1

SOP - PHE-LA Joint Management of Care Home COVID-19 Outbreaks in EoE V8 EoE COVID-19 Implementation Group* Lead: Smita Kapadia

Date Updated: 24.08.2020 Review date: Living document Overview

This Standard Operating Procedure (SOP) has been developed jointly by PHE East of England (EoE) Centre and Local Authorities (LA) Directors of Public Health to ensure a co-ordinated response for managing COVID-19 outbreaks in care homes.

This provides a framework for working across PHE EoE, public health structures in LAs, Clinical Commissioning Groups (CCGs) and other relevant organisations for dealing with COVID-19 outbreaks in care homes.

This SOP will be kept under review, in line with national guidance. This is an outline document intended to be flexible and adaptable for local operation. Different local systems in EoE have different care home support and outbreak management arrangements, including differing LA Public Health team roles, so this SOP is intentionally flexible to allow for that.

The overarching joint approach to managing care home outbreaks will be as follows, although specific details on local management will differ between LA areas:

- PHE will undertake risk assessment, advise the care home on infection control measures and hand over the follow up of the outbreak to the LA cell.

Rationale for the joint SOP

1. To have a joint collaborative and co-ordinated approach to supporting EoE care settings including care homes, extra care housing and supported housing in managing COVID-19 outbreaks with the aim of reducing transmission, protecting the vulnerable and preventing increased demand on healthcare services.

2. To streamline the follow up of EoE care settings by the LA, CCG and PHE Health Protection Team (HPT).

3. To provide consistent advice to care homes.

4. To have a single point for contact and regular follow up.

5. To provide a joint response for outbreak management, providing infection control advice and support for operational issues.

6. To maintain a single database for surveillance and monitoring of care homes for COVID-19

7. To share outbreak information between PHE, LA and CCGs to facilitate patient

2

discharges from hospitals and admissions in to care homes.

Governance and Key Guiding Principles

PHE will fulfil its statutory duty as outlined below by receiving the notification of the outbreak, undertaking the risk assessment and providing public health advice in accordance with the national guidance.

As per this joint SOP and in line with the statutory roles outlined below, LAs will conduct follow up of these homes as a shared responsibility with CCGs and fulfil their statutory duty for safeguarding and protecting the health of their population:

1. PHE has responsibility for protecting the health of the population and providing an integrated approach to protecting public health through close working with the NHS, LAs, emergency services, and government agencies1. This includes specialist advice and support related to management of outbreaks and incidents of infectious diseases.

2. The health system has a shared responsibility for the management of outbreaks of

COVID-19 in care homes in EoE.

3. Infection control support for care homes is provided by CCGs / other local arrangements.

4. Under the Care Act 2014, Local Authorities have responsibilities to safeguard adults

in its area2. LAs responsibilities for adult social care include the provision of support and personal care (as opposed to treatment) to meet needs arising from illness, disability or old age.

5. Under the Health and Social Care Act 20123, Directors of Public Health in upper tier and unitary local authorities have a duty to prepare for and lead the local authority (LA) public health response to incidents that present a threat to the public’s health.

6. For COVID-19 outbreaks in care homes, the Adult Social Care Plan outlines that LAs

have responsibility for supporting the care homes with operational issues, including PPE and staffing issues4.

7. Under the Health and Social Care Act 2012, CCGs have responsibility to provide

services to reasonably meet health needs and power to provide services for prevention, diagnosis and treatment of illness.

8. Medical practitioners have a statutory duty to notify suspected and confirmed cases of notifiable diseases to PHE, under the Health Protection (Notification) Regulations

1See:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/199773/Health_Protection_in_Local_Authorities_Final.pdf 2 http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted

Note Care Act easements created under Care Act 2020 – to help LA manage by prioritising only the most pressing needs. See: https://www.gov.uk/government/publications/coronavirus-covid-19-changes-to-the-care-act-2014/care-act-easements-guidance-for-local-authorities 3 http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted

4 https://www.gov.uk/government/publications/coronavirus-covid-19-adult-social-care-action-plan

3

2010 and the Health Protection (Notification) Regulations 20205.

9. Under mutual aid arrangements, this collaborative arrangement creates a shared responsibility between the LAs and PHE in dealing with COVID-19 outbreaks in care homes.

10. In practice the LAs and PHE HPT will work closely together to deliver the duty to

collaborate as part of a single public health system to deliver effective control and management of COVID-19 outbreaks in care homes.

PHE HPT Role

1. Risk assessment of Care Home Outbreaks 1.2 On initial notification (from the care home or any other source) the HPT will

undertake a risk assessment for care homes reporting one or more residents or staff with confirmed or suspected COVID-19 infection (see case definition below). This will also include asymptomatic residents or staff who may test positive and are reported to the HPT. Case definition: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-initial-investigation-of-possible-cases/investigation-and-initial-clinical-management-of-possible-cases-of-wuhan-novel-coronavirus-wn-cov-infection)

1.3 The HPT will give infection control advice (verbal and email) to the care home to minimise spread of infection. The template for advice is included as Appendix 2.

1.2 In complex situations a joint discussion on control measures will take place

between LA/CCG lead and PHE EoE CRC Consultant. An example indicating poor outbreak control would include sudden high attack rate, increase in deaths or other operational issues.

1.3 The HPT will inform the local care home management cell or its equivalent of the outbreak by email.

1.4 The LA care home cell or its equivalent will have the responsibility for organising ALL testing of the care home, as agreed in the joint EoE PHE-LA SOP for care homes in line with the revised recommendations in the DHSC letter of 3rd July.

1.5 LAs will support the care homes to implement control measures.

1.6 HPT will continue to provide ongoing advice and support the care home or LA cell for managing the outbreak, as needed.

2. Operational Reporting6 to Local Systems

5http://www.legislation.gov.uk/uksi/2010/659/contents/made

http://www.legislation.gov.uk/uksi/2020/129/contents/made

4

HPT will inform local system of care homes reporting a new outbreak, including during weekends, in an email (Template email - Appendix 3) which will include the following information:

Layout of Home:

1) Date of onset of the first case: 2) Total bed capacity: 3) Current no. of residents in the home: 4) No. of symptomatic residents on the day of reporting: 5) Total no of confirmed residents (symptomatic or asymptomatic) to date: 6) Total no. of staff: 7) Total no of confirmed staff (symptomatic or asymptomatic) to date: 8) Total no. of residents who have died (in hospital or in the care home): a) Total no. of COVID-19 suspected deaths in the care home: b) Total no. of COVID-19 confirmed deaths in the care home:

10) Infection control/outbreak control measures advised (verbal and via email): Yes/NO

3. Operational Enquiries

Enquiries received by HPT relating to operational issues, such as listed below, will be forwarded to local systems’ agreed email for each local cell. 1) Sourcing PPE 2) Operational issues relating to staff capacity and other support to business 3) Staff swabbing

Local System Role

1. LAs have established arrangements for regular follow up of care homes to facilitate discharges from hospitals and support care homes. In response to COVID outbreaks in care homes, local systems should have in place processes to support homes where there is evidence of poor outbreak control measures. An example indicating poor outbreak control would include sudden high attack rate, increase in deaths or other operational issues.

2. As part of their regular updates local systems are collecting a range of information,

including the number of symptomatic residents, staffing numbers etc. Example Bed Trackers are attached in Appendix 4.

6 This data will be provided for operational purposes and not for wider circulation.

5

3. Local systems will have the following arrangements in place: In line with the revised testing recommendations in the DHSC letter of 3rd July 2020 swabbing will be undertaken in three rounds;

Adult Social Care

testing strategy letter to DPHs and DASSs 3.7.20.pdf

For care homes WITH outbreaks:

Round 1: whole home testing at the point of notification of the outbreak. The LA cell will arrange swabbing of the whole home (all staff and residents) via Pillar 1*

Round 2: repeat testing (via Pillar 1) will be offered between days 4 and 7 from round 1 ONLY to those staff and residents who tested negative in round 1 AND to those staff and residents who were missed in round 1.

Round 3: whole home testing (all staff and residents) will be offered at 28 days AFTER the date of onset in the last suspected case (via Pillar 2*).

(Should a resident develop symptoms between the 2nd and 3rd round of testing, they should be offered a test via Pillar 1).

(Should a member of staff develop symptoms between the 2nd and 3rd round of testing they should be asked NOT to come to the care home to be tested, self-isolate and to organise online testing via Pillar 2).

PHE recommends that you do not re-swab an individual who has had a PCR positive result for at least six weeks. This swab test looks for key fragments of the SARS-COV-2 virus that causes COVID-19, but it does not distinguish between virus that is able to replicate and transmit or inactive (broken or destroyed fragments that are not able to replicate or are ‘inactive’). Fragments of dead COVID-19 virus (inactive) can be commonly recovered from a person’s nose for six weeks following infection and sometimes longer.

For care homes WITHOUT outbreaks:

LA cells should organise swabbing and testing via Pillar 2 for: Staff every week Residents every 28 days

Should any staff or resident test positive then the HPT should be notified, and process for care homes with outbreaks as described above should be followed.

Please find the updated draft EoE Regional Protocol (Appendix 1) – to be ratified via the NHS Out of hospital cell Group

*Pillar 1: this refers to testing carried out in PHE, NHS labs, NHS labs using Source

BioScience in Nottingham and Roche laboratories

6

*Pillar 2: testing carried out in collaborating commercial laboratories Results reporting:

As is current practice, test results will be communicated to the care homes by the commissioned swabbing providers or via the e-portal for Pillar 2 results. Care Homes will be advised to communicate results to relevant GPs.

HPT will continue to receive results from SGSS (Second Generation Surveillance System) for surveillance purposes.

4. LAs will follow-up and support the care home to continue to operate whilst managing the outbreak, including support with infection prevention and control;

5. PHE will continue to give advice on complex situations on request from local systems, including advice on closing and opening care homes to admissions

6. Systems for collating, recording and reviewing the COVID-19 care home test results data

7. Review the data on number of cases, number of deaths and staffing levels to inform a

strategic view across the local authority area

8. Provide LA-wide surveillance and monitoring of COVID-19 outbreaks in care homes, and any embargos etc.

9. Support care homes to continue to operate in order to manage and sustain capacity; support swabbing and testing arrangements (after initial outbreak testing); and maintain effective discharges from acute hospitals

10. Coordinate and expedite clinical advice and support around Infection Control to care homes and home care agencies through local systems and expertise.

11. Consider national guidance on the management of Covid 19 within care homes and home care, including advice and support on PPE

12. Bring expertise together to share knowledge and best practice, respond to operational queries and escalate situations to other agencies (e.g. CQC) as appropriate.

13. Information on deaths in care homes in the local system will be managed through LA processes and local data sharing7.

14. There will be a two-way communication between the HPT and the LA on a regular basis to keep each other informed of any significant issues relating to care homes.

15. Decisions on care home closure to new admissions and on re-opening will be jointly taken by local system leads and service providers, taking into account HPT advice, which will be provided where sought.

7 A template for this can be shared by PHE on request.

7

16. The outbreak can be declared over once there are no further residents or staff who test positive for COVID-19 for 28 days since the appearance of symptoms or a positive test in the most recent case. Please refer to bullet point 3.

8

Version Control

Version & Date Amendments *Authors/ EoE Covid-19 Care Home SOP Development Group

V1.0, 19/04/20 Initial Draft Deepti Kumar

V1.2, 20/04/20 Revisions to Principles, PHE HPT Role and Local System Role

Deepti Kumar, Jo Broadbent, Smita Kapadia, Krishna Ramkhelawon, Sally Cartwright, Tom Hennessey, Teresa Salami-Oru

V2.0, 21/04/20 Revisions to data reporting elements, local system role, PHE HPT role

Addition of Appx 1 & 3

Data Reporting T&F Group via Jo Broadbent, Smita Kapadia, Deepti Kumar

V3.0 / 3.1, 23/04/20 Amendments from PHE HPT and incorporation of comments from LA and CCG partners

Addition of Appx 2

PHE HPT amendments added by Amelia Cummins, Smita Kapadia, Deepti Kumar

LA/CCG amendments added by Jo Broadbent

V3.2, 23/04/20 Clarification of flexibility of SOP to local circumstances and expectations in common across systems

Feedback from PHE/DsPH tele conference 23/04/20

V3.3, 08/05/20 Deleted requirement for LAs to inform HPT at 14 days re status of the outbreak

Amended Appendix 1 (Template email to care homes, incorporates changes in the testing arrangements an updated guidance list)

Included Appendix 4 (Template email to LA cell from HPT)

PHE amendments added by Deepti Kumar, Smita Kapadia, Amelia Cummins and Nigel Fletcher

V4 18/05/2020 Updated the case definition

If one or more asymptomatic residents or staff test positive, then this will be considered as an outbreak and LA cells are requested to advise care homes to report this to the HPT

PHE amendments added by Deepti Kumar, Smita Kapadia, Amelia Cummins and Nigel Fletcher

9

Included the Regional Swabbing Algorithm and changed pathway accordingly

Updates recommendation to declare the outbreak over if no cases reported within 28 days (previously 14 days)

Revised email template for care homes

V5 11/06/20 Incorporated follow up arrangements of care home residents and staff reported via Test & Trace (T&T)

Deepti Kumar, Smita Kapadia, Amelia Cummins, Lucianne Lambourne and Nigel Fletcher

V6 06/07/20

Incorporated the care home swabbing arrangements from 6 July

Deepti Kumar

V7 11/07/20 Incorporated Adult Social care guidance. along with local arrangements and draft swabbing algorithm. Removed reference to contact tracing until information sharing arrangements are confirmed.

Smita K, Amelia C, Sultan S

V8 24/08/2020

26/08/2020

Added paragraph on PHE’s advice on re-testing positives within 6 weeks on page 5

Revised Appendix 2 Generic email to care homes

Revised Appendix 3 email template to LA cells

Added Appendix 4 Risk assessment following a positive member of staff

Added Appendix 5 Risk assessment following an (unexpected) positive result in an asymptomatic resident

Appendix 6 Flow chart for staff members exposed to cases in the community

Smita K, Nigel F

10

Capacity tracker is Appendix 7

11

Appendix 1 – To be ratified at the PHE & NHS ICCs

Revised draft East of England Regional Swabbing Protocol

12

Appendix 2

(Revised) Generic email template for care homes reporting an outbreak Dear <NAME>

Ref: <HPZONE No.>

Thank you for contacting the PHE East of England Health Protection Team (HPT). We will now inform your Local Authority Adult Social Care Team and commissioners of this situation. From now on, until notified otherwise, please seek their advice and support for operational issues, staffing and mutual aid as needed. Ensure you update your ADASS tool/capacity tracker. Testing residents for COVID-19:

As discussed, we will now request your Local Authority Cell to arrange swabbing with the exception of Care Homes in:

1) Milton Keynes where we ask the Care Home to contact mkccg.outbreaks@nhs.net directly to request swabbing

AND 2) Essex (Except: Southend-on-Sea Borough Council & Thurrock Council) where

we ask the Care Home to contact mobile.covid19@nhs.net (Commisceo) directly to request swabbing

These results will be sent to you in due course by the swabbing provider. Please do not contact the HPT for any testing. This can be organised in accordance with your local arrangements. Please be aware that the HPT will be unable to provide you with any results. The Local Authority Adult Social Care Team will now be your first contact regarding any issues you may have, including: 1. PPE enquiries and supplies 2. Operational issues 3. Further infection control advice 4. Visiting Please carefully read and implement the COVID-19 national guidance: (https://www.gov.uk/government/publications/coronavirus-covid-19-admission-and-care-of-people-in-care-homes) This will also be useful for clarification for PPE: https://www.gov.uk/government/publications/covid-19-how-to-work-safely-in-care-homes Infection prevention and control training for care homes is now available online: https://www.skillsforcare.org.uk/Learning-development/ongoing-learning-and-

development/infection-prevention-control/Infection-prevention-and-control.aspx

13

For residents who require medical attention, please phone and discuss with their GP or NHS 111. In an emergency call 999 and inform the ambulance provider and receiving hospital of any outbreak. A list of additional guidance relevant to care homes can be found at the end of this email; please do take some time to have a look through these. Your sincerely, <Name> <Position>

14

A list of additional guidance relevant to care homes can be found at the end of this email; please do take some time to have a look through these. Further Guidance Documents Ethical framework for adult social care https://www.gov.uk/government/publications/covid-19-ethical-framework-for-adult-

social-care

COVID-19: infection prevention and control (IPC) guidance COVID-19: infection prevention and control (IPC) - GOV.UK Managing the COVID-19 pandemic in care homes https://www.bgs.org.uk/resources/covid-19-managing-the-covid-19-pandemic-in-

care-homes

Guidance for employers and businesses https://www.gov.uk/government/publications/guidance-to-employers-and-

businesses-about-covid-19

Coronavirus (COVID-19): adult social care guidance https://www.gov.uk/government/collections/coronavirus-covid-19-social-care-

guidance

Guidance for supported living and home care https://www.gov.uk/government/publications/covid-19-residential-care-supported-living-and-home-care-guidance Coronavirus (COVID-19): looking after people who lack mental capacity https://www.gov.uk/government/publications/coronavirus-covid-19-looking-after-people-who-lack-mental-capacity

Some additional resources and support

Care home capacity tracking: https://carehomes.necsu.nhs.uk/

Social Care Institute for Excellence: https://www.scie.org.uk/care-

providers/coronavirus-covid-19

London Association of Directors of Adult Social Services (ADASS):

https://londonadass.org.uk/

Care Quality Commission: https://www.cqc.org.uk/guidance-providers/adult-

social-care

Health Education England e-Learning (free): https://www.e-

lfh.org.uk/programmes/coronavirus/

Skills for Care: https://www.skillsforcare.org.uk/home.aspx

15

Appendix 3

Revised Email Template for LA Care Home Cells

Dear Colleague

Re: < insert HP Zone No. Care Home Name, address/postcode, contact number> 1. The East of England Health Protection Team (HPT) has been informed of an outbreak or single case (exposure) of COVID-19 in the above care home. The information that has been provided to us is as follows: Care Homes CQC LOCATION Number:

1) Outbreak or exposure: 2) Layout of Home:

3) Date of onset of the first case: 4) Total bed capacity: 5) Current number of residents in the home: 6) Number of symptomatic residents since outbreak onset 7) Number of COVID-19 confirmed residents (symptomatic or asymptomatic) to date: 8) Number of residents who have been hospitalised: 9) Total number of residents who have died (in hospital or in the care home):

a) Total number of COVID-19 suspected deaths in the care home: b) Total no. of COVID-19 confirmed deaths in the care home:

10) Total number of staff: 11) Number of symptomatic staff since outbreak onset: 12) Total number of confirmed staff (symptomatic or asymptomatic) to date:

13) Infection control/outbreak control measures advised (verbal and via email): Yes/No 2. We have provided public health and infection control advice in line with national guidance.

3. Please arrange swabbing of all symptomatic residents and/or whole care home

testing in accordance with your local arrangements.

4. Advise care homes to report new outbreaks of COVID-19, including when asymptomatic

residents or staff test positive and other infectious diseases to the HPT.

5. If you would like to alert the HPT with any updates or discuss any issues in relation to this

care home please email- eoe.crc@phe.gov.uk

6. Please be advised that the outbreak will be declared over in this care home if

there are no new COVID-19 cases within a 28 day period since the last positive

case.

We would like to thank you for your support.

Yours sincerely,

a) Have any staff members been admitted to hospital: b) Have any staff members died:

16

<insert name> <Position>

eoe.crc@phe.gov.uk.

Appendix 4 (Risk assessment following a positive staff member)

Dear Care Home Manager,

We have received notification that a member/s of your staff have recently tested positive for COVID-19. If you are not aware of this result, please call us immediately on 0300 303 8537.

When can this member of staff return to work?

Please follow the web links below where you will find the following algorithms for assessment of staff and when they can return to work:

1) Symptomatic worker flow chart for return to work following a COVID-19 test

2) Asymptomatic worker flow chart for return to work following a SARS-CoV-2 test

3) Please refer to the flowchart for staff exposed to a confirmed case in the community on page 3 (final page).

How does contact tracing happen for the member of staff?

The NHS Test & Trace service will speak to the member of staff to identify the contacts in their household and anyone else outside their work e.g. neighbours or friends.

You as the Care Home need to identify the contacts the member of staff had AT WORK, including with residents and other staff members (including any social contact with other members of your staff outside work). This includes agency staff and non-care staff, such as cleaners and any other visitors to the home, for example medical professionals, religious ministers or relatives.

For what period of time was the person infectious?

For a positive case, they are a risk of infecting others from 2 days prior to symptom onset until 10 days after symptom onset. If they have a positive test result but no symptoms, use the date the test was taken as the ‘onset’.

17

Contact tracing needs to happen for all the time during this window that the member of staff was at work.

How do I assess whether other staff or residents were a ‘contact’ for this case?

Additional guidance around risk assessment of staff and residents can be found here:

COVID-19: management of staff and exposed patients or residents in health and social care settings

This will assist you in your risk assessment on who may need isolation because of contact with a positive case, the general premise is as follows:

Any resident who has had contact with the positive member of staff without the required PPE or if there was a breach of PPE (refer to guidance above) must be isolated for 14 days from last contact with the staff case.

Any member of staff who has had any significant exposure without the required PPE to the positive staff case from 2 days prior to symptom onset/or if asymptomatic the date of the positive test, until 10 days after, use the following criteria:

Direct contact:

Face to face contact with the positive staff case for any length of time, within 1m, including being coughed on

A face to face conversation with the positive staff case, unprotected physical contact (skin to skin). This includes exposure within 1 metre for 1 minute or longer

Travel in a small vehicle (such as a car or van) with the positive staff case

Proximity contact:

Extended close contact (between 1 and 2 metres for more than 15 minutes) with the positive staff case

Staff who meet any of the above contact definitions will be required to self-isolate for 14 days from last contact as per the following guidance:

Guidance for contacts of people with possible or confirmed coronavirus (COVID-19) infection who do not live with the person

18

Please fill out the line list attached for all identified contacts (both residents and staff members) – Please ensure this is emailed securely to the HPT within 48hrs using an nhs.net email account to the following address: PHE.EoEHPT@nhs.net if this is not possible please phone the Health Protection Team with the details of the contacts.

If you have any concerns or need further advice, please do not hesitate to contact the Health Protection Team on 0300 3038537.

Please note that the same process will apply to any members of staff testing positive in the future.

Kind regards,

PHE East of England Health Protection Team

19

Single (unexpected) Positive COVID-19 PCR Result in an

Asymptomatic Resident

Whole care home PCR testing for COVID-19 is conducted weekly for care home staff

and monthly for care home residents

As the number of people with COVID-19 infection in care homes and the local

population reduces, the positive predictive value of the PCR test will also reduce, this

increases the likelihood of a false-positive test result

As a result, this has important implications, for the interpretation of an isolated

(unexpected) positive PCR result in an asymptomatic resident

A risk assessment must be undertaken to determine proportionate actions. Initially a positive result must be considered as accurate, and appropriate public health measures must be initiated including isolation of the resident and identified contacts

The resident’s health must be assessed. It’s harder to recognise COVID-19 infection in people who may not be able to report symptoms they are experiencing.

Assess if the resident has:

1) Symptoms consistent with COVID-19 such as, a high temperature, cough, or a change in sense of taste or smell

2) Softer indications such as, being short of breath, not as alert, having a new onset of confusion, reduced fluid or food intake, diarrhoea or vomiting

Other residents who are known to have been exposed to the COVID-19 PCR positive resident during their infectious period (from 48 hrs prior to swabbing until 14 days after) must be isolated, whilst the risk assessment is carried out or until 14 days after last exposure. depending on the re-test result.

The risk assessment algorithm will aid in assessing if re-testing should take place within 24hrs and de-escalation of isolation is possible (see Appendix5 ).

Appendix 5: Algorithm for management of care home resident with

unexpected positive test

20

21

Appendix 6 Flow chart for staff exposed to a confirmed case in the community

Is a summary of the national guidance and should be used in conjunction with the guidance and ‘return to work’ algorithms for staff tested as part of ‘routine’ testing.

https://www.gov.uk/government/publications/covid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settings?utm_source=c7ec03ce-904a-41af-b22b-9935f45bde43&utm_medium=email&utm_campaign=govuk-notifications&utm_content=immediate

(Staff advised to self-isolate regardless of the results of any SARS-CoV-2 antibody testing. A positive antibody result signifies previous exposure, but it is currently unknown whether this correlates with immunity).

Health and Social Care Staff exposed to a confirmed case in the community or contacted by

NHS Test and Trace*

Inform line manager and exclude from work immediately

Remains asymptomatic

Develops symptoms.

Get tested as per National Guidance. Household contacts self-isolate for 14

days

Still need to complete the 14-day self-isolation

period as per new National Guidance

Return to work on day 15

Tests negative**

(household contacts can stop self-isolating)

Tests positive

Self-isolate for 10 days from the date of onset of

symptoms. Household contacts complete isolation

for 14 days

Re-testing not required***

Return to work on day 11, if

clinically well and afebrile for 48 hours without medications

Self-isolate for 14 days from the date of

exposure. Household contacts do not need to

self-isolate

Return to work on day 15

symptoms develop at any point in the 14 days

* Hospital staff exposed in the workplace will be assessed by IPCT for their risk based on the use/breach of PPE as per National Guidance

** Interpret negative results with caution together with clinical assessment

*** Some Staff may require evidence of viral clearance prior to working with extremely vulnerable people such as caring for immunosuppressed patients in oncology/haematology wards, ITU etc. This is subject to local policy.

22

Appendix 7 – Example Care Home Bed Tracker Spreadsheets

Example Care Home

BedTracker Spreadsheets.xlsx