Background
COVID-19 is an illness first discovered in 2019 and caused by a respiratory coronavirus. This virus is referred to as Severe Acute Respiratory Syndrome – Coronavirus 2 (SARS-CoV-2), and the associated illness as COVID-19.
People who are at higher risk of severe illness from COVID-19 include:
The risk of becoming seriously unwell from COVID-19 and other respiratory infections is very low for most children and young people.
Further background information on epidemiology, virology and clinical features is available.
Symptoms of COVID-19
COVID-19 can present with a range of symptoms of varying severity. It is estimated that 1 in 3 people have COVID-19 without displaying any symptoms.
The main symptoms include fever, a new and continuous cough, anosmia (loss of smell) and ageusia (loss of taste).
Examples of other symptoms include, shortness of breath, fatigue, loss of appetite, myalgia (muscle ache), sore throat, headache, nasal congestion (stuffy nose), runny nose, diarrhoea, nausea and vomiting. Older people may present with less common symptoms.
In some individuals cough or a loss of, or change in, normal sense of smell or taste may persist several weeks, and are not considered an indication of ongoing infection when other symptoms have resolved.
Individuals who are infected with SARS-CoV-2 and who are asymptomatic can still transmit virus to others, however there is emerging evidence suggesting that asymptomatic cases are less infectious than symptomatic cases.
Infectious period
Transmission of SARS-CoV-2 occurs from 9 days before symptom onset to 15 days after symptom onset, with most transmission occurring 3 days before symptom onset to 5 days after symptom onset.
Immunocompromised patients can remain infectious for a much longer period.
There is some evidence that children may be less infectious, and are infectious for a shorter period of time, compared with adults.
Positive lateral flow device (LFD) tests have been shown to be associated with high viral load in infectious cases. People who have high viral loads are more infectious to other people.
Management of COVID-19 patients in health and care settings
In health and care settings, non-pharmaceutical interventions (such as mask wearing and enhanced ventilation) may be used, depending on local prevalence and risk assessment, with the aim to reduce the spread of SARS-CoV-2.
Transmission-based precautions should only be discontinued in consultation with clinicians, and should take into consideration the individual’s test results as well as resolution of clinical symptoms.
There is guidance available for adult social care settings.
Stepping down COVID-19 precautions for inpatients
For inpatients with COVID-19, isolation is recommended to continue up to 10 days after the onset of symptoms (or their first positive COVID-19 test if they do not have any symptom).
A locally decided testing protocol can be used in hospitals to reduce the isolation period down from 10 days in patients who have improved, with ideally 2 negative tests 24 hours apart before being moved out of isolation.
The residual risk of onward infection after a negative test on day 6 and 7 is similar to stepping down precautions without testing at day 10.
Stepping down precautions based on test results obtained earlier than day 6 slightly increases this risk, however organisations may wish to balance this risk against other potential harms to patients.
It is possible for immunocompromised patients to remain infectious for prolonged periods, even if they do not display any symptom of COVID-19.
If the patient is immunosuppressed or symptoms persist, and the patient remains in hospital, consultation with the hospital microbiology, infectious diseases or infection prevention and control (IPC) team is advised.
In severely immunocompromised patients, resolution of symptoms cannot be used as a marker of decreased infectiousness and these patients should be isolated in a single room until they return a negative PCR test.
Stepdown of precautions in care homes is described in the COVID-19 supplement to the infection prevention and control resource for adult social care.
Reporting infections
COVID-19 is a notifiable disease.
Further information on reporting notifiable diseases and causative organisms is available.
Occupational health, vaccination and IPC considerations for staff
Systems should remain in place to ensure that vaccination and testing policies are implemented.
Employers must ensure that COVID-19 is included in risk assessments for any health and care staff who come into contact with COVID-19 due to their work activity.
All staff should be vigilant for any signs of respiratory infection and should not come to work if they have respiratory symptoms. They should seek advice from their IPC teams, occupational health department, GP or employer as per the local policy.
Symptomatic staff should follow the guidance for people with symptoms of a respiratory infection.
Additional guidance for the management of staff with a respiratory infection or a positive COVID-19 result is available.