Coronavirus COVID 19 guidance for care settings

Published: Thursday, 02 April 2020

Martin Hodgson provides a summary of the coronavirus guidance for care providers.

Summary

  • People in the UK have been told to stay at home in an effort to combat the spread of the COVID-19 virus.
  • Those who develop symptoms - a new continuous cough and/or high temperature – must self-isolate for seven days.
  • It is important that care providers, managers and staff keep as up-to-date as possible about the latest official guidance. The outbreak has escalated rapidly so check often for updates.
    COVID-19 Guidance for care homes and home care has been published by Public Health England.

Coronaviruses are micro-organisms that cause serious infectious diseases. Previous outbreaks have included Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).

COVID-19 is a new strain of coronavirus which first appeared in China at the end of 2019. The virus proved highly infectious and rapidly spread to other countries through infected travellers.

In January 2020 the World Health Organisation declared a global emergency and early in March they defined the disease outbreak as a pandemic.

The virus spreads from person to person in droplets from the nose or mouth of an infected person. These are spread when the person coughs or exhales. Others become infected when they breathe in the droplets or touch contaminated surfaces and then touch their eyes, nose or mouth. Incubation is between 2 to 14 days.

It is known that some people may be infected but remain symptom free.

Symptoms and treatment

Symptoms of COVID-19 include fever, tiredness, and persistent dry cough. Other symptoms such as aches and pains, nasal congestion, runny nose, sore throat and diarrhoea are also reported.

Most infected people will have fairly mild symptoms with no significant infection in the lungs. Most people with mild symptoms will recover at home with no treatment needed. They should drink plenty of water and take paracetamol to lower fever.

However, some will have severe symptoms causing serious shortness of breath, low blood oxygen or other lung problems. A minority will suffer critical respiratory failure and pneumonia. People who are critically ill require hospital treatment. Many will need to be placed on a ventilator.

The exact mortality rate of COVID-19 is as yet unknown. However, the virus has caused thousands of deaths around the world. It is particularly dangerous for older people over 70 and for people with weakened immune systems or long-term conditions, including diabetes, cancer and chronic lung disease.

There is no vaccine currently available and the virus does not respond to known anti-viral medication.

How can people protect themselves?

Public Health England (PHE) state that people can protect themselves from catching COVID-19 by regularly washing hands with soap and water for at least 20 seconds. They are advised to use 60% alcohol hand sanitiser gel if soap and water are not available. PHE also recommend that people cover their mouth and nose with a tissue or with their sleeve when coughing or sneezing. They should not use their hand. Used tissues should be disposed of straight away and frequently touched objects and surfaces cleaned and disinfected. Lastly, they should avoid close contact with people who are unwell and should not touch their eyes, nose or mouth if their hands are not clean.

As well as handwashing and respiratory hygiene, key government strategy is to prevent people from passing the virus on to each other. This is accomplished by ‘locking down’ the country and asking people to ‘self-isolate’ and observe ‘social distancing’ rules.

Self-isolation

The following ‘self-isolation’ rules must be followed:

  • those who live alone and have symptoms of new continuous cough and/or high temperature - however mild - should ‘self-isolate’ by staying at home for 7 days from the symptoms start
  • those who live with others should self-isolate as a household for 14 days from the day the first person in the house became ill.

People self-isolating must stay-at-home. They must not have visitors and should arrange for friends or family to shop for them. They should use the internet and NHS111 online for information and call NHS111 if without internet access or if symptoms worsen. People are asked to avoid going directly to a GP, a pharmacy or a hospital. For a medical emergency they should dial 999.
People do not need to call NHS111 to go into self-isolation.

Social-distancing and lockdown

In addition to self-isolation many countries, including the UK, have introduced mandatory ‘social distancing’ as well as restrictions on people’s movements.

On the 23 March the Prime Minister announced a ‘lockdown’ where the majority of the population are required to stay at home. They should only go outside if:

  • shopping for necessities, such as food and medicine, as infrequently as possible
  • to do one form of exercise a day, such as running, alone or with household members
  • for medical or care needs, for example to help a vulnerable person
  • travelling to and from work, but only if the work cannot be done from home.

Meeting friends, shopping for anything beyond essentials, and gathering in crowds or groups of more than two people are banned.

Every citizen must comply. The restrictions are designed to protect the NHS. They will be enforced by the police and may lead to fines for non-compliance.

To support the lockdown people are being asked to work at home, wherever possible, and to only travel for essential reasons. They should not have visitors, including friends and family. Sporting events have been cancelled and pubs, restaurants, bars, cafes, libraries, outdoor gyms and playgrounds, places of worship and leisure centres have been ordered to close. Most schools and nurseries have also closed with the exception of a reduced network of schools to look after children of ‘key workers’ such as doctors, nurses and paramedics who cannot be looked after at home, and certain vulnerable children. Shops that sell essentials such as food remain open.

A business operating in contravention of the Health Protection (Coronavirus, Business Closures) Regulations 2020 is committing an offence.

Social distancing means that when people do go out, or when they go to work, they should avoid any unnecessary social contact. They must stay at least 2 metres (about 3 steps) away from anybody outside their immediate household and should stay away from people who are unwell.

Because they are more at risk, vulnerable people such as those aged 70 and over are being strongly advised to stay at home. Even visits from family members must be avoided.

The intention of the lockdown and social distancing policy is to suppress the transmission of the disease and slow it down so that NHS critical care capacity can be protected for the sick. It is hoped that this will be enough to ensure that hospitals can avoid being over-whelmed with the strain of so many sick people all at once.

People are advised to keep in touch using the phone, internet, and social media.

The lockdown rules will be kept under review. In time the transmission rate of the virus will be suppressed far enough for the lockdown requirements to be gradually relaxed. However, it is likely that periodic restrictions and social distancing will be a part of everybody’s life for some time, probably until a vaccine is developed.

Guidance on social distancing for everyone in the UK can be found at https://www.gov.uk/government/publications/staying-alert-and-safe-social-distancing 

Shielding’ high-risk individuals

Arrangements have been introduced to ‘shield’ people considered as especially high-risk. Some people in this category will be adult social care users.

‘High-risk’ individuals are identified as those who:

  • have had an organ transplant
  • are having certain types of cancer treatment
  • have blood or bone marrow cancer, such as leukaemia
  • have a severe lung condition, such as cystic fibrosis or severe asthma
  • have a condition that makes them much more likely to get infections
  • are taking medicine that weakens their immune system
  • are pregnant and have a serious heart condition.

People in these categories have been written to by the NHS advising them not to leave their home for a period of at least 12 weeks from receipt of the letter. They are urged to avoid close contact with other people in their home, not to go out for shopping, not to visit friends or family, and not to attend any gatherings. Other people living with high-risk individuals are not required to adopt these protective shielding measures for themselves. However, they should be stringent in following guidance on social distancing.

Visits from people who provide essential support such as healthcare, personal support or social care should continue, but carers and care workers must stay away if they have any symptoms of COVID-19.

Some high-risk individuals will already be supported by their families, in a care home or by an agency such as a domiciliary care provider. However, others may find the restrictions difficult. Local authorities are therefore coordinating care packages to ensure that shielded individuals have the support they need, such as supplying essential medicines, food or supplies.

Details of the scheme are set out in Guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from COVID-19, published by Public Health England (PHE).

People can register for high-risk support at www.gov.uk/coronavirus-extremely-vulnerable

Testing

A test is available for determining whether somebody has the virus. However, due to a shortage of test kits in the UK these have largely been employed on symptomatic people in hospital. They are not routinely done on people who self-isolate themselves at home.

The government has responded to criticism of a lack of testing in the UK by announcing plans of an ambitious increase in testing capacity. Testing is already being increased for NHS workers and it is understood that further plans will include testing being rolled out for all care home residents and staff who show COVID-19 symptoms.

The government has responded to criticism of a lack of testing in the UK by announcing plans of an increase in testing capacity. NHS, social care workers and other essential workers and their families should have access to tests, whether they are showing symptoms or not. As the capacity of tests builds tests the government has announced that they will also be available for all care home residents, for symptomatic workers who cannot work from home, and for everyone over the age of 65 with symptoms - and other members of their household also showing symptoms.

Guidance on coronavirus testing, including who is eligible and how to get tested, is available online. Coronavirus (COVID-19): getting tested states that:

  • self-referral and employer referral test booking routes are available for essential workers who work in England, Scotland and Northern Ireland
  • tests involve taking a swab of the nose and the back of the throat
  • home test kits can be delivered to someone’s door so they can test themselves and their family without leaving the house

The government has also promised that all people being discharged from hospitals to care homes will be tested.

It is hoped that additional antibody tests will become increasingly available. These will be able to show whether someone recently had coronavirus, even if they had no symptoms.

More widespread testing is seen as key to tackling coronavirus.

Care sector guidance

The government has produced specific guidance for the care sector to help providers protect their service users. This includes:

  • Admission and Care of Residents During COVID-19 Incident in a Care Home
  • COVID-19: How to work safely in care homes

These documents are available on the main GOV.UK coronavirus website at https://www.gov.uk/coronavirus

Additional guidance is published in Coronavirus (COVID-19): adult social care action plan. This contains amendments to the published documents.

Care home guidelines

The Admissions and Care of Residents guidance for care homes covers:

  • Admission of residents
  • Caring for residents, depending on their COVID-19 status
  • Reporting COVID-19 cases
  • Providing care after death
  • Advice for staff on using personal protective equipment (PPE)
  • Supporting existing residents that may require hospital care
  • National support available to care home managers

A number of annexes provide further details on aspects of care such as infection prevention measures, caring for higher risk residents, isolating symptomatic residents, decontamination and cleaning processes, and communications with residents and families.

Care homes are advised to instigate a programme of daily monitoring. Staff conducting the monitoring should watch both residents and staff for early signs of fever (≥37.8°C), cough or shortness of breath.

Any resident presenting with symptoms of COVID-19 should be promptly isolated. Annex C provides details about how isolation should be conducted. Wherever possible symptomatic residents should be cared for in their own room with their own en-suite bathroom.

The guidance states that, at the present time, family and friends should be advised not to visit care homes, except next of kin in exceptional situations such as end of life. Care home managers and staff are advised to utilise phone and video technology wherever possible to help residents keep in contact with their loved ones.

PPE is vital to protect staff from infection and to prevent the virus from spreading. COVID-19: How to work safely in care homes sets out what PPE should be worn and used in different care tasks. It should be read alongside COVID-19 personal protective equipment (PPE).

When providing personal care which requires direct contact with residents (e.g. touching) or being within 2 metres of any resident who is coughing, staff are advised to wear:

  • Disposable gloves
  • A disposable plastic apron
  • A fluid repellent surgical mask
  • Eye/face protection if there is risk of splashing/respiratory droplets contacting the face

Single-use disposable gloves and aprons should be disposed of after each episode of care. However, surgical masks and eye protection may be used on a continuous or ‘sessional’ basis until a member of staff takes a break.

Home care guidelines

The guidance for home care providers includes advice on:

  • Action to take if a care worker is concerned they have COVID-19
  • Safe working procedures if an individual being cared for has symptoms of COVID-19
  • Procedures if an individual being cared for does not have symptoms but is part of a household that is isolating
  • Domiciliary care providers are advised to review the support needs of their clients and work with local authorities where necessary to establish plans for mutual aid.

PPE

As well as criticism over a lack of testing, the government has also faced sustained calls over a lack of appropriate PPE, particularly for social care. The government has insisted that it is working with PPE manufacturers and suppliers to address any shortfall.

All staff who are required to use PPE should be trained how to put it on and take it off safely. A video on ‘donning and doffing’ PPE can be found on the GOV.UK website at https://www.gov.uk/government/publications/covid-19-how-to-work-safely-in-care-homes

Inspections

In England the Care Quality Commission have announced the cessation of inspections for the duration of the crisis.

Ethical considerations

Further guidance from the government is published in Responding to COVID-19: the ethical framework for adult social care.

This framework is aimed at strategic policy makers at local, regional and national level. It is intended to support them in considering the difficult ethical issues that will inevitably emerge as they plan and organise adult social care during the COVID-19 crisis.

NICE guidelines

The National Institute for Health and Care Excellence (NICE) have published the first of a series of ‘rapid guidelines’ to help UK doctors and nurses know the best course of treatment for patients amid the coronavirus pandemic. The guidelines cover patients in critical care, those having kidney dialysis and people being treated for cancer.

Up-to-date information

It is important that care providers, managers and staff keep as up-to-date as possible about the latest official guidance. The outbreak has escalated rapidly so check often for updates.
The further information contains links to the latest guidance. Information should be passed on to service users and their relatives and carers as required.

Further information

Toolkit

Use the following item in the Toolkit to put the ideas in the article into practice:

About the author

Martin Hodgson MSc, PGCEA is a community psychiatric nurse by background, and has had a long career working as a senior manager in various health agencies, including mental health, primary and community care.

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