COVID-19 - guidance for health protection teams (HPTs)
Version 2.3

Physical distancing

Physical distancing is an effective measure to prevent the transmission of SARS-CoV-2 and other respiratory infections.

Physical distancing should be used where possible. This means:

• maintaining distance between people
• avoiding crowded places or large gatherings

This is achieved through:

• behaviour change – such as advising people to maintain distance
• adaptation of environments – such as screens or one-way systems

There is no legal requirement to implement physical distancing in any setting.

Health and social care settings

Guidance and advice for care homes, prisons and social, community and residential settings is available in appendix 18 of the National Infection Prevention and Control Manual (NIPCM).

Non-healthcare settings

Guidance on how measures can be maintained – such as through hybrid working – are available from the Scottish Government guidance for safer workplaces and public settings. 

Face coverings or face masks

The wearing of face coverings or masks is no longer a legal requirement, however WHO recommends using face coverings or face masks in the community to reduce transmission of COVID-19.

Health and care settings

Face coverings should be worn in line with the:

• NIPCM transmission-based precautions

as well as Scottish Government guidance on:

• extended use of face masks and face coverings in hospitals, primary care and wider community care
• use of face coverings in social care settings including adult care homes

Note that face coverings are not regarded as personal protective equipment (PPE).

Health and social care workers (HSCWs) who are exempt from wearing a face covering or mask should discuss this with their line manager and occupational health (OH) team.

Exemption from wearing a face covering or face mask should form part of any workplace risk assessment.

Non-healthcare settings

Wearing face coverings or masks is strongly recommended when:

• the risk of transmission is higher – for example, where physical distance cannot be maintained
• a risk assessment supports the wearing of them, noting exemptions

More detail can be found in Scottish Government guidance for safer workplaces and public settings. 

Ventilation

Good ventilation in indoor spaces can reduce the risk of SARS-CoV-2 transmission [6].

Maximise fresh air entering a room either through:

• natural ventilation – opening windows, vents and doors, excluding fire doors
• mechanical ventilation systems – minimising the recirculation of air in rooms and throughout buildings

Health and Safety Executive (HSE) ventilation in the workplace guidance provides practical steps on improving ventilation in workplaces.

The Scottish Government provide more COVID-19 specific guidance for ventilation in workplaces.

Ventilation in healthcare settings is covered in appendix 20 of the NIPCM.

Hand, respiratory and environmental hygiene

Good personal and environmental hygiene reduces the risk of SARS-CoV-2 transmission.

Guidance on approaches to promote personal hygiene and ensure environmental hygiene is in our information and guidance for workplaces and community settings.

Healthcare settings should follow hand, respiratory and environmental hygiene advice in the National Infection Prevention and Control Manual (NIPCM).

Personal Protective Equipment (PPE)

Health and care settings

Information on PPE in health and social care is available in:

• NIPCM standard infection control precautions
• DL (2022) 10 health and social care worker access to FFP3 masks

Non-healthcare settings

The use of PPE to reduce transmission of SARS-CoV-2 or other respiratory disease in non-health and care settings should be based on an individual risk assessment. This is set out in our guidance for workplaces and community settings and in specific Scottish Government sectoral guidance.

People at highest risk

Some groups of people are at higher risk of severe illness if they catch COVID-19, even when fully vaccinated.

This includes those with a weakened immune system.

Scottish Government provides advice for people who are immunosuppressed.

Scottish Government ended the highest-risk list in Scotland on 31 May 2022.

Pregnancy

View further information on COVID-19 and pregnancy on:

• NHS inform
• Royal College of Obstetricians & Gynaecologists (RCOG)

Pregnant staff may also seek advice from their line manager or local OH service.

COVID-19 vaccines are recommended in pregnancy.  

Lateral flow device (LFD) test

LFD tests are rapid antigen tests, usually self-administered, that can be used to identify cases with a high viral load.

Positive LFD test result

A positive LFD test result indicates that someone is infected with SARS-CoV-2 and needs to be managed as a confirmed COVID-19 case.

Confirmatory PCR is not routinely required following a positive LFD test. However, someone who tested positive on an LFD may need to undertake a confirmatory PCR if:

• they need to apply for a self-isolation support grant.
• they are in the highest risk group and are eligible for new COVID-19 antivirals, monoclonal anti-body therapies and other treatments – more information can be found on NHS inform (COVID-19 treatments).
• they are taking LFD tests as part of formal research or surveillance programmes, for example, SARS-CoV-2 immunity and reinfection evaluation (SIREN).
• an HPT or another health professional asks them to, for the purposes of further investigation

In instances where a PCR result is needed, a confirmatory PCR should be taken as soon as possible and ideally within 48 hours of the LFD test.

• If the confirmatory PCR is positive, the person should continue to be treated as a confirmed case. The stay at home period should be calculated from the day of the earlier (LFD) test, even if symptoms subsequently develop.
• If the confirmatory PCR is negative and the person has no symptoms, it can be assumed there is no SARS-CoV-2 infection and no further public health action is required.
• If the person does have symptoms, but returns a negative confirmatory PCR, the person should follow guidance for individuals with respiratory symptoms as other causes of infection cannot be ruled out.

Negative LFD test result

People who receive a negative LFD result must not regard themselves as definitively free from infection as the test could be a false negative.

In addition, they may still be incubating the virus or could go on to acquire the infection in the period before their next test.

Everyone must remain vigilant to the development of COVID-19 symptoms and continue to follow existing general control measures appropriate to the setting, for example IPC measures.

False-positive LFD test results

It is rare for repeated false-positive LFD results to occur in the same individual.

When this happens during routine asymptomatic testing – for example, for work as a patient-facing HSCW – a PCR test should be recommended.

If negative, the person should be advised that repeated false-positive LFD results may continue to be obtained.

If LFD testing is essential, tests from a different manufacturer can be considered, although there is no guarantee that false-positive results will not continue to arise.

Asymptomatic testing

People who have tested positive should pause any routine asymptomatic LFD testing after the end of their isolation period.

This is for 28 days from the date of symptom onset or positive test date if asymptomatic.

Polymerase chain reaction (PCR) test

PCR is the main diagnostic test used in Scotland in NHS laboratories and UK government lighthouse laboratories.

Positive PCR test result

A positive PCR test result indicates that someone is infected with SARS-CoV-2 and needs to be managed as a confirmed COVID-19 case.

In some instances, a positive PCR result may reflect past infection (remnant viral RNA), but without a previous positive result it is not possible to know this. It may need to be managed as evidence of active infection following risk assessment.

To minimise this, people who have tested positive should pause any asymptomatic PCR testing for 90 days from the date of:

• symptom onset
• positive test date if asymptomatic

Where a test is processed

It is important to know where a PCR test is processed, for example, in a non-NHS laboratory.

You can request a list of laboratories with agreements in place with local NHS laboratories from nss.nlpq@nhs.scot

A risk assessment should be carried out for results from non-NHS laboratories that are not aligned with their local NHS laboratories or UK-accredited.

Point of care test (POCT)

A POCT – or rapid molecular diagnostic test – is performed on an individual by a health care professional and provides rapid results at, or near the point of care (or in the laboratory).

Test results are generally available in under 2 hours, often within 20 to 60 minutes.

Positive POCT test

A positive POC test result indicates that someone is infected with SARS-CoV-2 and needs to be managed as a confirmed COVID-19 case.

In some cases, rapid diagnostic tests for SARS-CoV-2 may be used to inform patient pathways.

More information is available in the COVID-19 testing requirements section of appendix 21 of the NIPCM – 'purpose of COVID-19 screening and testing' and 'testing/screening requirements in secondary care settings'.

Department of Health and Social Care's Technologies Validation Group have identified four categories for testing. This includes healthcare screening, and the minimum performance standards recommended for a test assay in each context.

Category 1 tests

Category 1 tests are PCR tests and do not require confirmation.

Category 2, 3 and 4 tests

It is good practice for all results – both positive or negative – on SARS-CoV-2 admission screens for these categories to be confirmed by PCR testing.

Samples positive by PCR have the advantage that they may be suitable for further testing by allele-specific PCR (ASP) and whole-genome sequencing (WGS). The purpose of this is for:

• clinical management
• surveillance – for example, the identification of variants and mutations (VAMs)

Eligibility for SARS-CoV-2 testing

Testing has changed from population-wide testing to reduce transmission, to targeted testing to support clinical care.

This is in line with the Scottish Government's Test and Protect transition plan.

Routine asymptomatic or symptomatic testing is recommended for the following groups.

Health and social care workers (HSCWs) and volunteers

HSCW and volunteers who work with patients and service users in a face-to-face setting should test asymptomatically and as soon as they feel unwell if they develop symptoms. This is set out under the case definitions.

This should be done by LFD twice weekly, with additional weekly PCR testing in social care.

Guidance on frequency, types of tests and related actions are set out in the DL (2022) 12 and on the Scottish Government websites for healthcare workers and social care workers.

These are subject to regular updates.

HSCWs who do not work face-to-face

HSCWs who do not work with patients and service users in a face-to-face setting should follow the advice for the general population.

This includes staff working in the emergency services and national critical infrastructure.

Face-to-face roles outlined in Annex B of DL (2022) 12

Roles considered face-to-face in social care settings are outlined in Annex B of DL (2022) 12.

These include:

• members of staff or volunteers who are regularly in a social care setting – for example, a care home or adult day care centre
• cleaners, catering, and support staff but not office-based staff members who do not enter these settings
• in the context of an individual’s own home – including sheltered or very sheltered housing – staff includes:
  • those who provide care or support to the individual, such as those staff working in care at home
  • personal assistants, but not, for example, maintenance staff

Highest-risk groups

People in the highest risk group who are eligible for new COVID-19 antivirals, monoclonal anti-body therapies and other treatments require a positive LFD or PCR test result to access this. There is more information on COVID-19 treatments on NHS inform.

Patients and residents in health and social care settings

People who are patients and residents of health care settings may undergo testing for appropriate management within the setting. This includes placement.

For health care settings, see appendix 21 of the NIPCM – pandemic controls for acute NHS settings including Scottish Ambulance Service (SAS)

For social care refer to the Scottish Government social care and community-based testing guidance.

Unpaid carers and visitors to health and social care settings

Unpaid carers and people visiting an adult care home should read the Scottish Government social care and community-based testing guidance.

People who are visiting a hospital should read the Scottish Government hospital visiting guidance.

Prison settings

Testing is recommended in people being admitted to prison or undergoing transfer and people resident in a prison who develop symptoms.

Other eligible groups

• People with respiratory symptoms who intend to apply for a self-isolation support grant.
• People participating in COVID-19 surveillance programmes.
• People advised to test by a health professional:
  • as part of an outbreak investigation
  • in relation to investigation of a COVID-19 variant and mutation (VAM).

Private testing

Private testing is available, for example, for international travel requirements.

COVID-19 remains a notifiable disease under the Public Health etc. (Scotland) Act 2008 (Notifiable Diseases and Notifiable Organisms) Amendment Regulations 2020.

Therefore, it is expected that private providers notify HPTs of all positive results, regardless of the purpose of testing.

Ordering tests

If eligible for testing, tests are available through the UK.GOV booking portal.

More information on when tests are recommended and how to access them is available:

• on NHS inform
• by phoning the national helpline on 119 – open Monday to Friday from 8am to 6pm, Saturday and Sunday from 9am to 1pm

Further testing information

More information on testing is provided in:

• COVID-19 guide for non-NHS laboratories
• laboratory FAQs

Adults

Adults (aged over 18) who meet the possible COVID-19 case definition should:

• stay at home
• avoid contact with other people until:
  • they feel well
  • there is no high temperature, if there was a high temperature

Children and young people

This section covers children and young people (aged 18 or under) who meet the possible COVID-19 case definition.

Mild symptoms

Children with mild symptoms can continue to attend their education setting as normal.

Mild symptoms may include having a runny nose, sore throat, or slight cough. The child should be otherwise well and not have a high temperature.

Unwell or with high temperature

Children who are unwell or have a high temperature should:

• stay at home
• avoid contact with other people, where they can, until:
  • they feel well
  • there is no high temperature, if there was a high temperature

There is no minimum time period for staying at home.

They can go back to school, college or childcare, and resume normal activities when they feel well and there is no high temperature (if there was a high temperature).

Health and social care workers (HSCWs)

These actions are for HSCWs and volunteers who work with patients and service users in a face-to-face setting and are possible COVID-19 cases.

Further information is available in the Directors Letter (2022) 12.

HSCWs who meet the possible COVID-19 case definition should:

• take a lateral flow device (LFD) test as soon as they feel unwell
• report the test result to their line manager

Positive LFD result

Manage as a confirmed COVID-19 case.

Negative LFD result

• Attend work if clinically well enough to do so and they do not have a high temperature.
• Continue with routine asymptomatic LFD testing at work.

If they are unwell, or have a high temperature, they should:

• stay at home
• avoid contact with other people

There is no minimal timeframe for staying at home.

On returning to work, staff should:

• resume routine asymptomatic LFD testing at work
• speak to their line manager and have a risk assessment undertaken if they meet either (or both) of the following criteria.
  • They work with individuals whose immune system means that they are at higher risk of serious illness despite vaccination.
  • They still display respiratory symptoms when they return to work.

Human Resources (HR) and Occupational Health (OH) may support line managers with risk assessments, as needed.

HPTs do not need to undertake individual risk assessments but may wish to have oversight of decision-making processes.

Adults

Adults (aged over 18) who meet the confirmed COVID-19 case definition should:

• stay at home
• avoid contact with other people for a minimum of 5 days after the day they took the test, regardless of symptoms
• continue to avoid contact with other people until they no longer feel unwell and no longer have a high temperature (if they had a high temperature)

For most people, there is no requirement for further testing.

Specific groups of health and social care workers who may require further testing are described in the eligibility for SARS-CoV-2 testing section.

Children and young people 

It is not recommended that children and young people test for COVID-19, unless directed to by a health professional.

Children and young people who are confirmed COVID-19 cases should:

• stay at home
• avoid contact with other people for a minimum of 3 days after the day they took the test, if possible
• continue to avoid contact with other people until they no longer feel unwell and no longer have a high temperature (if they had a high temperature)

For most children and young people there is no requirement for further testing.

A young person who works in a specific group of health and social care workers may require further testing as described in the health and social care workers section.

Health and social care workers (HSCWs)

These actions are for health and social care staff and volunteers – including those aged 18 and under – who work with patients and service users in a face-to-face setting and are a confirmed COVID-19 case.

Further information is available in the Directors Letter (2022) 12.

They should:

• stay at home
• not attend work
• avoid contact with other people for a minimum of 5 days after the day they took the test, regardless of symptoms
• continue to avoid contact with other people until they no longer feel unwell and no longer have a high temperature (if they had a high temperature)

Testing

Staff working with patients and service users in face-to-face settings can return to work when they have had two consecutive negative LFD test results.

• The first LFD test should be taken no sooner than 5 days after the day symptoms started, or the day the first positive test was taken if asymptomatic. This is described as day 0.
• Tests should be taken at least 24 hours apart.

Two negative tests

If both LFD test results are negative, staff may return to work immediately if they:

• no longer feel unwell
• no longer have a high temperature (if there was a high temperature), and have not had a high temperature for 48 hours without the use of medication

Staff must also be risk assessed if they work face to face with patients or service users whose immune system means that they are at higher risk of serious illness despite vaccination. Consideration should be given to redeployment, until 10 days after their symptoms started, or the day their first positive test was taken if asymptomatic.

All staff must continue to comply rigorously with infection control precautions and wear personal protective equipment (PPE) correctly.

Day 5 LFD test is positive

If the day 5 test is positive, staff should:

• continue to test daily, up until day 10, until there are two negative LFD test results
• take tests at least 24 hours apart

If the LFD test result is positive on day 10, they should discuss this with their line manager who may undertake a risk assessment.

Returning to work

On returning to work staff should:

• pause routine asymptomatic LFD testing for 28 days from the date of symptom onset (or first positive test date if asymptomatic)
• speak to their line manager and have a risk assessment undertaken if they:
  • feel well enough to return to work but still display respiratory symptoms
  • work with individuals whose immune system means that they are at higher risk of serious illness despite vaccination

Consideration should be given to redeployment until 10 days after their symptoms started (or the day their first positive test was taken if asymptomatic).

HR and OH may support line managers with risk assessments as needed. HPTs do not need to undertake individual risk assessments but should have oversight of decision-making processes.

Patients and residents of health and social care settings

This section covers patients and residents of health and social care settings who are a confirmed case.

Hospital settings

Refer to the NIPCM transmission-based precautions where a possible case is:

• being admitted to hospital
• currently resident in hospital
• recently discharged from hospital

Care home settings

For care home settings, refer to our:

• information and guidance for care home settings (older adult)
• information and guidance for social, community and residential care settings

Health and social care worker (HSCW) household or overnight contacts

These actions are for health and social care staff and volunteers – including those aged 18 and under – who work with patients and service users in a face-to-face setting and are a household or overnight contact of a confirmed COVID-19 case.

Further information is available in Directors Letter (2022)12.

Health and social care staff and volunteers should:

• continue to attend work
• continue routine asymptomatic testing at work
• continue to comply rigorously with IPC measures as set out in the NIPCM
• wear appropriate PPE for their setting
• discuss ways to minimise risk of onward transmission with their line manager, such as:
  • considering redeployment to lower risk areas if they work face to face with patients or service users whose immune system means that they are at higher risk of serious illness despite vaccination
  • limiting close contact with other people especially in crowded, enclosed or poorly ventilated spaces
  • working from home for non-patient-facing staff

If staff develop any symptoms during these 10 days, or at any other point, they should follow the advice set out for possible cases.

Patient contacts in healthcare settings

Where a contact is currently resident or was recently discharged from a setting such as a hospital or care home, refer to the NIPCM chapter 3 – healthcare infection incidents, outbreaks and data exceedance.

Setting-based management

Most setting outbreaks will be managed by settings themselves.

It is not a recommendation that HPTs should be involved in proactive identification and management of outbreaks in all settings.

The risk of spread of infection between vaccinated or otherwise healthy younger or working-age people would not usually be an indication for setting-based outbreak management by an HPT.

HPTs should be available to:

• regularly communicate and respond to those living and working in the health board area
• support setting-based preparation for, and reaction to, outbreaks

Risk-based management

HPTs have limited resources and cannot focus on all settings equally.

A risk-based approach can help identify highest priority settings. HPTs should determine priorities based on outbreak context and available resources.

HPTs should support COVID-19 outbreak self-management in lower-risk settings.

HPTs should lead COVID-19 outbreak management in higher-risk settings or situations.

Lower-risk settings or situations – supported self-management

A lower risk settings is where there is:

• relatively lower risk of direct health harms arising from infection
• a predominantly younger or working-age population

These would include the majority of:

• community-based and workplace settings
• hospitality settings, including those offering accommodation
• early learning settings, schools, and further and higher education

It is not recommended that HPTs undertake active surveillance of lower-risk settings to identify outbreaks.

Reporting COVID-19 outbreaks in lower-risk settings

There is no obligation for lower-risk settings to report to HPTs:

• clusters of confirmed COVID-19 cases
• unusually high levels of absence thought to be associated with COVID-19 – in other words, possible cases

Most of these situations will be managed by standard working practices for sickness and absence at work within each setting.

Some settings might have obligations to report clusters or outbreaks to other agencies, for example, the Care Inspectorate, environmental health departments or the HSE.

This requirement does not necessarily mean HPT notification is required or recommended.

People with higher vulnerability

There may be people with higher vulnerability within a lower-risk setting, including those who are immunocompromised.

If there is an outbreak in a setting they regularly attend, they should follow Scottish Government advice for those with higher vulnerability or any individual advice from their clinician.

HPTs should engage and support any setting to manage an outbreak, proportionate to their assessment of the risk to public health, if approached for advice.

Lower-risk settings or situations – HPT management

HPTs may consider some settings in the proposed lower-risk categories as higher risk.

HPTs may choose to manage individual-specific outbreaks in lower-risk settings as higher-risk outbreaks.

For example:

• outbreaks in lower-risk categories that have the potential to severely disrupt health services or critical infrastructure
• a persistently high or increasing staff absence due to possible or confirmed COVID-19 that is causing operational difficulties for a setting that provides a critical local role, for example, an ongoing outbreak lasting weeks
• evidence of a cluster of severe disease due to suspected or confirmed COVID-19, for example, a cluster of hospitalisations or deaths in a younger or working-age population

HPTs may make the decision to engage in the handling of any individual cases, clusters or outbreaks at their discretion.

Additional measures for these situations are set out in the higher-risk section.

National guidance for lower-risk settings

Schools

Scottish Government guidance on reducing the risks in schools

Early learning settings

Scottish Government guidance for early learning and childcare services

Community and workplaces

Scottish Government guidance on safer businesses and workplaces

All other non-healthcare settings

PHS information and guidance for workplaces and community settings