COVID-19 guidance for Adult Social Care providers

COVID-19 summary of guidance for adult social care staff working in Extra-care, Supported Living and Domiciliary Care Settings (April 2023). Taken from government guidance:

• COVID-19: testing from 1 April 2023 - GOV.UK
• COVID-19 supplement to the infection prevention and control resource for adult social care - GOV.UK

This guidance is subject to change depending on national and local epidemiology and on government policy.

COVID-19 testing - recent national changes 

Summary of main changes:

• From 1 April 2023 symptomatic testing is now only advised for those eligible for COVID-19 treatments. See who is eligible for COVID-19 treatments
• Individuals who do test positive for COVID-19 can return to their usual activities after 5 days of isolation if they feel well and no longer have a high temperature. A negative test is not required.
• Outbreak testing is no longer routinely required in extra-care and supportive living settings. This can, however, be deployed if there are specific concerns within the setting and your local Health Protection Team can advise on this.

Rationale for the changes

As a result of high vaccination coverage and increased access to COVID-19 treatments, it has been recommended to manage COVID-19 like other respiratory infections. With this approach, testing and infection prevention control (IPC) measures are focused on protecting those most at risk of severe illness.

Vaccination remains a primary protection measure against both COVID-19 and Flu, helping to reduce the risk of serious illness, hospitalisation, and death. Please continue to encourage all eligible persons in your setting to be vaccinated.

An extra COVID-19 booster dose in spring 2023 should be offered to:

• adults aged 75 years and over
• residents in a care home for older adults
• individuals aged 5 years and over who are immunosuppressed (as defined in tables 3 or 4 of the Green Book)

Everyone eligible for a COVID-19 vaccination can book their booster dose online via the national booking service or by phoning 119.

Management of a resident who is symptomatic or tests positive for COVID-19 in extra care, supportive living, or domiciliary settings 

Symptomatic resident or service user

Any resident or service user who is eligible for COVID-19 treatments and has symptoms (even if they are mild) of a respiratory infection should take a test using a lateral flow device (LFD) immediately and follow the guidance for people eligible for COVID-19 treatments

Symptomatic residents who are not eligible for COVID-19 treatments are no longer required to test using an LFD. Any person who does develop symptoms of a respiratory infection and has a high temperature / does not feel well, are advised to try to stay at home and avoid contact with other people, until they no longer have a high temperature or no longer feel unwell.

It is particularly important for symptomatic residents to avoid close contact with anyone that is at a higher risk of becoming seriously unwell if they are infected with COVID-19 and other respiratory infections.

The following actions will reduce the chance of passing on respiratory infections to others in the setting:

• keeping some distance between yourself and other people you live with
• wearing a face mask whilst moving around the setting or in shared spaces in the setting
• ventilate the rooms you have been in by opening windows and leaving them open for 10 minutes after you have left the room
• washing your hands regularly and covering your mouth and nose when coughing or sneezing
• advise anyone that does need to come into your home/room that you have symptoms, so they can take precautions to protect themselves such as wearing a face mask, keeping their distance if they can, and washing their hands

Please see the full guidance for people with signs of a respiratory infection, including COVID-19

Positive resident / service user

Any resident or service user who is eligible for COVID-19 treatments and who test positive for COVID-19 should follow the guidance for people eligible for COVID-19 treatments

The test result should be reported via GOV.UK or by dialling 119 in order to generate a referral to a COVID-19 Medicines Delivery Unit (CMDU) clinician.

Any resident within the setting who tests positive for COVID-19 should be supported to try and stay away from others for a minimum of 5 days after the day they took the test.

Although many people will no longer be infectious to others after 5 days, some people may be infectious to others for up to 10 days. Residents testing positive to COVID-19 should avoid mixing with people at higher risk of becoming seriously unwell from COVID-19, for 10 days after the day they took the test where possible.

Management of staff who are symptomatic or test positive for COVID-19 in extra care, supportive living and domiciliary care settings 

Symptomatic staff

Staff who are eligible for COVID-19 treatments and who have symptoms of a respiratory infection should take an LFD test immediately and follow the guidance for people eligible for COVID-19 treatments

Please encourage any staff who are eligible for COVID-19 treatments to keep some rapid lateral flow tests at home. They can order free NHS rapid lateral flow test kits HERE

Staff who are not eligible for COVID-19 treatments are no longer required to test. Staff in this category who do develop symptoms of a respiratory infection and have a high temperature / do not feel well enough to go to work, are advised to stay at home and avoid contact with other people.

They should follow the national guidance for people with signs of a respiratory infection, including COVID-19. Managers should undertake a risk assessment before staff return to work in line with routine return to work processes.

Staff who test positive

Staff who are eligible for COVID-19 treatments and who test positive for COVID-19 should follow the guidance for people eligible for COVID-19 treatments

Any member of staff who tests positive should stay away from work for a minimum of 5 days after the day they took the test.

After 5 days, staff can return to work once they feel well, and do not have a high temperature. If they work with vulnerable residents or service users, they should speak to their line manager when they ready to return to work who should undertake a risk assessment. Although many people will no longer be infectious to others after 5 days, some people may be infectious for up to 10 days from the start of their infection. Staff working should be supported to avoid contact with people at higher risk from becoming seriously unwell from COVID-19 for up to 10 days after the day they took their test.

Routine asymptomatic testing for COVID-19 

There should be no regular asymptomatic testing for staff or residents in extra-care, supportive living or domiciliary care settings.

Outbreak testing and management in extra care and supported living settings 

Settings are no longer required to carry out whole home testing or rapid response testing to confirm if there is a COVID-19 outbreak within the setting.

Any testing of individuals should focus on symptomatic people who are eligible for COVID-19 treatments. Please see guidance for people eligible for COVID-19 treatments

Although outbreak testing measures have ended for supportive living and extra-care settings, the Health Protection Team at Coventry City Council are available to discuss specific concerns and give advice on further protective measures if an outbreak is suspected. Please contact HPTeam@coventry.gov.uk for support. The team are also available on: 024 7697 8919.

UKHSA regional health protection teams are also available to support settings with COVID-19 outbreak management, particularly where there are specific concerns.  UKHSA West Midlands Health Protection Team are available on Tel: 0344 225 3560 (Option 0 / Option 2)

Symptoms of COVID-19, flu and common respiratory infections include:

• continuous cough
• high temperature, fever or chills
• loss of, or change in, your normal sense of taste or smell
• shortness of breath
• unexplained tiredness, lack of energy
• muscle aches or pains that are not due to exercise
• not wanting to eat or not feeling hungry
• headache that is unusual or longer lasting than usual
• sore throat, stuffy or runny nose
• diarrhoea, feeling sick or being sick

Who is eligible for COVID-19 treatments?

Individuals who are at highest risk of getting seriously ill from COVID-19 are eligible for treatments to reduce their risk of serious illness.

Who is classed as being at a higher risk of getting seriously ill from COVID-19?

Please see guidance for people eligible for COVID-19 treatments

A person may be at highest risk if they have:

• Down's syndrome, or another chromosomal disorder that affects your immune system
• certain types of cancer or have received treatment for certain types of cancer
• sickle cell disease
• certain conditions affecting the blood
• chronic kidney disease (CKD) stage 4 or 5
• severe liver disease
• had an organ transplant
• certain autoimmune or inflammatory conditions (such as rheumatoid arthritis or inflammatory bowel disease)
• HIV or AIDS and have a weakened immune system
• a condition affecting your immune system
• a rare condition affecting the brain or nerves (multiple sclerosis, motor neurone disease, Huntington’s disease or myasthenia gravis)

Please encourage individuals who are eligible for COVID-19 treatments to have some rapid lateral flow tests for use if they become symptomatic. They can be supported to order free NHS rapid lateral flow test kits.

If a resident or service user is unsure if they are eligible, they can check with their GP or hospital specialist. It is recommended that settings keep records (where appropriate) of residents and staff who are eligible for COVID-19 testing and treatments.