On 21 February 2021 the Government announced that its new approach to Covid-19 would be to live with Covid-19 rather than continue with restrictions and testing. This means mask mandates, Covid-19 passes, and isolation will all be scrapped. It also means the end of free testing. The Government maintains that our strongest defence against Covid-19 is vaccines and so will continue to encourage and support vaccine rollout and booster uptake where they can. In response, the guidance on admission to care homes was updated on 24 February 2022 and the guidance on testing in care homes was updated on 25 February 2022.
Updates to Guidance
According to the Government’s Covid-19 Response paper, “The approach to managing COVID-19 in NHS and adult social care services … will continue to focus on providing care for those that need it and supporting people who are most vulnerable to COVID-19.” It is reasonable to assume that this means extra precaution will still be taken in adult social care (“ASC”) settings and where vulnerable populations are involved. As the guidance will show, testing and isolation has not been scrapped in ASC settings like it has for the general public. However, there are some key changes in the guidance that providers will want to be aware of because this will have an effect on their Infection Prevention and Control (“IPC”) policies.
Testing Guidance Updates
The previous policy for testing and isolation in care homes stated staff must take three Lateral Flow Tests (“LFTs”) a week and one PCR on the same day as one of their LFTs while residents need only take one PCR a month. Further, where there was an outbreak, defined as two or more positive Covid-19 cases, then residents were required need take two PCRs, one on day 1 after exposure and one between days 4 and 7 after exposure or a positive test. Additionally, they had to take a LFT test on those days. For staff, they had to take daily LFTs during the isolation period and a PCR on day 1 and between days 4 and 7 in addition to the daily LFT tests.
According to the updated guidance all staff should take daily LFTs prior to their shifts, rather than a combination of LFTs and PCRs, while residents still only need to take one PCR a month. Should any of these tests come back positive, the same rules apply as above for outbreaks, still defined as two or more positive cases, when it comes to testing and isolation.
Admission Guidance Updates
The previous version of admission guidance, which outlined isolation requirements for those who tested positive for Covid-19, implemented a policy for residents who tested positive to isolate for a full 14 days, with no exceptions. Staff were able to abide by the general government guidance at the time and end their isolation early if they received a negative LFT test on day 6 and day 7 of their isolation period. This meant they could return to work on day 7 after testing positive while residents had to remain in isolation through day 14.
The updated guidance for admission to a care homes states that where a staff member has a positive LFT, they should not work until they receive two negative LFTs in a row, which can be taken five days from the positive result, which is day 0. This is not a change from the previous guidance in terms of how long staff are required to stay off of work. However, it seems that wearing Personal Protective Equipment (“PPE”) appropriately will eliminate individuals as a “close contacts” for the purposes of isolation and testing. Additionally where individuals are exposed to Covid-19, provided they have no symptoms and use PPE correctly and test, then there is no need to stop working or isolate at home. Thus, where a resident tests positive, if a staff member working with that resident was wearing PPE correctly and they do not have symptoms they can continue work as usual in line with the above testing requirements. This will have a huge impact on the staffing struggles care homes have been facing because it means that time and amount of staff that need to be off work due to Covid-19 is significantly reduced. This change cannot come at a more convenient time when around 30% of staff who are off work are off for Covid-19 related reasons.
The rules for isolation for residents has also changed. The new isolation period is 10 days instead of 14, and they may end isolation early pending risk assessments and negative LFTs. The new guidance specifically states “Residents who test positive for COVID-19 – regardless of their vaccination status – should self-isolate and then take part in daily rapid lateral flow testing from day 5 (counting the day of the original positive test as day 0). They can end self-isolation after receiving 2 consecutive negative tests 24 hours apart.” The guidance for high risk exposure is slightly different, stating “Vaccinated residents who have attended a high-risk setting should self-isolate and then take part in daily rapid lateral flow testing from day 4. After receiving 3 consecutive negative rapid lateral tests each 24 hours apart.” Residents who end isolation early are still advised to limit contact with anyone who is at higher risk of severe illness if infected with Covid-19 for the full 10 day period. However, significantly, residents isolation period has been cut in half, meaning they have more freedom and are able to maintain social contact which was severely lacking under previous Covid-19 restrictions.
Progress or Not?
While the lightened restrictions are a much welcome relief to residents, providers and staff alike, it has yet to be determined whether or not “Living with Covid-19” will be beneficial overall for ASC or be another bump in a very long road to recovery from the pandemic.
ASC staff are working with extremely vulnerable groups of people. From 1 April 2022, Covid-19 testing in ASC will not fully match the public health advice because of spending considerations. Generally, higher frequency of testing and longer isolation is recommended. However, the ASC sector will not be able to keep up with the recommended frequency of testing because it is unlikely that there will be funding to pay for it. The government will be making a decision over the next month as to whether or not free testing will be available for elderly and/or vulnerable, but that does not necessarily mean it will apply to the staff who work with them.
However, there are significant pros that come with the new guidance. The most obvious will be greater availability of staff to help fill the gaps from an ongoing staffing crisis in the sector. It also means more income for staff who are on hourly rates as COVID-19 provisions within Statutory Sick Pay and Employment and Support Allowance regulations will end on 24 March 2022. The other is that residents will no longer feel “trapped” in the homes as their social freedoms have increased with the new guidance.
Overall it seems like this is a step forward for ASC. Providers will still want to ensure they are aware of guidance updates as the government makes decisions around free testing and isolation rules. However, in the meantime nothing has really substantially changed and thus providers can rest easy, at least for the next month, knowing that significant changes do not need to be made to any policies, especially IPC, they currently have in place.
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