COVID-19 - guidance for health protection teams (HPTs)
Version 3.2

Links refreshed and updated across the document.

Minor corrections across the document to clarify recommendations.

This guidance has been updated to capture the advice on testing in healthcare settings in the CMO letter SGHD/CMO(2023)12 published on 9 Aug 2023, advising to pause all routine testing in health, social care and prison settings. An exception to the pause is for individuals in hospital, prior to being discharged to a care home or hospice; this routine testing will remain.  These changes should take effect no later than 30 August 2023.

The full document has been synthesised and updated to capture the current situation in relation to COVID-19 infections, as well as the impact on public health management of outbreaks, in line with the approach on testing, adopted in the SGHD/CMO(2023)12.

Advice on face coverings in non-healthcare settings updated, to reflect updates (17 July 2023) in Scottish Government recommendations on face coverings.

• Removal of reference to the Scottish Government Coronavirus (COVID-19): extended use of face masks and face coverings in hospitals, primary care and community healthcare settings guidance, with reference to existing IPC guidance in the NIPCM.
• Removal of test defining ‘fully vaccinated’, provide link out to Green Book for definition.
• Updated links to PHS Information and guidance for social, community and residential care settings.
• Links to the new PHS COVID-19: guidance for prison settings added 

   

• Merged information from PHS guidance document 'Information and guidance for workplaces and community settings' – this has now been archived.
  • Added sections for 'non-healthcare settings' through 'General prevention measures' section.
  • Added section 'Workplace and community settings risk assessment' in 'General prevention measures' section.
  • Added section 'Workplace and community settings management' in 'Management of COVID-19 outbreaks' section.
• Updated links to Information and guidance for social, community, residential care and prison settings throughout and removed links to archived PHS guidance documents.

• Merged information from PHS guidance document 'Information and guidance for workplaces and community settings' – this has now been archived.
  • Added sections for 'non-healthcare settings' through 'General prevention measures' section.
  • Added section 'Workplace and community settings risk assessment' in 'General prevention measures' section.
  • Added section 'Workplace and community settings management' in 'Management of COVID-19 outbreaks' section.
• Updated links to Information and guidance for social, community, residential care and prison settings throughout and removed links to archived PHS guidance documents.

• Under ‘Introduction’ section, updated information for infectious period to highlight variance in infectious period in SARS-CoV-2 variants. Aligned with UKHSA.
• Under ‘Assessing Inequality’ section
  • updated legislative information in line with expiry of Coronavirus Discretionary Compensation for Self-Isolation (Scotland) Act 2022
  • Removed information referring to Scottish Government Self-Isolation Support Grant, as grant withdrawn from January 2023
  • Added link to Social Care Staff Support Fund
• Under ‘Positive LFD test result’ removed ‘need to apply for a self-isolation support grant’ as reason for a confirmatory PCR test.
• Under ‘Testing for respiratory pathogens other than SARS-CoV-2’ added link out to Chief Medical Officer Antiviral letter CMO(2022)39
• Removed section ‘Lab FAQ’ after consultation with Labs cell and Boards (via WNHP meeting). Local NHS Lab contact details moved into ‘Checklist’
• Removed references in document (7 in total, to websites and scientific articles) other than within-text hyperlinks. Removed ‘References’ list.

• 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?’.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.  

First published on Public Health Scotland.

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