Social care approach to respiratory viruses: autumn and winter 2022 to 2023

Based on the latest available clinical advice about the benefits of asymptomatic testing when the prevalence of coronavirus is lower, from 8 September we will pause regular asymptomatic testing for social care settings, including care homes and hospice services.

It is recommended for this autumn/winter that all symptomatic care home and hospice staff have a multiplex test that will diagnose COVID-19 and other respiratory viruses including influenza and RSV. 

We will continue to provide symptomatic testing for care home residents and we are providing multiplex tests that detect COVID-19 and other respiratory viruses. This will help to manage outbreaks and inform our ongoing surveillance.

We will continue to provide LFD and PCR testing for those eligible for COVID-19 treatments.

Residents being discharged from hospital to a care home will be offered an LFD test.

The legal requirement to self-isolate positive cases and unvaccinated contacts ended on 28 March 2022. The Self-Isolation Support payment scheme ended on 30 June 2022. The COVID-19 statutory sick pay enhancement scheme ended on 31 August 2022. 

Social care staff who test positive are very likely to have COVID-19 and can pass on the infection so they are advised to:

• stay at home and avoid contact with other people if they can
• report their result online (gov.uk) 
• notify their manager
• engage with the contact tracing process which, as health and social care professionals, will include potential follow up telephone calls with a contact tracer or completion of an e-form
• take a lateral flow test on day 5 and 6 after they tested positive and: 
  • when they have two consecutive negative lateral flow tests 24 hours apart they can return to work 
  • If they test positive on either day 5 or 6, they should continue to stay away from work until they have 2 negative tests taken 24 hours apart or up until day 10. They are also strongly advised to stay at home and avoid contact with others whilst they continue to test positive

The likelihood of a positive LFT in the absence of symptoms after 10 days is very low. However, if their LFT result is positive on the 10th day, they should continue to test and only return to work when a single negative LFT is achieved. Full guidance can be found at: COVID-19 testing for health and social care workers 

Social care staff identified as household contacts should follow specific social care guidance here. In brief however: 

• social care staff who are identified as a household or overnight contact of someone who has had a positive COVID-19 test result should discuss ways to minimise risk of onwards transmission with their line manager.

This may include considering:

• redeployment to lower risk areas for patient-facing healthcare staff, especially if the member of staff works with vulnerable patients including those who are immunosuppressed meaning  that they are at higher risk of serious illness despite vaccination (gov.uk)
• working from home for non patient-facing healthcare staff
• limiting close contact with other people especially in crowded, enclosed or poorly ventilated spaces

While they are attending work, staff must continue to comply rigorously with all relevant COVID-19 IPC guidance and the National Infection Prevention and Control Manual Wales.

If staff develop any symptoms within the 10 days, they should follow the advice for staff with symptoms of a respiratory infection, including COVID-19.

The current COVID-19 IPC Guidance provides disease specific IPC measures to prevent transmission of SARS-CoV-2 in health and care settings in Wales. This guidance should be read in conjunction with the National Infection Prevention and Control Manual Wales. This describes the application of Standard Infection Prevention and Control Precautions (SICPs) and Transmission Based Precautions (TBPs).

Details on the PPE recommended for providing direct care in COVID-19 confirmed or suspected cases can be found at: Infection Prevention and Control Measures for SARS-CoV-2 (COVID-19) in Health and Care Settings - Wales

In summary, single use gloves, aprons and single use FRSM Type 11R mask and visor or goggles should also be worn when providing direct, personal care to people with suspected or confirmed COVID-19.  

A risk assessment tool to support social care organisations in applying the Hierarchy of Controls (HoC) including PPE is available: Criteria for completing a local risk assessment. It is recommended that assessment using this tool is performed on a regular basis to ensure preparedness.

Staff should continue to wear single use gloves and aprons when providing direct, personal/ intimate care where there is anticipated blood/body fluid exposure.

Where there is no COVID-19 outbreak or incident at the care home setting, providers may risk assess the continued use of masks for staff not providing direct, personal care. 

Mask wearing for staff not providing direct, personal care should resume if COVID-19 infection is suspected or confirmed within the setting.

Visitors should be welcomed, encouraged and enabled when there is no outbreak at the care home. Visiting arrangements should be as open and flexible as possible. With regular asymptomatic testing being paused for social care settings,  visitors will no longer need to undertake LFD testing before visiting a care home.

Anyone with symptoms or who is a close contact of a positive case of COVID-19 in the last 10 days, or has had any other respiratory virus symptoms are asked to not attend the care home during this period of time. 

Care homes should take a risk-based approach to supporting visiting during an outbreak/incident. If a care home is in outbreak/incident status decisions about supporting visitors into the home should be informed by the characteristics of the outbreak and advice from the local health and public protection teams supporting that home. In some circumstances it maybe proportionate to introduce additional control measures to enable routine visiting to continue. An example would be where infection is confined to a defined building or floor of the home or confined to kitchen staff. 

Essential visitors can continue to visit during an outbreak/incident. People may nominate 2 essential visitors in order to give greater flexibility without significantly increasing footfall into the home during an outbreak. They may visit separately or at the same time. 

We would encourage health boards to work with care home providers on discharge testing arrangements.

Patients who have tested positive for COVID on or since admission can assume non-infectivity when symptoms have resolved, plus:

• 20 days have elapsed, or
• 10 days have elapsed with either a negative LFD or a negative or low positive NAAT

Asymptomatic patients who have not previously tested positive for COVID to be tested with an LFD within 24 hours of planned discharge to a care facility. Care home residents are still recommended to self-isolate following discharge, but may test to release using LFD tests on day 3.

Guidance on testing prior to discharge and subsequent self-isolation arrangements can be found at: COVID-19 Hospital Discharge Service Requirements.

Individuals requiring admission to a care home from their own home, the home of a relative or from another care setting should receive a risk assessment in regard to their infection risk, including for COVID-19 infection.

If an individual has symptoms of COVID-19 or has tested positive, placement or admission could be delayed for 10 days (or 14 days for those who are clinically or extremely clinically vulnerable) or the care home could consider admitting into isolation if they have the facilities to do so.

Providers should support and encourage people living in care homes to exercise their right to go out and to participate in family and community life. This right should not be restricted or inhibited.

With asymptomatic testing being paused from 8 September, LFD testing is not advised when returning from visits out into the community.

Guidance for people with symptoms of a respiratory infection, including COVID-19 can be found at: Guidance for people with symptoms of a respiratory infection, including COVID-19. 

The declaration and management of outbreaks of COVID-19 within care homes has been brought in line with existing respiratory infection guidance so that an incident/outbreak is only declared if two or more patients or staff cases of COVID-19 occur within a specific setting where nosocomial infection and ongoing transmission is suspected.

For an outbreak to be declared over, there should be no new outbreak-associated symptomatic or confirmed COVID-19 cases for a minimum period of at least 14 days. 

Mobile testing units retained to manage and support outbreaks. 

Contingency LFD capacity to be retained to support local outbreak management and investigating emerging variants. 

• The roll-out of the autumn booster dose programme began at the start of September 2022 to help boost the immunity of those at higher risk from COVID-19, improving their protection against severe illness.

• It is recommended for this autumn/winter that all symptomatic care home and hospice staff have a multiplex test that will diagnose COVID-19 and other respiratory viruses including influenza and RSV. 
• Staff will not be required to undertake twice weekly asymptomatic testing at this time.

• We will continue to provide multiplex PCR testing for COVID-19 and other respiratory viruses for symptomatic care home residents.
• We will continue to provide LFD and PCR testing for those eligible for COVID-19 treatments.
• Residents being discharged from hospital to a care home will be offered an LFD test. 
• Care home residents are still recommended to self-isolate following discharge, but may test to release using LFD tests on day 3.

Asymptomatic staff who are identified as a household or overnight contact of someone who has had a positive COVID-19 test result should discuss ways to minimise risk of onwards transmission with their line manager.

This may include considering:

• redeployment to lower risk areas for patient-facing healthcare staff, especially if the member of staff works with vulnerable patients including those who are immunosuppressed meaning  that they are at higher risk of serious illness despite vaccination (gov.uk)
• working from home for non patient-facing healthcare staff
• limiting close contact with other people especially in crowded, enclosed or poorly ventilated spaces

While they are attending work, staff must continue to comply rigorously with all relevant COVID-19 IPC guidance and the National Infection Prevention and Control Manual Wales.

If staff develop any symptoms within the 10 days, they should follow the advice for staff with symptoms of a respiratory infection, including COVID-19.

• Single use gloves, aprons and single use FRSM Type 11R mask and visor/goggles should be worn when providing direct, personal care to people with suspected or confirmed COVID-19.  
• Standard Infection Control Precautions (SICPs) should be used by all staff, in all care settings, at all times for all residents/service users.
• Staff should continue to wear gloves and aprons when providing direct, personal/ intimate care where there is anticipated blood/body fluid exposure.
• Where there is no COVID-19 outbreak or incident at the care home setting, providers may risk assess the continued use of masks for staff not providing direct, personal care. 
• Mask wearing for staff not providing direct, personal care should resume if COVID-19 infection is suspected or confirmed within the setting.
• The legal requirement for visitors to wear face coverings when in public areas of care homes and when moving through the care home ended on 30 May 2022. Providers may take a risk assessed approach.

• Social distancing can be relaxed when there is no evidence of COVID-19 circulating in the setting. 
• Should an incident or an outbreak occur in a care home, social distancing could be re-introduced as a mitigating measure.

• Routine indoor visiting should be enabled and encouraged when there is no outbreak at the care home. Visiting arrangements should be as open and flexible as possible and if appointment systems are used they should facilitate rather than restrict visiting.  
• There should not be inappropriate restrictions on visitor numbers or on the length and frequency of visits.  
• People may nominate 2 ‘essential visitors’ to ensure continuity of visits during an outbreak. They may visit separately or at the same time. 
• With regular asymptomatic testing being paused for social care settings, visitors will no longer need to undertake LFD testing before visiting a care home.
• Anyone with symptoms of COVID-19 or who is a close contact of a positive case of COVID-19 in the last 10 days, or has had any other respiratory virus symptoms are asked to not attend the care home during this period of time. 
• Care homes should take a risk-based approach to supporting visiting during an outbreak/incident. Decisions about supporting visitors into the home during an outbreak/incident should be informed by the characteristics of the outbreak and advice from the local health and public protection teams supporting that home.

• Providers should support and encourage people living in care homes to exercise their right to go out and to participate in family and community life. 
• With asymptomatic testing being paused from 8 September, LFD testing is not advised when returning from visits out into the community.