RCN position on potential reduction of isolation time from seven to five days (England)
On 13 January 2022 the UK Government announced that as of 17 January 2022 the current seven-day isolation period would reduce from seven to five days in England. The RCN has called for health and care workers to be exempt from this policy change.
The UK Government has cited UK Health Security Agency estimates which suggest a 31% infection rate at 5 days. Health and care workers will fall into this group in large numbers and there can be minimal room for error or complacency. The European Centre for Disease Control’s (ECDC) guidance on isolation of COVID-19 cases acknowledges scientific evidence is limited and ‘…when recommending a shorter duration of isolation, the residual risk of onward transmission of SARS-CoV-2 increases.’
The RCN has serious concerns about risks associated with this policy. The identified risks to the safety of professionals and, consequently, their patients, must be assessed and mitigated against in any change of policy. Information about risks and mitigation must be disclosed, in the interest of transparency and for public assurance. Where sufficient evidence is not available, the UK Government must apply a precautionary principle in the management of risks.
The evidence base is not conclusive as to how long an individual may remain infectious when asymptomatic or with resolving symptoms, and questions remain as to the risk of passing on infection at day 5 of a receiving positive test. Therefore, qualified concern remains that health care workers may unwittingly transmit the virus to vulnerable patients and colleagues. The US Centers for Disease Control has updated guidance in a similar way but explicitly exempted health care workers.
The UKHSA has recently revised the testing guidance and removed the requirement to seek a confirmatory PCR test for non-symptomatic individuals after a positive lateral flow. However, the RCN is concerned that the symptoms referred to here have not changed since early 2020 and may not be in line with those expected of dominate variants at present. Priority access to all forms of testing must be given to health and care workers.
Meanwhile, the introduction in England of mandatory vaccinations as a condition of deployment in health and care services requires transparent monitoring of and mitigation against the risks and impact associated with mandation. This decision is likely to compound staffing pressures in frontline services and implementation of this policy must be delayed. Growing workforce pressures is must not be a driver to reduce isolation requirements to unsafe levels, given the risk of transmission to other staff, and to vulnerable patients, as well as risks around access to Personal Protective Equipment (PPE) and to testing kits.
There is a legal duty on employers to either prevent or adequately control exposure to a level 3 biological agent, like the SARS-CoV- 2 virus, as far as is reasonably practicable. This is under the Control of Substances Hazardous to Health (COSHH) Regulations 2002 in Great Britain, and Control of Substances Hazardous to Health Regulations (Northern Ireland) 2003.Governments, health and care regulators and employers must consider and manage this risk.
The RCN reiterates the call for use of precautionary levels of Personal Protective Equipment (PPE), specifically respiratory protective equipment such as FFP3 masks, and availability of or access to fit testing for staff in all health and care settings.