As Omicron cases increase in the community, there is an inevitability that general practice is the obvious place for these cases to be managed. As part of that role, we will have to explain to the public exactly what the isolation rules for COVID positive patients and their contacts are. These rules are complicated, but we need to understand them for the sake of our patients.
Isolation protocols relating to COVID-19 exposure fall into two classes of people and three disease states.
The public and critical care workers
The two classes of people are: the general public and critical care workers (CCWs). The systems are designed such that CCWs have to do more testing BUT are likely to be able to get back to work earlier than the general public. The fast tracking of exposed CCWs is to minimize the risk of essential services (including health care) becoming crippled because staff are having to isolate.
The potential disease states are: A positive or probable COVID case, a household contact of a positive case and a close contact of a positive case.
When counting the number of days of isolation required in the following scenarios, you can use EITHER the onset of symptoms OR the date of the test. For clarity, a person might get symptoms on day 1 but not be tested until 5 days later; however they can count their isolation period from the day the symptoms started.
Likewise, a household contact can count their isolation period from the same date as the infected started their isolation period.
- member of the general public with positive Covid test (PCR or RAT)
- action:10 days isolation from EITHER, onset of symptoms or a +ve RAT or PCR test. No further testing needs to occur.
- member of the general public who is a household contact
- action :10 days isolation from the index case’s positive test OR the onset of the index case’s symptoms. Further testing needs to occur at day 3. If test is positive then a further 10 days isolation. If the test is negative, stay isolated to day 10 of the index cases symptoms/test and get a further RAT test at day 10.
- member of the general public who is a close contact
- action: under Omicron phase 3 there is NO requirement to isolate and only test if symptoms arise.
- extra support in place for health and critical workforces.
- CCW with positive Covid test AND is asymptomatic or only mildly symptomatic.
- action: there are three options:
- 10 day isolation as per positive general public
- Carry out a RAT test at day five and 6; if both are negative can return to work on day 6
- Carry out a RAT test day 5; if this is positive; then daily RAT until negative and can return to work when the test becomes negative OR reaches day 10
- CCW who is COVID positive and has significant symptoms.
- action: Stay home and at the end of 10 days discuss options with employer.
- asymptomatic CCW who is either a household contact OR a close contact in the community
- action: can go to work but daily RAT testing for 7 days prior to starting shift (Note that there are other restrictions on movement that need to be followed).
Notifying the public of a positive test
Experience has shown that people respond in various ways when told they have a positive test and all need to bed managed both efficiently and with empathy.:
- Concern that they do not haver the facilities to self isolate: these people need to be referred to the relevant Social agency.
- Anxiety about the nature of the disease: they need calm reassurance and a clear action plan particularly if they are at particular clinical risk.
- Those who react negatively to isolation protocols: It is not your job to take on the role of the police. Explain that you are the messenger and don’t engage in the debate.