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 (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.
This guidance should be read with reference to these related resources.
Health protection team contacts
Access up-to-date contact information for local HPTs.
The disease COVID-19 is caused by severe acute respiratory syndrome coronavirus 2, also known as SARS-CoV-2.
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.
On 5 May 2023, WHO stated that COVID-19 was "…over as a global health emergency".
The cardinal symptoms of COVID-19 include:
- high temperature, fever or chills
- new and continuous cough
- change in, or absence of, normal sense of smell (anosmia) or taste (ageusia)
Other symptoms can be:
- 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
- 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:
- older people with frailty: more information can be found in PHS COVID-19 information and guidance for social, community, and residential care settings
- those with pre-existing conditions
- those who are immunocompromised
SARS-CoV-2 is spread by respiratory particles. This occurs mainly through close contact with infectious individuals.
Transmission risk increases when:
- people are close to each other (usually within 2 metres) or overcrowding
- people are displaying symptoms
- in indoor and in poorly ventilated environments not cleaned regularly
There is limited evidence of long-range aerosol transmission. Further research is needed to better understand aerosol transmission of SARS-CoV-2 virus.
SARS-CoV-2 virus can survive on surfaces from a few hours to days.
The amount of virus on surfaces is not always enough to cause infection.
SARS-CoV-2 can be transmitted even if the infected person does not have symptoms. This is called asymptomatic transmission.
Infectious and incubation periods
Studies show that the highest risk of transmission occurs a few days before and within the first 5 days after symptom onset, but can be up to 10 days after symptom onset.
The average incubation period is between 3 and 6 days, with a range from 1 to 14 days.
Public Health Scotland (PHS) provides a dashboard with the latest available data including, but not limited to:
- estimated COVID-19 infection levels and number of reported positive COVID-19 cases
- acute COVID-19 admissions to hospital and intensive care unit admissions
- hospital and intensive care unit bed occupancy
We also publish COVID-19 vaccination data.
General prevention measures
General prevention advice is recommended to:
- help reduce the spread of COVID-19 and other respiratory infections
- protect those at highest risk
- adhering to the recommended vaccination schedule – see NHS inform on COVID-19 vaccination
- ensuring effective hand hygiene, respiratory and cough hygiene and safe management of the care environment (see NIPCM and CH IPCM for care home information)
- allowing fresh air into indoor environments – see Health and Safety Executive (HSE) ventilation in the workplace guidance.
- staying at home and avoiding contact with other people, in case of high fever or feeling unwell
Health and social care settings
Health and social care settings are advised to adopt and implement the infection prevention and control (IPC) guidance for standard infection control precautions and transmission-based precautions.
These are detailed in the NIPCM:
Care homes settings
Care Home settings are advised to adopt and implement infection prevention and control (IPC) guidance for standard infection control precautions and transmission based precautions.
These are detailed in the CH IPCM:
Workplace and community settings risk assessment
Risk assessments help to identify the most effective mitigation measures to be followed by organisations, their employees and service users.
Find out more information in the Scottish Government safer workplaces and public settings.
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.
View further information on COVID-19 and pregnancy on:
Pregnant staff may also seek advice from their line manager or local occupational health (OH) service.
COVID-19 vaccines are recommended in pregnancy.
The best protection against the virus are COVID-19 vaccinations and boosters.
The Joint Committee for Vaccines and Immunisation (JCVI) provides details on the groups that are to be prioritised for vaccination.
The Green Book, chapter 14a (COVID-19) provides up to date information on COVID-19 vaccines, effectiveness, schedule and other relevant information.
For the purposes of public health management case definition has been updated to reflect changes to community testing practice.
- 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
- a positive lateral flow device (LFD) test
The case definition may differ from the epidemiological definition in the context of an outbreak investigation.
Testing for SARS-CoV-2
In the absence of testing, it may not be possible to know if a person has COVID-19, flu or another respiratory infection based on symptoms alone.
Most people can no longer get free covid tests and do not require them since presumed COVID-19 can now be generally managed based on symptoms.
However, the public can still access tests if eligible for new COVID-19 treatments due to a health condition.
Eligibility for SARS-CoV-2 testing
Testing for COVID-19, from 30 August 2023, remains to:
- support clinical diagnosis, when advised by a healthcare professional
- test those who are eligible for COVID-19 treatments
- support surveillance
- support outbreaks management, as per the National Infection Prevention and Control Manual or on advice from local IPC teams or local HPT teams.
Testing individuals for COVID-19 prior to their discharge from hospital to a care home or hospice remains in place, as advised in government policy.
The routine COVID-19 testing of symptomatic health and social care staff is no longer required, in line with the SGHD/CMO(2023)12 letter.
Health and social care staff should adhere to the NHS inform advice on managing symptoms of a respiratory infection.
People in the highest-risk group who are eligible for COVID-19 antivirals, monoclonal antibody therapies and other treatments require a positive LFD test result to access these.
Patients and residents in health and social care settings
Patients and residents of health care settings may undergo testing for appropriate management (including placement) within the setting.
For social care settings, refer to PHS COVID-19 information and guidance for social, community, and residential care settings.
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.
A positive LFD test result indicates that someone is infected with SARS-CoV-2.
Confirmatory PCR is not routinely required following a positive LFD test.
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 periods of low prevalence an LFD can indicate false positivity.
In addition, they may still be incubating the virus or could go on to acquire the infection in the period before their next test.
Polymerase chain reaction (PCR) test
PCR is the gold standard diagnostic test for SARS-CoV-2 and is used in Scotland in NHS laboratories.
Positive PCR test result
A positive PCR test result indicates that someone is infected with SARS-CoV-2.
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 (often private) 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.
Samples positive by PCR have the advantage that they may be suitable for further testing by whole-genome sequencing (WGS).
The purpose of this is for surveillance – for example, the identification of variants and mutations (VAMs).
Further testing information
Find out more information on testing in the Medicines and Healthcare products Regulatory Agency (MHRA) guidance on the variety of tests available for COVID-19.
Testing for respiratory pathogens other than SARS-CoV-2 as part of an investigation of a cluster
When necessary, HPTs should consider testing for pathogens other than SARS-CoV-2 when respiratory symptoms are present.
This may include:
- influenza A
- influenza B
- respiratory syncytial virus (RSV)
This particularly applies to closed settings, for example care homes or prisons, and in at-risk populations.
Virological testing should be done in discussion with the local microbiologist/virologist – depending on local arrangements. Generally, two swabs, or another respiratory sample, may be needed if testing for pathogens other than SARS-CoV-2.
This may be particularly important if testing of SARS-CoV-2 is negative during investigation of a cluster.
Public health management of COVID-19 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 and children – including health and social care workers (HSCW) – who meet the confirmed COVID-19 case definition should:
- stay at home
- avoid contact with other people
- continue to avoid contact with other people until they no longer feel unwell and no longer have a high temperature.
There is no need to test to end isolation.
Staying away from others can end any time once they no longer have a high temperature and they feel well.
Staff should return to work once the fever and feeling of unwellness has subsided.
Patients and residents of health and social care settings
Implement chapters 1 and 2 of the NIPCM where a service user is:
- being transferred to hospital or another health and care setting
- recently discharged from hospital or another health and care setting
Care home and other social care settings
Refer to the CH IPCM for required IPC measures.
Management of COVID-19 outbreaks
COVID-19 outbreaks should be managed following principles and practices outlined in management of public health incidents underpinned by the Public Health etc (Scotland) Act.
The outbreak can be declared as over when:
- there have been no new cases for a minimum of 14 days from the last potential exposure to a confirmed case
- HPT considers that:
- existing cases have been isolated or cohorted effectively
- guidance on IPC and other interventions is being applied appropriately
Patient access to clinical care
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
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.
Accessing healthcare services
Access to healthcare services should not be prevented for individuals with suspected infectious diseases.
An admission screening respiratory symptom assessment aide is available and further information on IPC measures can be found in the NIPCM and CH IPCM.
Refer to the Scottish Government guidance for international travel for the most up-to-date advice on local and international travel.
This guidance should be read with reference to these related resources.
COVID-19 guidance for specific settings, in particular for:
Scottish Government and Scottish Health Protection Network (SHPN) guidance
Infection prevention and control (IPC) guidance
- Antimicrobial Resistance and Healthcare Associated Infection Scotland (ARHAI) guidance is available in the National Infection Prevention and Control Manual (NIPCM).
- Care Home Infection Prevention and Control Manual (CH IPCM)
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.
Local NHS laboratory contact details
- NHS Ayrshire and Arran
- NHS Borders
- NHS Dumfries and Galloway
- NHS Fife
- NHS Forth Valley
- NHS Golden Jubilee
- NHS Grampian
- NHS Greater Glasgow and Clyde
- NHS Highland
- NHS Lanarkshire
- NHS Lothian
- NHS Orkney
- NHS Shetland
- NHS Tayside
- NHS Western Isles
Antimicrobial Resistance and Healthcare Associated Infection Scotland
- CH IPCM
Care Home Infection Prevention and Control Manual
coronavirus disease 19
filtering face piece
health protection team
health and social care worker
Health and Safety Executive
incident management team
infection prevention and control
lateral flow device
Medicines and Healthcare Products Regulatory Agency
National Infection Prevention and Control Manual
polymerase chain reaction
Public Health Scotland
point of care testing
personal protective equipment
respiratory syncytial virus
severe acute respiratory syndrome coronavirus 2
Scottish Health Protection Network
Scottish Intercollegiate Guidelines Network
SARS-CoV-2 immunity and reinfection evaluation
UK Health Security Agency (formerly Public Health England)
variants and mutations