Public Health Scotland (PHS) are currently working to update all PHS guidance documents in response to the most recent changes announced on 05/01/22. If you were told to self-isolate before 06 January 2022, you should continue to follow the advice you were given at that time.
Updates to health protection team (HPT) guidance will be prioritised and approaches to public health management of COVID-19 including testing, contact tracing and isolation set out in this guidance should be followed across all settings.
Health protection teams (HPTs) can access the updated COVID-19: Guidance for HPTs on the PHS website. PHS is aiming to publish other updated guidance on the PHS web pages as soon as possible.
This is a live document which will be updated as the situation develops. HPTs are encouraged to use these links rather than saving versions offline to ensure using the most recent version.
While alignment takes place, there are a number of common key changes across guidance which are summarised below. Please ensure you review the Guidance on SPHIR for full details.
There is also a short section outlining changes in the advice for adult care home settings at the bottom of this page. The PHS COVID-19: information and guidance for adult care home settings will be updated as soon as possible to reflect these changes.
Key guidance changes
Pausing confirmatory PCR following positive LFDs
- Due to current high prevalence of COVID-19 in Scotland, no confirmatory PCR should be requested or recommended following a positive LFD. Contact tracing and other public health actions should commence immediately on receipt of notification of a positive LFD test.
- This is both due to the high likelihood of positive LFDs going on to be positive on PCR at times of high prevalence, and to preserve the use of PCR tests for higher priority groups.
Shortening of case isolation periods
- Cases can end their self-isolation period early (reducing this from a minimum of 10 days to a minimum of 7 days) subject to LFD testing requirements and the absence of fever, as set out below:
- Cases should be advised to take an LFD test from 6 days after the day of their symptom onset (or the day their test was taken if they have no symptoms), and another LFD test the following day. The second LFD test should be taken at least 24 hours later. If both these test results are negative, and the case does not have a high temperature, they may end self-isolation after the second negative test result.
- If either of these tests are positive the case may continue to test daily until the end of their isolation period. If they receive two consecutive negative LFDs taken 24 hours apart, and remain without fever, then they may end isolation. Daily testing should not continue past the end of the isolation period and people should return to regular weekly testing.
- They should be advised to report their LFD test result after taking each test, regardless of the result.
- All cases are eligible for this isolation shortening regardless of vaccination status, age or previous infection.
- If cases without any symptoms are isolating then subsequently develop symptoms, they do not need to reset their isolation period or take a PCR if their original positive test was a LFD. Their household also do not need to reset their isolation period and they should keep following testing advice as a contact. Cases should continue to adhere to the above advice on shortening their isolation period before ending isolation.
Replacing isolation with daily testing for some contacts
- There is no change to definitions of contacts, or the low risk / high risk approach to managing children and young people.
- After contacts are identified they can replace self-isolation with a daily LFD as long as they are fully vaccinated or aged under 18 years and 4 months. In Scotland, fully vaccinated now means the person has had a primary course of vaccine and has received a booster. This should have been completed at least 14 days before the contact took place. All others, including the partially vaccinated, are considered unvaccinated for the purposes of self-isolation requirements.
- Contacts who develop symptoms that have taken a LFD test that is negative, should self-isolate and seek a PCR test.
- Contacts who have a positive LFD test do not need to arrange a confirmatory PCR test regardless of symptoms, as they are already in receipt of a positive test result. These individuals should follow the advice for a COVID-19 case.
- Where the contact is aged under 5 years they will be recommended to take a LFD before ending isolation but will not be required to take daily LFDs. There is no longer a requirement for any fully vaccinated or child or young person contact to take a PCR unless they develop symptoms.
- Where the contact is unvaccinated, they should take a PCR and isolate for the full 10-day isolation period provided to them. Negative PCR in unvaccinated contacts does not shorten isolation.
- Where someone with symptoms is isolating and awaiting a PCR result, their household members should follow the advice specific to their vaccination status or age as set out above i.e. fully vaccinated adults and children and young people in the household (regardless of their vaccination status) can leave isolation while they await the PCR test result of the symptomatic person in their household as long as they record a negative LFD each day. Unvaccinated adults should isolate while they await the result.
Health and social care workers and critical service workers
- Health and social care workers (HSCWs) who are cases are eligible to shorten self-isolation but if isolation is shortened they should continue to follow the advice to LFD test on all days they are working as set out in previous advice from Scottish Government: DL(2021)51 - Healthcare Workers to increase Lateral Flow Device (LFD) testing frequency from twice weekly to daily.
- If the HSCW continues to test positive on LFD tests at day 10 of their isolation period then they should stay off work and continue to take daily LFD tests until they have one negative LFD test. If this situation of testing LFD positive prolongs then a risk assessment by the local HPT can be undertaken.
- HSCWs who are contacts still require a negative PCR result before returning to work. Once in receipt of a negative PCR result, HSCWs who are contacts remain eligible for using daily testing in place of isolation under the agreement as set out in DL(2022)01 - Update on self-isolation exemption for health and social care staff.
- Due to the introduction of daily testing in place of isolation for the general public, the requirements for exemption of self-isolation in critical service worker contacts has been stood down, but those who are currently using it can continue to do so during this transition period.
Adult care home specific advice – care home staff
The advice remains that all care home staff with symptoms of COVID-19 infection (new continuous cough, fever, loss of or change in sense of taste or smell) should self-isolate and arrange a PCR test. Asymptomatic staff should also continue to take lateral flow device (LFD) tests on each working day and continue with weekly staff screening using PCR tests.
- If the staff member has a positive PCR test then they should self-isolate for 10 days.
- If an asymptomatic staff member has a positive LFD test, no confirmatory PCR test is required and the staff member should self-isolate for 10 days. If the staff member who had a positive LFD test whilst asymptomatic then goes on to develop symptoms, they do not require a confirmatory PCR test, unless advised by a clinician, and do not need to restart their self-isolation period.
Care home staff who are COVID-19 cases may shorten their 10 day self-isolation period, as outlined above in the ‘Health and social care workers and critical service workers’ section.
On all days the staff member is working, after self-isolation has ended, a LFD test should be taken prior to beginning their shift, as close as possible to the start time.
The staff member must continue to comply with all relevant infection control precautions (see Winter (21/22), Respiratory Infections in Health and Care Settings Infection Prevention and Control (IPC) Addendum) and remain symptom vigilant.
Care home staff who have been identified as a contact of a COVID-19 case should still arrange a PCR test, as per existing advice, and only return to work when they receive a negative PCR result. This only applies where the care home staff member meets all the criteria for the health and social care worker isolation exemption policy (asymptomatic and fully vaccinated). Compliance with daily LFD tests and IPC measures remain key.
Adult care home specific advice – residents
As per existing advice, if there is an outbreak or cluster in a care home, then the local HPT will conduct a risk assessment to decide whether whole home testing is required (previously involved PCR testing).
- The local HPT can now determine whether to use LFD tests (e.g. where less evidence of transmission and no residents causing undue concern) or whether to use PCR tests (e.g. good evidence of transmission and residents with symptoms indicative of COVID-19 infection).
- All symptomatic residents should be tested using PCR tests.
- If a resident returns a positive LFD result, no confirmatory PCR is required and the resident should complete the 14 day self-isolation period.
- A risk assessment by the local HPT will determine whether further rounds of whole home testing of asymptomatic residents is required. The local HPT can also decide to repeat testing in specific groups of residents only in some circumstances, rather than repeating whole home testing.
If care homes have any questions regarding the above information, please contact your local Health Protection Team.