take, Information Governance questions can be directed to: NHSX IG team.

Travel restrictions

The Foreign Office currently advises against all but essential journeys, and the government has stipulated a two-week quarantine period for people arriving in the UK will be introduced in the near future. There will be some exemptions for people arriving from the Republic of Ireland

On arrival, if international travelers are not able to state where they plan to self-isolate for 14 days, they will have to do so in accommodation arranged by the government.

All passengers are advised to remain 2m (6ft) apart wherever possible. They should also consider wearing gloves and a face covering which have been made compulsory in some airports and airlines.

Latest travel advice can be found on the GOV.UK web platform.

The Health Protection (Coronavirus) Regulations 2020 supplement the health protection regime found in Part 2A of the Public Health (Control of Disease) Act 1984. These Regulations may be cited as the Health Protection (Coronavirus) Regulations 2020 and came into force immediately.

What next

The Government has published an extensive document: Our Plan to Rebuild: The UK Government’s COVID-19 recovery strategy which provides detail on the predicted next steps. This may be found on the government website.

Last reviewed 26 May 2020