Reduced Isolation Period Gets Mixed Welcome

Dr Sheena Meredith

January 14, 2022

Editor's note: This article has been updated with additional comments

The Government has announced that from Monday 17 January, self-isolation for those testing positive for COVID-19 can end after 5 full days, provided they test negative on days 5 and 6 and do not have a raised temperature. People whose rapid lateral flow tests remain positive must stay in isolation until they have had two consecutive negative tests taken on separate days.

The self-isolation period was already cut back in December from 10 to 7 days if people had negative tests on days 6 and 7.

The default self-isolation period remains at 10 days, and people may only leave self-isolation early if they fulfill the new requirements.

The new measures were intended “to support essential public services and keep supply chains running over the winter”, the Government said. It stressed that it remained crucial that people isolating wait for release until they have received two negative rapid lateral flow tests on 2 consecutive days, to reduce the chance of still being infectious.

The decision has been made after "careful consideration" of modelling from the UK Health Security Agency. Health and Social Care Secretary Sajid Javid said: "After reviewing all of the evidence, we’ve made the decision to reduce the minimum self-isolation period to 5 full days in England. These 2 tests are critical to these balanced and proportionate plans."

Mixed Reactions

The Government’s announcement met with opposition however.

The Royal College of Nursing responded by issuing a press release asking for health and care workers to be exempt from reduced self-isolation. Pat Cullen, RCN general secretary and chief executive, said: "By the Government’s own estimate, almost a third of individuals are infectious 5 days after symptoms starting. Health and care workers will fall into that group in large numbers and there can be minimal room for error or complacency.

"Current and growing workforce pressures must not drive a reduction in isolation requirements in an unsafe way.

"This change could increase the risk of transmission to other staff and patients. When providing close care, including to those with compromised immune systems, nursing staff must be confident that they are not putting patients at risk."

Lawrence Young, virologist and professor of molecular oncology, Warwick Medical School, agreed: "This policy is certainly not following the science. Reducing the self-isolation period to 5 days runs the risk of highly infectious people returning to work or school," he told the Science Media Centre. "This is not helped by current problems with the availability of lateral flow tests and with concerns about people reporting the results from these tests."

However NHS Providers gave a cautious welcome to the announcement. Deputy chief executive Saffron Cordery said: "There has always been the need to balance getting staff who have been isolating due to COVID back to work as quickly as possible on the one hand, with the need to protect patients and other staff from COVID cross infection in healthcare settings on the other.

"This is particularly important given the increased transmissibility of the Omicron variant and the impact this could have for vulnerable patients in healthcare settings.

"Trust leaders will welcome findings from the UKHSA that the new arrangements do not substantially increase risk of nosocomial infection. This will mean their staff can come back to work sooner, if LFTs allow.

"This is a significant development given the huge operational pressures facing the service and the risks to patient care associated with the current level of COVID isolation driven staff absences.

"Trust leaders will continue to follow UKHSA guidance to ensure everything possible is done to minimise the risks of nosocomial infections."

Concern Regarding Availability of Tests and PPE

The College of Paramedics also broadly welcomed the move but expressed concern about the availability of test kits and protective equipment. A spokesperson told Medscape UK: "We know there has been an issue for our members in accessing lateral flow test kits and, with the extremely close range care delivery that paramedics give, it is vital that we aim to protect both paramedics, and the people who use their services, both in emergency and primary care.

"Sickness levels make an already-stretched workforce work even harder and it is important that employers utilise the latest risk assessments for better respiratory protective equipment of their staff."

The BMA, which last weekend declared the NHS in a "perilous state", with 1 in 5 doctors self-isolating within the previous 2 weeks, also said access to tests and PPE remained problematic.

Dr Penelope Toff, BMA public health medicine committee chair, told Medscape UK: "All sectors and, in particularly the health service, are experiencing disruption from widespread absences due to the rapid spread of Omicron, but healthcare workers do not want to risk infecting colleagues and patients - many of whom are clinically vulnerable. So they can only return to work safely after a shorter period of isolation and two negative lateral flow tests if they have access to high-grade masks, and many are finding that this is still not the case."

She continued: "The Government accepts that, under this new policy, at least 7% of people will still be infectious when they leave isolation, even after two negative lateral flow tests on day 5 and 6, meaning these continued infection control measures among the public and within healthcare settings are absolutely vital."

In last week’s survey, almost half of doctors said they were extremely concerned about staffing levels, but fewer than half said they could always access lateral flow tests and almost half said that when working in red zones they were not provided with respirator masks.

Other Guidance to be Reviewed

The Government will also consider the guidance for those identified as close contacts of people with COVID-19, which currently remains unchanged: fully vaccinated contacts are not required to isolate but should take daily rapid lateral flow tests for 7 days; unvaccinated contacts are legally required to self-isolate for the full 10-day period.

Following the announcement, Mr Javid said: "We’re doing more tests than any other country in Europe. We raised the distribution of free lateral flow tests from 120 million in November to 300 million in December... and we’re expecting to make around 400 million tests available over the course of this month – that’s 4 times the pre-Omicron plan."

He added: "UKHSA data shows that around two thirds of positive cases are no longer infectious by the end of day 5 and we want to use the testing capacity that we’ve built up to help these people leave isolation safely."

Different UK nations set their own isolation rules and Welsh ministers said they have no plans to cut their self-isolation period. A further review of Wales' COVID-19 restrictions is planed for Friday. Northern Ireland's First Minister Paul Givan indicated support for such a policy but said it was a decision for Health Minister Robin Swann to make. In Scotland people may end self-isolation early following 2 negative LFD test results 24 hours apart from day 6 onwards.

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