COVID-19 Contact Tracing Guidance (Including Complex Settings) Health Protection Team Guidance Version 3.5 Publication Date: 29 April 2021

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COVID-19 Contact Tracing Guidance (including complex settings) Health Protection Team Guidance Version 3.5 Publication date: 29 April 2021

This document is uncontrolled when printed. Before use check the COVID-19 page to verify this is the current version.

Version history An archive of all previously published versions of this guidance and supporting resources that relate to COVID-19 is available on the PHS website. This includes resources that have been retired from the website because they have been superseded or are no longer required.

Version Date Summary of changes V3.3 19/12/2020 Section 1: Introduction updated to include lateral flow devices and vaccines Section 4: Contact tracing updated to include lateral flow devices, testing of asymptomatic people in the community, participants in surveillance studies Section 6.1: Section on self-isolation period added, with details on change to 10 days for contacts and returning travellers Section 6.2: additional settings added, including care at home, early years and childcare settings. A section has been added for healthcare workers who test positive for COVID-19 whilst on duty during their infectious period Section 6.3: Link to SG COVID-19 protection levels added Section 7: initial follow up for cases updated with information for asymptomatic cases who have had LFD testing Section 8: self-isolation period updated from 14 to 10 days for contacts and returning travellers Section 11: PHS email address updated Section 12: Link to infection control addendum added Section 14: Confidentiality section updated about information that must be shared with contacts Appendices: Self-isolation period updated from 14 to 10 days for contacts and returning travellers. Contact details for HPTs updated with new email addresses. Addition of appendix 7 re self-isolation period for cases and contacts. V3.4 31/12/2020 Introduction updated to include the AstraZeneca vaccine Appendix 7 updated to Appendix 6 V3.5 29/04/2021 Guidance restructured with sections moved around for better flow Contact Tracing guidance for complex settings merged into this guidance, including appendices Section 1: Introduction updated to include regulatory approval of a number of vaccines Section 4: Access to universal rapid testing and Lateral Flow Devices (LFD) added Section 5: Added in what to do if a case tests positive within 90 days of an initial positive Section 6: Added in the need for all contacts to be tested Section 6.3: Added in additional scenarios of what to do if someone from outside the household visits either during the infectious period of a household case or their own infectious period Section 6.4: Self-isolation period updated to remove mentions of reduction of isolation period with effect from 14 December

2 Version Date Summary of changes Section 6.5 added in section for international travel and managed isolation (quarantine) Section 7: Added in a short summary of the Ct value of a PCR test Section 8: Proximity contact definition updated to include cumulative duration of contact during infectious period. Updated section on airline contacts to reflect current regulations and the need to carry out a risk assessment if more than one case is reported on a flight Section 9.1: complex settings updated to include settings that may have to close as a consequence of advice being given and settings where suspected clusters or outbreaks require further public health investigation. Section from guidance for complex settings added around following up community contacts and assessing risk of exposure Section 9.2: Links to setting specific guidance added and additional headings and sub-headings added for clarity for health and social care settings. Sections on general principles for patients and residents and appropriateness of PPE added from guidance for complex settings. Sub sections on PPE use, staff symptoms and what to do if a healthcare worker test positive updated Section 13: Associated legislation added from guidance for complex settings Appendix 1: Table 2 cumulative duration of contact updated for proximity contact Appendix 2 Table 1: guidance for travellers and contact categories updated with current travel regulations and the need to carry out a risk assessment if more than one case is reported on a flight Appendix 3: Contact tracing by setting-added in from guidance for complex settings Appendix 3 Table 2h: summary of occupational case and contact management in an aircraft updated with current regulations and additional information on managed isolation and self-isolation added, along with the SG’s list of acute risk countries Appendix 7: Table 1c updated with prisons/custody settings. Notes updated to remove 14th day of isolation. Additional scenarios added to include consideration for returning travellers developing symptoms during quarantine period and asymptomatic positive people who then develop symptoms within isolation periods. Self-isolation period for returning travellers updated Appendix 8 added in to provide additional clarity around self-isolation for a household Additional links to appendix 7 and 8 added in throughout Appendix 9 added in to provide clarity around travel regions and associated public health actions

3 Contents 1. Introduction ...... 6 2. Purpose of this document ...... 6 3. Case definition ...... 7 Case definition for individuals in the community ...... 7 Possible COVID-19 case (clinical criteria) ...... 7 4. Investigation and initial management of possible cases ...... 8 5. Follow up of cases ...... 9 6. Follow up of contacts ...... 11 6.1 Testing of contacts ...... 11 6.1.1 Booking a test ...... 11 6.2 Advice for household contacts who live with the index case ...... 12 6.3 Advice for non-household contacts and household contacts who do not usually live with the case ...... 12 6.4 Self-isolation period ...... 13 6.5 International travel and managed isolation (quarantine) ...... 13 7. Understanding and managing a positive PCR test result for COVID-19 ...... 14 8. Definition and classification of a contact ...... 15 Household contact ...... 15 Non-household contact ...... 15 Direct contact: ...... 15 Proximity contact: ...... 16 Airline contacts ...... 16 9. Contact tracing approach ...... 16 9.1 Management of complex settings and scenarios ...... 16 9.2 General principles for assessment of exposures where PPE is being used ...... 18 9.2.1 Health and social care settings ...... 18 PPE use ...... 18 Staff symptoms ...... 18 Positive Healthcare worker (HCW) ...... 19 9.2.2 General principles for positive patients/residents are: ...... 19 9.2.3 Settings other than health and social care ...... 20 9.3 Local geographical and incident specific variation ...... 20 10. Contacts from other health boards or other countries ...... 21

4 11. Identification of exposed settings ...... 21 12. Data collection and recording ...... 21 13. Associated legislation ...... 21 14. Confidentiality ...... 22 15. Dealing with people who are unwilling to self-isolate ...... 22 16. Further information ...... 22 Appendices ...... 23 Appendix 1 - Definition and classification of contacts ...... 23 Appendix 2 - Summary of contact categories and guidance for travellers ...... 26 Appendix 3 - Contact Tracing Guidance by setting ...... 27 Appendix 4 - Contact details for local Health Protection Teams ...... 35 Appendix 5 - Email text for GP of index case ...... 37 Appendix 6 - Contact tracing points of contact for UK public health agencies and UK armed forces ...... 38 UK Armed Forces personnel ...... 38 Appendix 7 - Self-isolation periods for cases and contacts ...... 39 Additional points to note when reading Appendix 7: ...... 40 Appendix 8: COVID-19 self-isolation for a household ...... 41 Additional points to note when reading Appendix 8 ...... 42 Regarding isolation ...... 42 For anyone from another household ...... 43 Appendix 9: Travel areas and public health actions ...... 44

5 1. Introduction

The disease COVID-19 is caused by a new strain of coronavirus (SARS-CoV-2) that was first identified in Wuhan City, China in December 2019. Symptoms range from mild to moderate illness to pneumonia or severe acute respiratory infection requiring hospital care. COVID-19 was declared a pandemic by the WHO on 12 March 2020 and the first cases in the UK were detected on 31 January 2020.

A range of measures are being used to control transmission of COVID-19, including physical distancing, hand hygiene, face coverings, testing and contact tracing. In Scotland, the programme of community testing, contact tracing, isolation and support is known as ‘Test and Protect’. Further details can be found on the Scottish Government website and NHS inform.

The Medicines & Healthcare products Regulatory Agency (MHRA) has given regulatory approval to a number of vaccines. Details and arrangements for the COVID-19 immunisation programme can be found on NHS inform. See COVID-19: guidance for Health Protection Teams for further information.

The current definitions of a contact are provided in Appendix 1 and Appendix 2.

2. Purpose of this document

This guidance provides recommendations for the public health follow-up and management of contacts of confirmed human cases of coronavirus (COVID-19).

This document is for use by all staff involved in tracing and managing contacts of cases. This is being undertaken by NHS Board health protection teams (HPTs) working in partnership with the National Contact Tracing Centre (NCTC).

Contact details for local HPTs can be found in Appendix 4.

6 3. Case definition

The case definition being used across the UK reflects our current understanding from the epidemiology available and will be subject to change as new information emerges. For most people COVID-19 will be a self-limiting infection and will not require admission to hospital.

Case definition for individuals in the community

Possible COVID-19 case (clinical criteria)

A person presenting recent onset of any of the following cardinal COVID symptoms:

• new continuous cough OR

• fever / temperature ≥37.8°C OR

• loss of, or change in, sense of smell (anosmia) or taste (ageusia).

A wide variety of clinical symptoms have been associated with COVID-19: headache, loss of smell, nasal obstruction, lethargy, myalgia (aching muscles), rhinorrhea (runny nose), taste dysfunction, sore throat, diarrhoea, vomiting and confusion; fever may not be reported in all symptomatic individuals 1. Cases may also be asymptomatic 2.

Clinicians should be alert to the possibility of atypical and non-specific presentations in children, older people with frailty, those with pre-existing conditions and patients who are immunocompromised. Patients must be assessed for bacterial sepsis or other causes of symptoms as appropriate.

1. Grant, M.C.et al. The prevalence of symptoms in 24,410 adults infected by the novel coronavirus (SARSCoV-2; COVID-19); A systematic review and meta-analysis of 148 studies from 9 countries. (2020) 2. He, J., Guo, Y., Mao, R. & Zhang, J. Proportion of asymptomatic coronavirus disease 2019: A systematic review and meta analysis. (2020)

7 4. Investigation and initial management of possible cases

Full details of the public measures to prevent spread of COVID-19 and to protect people at increased risk of severe illness are given in the PHS Guidance for Health Protection Teams.

People showing any of the three cardinal symptoms of COVID-19 (section 3) and well enough to remain in the community are advised to:

• Self-isolate for at least 10 days (details of household isolation are available on NHS inform).

• Appendix 6 provides a summary of self-isolation periods for cases and contacts in different settings.

• Seek COVID-19 testing (details of how to access testing are available on NHS inform).

Everyone who has a positive test result should be contact traced, whether or not they have symptoms at the time the test is taken.

Everyone in Scotland is now able to access rapid coronavirus (COVID-19) testing, even if they have no symptoms. This asymptomatic testing is using Lateral Flow Devices (LFDs). People who receive a positive test result from an LFD should undertake a confirmatory PCR test, and they and their household should isolate whilst awaiting the result of the PCR test.

When contact tracing is commenced based on a positive LFD result alone, and a negative PCR test is received later, but within the isolation period, the cases will be automatically flagged to local HPT via CMS, who will conduct a risk assessment to decide whether contact tracing will stop. Every individual with a positive LFD result and a negative PCR result should be contacted and told whether they can stop self-isolation.

Further information on LFDs is available in the PHS Guidance for Health Protection Teams.

8 5. Follow up of cases

• Confirmed cases (whether or not they have symptoms) should be provided with the current Scottish isolation advice for households with coronavirus infection and self- isolate in line with Appendix 8.

• Cases can return to their usual activities on the 11th day from the onset of cardinal symptoms, if they feel better and have not had a high temperature for 48 hours.

• A cough or change in sense of smell/taste may persist for several weeks in some people, even though the coronavirus infection has cleared. Cases do not need to continue to self- isolate for more than 10 days if they have a persistent cough or change in sense of smell/taste with no other symptoms or signs.

• For asymptomatic cases, isolation should be for 10 days from the date the sample for the test was taken. If cardinal symptoms develop subsequently, isolation should be re- started from the date of cardinal symptom onset.

• For asymptomatic cases who had an initial positive LFD followed by confirmatory positive PCR test, isolation should be for 10 days from the date of the initial positive LFD test.

• If a person has a positive LFD test, the result will go straight into CMS and trigger contact tracing. The person should have a confirmatory PCR test and if this is negative, the case will be flagged up to the local HPT so that they can conduct a risk assessment and decide whether to reverse the contact tracing.

• The case should be advised that if their symptoms do not get better after 7 days, or their condition gets worse, they should look for further advice on NHS inform or call NHS 24 (dial 111). For a medical emergency, they should dial 999 and tell the call handler they have confirmed COVID-19. They should not go to a GP surgery, pharmacy, or hospital without calling first for advice.

• Cases should be advised to check NHS inform for further information.

• The GP of the case should be notified as soon as possible that their patient has confirmed COVID-19 and that contact tracing is underway. A template notification email is provided in Appendix 4.

• If a case who tested positive has recovered, and then develops cardinal symptoms again, they should self-isolate and have a PCR test again.

9 • If an asymptomatic person is inadvertently re-tested and tests positive by LFD or PCR within 90 days of a previous positive PCR result, there is no need to do a confirmatory PCR, isolate or contact trace again, as long as the person with the repeat positive test:

o remains asymptomatic

o is not required to isolate as a contact of a confirmed case

o is not required to isolate having returned from travel to a non-exempt country

• In certain situations, for example, an outbreak, risk of reinfection with a new variant, specific clinical or travel risks, the HPT may conduct a risk assessment and recommend action such as isolation or whole genome sequencing.

• Repeat positive tests (asymptomatic or symptomatic) after 90 days should result in the usual public health action, i.e. isolation of the person with the positive test and contact tracing.

• If the case resides with any vulnerable individuals (such as the elderly or those with underlying health conditions) they should consider how to best separate themselves from these vulnerable individuals. Dependent on risk assessment this could include the confirmed case or the vulnerable contact being housed in separate accommodation.

o N.B. The local authority is responsible for deciding whether to provide this publically funded alternative accommodation, taking into account the public health risk assessment.

• Where a case is associated with a complex setting such as a hospital or care home, local risk assessment will be required in line with section 9.1.

10 6. Follow up of contacts

All identified contacts should be alerted that they are at greater risk of COVID-19 infection and that they should follow the NHS inform advice for self-isolation and get a PCR test (see section 6.1 below for more information on testing of contacts)

6.1 Testing of contacts

• All contacts will receive an SMS and a phone call informing them that they are a contact of a case and advising them to self-isolate and get a PCR test. This should be kept under review in line with the case management framework

• The test doesn't replace self-isolation and any contact who has a negative test during the isolation period must still complete the 10 day isolation period recommended for contacts, as they may still be incubating the COVID-19 virus.

• Contacts who test positive will be asked to self-isolate for an additional 10 days from the day the sample for the test was taken

• Any contact who has a positive test during their isolation period will be managed as a case and subject to contact tracing.

6.1.1 Booking a test

• Everyone in Scotland is now able to access rapid coronavirus (COVID-19) testing, even if they have no symptoms.

• Guidance on booking testing through the UK Government test sites can be found on NHS inform and the Scottish Government website.

• Anyone unable to access these websites can call NHS24 free on 0800 028 2816 or NHS 111.

• Guidance on testing in health and care settings can be found in the Novel coronavirus (COVID-19) Guidance for Health Protection Teams.

11 6.2 Advice for household contacts who live with the index case

• Please see appendix 7 and appendix 8 for clear guidance on potential scenarios.

• Contacts sharing the same household as the index case should isolate at home for 10 days from the date of onset of cardinal symptoms in the index case.

• Isolation should commence as soon as cardinal symptoms (in line with section 3) develop in the index case, whilst awaiting the result of testing.

• In situations where the index case is initially asymptomatic, isolation should be for 10 days from the date the test was taken from the index case. If cardinal symptoms develop subsequently, isolation for the case and for contacts should be re-started from the date of symptom onset in the index case.

• A contact who is already in their 10 day isolation period does not need to re start isolation if another member of the household becomes a case.

• Advice on household isolation of cases and contacts is also available on NHS inform

6.3 Advice for non-household contacts and household contacts who do not usually live with the case

• This includes sexual contacts, overnight stays and cleaners-see section 8 for more information on contacts

• Contacts from outside the household of the case should be told to self-isolate at home for 10 days from the date of last exposure to the case during their infectious period

• They should be advised to avoid contact with the rest of their household as far as possible, especially anyone who is at higher risk of severe illness or extremely high risk of severe illness (including anyone who had been shielding). Separation of contacts from the extremely vulnerable should be considered and local measures implemented to facilitate this as required.

o N.B. The local authority is responsible for deciding whether to provide this publically funded alternative accommodation, taking into account the public health risk assessment.

• Other members of the contact’s household do not need to isolate unless the contact develops cardinal symptoms or tests positive.

• GPs of any contacts do not need to be routinely notified.

12 • Where a contact is associated with a complex setting such as a hospital or care home, local risk assessment will be required. See section 9.1 for more information.

• If a person comes from another household into the main household and meets the criteria for a close contact or proximity contact during the infectious period of a household case, that person is a contact and must self-isolate in their own household for 10 days starting from the day of their visit.

• If a person from another household comes into the main household and meets the criteria for a close contact or proximity contact during their own infectious period, then the main household must self-isolate for 10 days from the day of the person's visit.

• See Appendix 7 and Appendix 8 for more information on self-isolation for cases, contacts and households.

6.4 Self-isolation period

The self-isolation period for contacts of a confirmed case of COVID-19 is 10 days for the general public. In some complex setting the period is 14 days. See Appendix 7 for more details on the self-isolation period for cases and contacts.

• Anyone who has been contacted through Test and Protect – including by the Test & Protect app – or by their Local Health Board, and have been notified to self-isolate should do so for 10 days.

• Close contacts include members of the same household as someone who has tested positive for COVID-19

6.5 International travel and managed isolation (quarantine)

The Scottish Government state:

"A Common Travel Area (CTA) exists between the United Kingdom, the Republic of Ireland, the Isle of Man, and the Channel Islands. If you arrive directly in Scotland from any country outside the CTA, you must quarantine for 10 days and have a valid Managed Quarantine Facility booked prior to departure (unless exempt)."

If an individual is in managed quarantine, then they need to isolate for 10 days starting from the day after the test, i.e. the day of the test is day 0.

More information is available here and in Appendix 9.

13 7. Understanding and managing a positive PCR test result for COVID-19

Where a positive PCR test result is received within 14 days of a previous positive result, this will not appear as a new case in the Case Management System (CMS).

For repeat positive PCR tests arising more than 14 days apart, these should be risk assessed by the local HPT to decide if public health action, including contact tracing, is indicated. Factors to consider include the emergence of new symptoms, the clinical status of the individual, the setting, the Ct values (this indicates how much virus is present-for more information see below) and any trend in Ct values across repeat test results.

People who have had a positive PCR test should be excluded from any asymptomatic testing, for example occupational or community testing initiatives, for 90 days following the initial positive.

However, if someone develops the cardinal symptoms of COVID they should get a further test.

The Cycle Threshold, or Ct value is the number of PCR cycles that it takes before the virus is first detected; the lower the Ct value the higher the level of virus in the original sample. More information is available from PHS guidance on lab testing and frequently asked questions and PHE's guide to understanding cycle threshold (Ct) in SARS-CoV2 RT-PCR for HPTs

Participants in surveillance studies (e.g. SIREN, ONS survey) will undertake regular repeat testing regardless of symptoms, in accordance with study protocols. First positive tests amongst surveillance study participants should be managed in accordance with routine guidance, including isolation of the individual with the positive result and contact tracing.

ONS study guidance issued to participants and investigators advises that repeat positive tests within 90 days of an initial positive should not routinely be managed with repeat isolation of the positive test case nor their contacts, as long as the person with the repeat positive test:

• remains asymptomatic

• is not required to isolate as a contact of a confirmed case

• is not required to isolate having returned from travel from outside the common travel area (see section 6.5 for more information)

Repeat positive tests after 90 days should result in the usual public health action, i.e. isolation of the person with the positive test and contact tracing.

14 8. Definition and classification of a contact

A contact is defined as a person who, in the infectious period from 48 hours prior to and 10 days after the confirmed case’s symptom onset, or date a positive test was taken if asymptomatic, had at least one of the following types of exposure:

Household contact

• Those who are living in the same household as a case e.g. those that live and sleep in the same home, or in shared accommodation such as university accommodation that share a kitchen or bathroom.

• Those who do not live with the case but have contact within the household setting:

o Those that have spent a significant time in the home (cumulatively equivalent to an overnight stay and without social distancing e.g. 8 hours or more) with a case.

o Sexual contacts who do not usually live with the case.

o Cleaners (without protective equipment) of household settings during the infectious period, even if the case was not present at the time.

Non-household contact

Direct contact:

• Face to face contact with a case within 1 metre for any length of time, including:

o Being coughed on

o Having a face-to-face conversation

o Having skin-to-skin physical contact

• Any contact within 1 metre for one minute or longer without face-to-face contact

• A person who has travelled in a small vehicle with someone who has tested positive for coronavirus (COVID-19); or in a large vehicle near someone who has tested positive for coronavirus (COVID-19).

15 Proximity contact:

A person who has been between 1 and 2 metres of someone who has tested positive for coronavirus (COVID-19) for more than 15 minutes, cumulatively within any 24 hour period, during the infectious period defined above.

Airline contacts

• Flight passengers sitting within two seats in every direction of a case (i.e. the 2 seats either side, and then 2 rows in front and behind these seats) and cabin crew serving the area where the case was seated.

• N.B. If more than one case is reported on a flight, a risk assessment should be carried out to consider whether to expand the list of contacts to part or whole of the aircraft.

The current definitions of a contact are provided in Appendix 1 and Appendix 2.

9. Contact tracing approach

The National Contact Tracing Centre (NCTC) alongside local enhanced HPTs are responsible for contact tracing of all new cases and their contacts. Contact details for local HPTs can be found in Appendix 4.

9.1 Management of complex settings and scenarios

Cases that are complex or involve high risk settings (see list below and appendix 3), requiring specialist health protection management will be referred to the appropriate level according to protocols. Escalation of complex or challenging cases or contacts can occur regardless of whether they are identified before, or during contact tracing interviews.

A complex or high risk setting can be one where the case or contact work, reside or have visited during any part of the infectious period. They include, but are not limited to the following:

• social care settings (e.g. care homes, care at home)

• healthcare settings (e.g. hospital, GP, dental practice, pharmacies)

• emergency services

• prison or other detention facility

• educational establishments (including nurseries, special needs school, early years and childcare settings)

16 • homeless hostel or shelter, refuge, dormitory or similar setting

• food production/processing

• day care centre for older/vulnerable people

• port and maritime setting (e.g. cruise ship or offshore installations)

• defence establishment

• air travel (domestic or international) – these scenarios are covered in separate guidance

• any setting where there will be potential impact on the delivery of essential services as a consequence of the advice being given e.g. an essential service that will have to close as many staff quarantining

• any setting where there is a suspected cluster or outbreaks in facilities requiring further public health investigation e.g. reported high absenteeism rate in school or workplace, reported high levels of hospitalisations.

Full details of the public measures to prevent spread of COVID-19 and to protect people at increased risk of severe illness are given in the PHS Guidance for Health Protection Teams

Contact tracing in complex settings may require the establishment of a Problem Assessment Group (PAG) or Incident Management Team (IMT) and the Scottish Health Protection Network Guidance for the Management of Public Health Incidents should be considered alongside COVID-19 specific guidance.

Community contacts i.e. outwith the complex setting, should be followed up in accordance with existing guidance and can be referred back to local and national contact tracing service, if appropriate.

In assessing the risk of significant exposure in complex settings, all COVID mitigation measures should be considered, including PPE use where appropriate, hand hygiene, physical distancing, safe systems and other infection prevention and control precautions. Employers can find further advice on how to reduce the risk of transmission of COVID-19 in the workplace on the PHS website and in relevant sectoral guidance published by the Scottish Government.

More experienced contact tracing support or supervision may also be required to manage scenarios including:

• challenging discussions with cases and/or contacts e.g. concerns about confidentiality or deductive disclosure, individuals unwilling to provide information or refusing to participate with the contact tracing process, or where cases/contacts disagree with the risk assessment and their identification as a close contact of a case

• the follow up of a case and their contacts associated with media or political interest e.g. death of a child, contact tracing of a person in the public eye.

17 9.2 General principles for assessment of exposures where PPE is being used

9.2.1 Health and social care settings

The following guidance should be read alongside setting-specific guidance for Primary Care, Secondary Care, Care Homes, Social, Community and Residential Care and the Care Home Infection Prevention and Control Addendum.

HPTs should work with Infection Prevention and Control Teams (IPCT) and Occupational Health services to identify and advise contacts in health and social care settings, as agreed locally.

PHE Guidance for exposed health and social care workers and patients/residents is available here. The general principles when considering potential exposures amongst health and social care staff are:

PPE use

• Were staff wearing the appropriate PPE during the exposure, taking account of the individual's presenting symptoms?

• Was the PPE donned and doffed appropriately ensuring hand hygiene at the appropriate points?

o If yes, it is unlikely that staff would be considered as a contact

• Staff who have not been wearing appropriate PPE during exposures to COVID-19 case, who meet the contact definitions described above, should be excluded from work and self-isolate in line with advice for general members of the public.

Staff symptoms

• Symptomatic staff must not report for duty; they should self-isolate and arrange to be tested.

18 Positive Healthcare worker (HCW)

Where a HCW tests positive for COVID-19 and has been on duty during the infectious period a risk assessment of exposure to other HCWs and patients must be undertaken:

• During routine care and working activities, where the COVID-19 positive HCW has been wearing a fluid resistant surgical mask, there should be no significant exposure risk to other staff and patients within 2 metres, provided the mask was worn correctly and the positive HCW adhered with all other standard Infection Prevention and Control Precautions.

• If the exposure was during an Aerosol Generating Procedure (AGP) and the COVID-19 positive HCW was wearing a valved respirator, it is possible that some exhaled breath/droplets may pose a risk to surrounding staff and the patient. If a visor was worn on top of the FFP3 respirator this will provide a physical barrier which will direct air flow downwards and intercept any respiratory droplets. Due to the many different designs of valved respirators and visors it is not possible to say that complete protection has been provided. A risk assessment must be undertaken to establish the level of any exposure to others from the exhaled breaths. The risk assessment should include whether the positive staff member was symptomatic or not and whether the contacts were wearing the appropriate PPE (if other staff members were wearing respirators, exclusion from work is not necessary).

• This would also apply to all individuals present in a care environment e.g. allied health visitor, visitor or family member, if they are following instructions from that institution. Any decision to deviate from the advice to self-isolate would be for local decision makers based on their risk assessment.

9.2.2 General principles for positive patients/residents are:

• If the case is a hospital inpatient, they should be isolated or cohorted with other confirmed COVID-19 cases.

• Any inpatients identified as contacts should be isolated in a side room where possible for 14 days. If the patient is discharged to their own home within the 14 days, they should complete a total of at least 10 days of self-isolation from the date of last exposure to a case. See Appendix 7 for further information. Where isolation facilities are not available, local risk assessment should be undertaken and cohorting considered in conjunction with the local IPCT or HPT.

• If a contact develops symptoms in keeping with COVID-19, they should be isolated in a side room and tested. If testing is negative, the 14-day isolation period must still be completed, as they may still be incubating COVID-19.

19 In settings where national guidance is not available, HPTs, or if appropriate IPCT, should undertake risk assessments and convene incident management teams as needed. This may result in the recommendation of further measures, such as self-isolation and wider testing outside the scope of this guidance.

9.2.3 Settings other than health and social care

Guidance on measures to reduce transmission of COVID-19 in non-health and care settings is available on the PHS website, in specific sectoral guidance published by the Scottish Government and in the Community Health and Care Settings Infection Prevention and Control Addendum.

Where Personal Protective Equipment (PPE) has been used, such as visors, masks, gloves etc., an individual risk assessment will have to be undertaken by the HPT to decide whether there has been an exposure risk sufficient to require contact isolation.

Assessment of appropriateness of PPE should include:

• whether the PPE is as recommended in approved guidance documents applicable to the setting and the task being undertaken; in settings where national guidance is not available, HPTs should undertake risk assessments and convene incident management teams as needed

• whether the PPE meets technical and quality standards

• whether staff are trained to use the PPE properly

• whether the PPE is adequate to protect in the situation e.g. eye protection and mask should be in use if the exposure is from spitting in the face

Where an interaction has taken place through a Perspex (or equivalent) screen, there should be a low risk of any significant exposure and contact isolation would be unlikely to be required, provided that there has been no other contact as defined in section 4 above.

Situational risk assessment may result in the recommendation of further measures, such as self-isolation and wider testing, which are outside the scope of this guidance.

9.3 Local geographical and incident specific variation

Temporary guidance for contacts of cases may be introduced to manage an incident or in designated geographical areas in response to epidemiological evidence. In such situations, contacts should follow the advice provided by their local Health Protection Team and Test & Protect team.

20 10. Contacts from other health boards or other countries

Details of any identified contacts who live in other Health Board areas should be passed directly to the NHS board of residence. Contacts who live elsewhere in the UK should be passed to the relevant national public health agency (see Appendix 6), or to PHS for follow-up (email [email protected]). Details of any identified contacts who live outside the UK should be passed to PHS, who will liaise with the relevant public health authority or national focal point.

11. Identification of exposed settings

In addition to contact tracing individuals, exposure settings (such as workplaces, trains, other households, or schools) should be identified through discussion with the confirmed case. All settings the index case has spent significant time in during the infectious time period (from 48 hours prior to the onset of symptoms (or positive test if asymptomatic) and for ten days from date of onset of symptoms (or positive test if asymptomatic)) should be recorded.

The case should be told that there may be a need to discuss with others in these settings to identify potential contacts and to ensure appropriate decontamination. A contact name e.g. owner, manager, occupational health etc. should be obtained where appropriate.

Guidance on infection control is available on the PHS COVID-19 page.

12. Data collection and recording

All data collected as part of the contact tracing process, including in complex settings, should be recorded on the Case Management System (CMS). This will enable Scotland wide data collation on contact tracing for monitoring and evaluation of the approach, and surveillance of epidemiological patterns and any emerging risks.

13. Associated legislation

This guidance is of a general nature and employers should consider the specific conditions of each individual place of work and comply with all applicable legislation, including the Health and Safety at Work etc. Act 1974.

21 14. Confidentiality

The name or other identifiable details of confirmed cases should not be shared with contacts without the stated permission of the case. Cases should be advised that there is risk of deductive disclosure, i.e. of the contact being able to work out who the case is on the basis of the date of last contact, the settings the contact has attended and people present, all of which information may have to be shared with contacts in order to assess isolation requirements and protect public health.

15. Dealing with people who are unwilling to self-isolate

Local teams can refer to the Public Health Scotland Act 2008 if a case or contact is unwilling to co-operate with providing information for contact tracing, or unwilling to self-isolate. Local procedures for such circumstances should be followed.

16. Further information

Further information for health professionals can be found on the PHS COVID-19 page.

Information for the general public is available on NHS inform.

Further information on the Test and Protect programme can be found here.

Further information for arranging a COVID-19 test is available at NHS inform and the Scottish Government website.

The National Assistance Helpline (0800 111 4000) is available for people staying at home to stop the spread of coronavirus who need extra help in order to self-isolate. This helpline is dedicated to supporting those who cannot leave their home and who cannot otherwise get the help they need, for example from family and friends.

22 Appendices

Appendix 1 - Definition and classification of contacts

Table 1: Classification of contact - household

Type of contact Definition Isolation Period

Household contacts Those who are living in the same household as a • Contacts sharing the same household as the index case should living with the case case e.g. those that live and sleep in the same isolate at home for 10 days from the date of onset of cardinal home, or in shared accommodation such as symptoms in the index case. university accommodation that share a kitchen • Isolation should commence as soon as symptoms develop in the or bathroom. index case, whilst awaiting the result of testing. • In situations where the index case is asymptomatic, isolation should be for 10 days from the date the test was taken from the index case. If cardinal symptoms develop subsequently, isolation should be re- started from the date of symptom onset in the index case. • If further cases arise within the household during the isolation period, there is no requirement to re-start the 10 day isolation of those resident within the household from symptom onset of any subsequent cases. • Advice on household isolation is available on NHS inform. • See Appendix 7 and Appendix 8 for more information

23 Type of contact Definition Isolation Period

Household contacts not • Those that have spent a significant time in • Contacts from outside the household of the case should be told to living with the case the home (cumulatively equivalent to an self-isolate at home for 10 days from the date of last exposure to the overnight stay and without social distancing case. e.g. 8 hours or more) with a case during the • Other members of the contact’s household do not need to isolate infectious period. unless the contact becomes symptomatic. • Sexual contacts who do not usually live with • See Appendix 7 and Appendix 8 for more information the case. • Cleaners (without protective equipment) of household settings during the infectious period, even if the case was not present at the time. N.B. Temporary guidance for contacts of cases may be introduced to manage an incident or based on specific geographical measures. In such situations, contacts should follow the advice provided by the local Test & Protect team.

24 Table 2: Classification of contact - non-household

Type of contact Definition Isolation Period Direct contact • Face to face contact with a case for any length of time, within • Contacts from outside the household of the case 1metre including being coughed on, a face to face conversation, should be told to self-isolate at home for 10 days unprotected physical contact (skin to skin). This includes from the date of last exposure to the case. exposure within 1 metre for 1 minute or longer without face-to- • Other members of the contact’s household do not face contact. need to isolate unless the contact becomes • A person who has travelled in a small vehicle (e.g. car or van) symptomatic. with someone who has tested positive for COVID-19 or in a large vehicle near someone who has tested positive for COVID-19. Proximity contact • Extended close contact (between 1 and 2 metres for more than • Contacts from outside the household of the case 15 minutes) with a case. should be told to self-isolate at home for 10 days • The duration of contact should be considered cumulatively over a from the date of last exposure to the case. 24 hour period, where exposure is within the infectious period (48 • Other members of the contact’s household do not hours prior to symptom onset, or positive test if the case is need to isolate unless the contact becomes asymptomatic, for 10 days from the date of symptom onset, or symptomatic. positive test if the case is asymptomatic). N.B. Temporary guidance for contacts of cases may be introduced to manage an incident or based on specific geographical measures. In such situations, contacts should follow the advice provided by the local Test & Protect team.

25 Appendix 2 - Summary of contact categories and guidance for travellers

Table 1: Category of contact exposure - airline contacts

Type of contact Description Alerting of contact Public advice International travellers Passengers sitting within two seats in every After case receives • Guidance for people travelling to from within or outwith the direction (i.e. the 2 seats either side, and then then positive test. Scotland on NHS inform. common travel area 2 rows in front and behind these seats) of a case • Scottish Government (CTA) and other local and cabin crew serving the area where the case international travel and managed flights. was seated. isolation (quarantine) process N.B. If more than one case is reported on a flight, for people entering the UK. carry out a risk assessment to consider whether to expand the list of contacts to part or whole of the aircraft

26 Appendix 3 - Contact Tracing Guidance by setting

Table 1: Summary of case and contact management in the community

Relevant PCR Positive Case isolation Contact identification Contact Isolation period guidance Case period COVID-19 Symptomatic or 10 days from Household and non- Household contact living with index case: Contact Tracing asymptomatic symptom onset. household as per • 10 days from onset of symptoms, or Guidance Appendix 1 • 10 days from date of test if asymptomatic. (this guidance) 10 days from test if asymptomatic- Household contact not living with index case, and reset clock if non-household contacts: symptoms develop • 10 days from last contact with case. • Reset clock if symptoms develop in a previously asymptomatic case.

See Appendix 7 and Appendix 8 for more information N.B. Infectious period for contact tracing purposes is from 48 hours prior to symptom onset (or date test is taken if asymptomatic) to 10 days from symptom onset (or 10 days from date test is taken if asymptomatic).

27 Table 2a: Summary of case and contact management. Setting - Secondary Care

Relevant guidance PCR Positive Case isolation period Contact identification-occupational (including Case where exposure has been in staff rest areas) HPS Guidance for secondary Staff • 10 days from onset of symptoms • Where appropriate PPE is in place and there care (including staff • 10 days from test if asymptomatic-reset has been no breach in PPE during exposure with inconclusive clock if symptoms of COVID-19 to COVID-19 case, no significant exposure UK Guidance on management test) develop. risk so should not be classified as contacts. of exposed staff and patients • For return to work guidance see UK • Where case/contact not using appropriate in health and social care Guidance on management of PPE, or PPE breach-isolation for contact if settings exposed staff and patients in health meets general definition following table 1b and social care settings and appendix 7. Assessing staff contacts in • Staff may require evidence of viral acute settings clearance prior to working with extremely vulnerable people. This is subject to local policy. HPS Guidance for secondary Patients • Inpatients: follow relevant pathway in • Where appropriate PPE is in place and there care the COVID-19 IPC addendum. has been no breach in PPE during exposure • Day case/outpatients:14 days from to COVID-19 case, no significant exposure UK Guidance on management symptom onset or 14 days from test if risk so should not be classified as contacts. of exposed staff and patients asymptomatic-reset clock if symptoms • Where case/contact not using appropriate in health and social care of COVID-19 develop. PPE, or PPE breach-isolation for contact if settings meets general definition following table 1b, and appendix 7 • Patients sharing a bay during any part of the infectious period may be considered as household contacts.

N.B. Infectious period for contact tracing purposes is from 48 hours prior to symptom onset (or date test is taken if asymptomatic) to 10 days from symptom onset (or 10 days from date test is taken if asymptomatic).

28 Table 2b: Summary of case and contact management. Setting - Primary Care

Relevant guidance PCR Case isolation period Contact identification-occupational (including where Positive exposure has been in staff rest areas) Case HPS Primary Care guidance Staff • 10 days from symptom • Where appropriate PPE is in place and there has been onset. no breach in PPE during exposure to COVID-19 case, UK Guidance on management of • 10 days from test if no significant exposure risk so should not be classified exposed staff and patients in asymptomatic-reset clock if as contacts. health and social care settings symptoms of COVID-19 • Where case/contact not using appropriate PPE, or PPE develop. breach-10 days isolation for contact if meets general definition.

HPS Primary Care guidance Patients • 10 days from symptom • Where appropriate PPE is in place and there has been onset. no breach in PPE during exposure to COVID-19 case, UK Guidance on management of • 10 days from test if no significant exposure risk so should not be classified exposed staff and patients in asymptomatic-reset clock if as contacts. health and social care settings symptoms of COVID-19 • Where case/contact not using appropriate PPE, or PPE develop. breach-10 days isolation for contact if meets general definition.

29 Table 2c: Summary of case and contact management. Setting - Care Homes

Relevant guidance PCR Positive Case Case isolation period Contact identification-occupational (including where exposure has been in staff rest areas) Guidance on the approach Staff • 10 days from symptom • Where appropriate PPE is in place and there has to control of COVID-19 in inconclusive result to be onset. been no breach in PPE during exposure to care home settings, repeated, not treated as • 10 days from test if COVID-19 case, no significant exposure risk so including testing positive as for healthcare asymptomatic-reset clock should not be classified as contacts. staff if symptoms of COVID-19 • Where case/contact not using appropriate PPE, develop. or PPE breach-isolation for contact if meets general definition following table 1a and appendix 7. Guidance on the approach Resident • 14 days from onset of • Where appropriate PPE is in place and there has to control of COVID-19 in symptoms. been no breach in PPE during exposure to care home settings, • 14 days from test date if COVID-19 case, no significant exposure risk so including testing asymptomatic-reset clock should not be classified as contacts. if symptoms of COVID-19 • Where case/contact not using appropriate PPE, develop. or PPE breach-isolation for contact if meets general definition following table 1a, appendix 7. • Assessment of the setting is required to identify household equivalent contacts amongst other residents. Consider shared facilities such as lounges and dining rooms and bathroom facilities. N.B. Infectious period for contact tracing purposes is from 48 hours prior to symptom onset (or date test is taken if asymptomatic) to 10 days from symptom onset (or 10 days from date test is taken if asymptomatic).

30 Table 2d: Summary of case and contact management. Setting - Ambulance Service

Relevant guidance PCR Case isolation period Contact identification-occupational (including where Positive exposure has been in staff rest areas) Case As for other healthcare staff and Staff or • 10 days from symptom • Where appropriate PPE is in place and there has been no PHE guidance for first responders case onset. breach in PPE during exposure to COVID-19 case, no attended • 10 days from test if significant exposure risk so should not be classified as asymptomatic-reset clock if contacts. symptoms of COVID-19 • Where case/contact not using appropriate PPE, or PPE develop. breach-10 days isolation for contact if meets general definition. N.B. Infectious period for contact tracing purposes is from 48 hours prior to symptom onset (or date test is taken if asymptomatic) to 10 days from symptom onset (or 10 days from date test is taken if asymptomatic).

Table 2e: Summary of case and contact management. Setting - Police / Fire and Rescue

Relevant guidance PCR Case isolation period Contact identification-occupational (including where Positive exposure has been in staff rest areas) Case Guidance for first responders for Staff or • 10 days from symptom • Contact isolation for 10 days from exposure for people reduction in risk of exposure is on contact onset. who meet general contact tracing definition. the PHE website. • 10 days from test if • Risk assessment required to consider whether PPE, if Employers should apply HSE asymptomatic-reset clock if used, is adequate to reduce exposure risk so that hierarchy of risk approach to symptoms of COVID-19 isolation not required – quality, training, effectiveness protection of staff from risk of develop. against specific exposure scenario. exposure. N.B. Infectious period for contact tracing purposes is from 48 hours prior to symptom onset (or date test is taken if asymptomatic) to 10 days from symptom onset (or 10 days from date test is taken if asymptomatic).

31 Table 2f: Summary of case and contact management. Setting - Other workplaces

Relevant guidance PCR Positive Case Case isolation Contact identification-occupational (including period where exposure has been in staff rest areas) • The main protection is physical Staff / clients / • 10 days from • Contact isolation for 10 days from exposure for distancing in the workplace, accompanied customers symptom onset. people who meet general contact tracing by hygiene measures and staff • 10 days from test definition. awareness to remain off work or leave if asymptomatic- • Risk assessment required to consider whether work if they develop symptoms. reset clock if PPE, if used, is adequate to reduce exposure • Key messages in the workplace can be symptoms of risk so that isolation not required – quality, found here COVID-19 training, effectiveness against specific exposure • Employers should apply HSE hierarchy of develop. scenario. risk approach to protection of staff from risk of exposure: • Additional guidance for non-healthcare settings is available on the HPS website • Scottish Government has published specific sectoral guidance N.B. Infectious period for contact tracing purposes is from 48 hours prior to symptom onset (or date test is taken if asymptomatic) to 10 days from symptom onset (or 10 days from date test is taken if asymptomatic).

32 Table 2g: Summary of case and contact management. Setting - prisons and detention settings

Relevant guidance PCR Positive Case isolation period Contact identification-occupational (including where Case exposure has been in staff rest areas) Key advice for prisons and detention Staff • 10 days from • Contact isolation for 10 days from exposure for settings now included in Information and symptom onset people who meet general contact tracing definition. guidance for social, community and • 10 days from test if • Risk assessment required to consider whether PPE, residential care settings asymptomatic-reset if used, is adequate to reduce exposure risk so that and Guidance for Health Protection clock if symptoms of isolation not required – quality, training, Teams COVID-19 develop effectiveness against specific exposure scenario.

Key advice for prisons and detention Those in • 10 days from • Contact isolation for 10 days from exposure for settings now included in Information and custody symptom onset people who meet general contact tracing definition. guidance for social, community and • 10 days from test if • Risk assessment required to consider whether PPE, residential care settings asymptomatic-reset if used, is adequate to reduce exposure risk so that and Guidance for Health Protection clock if symptoms of isolation not required – quality, training, Teams COVID-19 develop effectiveness against specific exposure scenario. • Setting specific assessment of those who might be classified as household contacts, including sharing of cell, or of other facilities. N.B. Infectious period for contact tracing purposes is from 48 hours prior to symptom onset (or date test is taken if asymptomatic) to 10 days from symptom onset (or 10 days from date test is taken if asymptomatic).

33 Table 2h: Summary of case and contact management. Setting - aircraft

Relevant guidance PCR Positive Case isolation period Contact identification-occupational (including Case where exposure has been in staff rest areas) Scottish Government Passenger 10 days from symptom onset. Contacts within 2 seats in all directions plus cabin international travel and 10 days from test if asymptomatic-reset crew serving area. managed isolation (quarantine) clock if symptoms of COVID-19 develop. Scottish Government Crew 10 days from symptom onset. Apply criteria for non-household contacts, international travel and 10 days from test if asymptomatic-reset managed isolation (quarantine) clock if symptoms of COVID-19 develop. N.B. Infectious period for contact tracing purposes is from 48 hours prior to symptom onset (or date test is taken if asymptomatic) to 10 days from symptom onset (or 10 days from date test is taken if asymptomatic).

• If the individual is in managed quarantine, then they need to isolate for 10 days starting from the day after the test, i.e. the day of the test=day 0

• More information on managed isolation and self-isolation is available here. This includes what to do if the flight arrived via England, Wales, Northern Island, the Republic of Ireland, Channel Islands or the Isle of Man before arriving into Scotland

• A list of acute risk countries is available here

34 Appendix 4 - Contact details for local Health Protection Teams

Health Board Office Hours Telephone Out of Hours Telephone Number Health Protection Team Email Number Ask for Public Health On Call Ayrshire and Arran 01292 885 858 01563 521 133 [email protected] Crosshouse Hospital switchboard Borders 01896 825 560 01896 826 000 [email protected] Borders General switchboard Dumfries and 01387 272 724 01387 246 246 [email protected] Galloway Fife 01592 226 435 01592 643 355 [email protected] Victoria Hospital switchboard Forth Valley 01786 457 283 01324 566 000 [email protected] Ask for CPHM on call Ask for CPHM on call Grampian 01224 558 520 03454 566 000 [email protected] Greater Glasgow & 0141 201 4917 0141 211 3600 [email protected] Clyde Gartnavel switchboard Highland 01463 704 886 01463 704 000 [email protected] Raigmore switchboard Lanarkshire 01698 858232 / 858228 01236 748 748 [email protected] Monklands switchboard Lothian 0131 465 5420/5422 0131 242 1000 [email protected] Edinburgh Royal switchboard Orkney 01856 888 034 01856 888 000 [email protected] Balfour Hospital switchboard Shetland 01595 743340 (answer 01595 743 000 [email protected] phone only) Gilbert Bain switchboard

35 Health Board Office Hours Telephone Out of Hours Telephone Number Health Protection Team Email Number Ask for Public Health On Call 01595 743060 (Board HQ who will pass on to appropriate PH person) Tayside 01382 596 976/987 01382 660 111 [email protected] Ninewells switchboard Western Isles 01851 708 033 01851 704 704 [email protected]

36 Appendix 5 - Email text for GP of index case

The following template for email should be revised by the HPT to suit individual circumstances.

Subject heading: Contact tracing on confirmed case of COVID-19 for information only

Dear

RE: Insert name, address, and CHI of case

This email is for information only

Your patient (named above) has been confirmed by PCR testing as a confirmed case of COVID-19. Your patient is aware of their result and has been advised to self-isolate at home for 10 days from the onset of symptoms. All household members have been advised to isolate for 10 days from the date of onset of symptoms in the case. Your patient has been given information on how to get further advice and how to get further help if their symptoms worsen.

Contact tracing has been undertaken by the (Board name) Health Protection Team.

Yours sincerely

37 Appendix 6 - Contact tracing points of contact for UK public health agencies and UK armed forces

Country Organisation Contact number Email England Public Health Tel: 0208 495 5403 Emails addressed to @gov.uk accounts England (PHE) must not be used for transfer of any personal information as these are not Contact Tracing sufficiently secure Cell Send any emails which enclose personal information to all 3 email addresses below [email protected] [email protected] [email protected]

Include [secure] in the subject

For other emails, use: [email protected] Wales Public Health Tel: 0300 0030032 [email protected]. Wales (PHW) uk Northern Public Health Monday to Friday 9am- [email protected] Ireland Agency (PHA) 5pm Monday to Friday Tel: 0300 555 0119 9am-5pm only

Out of hours (Monday to Friday 5pm-9am and 9am-9am Sat/Sun and public holidays) Tel: 028 90404045 and ask for the public health doctor on call

UK Armed Forces personnel

Where a case is identified as someone who works or resides in a military establishment, and they are reluctant to divulge any contact details, movements or locations, HPTs may request the support of the Defence Public Health Team to interview the case (email SG-DMed-Med-DPHU- [email protected]). This mailbox should not be used to transfer personal identifiable information but as a first point of contact for these scenarios. Responsibility for the follow up of contacts once identified can be determined on a case by case basis.

38 Appendix 7 - Self-isolation periods for cases and contacts

Table 1a: Self-isolation periods for cases and contacts - care home settings

Case or Contact Staff or Residents Self-isolation period (days) * COVID-19 cases Residents 14 COVID-19 cases Staff 10 Close contacts of cases Residents 14 Close contacts of cases Staff 10

Table 1b: Self-isolation periods for cases and contacts - healthcare settings

Case or Contact Staff or Residents Self-isolation period (days) * COVID-19 cases In-patients (case) remaining in the hospital 14 COVID-19 cases In-patients (case) discharged to older adult residential 14 setting COVID-19 cases In-patients (case) discharged to residential setting 14 other than older adult COVID-19 cases In-patients (case) discharged to own home 14 COVID-19 cases Staff 10 Close contacts of cases In-patients (contact) remaining in the hospital 14 Close contacts of cases In-patients (contact) discharged to older adult 14 residential setting Close contacts of cases In-patients (contact) discharged to residential setting Requires risk other than older adult assessment with regards to 10 or 14 days Close contacts of cases In-patients (contact) discharged to own home 10 Close contacts of cases Staff 10

Table 1c: Self-isolation periods for cases and contacts - prisons/custody settings

Case or Contact Staff or Residents Self-isolation period (days) *

COVID-19 cases People in prisons/custody settings 10 COVID-19 cases Staff in prisons/custody settings 10 Close contacts of cases People in prisons/custody settings 10 Close contacts of cases Staff in prisons/custody settings 10

39 Table 1d: Self-isolation periods for cases and contacts - general public

Case or Contact Self-isolation period (days) *

COVID-19 cases 10 Close contacts of cases 10

Table 1e: Self-isolation periods for cases and contacts - returning travellers

Case or Contact Self-isolation period (days) *

Traveller arriving in Scotland via air travel 10 days self-isolation counting Day 1 as the first full day after from outside the common travel area * the traveller arrives in Scotland. Day 0 is considered day of arrival to Scotland *

Additional points to note when reading Appendix 7:

For cases, day one of isolation is the first day of symptoms (or the date that a positive test was taken, if asymptomatic)

For close contacts day one of isolation is the last day exposure occurred (with a case)

Isolation ends at 23h59 on the 10th or 14th day of isolation (as appropriate) *

*These are minimum isolation periods and should be extended in line with guidance if the following apply prior to the end of the stated isolation period:

• A case has not recovered (e.g. is still not well and has not had a fever-free period for 48 hours without anti-pyretics)

• A close contact develops symptoms or has a positive COVID test result

• A case who tested positive whilst asymptomatic who then develops symptoms within the isolation period

• A returned traveller develops symptoms during the quarantine period

**Please see COVID-19: guidance for Health Protection Teams for further details about quarantine exemptions and defensible reasons for breaching quarantine regulations. Further information can also be found in COVID-19: international travel and managed isolation (quarantine) guidance.

40 Appendix 8: COVID-19 self-isolation for a household

41 Additional points to note when reading Appendix 8

• The cardinal symptoms of COVID-19 are new: continuous cough, fever or high temperature (37.8°C or greater) and loss of, or change in, sense of smell (anosmia) or taste (ageusia).

• Any reference in the table to “positive PCR test” and date corresponds to the date the sample was taken.

• A negative PCR result implies COVID-19 is unlikely at that moment in time, this may need to be repeated depending on symptom development. The reason for this is that the test may have been done too early or could be a false negative.

Regarding isolation

• A person with one of the 3 cardinal symptoms of COVID-19 must isolate for 10 days from the date of onset of the symptoms, they do not isolate from the date of a positive PCR test. For example, if a person has a positive PCR test and develops symptoms 2 days later, they must isolate for 10 days from the day of onset of symptoms.

• If there are no cardinal symptoms of COVID-19, isolation is for 10 days from positive test.

• Note that contact tracing starts from 2 days before cardinal symptoms onset OR positive test, if asymptomatic, and for the next 10 days.

• A contact who is already in their 10 day isolation period does not need to re start isolation if another member of the household becomes a case.

• A confirmed case does not need to re start isolation if another member of the household tests positive during the full incubation period (14 days) from onset of the household case. However, it at any time there is contact with a confirmed case from outside the household then the 10 day isolation period must restart.

• A person who has tested PCR positive in the previous 90 days does not need to be retested as an asymptomatic contact. If they have been tested LFD or PCR positive again in the 90 days, then the local HPT should be notified and they can do a risk assessment to decide whether to re isolate.

42 For anyone from another household

43 Appendix 9: Travel areas and public health actions

Region Public Health Action

Common Travel Area (CTA) • Advice as for UK citizens. • No isolation or testing. Acute Risk Countries (ARC) • Have to enter managed isolation if arrive in Scotland or other part of UK (except if exempt) • Additional actions may be required if Variants and Mutations (VAMs) are identified • There is a higher risk of VAMs in people returning from acute risk countries Non-ARC countries = • Have to enter managed isolation if arrive direct to anywhere not included in Scotland (except if exempt) above • If arrive in other part of UK, can travel on to Scotland and isolate at home address but require testing package • Lower risk of VAMs than from acute risk countries • If VAM identified, then further actions may be required.