Purpose and scope

This guidance is for staff working in health protection teams (HPTs) and healthcare settings across Scotland.

It supports staff managing coronavirus disease 19 (COVID-19).

Using this guidance

The guidance supports, but does not replace:

  • individual expert clinical judgment
  • local response arrangements

The guidance supports maintenance of agreed health protection principles and national policy in line with the Public Health etc. (Scotland) Act 2008 including:

  • exercising functions to encourage equal opportunities
  • observance of equal opportunities requirements

Employers should consider specific conditions of each place of work and  follow the Health and Safety at Work etc. Act 1974 and other appropriate legislation.

Related resources

This document should be read with these related resources.

Health protection team contacts

Access up-to-date contact information for local HPTs.

Introduction

The disease COVID-19 is caused by severe acute respiratory syndrome coronavirus 2, also known as SARS-CoV-2. SARS-CoV-2 is a ribonucleic acid (RNA) virus.

The first cases of COVID-19 in the UK were detected on 31 January 2020.

The World Health Organization (WHO) declared COVID-19 as a pandemic on 12 March 2020.

Transmission

SARS-CoV-2 is spread by respiratory particles. It occurs mainly through close contact with infectious individuals.

Transmission risk increases:

  • when people are close to each other (usually within 2 metres)
  • in indoor, poorly ventilated environments that are not regularly cleaned [1]

Evidence of long-range aerosol transmission is limited, although examples are recognised by WHO.

Further research is needed to examine the spectrum of droplet size and contribution of air-mediated transmission.

SARS CoV-2 virus can survive on surfaces from a few hours to days [2]. The amount of viable virus declines over time. It may not always be present in sufficient quantities to cause infection, despite viral RNA persistence.

There is evidence of asymptomatic transmission of COVID-19 [3].

Infectious period

  • The infectious period begins around 2 days before symptom onset to 10 days after.
  • People are most infectious during their symptomatic period, usually in the first 3 days [4].
  • The average incubation period is between 5 and 6 days, with a range from 1 to 14 days [5].

Latest data

PHS provides a dashboard with the latest available data including, but not limited to:

  • positive cases reported
  • tests carried out
  • numbers of vaccinations administered
  • percentage of Scotland's population who are vaccinated

General prevention measures

Non-pharmaceutical interventions help reduce transmission of COVID-19 across society.

For setting-specific advice, go to the following publications:

General advice is available in the following sections.

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 the National Infection Prevention and Control Manual (NIPCM) community infection prevention and control COVID-19 pandemic measures​.

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 National Infection Prevention and Control Manual (NIPCM):

as well as Scottish Government information about:

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, in crowded, poorly ventilated spaces and where it is not possible to maintain a safe distance from other people they would not normally meet
  • a workplace risk assessment supports the wearing of them, noting exemptions

More detail for the general public can be found in Scottish Government advice on staying safe and protecting others and for workplaces 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:

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:

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

COVID-19 vaccines are recommended in pregnancy.  

Addressing inequality

Age, sex, ethnicity and deprivation are inequalities that affect both risk and outcome of COVID-19 infection [7].

Older age remains the strongest risk factor for poor outcomes from COVID-19.

People from minority ethnic groups and socioeconomically deprived areas are more likely to experience harm from COVID-19.

Those living in socioeconomically deprived areas are more likely to be admitted to hospital with serious illness and have higher mortality rates.

Interventions designed to suppress viral transmission have an unequal impact across the population. This adversely affects people in more deprived populations.

Examples of this are:

  • overcrowded housing preventing adequate distance from others
  • financial barriers to self-isolating when symptomatic

Self-isolation support grant

The self-isolation support grant remains available to help address this inequality. There is more information in the section about eligibility for SARS-CoV-2 testing.

Vaccination

The Green Book, chapter 14a (COVID-19) provides up to date information on COVID-19 vaccines, effectiveness, schedule and other relevant information.

Vaccination status, if required in public health decision making, should be defined in the following way.

Fully vaccinated

An adult – 18 years and 4 months or older – who has had three or more doses of Medicines and Healthcare products Regulatory Agency (MHRA) approved vaccines.

This is either through completing one of the following, at least 14 days ago (where day 1 is the day of the most recent vaccination):

  • 2-dose course of approved vaccine and received a booster
  • 3 doses of an approved vaccine – for example, in the case of someone who is immunocompromised 

This includes people vaccinated as part of a formally approved COVID-19 vaccine clinical trial.

Unvaccinated

All other adults, including the partially vaccinated, are considered unvaccinated.

Case definitions

For the purposes of public health management case definitions have been updated to reflect changes to community testing practice.

For practical purposes these definitions may differ from current epidemiological definitions.

Confirmed COVID-19 case

A person with detection of SARS-CoV-2 by any one of the following:

  • laboratory-confirmed polymerase chain reaction (PCR) in a clinical specimen
  • COVID-19 rapid diagnostic test, including point of care testing (POCT) (PCR or antigen detection tests)
  • a positive lateral flow device (LFD) test
Possible COVID-19 case

In the absence of testing, it is not possible to know if a person has COVID-19, flu or another respiratory infection based on symptoms alone. 

A possible case should be considered where there are symptoms of a respiratory infection and:

  • a high temperature
    or
  • the person does not feel well enough to go to work or carry out normal activities

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

  • high temperature, fever or chills
  • new, continuous cough
  • change in, or absence of, normal sense of smell or taste
  • 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

Symptoms of COVID-19 vary in severity. Mortality is a potential outcome in those with severe disease.

Be alert to the possibility of atypical and non-specific presentations in:

  • children
  • older people with frailty
  • those with pre-existing conditions
  • those who are immunocompromised

People with epidemiological links to COVID-19 outbreaks or clusters should also be considered with a high degree of suspicion.

Testing for SARS-CoV-2

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:

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 defer any 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 gold-standard diagnostic test for SARS-CoV-2 and is 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.

Where a test is processed

Occasionally, a query may arise where a PCR test has been performed in a non-NHS laboratory.

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 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

A positive POCT 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'.

It is good practice for all results – both positive or negative – on SARS-CoV-2 admission POCT screens 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 is recommended for the following groups.

Health and social care workers (HSCWs) and volunteers

There is no requirement for routine asymptomatic testing for HSCW and volunteers, whether working in a face-to-face role or not.

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

HSCW who work in social care settings should refer to PHS guidance for social, community and residential care settings.

Further information on staff testing can be found in Director’s Letter DL (2022) 32 and on the Scottish Government website for:

This includes information on symptomatic testing for staff who are eligible. 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.

Roles considered face-to-face in social care settings are outlined in Director’s Letter DL (2022) 32.

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

Further information is available in PHS guidance for prison settings. This is subject to regular update.

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:

Testing for respiratory pathogens other than SARS-CoV-2

When necessary, HPTs should consider testing for pathogens other than SARS-CoV-2.

This may include:

  • influenza A
  • influenza B
  • respiratory syncytial virus (RSV)
  • adenovirus

Other respiratory pathogens may also need to be considered. This should be done in discussion with the local microbiologist or virologist – depending on local arrangements.

This may be particularly important if testing of SARS-CoV-2 is negative during investigation of a cluster.

Find out further information on testing on our laboratory FAQs.

Testing for additional pathogens

Two swabs, or another respiratory sample, may be needed if testing for pathogens other than SARS-CoV-2.

You should discuss this with the local laboratory to understand if a single swab will be sufficient. 

Public health management of possible cases

Individuals who are a possible COVID-19 case should follow the actions here.

NHS inform gives further advice on how possible COVID-19 cases can:

  • reduce the risk of onward transmission
  • protect those at higher risk of harm from COVID-19 infection

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
      and
    • 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
      and
    • 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 Director’s Letter DL (2022) 32.

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.

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

  • stay at home
  • avoid contact with other people

There is no minimum timeframe for staying at home.

On returning to work, staff should:

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.

Patients and residents of health and social care settings

This section covers patients and residents of health and social care settings who meet the possible COVID-19 case definition.

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 PHS information and guidance for social, community and residential care settings.

Public health management of confirmed cases

Individuals who are a confirmed COVID-19 case should follow the actions in this section.

NHS inform gives further advice on how confirmed COVID-19 cases can:

  • reduce the risk of onward transmission
  • protect those at higher risk of harm from COVID-19 infection

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 – count the day after the test as day 1
  • 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.

There is no need to test to end isolation.

Isolation can end any time after the 5 days once they feel better and no longer have a high temperature.

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, regardless of symptoms – count the day after the test as day 1
  • 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.

There is no need to test to end isolation.

Isolation can end any time after the 5 days once they feel better and no longer have a high temperature.

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 Director’s Letter DL (2022) 32.

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:

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 PHS information and guidance for social, community and residential care settings.

Financial support for low-income COVID-19 cases to stay at home

Individuals on low income who require financial support to stay at home as advised may be eligible for the Scottish Government Self-Isolation Support Grant.

Contacts of confirmed cases of COVID-19

Routine identification or isolation of contacts of a confirmed COVID-19 case by HPTs is not recommended.

Transmission is more likely to take place as proximity and duration of contact with a case increases. Situations with higher risk of transmission include:

  • within households
  • where there has been an overnight stay
  • where people work closely in an indoor setting

NHS inform provides further advice and actions for household and overnight contacts of both possible and confirmed cases.

Children and young people who live with someone who is a confirmed COVID-19 case should continue to attend school, college or childcare as usual.

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 Director’s Letter DL (2022) 32.

Health and social care staff and volunteers should:

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.

Prison setting household contacts

HPTs can access PHS guidance on prison settings.

Management of COVID-19 outbreaks

COVID-19 outbreaks should be managed following principles and practices outlined in the Scottish Health Protection Network (SHPN) guidance for the management of public health incidents.

This guidance aims to provide information that health protection teams (HPTs) can use to prepare or respond to COVID-19 or outbreaks in a proportionate way.

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 should be used to 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

Higher-risk settings or situations – HPT management

PHS advise that higher risk settings are those where there is:

  • relatively higher risk of direct health harms arising from infection
  • clustering of older or clinically vulnerable people
  • restricted movement or agency of elderly or vulnerable people, for example, care homes for the elderly and other vulnerable closed settings

HPTs may also choose to manage outbreaks that have the potential to severely disrupt health services or critical infrastructure as a higher-risk setting.

These would include the majority of:

  • care homes for the elderly or clinically vulnerable
  • care at home services for the elderly or clinically vulnerable
  • healthcare settings, including primary and dental care settings
  • prisons
  • social community and residential care (SCRC) settings including:
    • adult social care building-based day services
    • residential children’s homes – including settings registered as care homes
    • care home services for adults (registered with the Care Inspectorate)

For SCRC settings:

  • risk assessment should be undertaken in SCRC settings to provide appropriate advice
  • residential SCRC settings should generally follow higher risk advice – after risk assessment, they may be considered as lower risk
  • non-residential SCRC settings should generally follow lower risk advice – after risk assessment, they may be considered as higher risk

Reporting COVID-19 outbreaks in higher-risk settings

Higher-risk settings should have well-established processes for identifying outbreaks in line with setting-specific guidance.

HPTs should be informed of any outbreak identified in a higher-risk setting.

Proactive messaging from HPTs should ensure those in charge of higher-risk settings remain aware of the need to report COVID-19 outbreaks.

National guidance for higher-risk settings

Healthcare settings

NIPCM chapter 3 – healthcare infection incidents, outbreaks and data Exceedance

Social care and residential care

COVID-19 information and guidance for social, community and residential care settings

Dental settings

Expert advice on outbreaks in dental settings may be available from individual board Consultants in Dental Public Health.

Other higher-risk settings outside health and social care

Outbreaks may be identified where there is no setting-specific guidance.

Initial assessment

Perform an initial assessment if the setting or situation is considered high-risk by the HPT.

  • This is usually through a problem assessment group (PAG).
  • Alternative local arrangements may also exist for initial assessment.

The checklist for COVID-19 outbreaks can support the assessment.

Outbreak management plans
  • Review any COVID-19 workplace risk assessment or other outbreak management plan in place.
  • Work collaboratively with the setting to provide an individualised action plan for outbreak management.
Current measures and mitigations
  • Based on the problem assessment, HPTs should consider measures and mitigations that are already in place when recommending actions to support outbreak management.
  • Measures that need improvement should be adapted to fit with local arrangements.
  • Balance all introduced measures against potential wider harms as well as benefits, in relation to control of the outbreak.
Following PAG
  • Following the HPT problem assessment, management should progress to an incident management team (IMT) or be otherwise monitored as determined by the HPT.

Patient access to clinical care

Patients must be able to access clinical services as needed. Guidance on respiratory screening for all patients is available in the NIPCM standard infection control precautions.

People should contact their GP if:

  • they are unwell and worried about COVID-19
  • symptoms worsen after seven days
  • symptoms are severe at any time

Out of hours, call:

  • 111 for help and advice
  • 999 for emergencies

In emergencies

If it is an emergency and an ambulance is needed, tell the 999 operator that there is a concern about COVID-19.

Scottish Ambulance Service (SAS) will triage healthcare professional calls to provide the appropriate response.

Routine appointments

Confirmed and possible COVID-19 cases should contact services to postpone routine appointments until after their infectious period of 10 days unless, the service consider attendance clinically urgent.

Essential transport of cases to home or for health care

Exposure of a potentially infectious patient to staff or other patients should be minimised during essential transport home or to healthcare settings.

Public transport

Use of public transport is not recommended.

Private vehicles

Private vehicles with an accompanying friend or family member may be used if the companion has already had significant exposure to the patient or they are aware of the possible COVID-19 diagnosis.

  • The patient should sit in the rear of the car and wear a face covering or surgical face mask, if available.
  • The car should be well ventilated with open windows
  • All occupants of the car should ensure good hand and respiratory hygiene

Alternatives

If private transport is not available, alternative arrangements should be made locally.

  • Private commercial vehicles can be used if appropriately planned and risk assessed.
  • Risk assessment and travel arrangements may need to be undertaken on a case-by-case basis.
  • Healthcare services should consider what local arrangements need to be put in place, supplementary to SAS and other hospital patient transport provision, to support patients to access essential health care while self-isolating.

Travel should be undertaken as safely as possible. For example, do not drive if too unwell to do so.

Further information on travelling when symptomatic can be found in our information and guidance for workplaces and community settings.

Provide clear instructions to patients for what to do and where to go when they get to the healthcare setting to minimise risk of transmission.

International travel

Travel guidance

Refer to the Scottish Government guidance for international travel for the most up-to-date advice on local and international travel.

Pre-travel guidance

Members of the public can find out the latest advice on fitfortravel.

Health professionals can access more information on TRAVAX.

Laboratory FAQs

Sensitivity

Sensitivity is the number of true positive samples detected as positive by the test.

For example, if the sensitivity value of a test is 95%, then out of 100 true positive samples, five out of 100 would incorrectly be called negative by the test.

This is also known as a false-negative result.

Specificity

Specificity is the number of true negative samples detected as negative by the test.

For example, if the specificity value of a test is 95%, then out of 100 true negative samples, five out of 100 would incorrectly be called positive by the test.

This is also known as a false-positive result.

How they are determined

Sensitivity and specificity values are determined by comparing the test to a gold standard, and assessing differences in test performance.

No laboratory test is 100% sensitive and 100% specific.

Real-time PCR (RT-PCR) testing

Currently, RT-PCR is the best available technology for detecting respiratory viruses and is the gold standard against which other tests are measured.

The analytical sensitivity of a real-time RT-PCR is not the only factor considered when testing clinical samples.

The following also need to be considered.

  • The quality and timing of the clinical sample, particularly when the amount of viral material present in a patient sample will change during infection.
  • The population sampled, how the sample is taken and stored, and the type of sample.

These factors are variable at different periods of time, and across different laboratories and regions of Scotland.

It is therefore not possible to give one percentage value which is representative of the sensitivity or specificity value of PCR tests in Scotland.

PCR is the gold standard for diagnosing many viral infections.

The technique identifies and amplifies a specific section of the viral genetic material, known as a target.

There are a variety of PCR tests currently in use in Scotland to confirm the presence of SARS CoV-2, all of which are regulated and approved by the Medicines & Healthcare products Regulatory Agency (MHRA), and thereafter validated for use by the Scottish laboratory performing the test.

Furthermore, many of the commercial assays are used as the primary method for diagnosis by several other countries worldwide.

All these assays have been designed to target a section of the SARS-CoV-2 genetic material which is specific to the virus.

Additional information is available in the MHRA guidance for patients, the public and professional users: a guide to COVID-19 tests and testing kits.

The Scottish NHS laboratories offering SARS-CoV-2 testing work in collaboration with the Scottish Microbiology & Virology Network (SMVN) and PHS, as well as linking in with the UK Health Security Agency (UKHSA) to ensure that all tests are suitably quality controlled, sensitive and specific.

UKHSA guidance on the minimum performance standards of SARS-CoV-2 tests can be found in the following document: Technologies Validation Group: Using tests to detect COVID-19.

PHS does not hold information on the individual validation results performed for every PCR test in use, as the validation and interpretation of the test results are carried out by the individual laboratory performing the test.

NHS laboratories and UK Government Lighthouse laboratories perform quality control procedures as part of the routine workflow. These include the use of:

  • positive control material to show that the assay is working correctly
  • internal control material to show that viral nucleic acid extraction is working correctly
  • negative control material to show that cross contamination has not occurred

Laboratories may also take part in external quality control schemes for example Quality Control for Molecular Diagnostics (QCMD).

PHS does not hold information on the specific quality processes being used at individual laboratory level.

PCR tests are used to detect the presence of specific viral genetic material, known as a target, in a sample.

This is achieved through thermal cycling.

If the specific target is present in the sample, it is amplified in each PCR cycle.

Each manufacturer of a PCR assay will recommend a different maximum amplification cycle number, but a typical PCR assay will recommend a maximum of 40 thermal cycles.

The PCR test looks for the specific target during each cycle.

The Cycle threshold, or Ct value, is the number of PCR cycles that it takes before the virus is first detected. The Ct value may therefore be used as an indicator of the approximate amount of viral genetic material in a patient sample. In application the lower the Ct value the higher the level of virus in the sample.

There is no 'standard' Ct value. One of the roles of an NHS virology laboratory is to consider Ct values and assist in appropriate interpretation for healthcare providers. These results can be provided locally if required.

There are a number of factors involved in the interpretation of a PCR test and these are dependent on individual manufacturers and local validation.

Ct values are not directly comparable between assays and may not be reported by some PCR platforms in use. Individual laboratories will hold details of the Ct reached for each individual specimen and have quality systems in place to ensure the veracity of the results.

Serology tests detect antibodies to SARS-CoV-2 in the blood.

These are used for surveillance purposes and defined clinical situations in NHS Scotland laboratories.

Further information on seroprevalence studies is described in the COVID-19 weekly seroprevalence for Scotland overview.

All viruses continuously mutate to some extent as they spread through the population.

The impact of the mutation will differ depending on where it occurs in the genome and what component of virus that region encodes.

This can range from no change to a structural change to the virus in a key location.

When changes occur to the viral genome, this has the potential to impact a number of factors, such as:

  • how well the virus can spread from person to person
  • severity of the disease caused
  • how susceptible someone is to infection

Viruses that contain mutations that affect the properties of the virus may be identified in a number of different ways, such as:

  • routine surveillance of positive cases
  • additional investigation of outbreaks or incidents in the community or hospital setting

The tests used to identify and investigate potential variants and mutations (VAMs) include:

  • PCR: this test identifies samples which are positive for SARS-CoV-2
  • allele-specific PCR (ASP): this test identifies mutations associated with known variants – this allows for the characterisation of variant trends within the population, and the flagging of samples for additional investigation with sequencing
  • whole-genome sequencing (WGS): this looks at the entire genetic code of a virus and can be used to confirm suspected mutations from ASP, and also identify:
    • additional mutations required to confirm VAM status
    • new mutations

A number of different mutations have occurred in the SARS-CoV-2 virus.

When mutations have the potential to affect factors such as the virulence or transmissibility of the virus, then they will be investigated further.

These may be described as a variant of concern (VOC) or a variant under investigation (VUI).

Further information on VOCs and VUIs in the UK, including case definitions for VOC and VUI, is available within UKHSA investigation of SARS-CoV-2 variants of concern: technical briefings.

In Scotland, work is ongoing to enable all suitable samples which are PCR positive for SARS-CoV-2 to be sequenced.

For technical reasons laboratories can only reliably sequence samples with relatively high viral loads – below a cycle threshold (Ct) value of 30 – hence not all positive samples are suitable to be sequenced.

Samples used for some tests, such as LFD tests, are not suitable for sequencing, so new variants cannot be identified through these testing routes.

Additional information about the Scottish genome sequencing service is available on our WGS page.

Each sample must be labelled with:

  • ID
  • date of birth
  • type of sample
  • date and time of sample
  • location

Paperwork (request forms) should not be placed in the bag with the sample container.

Request form must include contact details for sharing of results.

Samples without appropriate paperwork will not be tested.

All samples should be packaged and transported in accordance with Category B transportation regulations.

UN 3373 packaging must be used for sample transport.

If required, transport requirements should be discussed with the local laboratory.

Further information on safe handling can be found in the UKHSA guidance for safe handling and processing for laboratories.

These are the contact details for local laboratories.

Health board Laboratory contact details
Ayrshire and Arran 01563 827 420
Borders 01896 826 250 or 01896 826 258
Dumfries and Galloway 01387 241 560
Fife 01592 648 169
Forth Valley 01324 566 692
Golden Jubilee 0141 951 5931
Grampian 01224 552 444
Greater Glasgow and Clyde 0141 201 8721 for virology
0141 211 4000 for out of hours – ask for on call virologist
west.ssvc2@nhs.scot
Highland 01463 704 206 or 01463 704 207
Lanarkshire (Wishaw) 01698 366 405
Lothian 0131 536 3373 (option 2) for virology
0131 536 1000 for out of hours – ask for on-call virologist
virologyadvice@nhslothian.scot.nhs.uk
Orkney 01856 888 217
Shetland 015950 743 011
Tayside 01382 632 559
Western Isles 01851 708 033

Checklist for COVID-19 outbreaks

The HPT should undertake an initial risk assessment following notification of an outbreak.

If possible, this should be done in collaboration with the setting owner or manager.

The HPT should develop a standardised approach to risk assessment.

The tools here can help with this.

Assess if anyone in the setting was:

  • admitted to hospital
  • admitted to an intensive care unit (ICU)
  • known to have died as a result of COVID-19 during this incident

Assess if the setting population is particularly vulnerable, for instance if they are:

  • unvaccinated adults
  • elderly people
  • immunocompromised people

Collate and review case and contact data using HPZone.

Produce a basic line-list summarising:

  • current known cases
  • contacts
  • onset dates
  • symptomatic or asymptomatic cases

Assess initial links between cases and the suspected attack rate within the setting.

Assess the potential for:

  • extensive spread
  • number of contacts or case
  • closeness of contacts in the setting, for example, shared sleeping accommodation

Reflect on the strength of collaboration:

  • Is the setting experienced and engaged with the management of incidents such as this?

Assess the potential for those in the setting to spread infection to other settings, including higher-risk settings, for example, medical students.

Assess the following:

  • actions taken to date
  • number of cases and contacts self-isolating or undertaking testing
  • compliance
  • infection control measures
  • handwashing
  • current physical distancing measures in place
  • setting layout

Consider likely adherence to any potential additional measures.

Consider:

  • any communications already issued
  • any operational issues due to staffing anxieties or absence
  • anxiety or misinformation circulating in staff or others in setting
  • social media context
  • press interest
  • ages and cohorts affected

Is a PAG or IMT required?

After the risk assessment, consider the need for a PAG or IMT meeting. 

This should be done in line with the management of public health incidents: guidance on the roles and responsibilities of NHS-led incident management teams.

Work in partnership

The HPT should work with key stakeholders – including the setting owner – to make recommendations on ongoing assessment and control of the incident.

This could be through an IMT or other approach.

If relevant, invite:

  • environmental health officers
  • HSE
  • Food Standards Scotland

For significant incidents, invite observers:

  • Public Health Scotland
  • Scottish Government

Use the following checklist for further investigation and control.

Maintain and update the line list.

Consider the operational implications of the incident for the setting.

Links between cases

Consider:

  • hypothesis of transmission
  • layout of setting and establish linkages between cases, both in setting and outside the setting, for example, social events

Testing

When a COVID-19 case occurs in a higher-risk setting, a lateral flow device (LFD) or polymerase chain reaction (PCR) test – or a combination – can be used to support an initial risk assessment.

Repeated rounds of mass testing are unlikely to be justifiable for outbreak management purposes.

Vaccination coverage

Assess coverage and consider approaches to maximise vaccination uptake in response to the incident.

The Green Book advises not to use vaccination as a tool in managing outbreaks.

The risks and benefits of a vaccination session during an outbreak must be carefully considered, in particular the ability to vaccinate while maintaining IPC measures.

The lack of an established evidence base on this means that the local HPT should undertake a risk assessment to determine the appropriate next steps in such situations.

Review implementation of appropriate PHS guidance for the setting.

Cohorting of population or minimising contact between groups ('bubbling').

Physical distancing – policy or guidance and adherence.

Include discussion of:

  • car sharing
  • communal areas
  • changing rooms
  • breaks, including smoking

Reminder to population of importance of symptom vigilance and following NHS inform advice.

PPE and face coverings

  • availability
  • quality
  • compliance

Personal hygiene

  • hand hygiene
  • respiratory hygiene

Environmental cleaning

Ventilation

Consider wellbeing and the impact of incident and any enhanced mitigations on those involved in or using the setting.

This includes the financial impact on cases and contacts.

Consider support required.

Inform other stakeholders and widening participation as required.

Assess the need for a proactive or reactive media statement.

The HPT should chair the problem assessment group (PAG) or incident management team (IMT).

Housekeeping

  • Ask for consent for supportive recording, if useful for minute-taking.
  • If there are new attendees, explain PAG/IMT process briefly, including acronyms.
  • Reminder about confidentiality regarding reporting back organisationally generally and for personal identifiable information.
  • Reminder about possible freedom of information (FOI) enquiry for documentation and other communication.
  • Declarations of potential conflicts of interest - for example, private owners, service managers or people otherwise connected to the situation. This could be a link to specific school, business or service.

Review

  • membership of the group
  • case definition

Update

If the company or setting manager is invited to provide an update or support risk assessment, this should be to only part of the PAG or IMT to enable members to discuss final conclusions.

Next meeting

  • Establish plans for next meeting.

Conclude the outbreak investigation when there have been:

  • no new cases for a minimum of 14 days from the last potential exposure to a confirmed case
  • no further follow-up actions are required to mitigate the potential for future outbreaks

Related resources

This guidance should be read with reference to these related resources.

Scottish Health Protection Network (SHPN) guidance

Guidance on the management of public health incidents.

Infection prevention and control (IPC) guidance

Antimicrobial Resistance and Healthcare Associated Infection Scotland (ARHAI) guidance found in the National Infection Prevention and Control Manual (NIPCM).

Scottish Government guidance

Clinical guidance

The Scottish Intercollegiate Guidelines Network (SIGN) produces clinical guidance on COVID-19.

Information for the public

NHS Inform provides information for the public, including translated materials.

 

Abbreviations

ARHAI

Antimicrobial Resistance and Healthcare Associated Infection Scotland

COVID-19

coronavirus disease 19

Ct

cycle threshold

GDG

guidance development group

FFP

filtering face piece

HPT

health protection team

HSCW

health and social care worker

HSE

Health and Safety Executive

IMT

incident management team

IPC

infection prevention and control

LFD

lateral flow device

MHRA

Medicines and Healthcare Products Regulatory Agency

NIPCM

National Infection Prevention and Control Manual

OC

occupational health

PAG

problem assessment group

PCR

polymerase chain reaction

PHS

Public Health Scotland

POCT

point of care testing

PPE

personal protective equipment

RNA

ribonucleic acid

RSV

respiratory syncytial virus

SARS-CoV-2

severe acute respiratory syndrome coronavirus 2

SHPIR

Scottish Health Protection Information Resource

SIGN

Scottish Intercollegiate Guidelines Network

SIREN

SARS-CoV-2 immunity and reinfection evaluation

UKHSA

UK Health Security Agency (formerly Public Health England)

VAMs

variants and mutations

VOC

variants of concern

VUI

variants under investigation

References

Submit feedback on this guidance

Health protection teams (HPTs) and other stakeholders have contributed to the development of this guidance through regular feedback and comments.

As this format is a new approach to delivering this guidance, we welcome feedback from health protection teams on this guidance and how we can improve it.

If HPTs have a specific query about the application of the guidance please email PHS Enquiries and Guidance Cell or call PHS on call for any urgent queries.

Your rating
Please rate this updated guidance in comparison to the previous version. 1 being much worse than previous version, 3 being no change and 5 being much better improvement.
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Last updated: 02 December 2022
17 October 2022 - Version 2.5
  • Alignment with policy change to remove routine asymptomatic testing for HSCW.
  • Updated links to current Director’s Letter.
  • Updated links to PHS SCRC guidance.
  • Removed Lab FAQ ‘how reliable are tests performed outside of the NHS?’.
12 July 2022 - Version 2.4
  • Rephrasing of laboratory FAQ 'How do you test for new variants of SARS-CoV-2?'
  • Addition of references throughout to appendix 22 of the NIPCM (community infection prevention and control COVID-19 pandemic measures).
  • Updated references throughout to newly merged information and guidance for care homes for older people and social, community and residential settings v2.2.
  • Under general prevention measures, addition of reference to Scottish Government advice on face coverings.
  • Clarification of wording regarding requirements for ending the stay at home period for confirmed and possible cases.
21 June 2022 - Version 2.3
  • Guidance produced in HTML format, includes changes to format and language throughout for accessibility.
  • Updated references to COVID-19 Guidance for Prisons v2.0 published 14 June 2022.
31 May 2022 - Version 2.2
  • Addition of reference to HPT contact details.
  • Removal of reference to the NIPCM Winter (21/22) Respiratory Addendum throughout.
  • Section 3.1 Addition of reference to NIPCM Appendix 18 for physical distancing guidance.
  • Section 3.2 Addition of reference to NIPCM Transmission based precautions for face mask guidance in health and care settings and Scottish Government guidance of the extended use of face masks for hospitals and care homes.
  • Section 3.3 Addition of reference to NIPCM Appendix 20 for ventilation guidance in health and care settings.
  • Section 3.5 Addition of reference to NIPCM Standard infection control precautions for PPE guidance in health and care settings.
  • Section 3.6 Removal of link to the Highest Risk List and inclusion of link to Scottish Government guidance for people.
    who are immunosuppressed.
  • Section 5.1 Addition of positive POCT to confirmed case definition.
  • Section 6.1.3 Addition of reference to NIPCM for further information regarding use if POCT and testing follow up good practice for POCT.
  • Section 6.2 Addition of reference to NIPCM Appendix 20 for guidance regarding testing and placement of patients in health and care settings.
  • Section 7.1.2 Addition of reference to NIPCM Transmission based precautions for guidance regarding COVID-19 positive patient placement.
  • Section 10. Addition of reference to NIPCM Standard infection control precautions for guidance for respiratory screening process in health and care settings.
  • Appendix 1. Addition to FAQ 7 of reference to Scottish WGS service, addition of FAQ 8 for information sample packaging and transport and FAQ 9 for local laboratory contact details.
02 May 2022 - Version 2.1
  • Updated references to NHS Inform throughout the guidance.
  • Rationalisation of introduction to remove out of date text.
  • Rationalisation of general prevention measures to make it clearer that there are still requirements for physical distancing and face masks in some settings whilst retaining guidance for NPIs in most settings.
  • Rationalisation of PPE section to make it clear that the NIPCM should be referred to for most up to date advice and inclusion under general prevention measures.
  • Inclusion of a 'People at highest risk' section for use when considering mitigations for individuals at highest risk.
  • Rationalisation of the vaccination section to ensure HPTs are utilising the most recent information regarding vaccine programmes. The vaccination definitions have also been moved into this section.
  • Update of case definitions: confirmed case definitions now include those with a positive LFD test for SARS-CoV-2, probable cases have now been removed, possible cases now include the wider range of respiratory symptoms.
  • Testing has been updated to remove symptomatic PCR testing and includes an updated eligibility criteria list for access to testing in line with the Test and Protect Transition Plan.
  • Case management has been updated to reflect the move to the 'Stay at home guidance' which replaces self-isolation criteria. This includes guidance for staying at home for confirmed and possible cases and includes updated references to Stay at Home advice and DL (2022) 12.
14 April 2022 - Version 2.0
  • In line with Scottish Government announcements on the 15 March 2022, the following updates are effective from 18 April 2022:
    • Routine asymptomatic testing recommendations have been removed from the general population. Only Health and social care workers should continue to test routinely.
    • Asymptomatic LFD testing for social care staff reverted to twice a week, in line with health care staff.
  • Update to introduction on evidence for transmission.
  • Update to 28 day exemptions for residents of care homes with residents now exempt from routine asymptomatic testing and contact tracing from 28 days after testing positive.
  • Update to outbreak management and outbreak checklist to reflect a risk based approach to management.
  • Update to references to COVID-19 Guidance for Care Home Settings (For Older Adults).
  • Update to LFD test kit access: kits should now be ordered from the UK Gov website or collected from local test sites
Not published online - Version 1.9
  • Addition of Appendix 3 Lab FAQs
  • clarification of wording throughout regarding frequency of asymptomatic LFD testing for social care workers, as per DL(2022) 05 social care workers should continue to test prior to each shift.
  • 6.2.1 Addition of text regarding the ability of a HPT to seek support from a local authority support team for a person needing to self-isolate despite a negative PCR test.
28 February 2022 - Version 1.8
  • This guidance now incorporates an updated version of COVID-19 Guidance for Healthcare Settings. This includes the addition of the following sections: 
    • section 2.1 NIPCM addendum
    • section 3.7.1. General prevention measures for healthcare workplaces
    • section 12. Patient access to clinical care
  • Updated in line with the updated DL(2022)01 from 24/01/22.
  • Updated in line with the DL(2022)05 regarding change in testing frequency for HSCW to align with the general public.
  • Removal of the need for a negative PCR result for a fully vaccinated HSCW identified as a contact to return to the workplace.
  • Addition of 28-day exemption for all, regardless of vaccination status, from routine and contact asymptomatic LFD testing after testing positive.
  • Addition of Appendix 3 which details the case and contact isolation periods for various high-risk settings.
  • Addition of Appendix 4 which gives exemplars of case and contact isolation periods for two common scenarios.
07 January 2022 - Version 1.7
  • Update to definition of fully vaccinated to include those with three doses of a primary course.
  • Added clarity on the need for a negative PCR test for HSCW contacts to return to work in line with updated DL (2022) 01.
  • Clarification that those who self-isolated prior to 06/01/2022 should follow the advice they were provided with at the time i.e. no retrospective application.
  • Clarification to not PCR test following an asymptomatic positive LFD if symptoms subsequently develop
  • Clarification that those with COVID symptoms who do take an LFD which returns negative should still undertake a PCR.
  • Clarification for asymptomatic case and household contacts to not reset isolation period if case subsequently develop symptoms post-test.
  • Reference and Hyperlink to DL (2022) 01 added throughout.
  • Minor wording updates to vaccination section to reflect the current advice on boosters.
  • Clarity given regarding testing within 90 days of a positive test; if cardinal symptoms develop the person should test with a PCR unless already having tested positive by LFD in the current episode.
  • Clarity given regarding no need to retest with a PCR if a positive LFD test result already received.
  • Additional wording on 14-day window post household contact where no further isolation is required.
21 December 2021 - Version 1.5
  • Section 6.2: Daily LFD testing for HSCWs from DL 2021-51
  • Section 8.2.1 and 8.2.2: Update to add 2 x LFDs for contacts with previous PCR positive in last 90 days
  • Section 8.2.4: Update to align with DL 2021-50 (17-12-21) and additional clarity for HPTs on when isolation exemption applies
  • Section 8.2.5: As above for Critical Workers.
Not published online - Version 1.4
  • Section 2.0: Broken link on transmission removed
  • Section 3.3: New section added for guidance on social interactions and limits on visitors in health and social care settings
  • Section 3.7: Measures in workplaces updated to reflect new guidance on working from home and reducing social interactions
  • Section 4.0: Clarification on wording around vaccination time frames and booster eligibility
  • Section 6.1.1: Updated to reflect change to exemption criteria which now includes other workplaces undertaking routine PCR testing; and change to exemption criteria, HSCW and critical service workers who have tested positive in last 90 days  should test with an LFD to meet exemption criteria no longer PCR
  • Section 6.2: Updated to reflect new guidance from SG regarding routine LFD testing in general population and extended workplace schemes
  • Section 7.0: Updated wording on managing acutely unwell cases
  • Section 8.2.1: Clarified wording around household isolation for multiple cases in a single household outbreak
  • Section 8.1.2: Red list link removed as no longer relevant to case management
  • Section 8.1.3: Clarification on high risk and low risk contact definition
  • Section 8.1.4: Wording clarification of clinical mask
  • Section 8.2: Update to testing requirements in response to update on 90 day testing exemptions
  • Section 8.2.5: Addition of critical service worker contacts section, drawn from SG guidance
  • Section 10.0: Reinfection wording updated to reflect Omicron reinfection risk 
Not published online - Version 1.3
  • Title page: removed mention of contact tracing
  • Added in list of abbreviations
  • Updated all mentions of PHE with UKHSA
  • Updated all mentions of IPC addenda to refer and link to new Winter (21/22) Respiratory Infections in Health and Care Settings Infection Prevention and Control (IPC) Addendum
  • Section 1: removed link to reference document for variants and mutations (currently not on SHPIR) and added in a link to contact details for HPTs
  • Section 2. Introduction. Text and references reviewed and updated.
  • Section 3: general prevention measures updated and reworded for clarity; in line with PHS guidance for healthcare settings
  • Section 4: vaccination section updated and reworded for clarity Section 6: removed link to lab FAQs (currently not available on PHS website)
  • Section 6.1: additional clarification around eligibility for PCR testing
  • Section 6.1.1: additional clarification around interpreting PCR results
  • Section 6.2: additional clarification around LFD testing
  • Section 6.2.1: additional clarification around interpreting LFD results
  • Section 6.3: added for point of care testing and interpretation Section 6.4: testing for other pathogens updated to remove human metapneumovirus and added in respiratory syncytial virus
  • Section 8.1: flight contact definitions updated to remove traffic light system, household and non-household contact definitions updated and high/low risk for definitions added for children and young persons
  • Section 8.2: fully updated self-isolation advice
  • Section 8.2.3: wording updated around self-isolation requirements for children and young people for clarity and to explain why this is different to requirements for adults; further emphasis that these requirements apply to all settings; additional clarification around the use of high and low risk contacts.
  • Section 8.2.4: wording updated for clarity around health and social care workers on self-isolation exemptions for general activities; to clarify that exemptions do not apply to unvaccinated HSCWs under 18 years old and to add that participants in vaccine trials may be eligible for this exemptions following risk assessment
  • Section 9.3: all mentions of “warn and inform” letters have been replaced with “information letters
  • Section 10.1: wording added for consideration of reinfection in the case of epidemiological links
  • Section 12: international travel and managed isolation updated in line with changes to regulations
  • Appendix 2: added in link to contact details for HPTs
  • Removed appendices 8 and 9 which previously contained sample “warn and inform” support letters. These have been shared with all health boards and local authorities.
  • Removed appendix 3 and 4 which contained redundant household and contact isolation information.
  • Removed appendix 6 which has been moved up to be contained within the text.  
13 September 2021 - Version 1.2

First published on Public Health Scotland.

28 January 2021 - Version 10

This publication was previously published on the Health Protection Scotland website.