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Covid-19 joint standard operating procedure (SOP)

Purpose  Back to top

The purpose of this SOP is to describe how Staffordshire County Council (SCC) and Public Health England (PHE) will work together to ensure an effective response to cases and outbreaks of Covid-19. This is to ensure clarity of roles and responsibilities so that we make the best use of our combined resources.

The SOP should be read in conjunction with the Staffordshire Covid-19 local outbreak control plan.

 


 

Principles   Back to top

Our key principles are that we will:

  • intervene early in order to prevent and control outbreaks and minimise the spread of infection
  • work in partnership to co-ordinate activities and ensure the best use of resources
  • draw on the skills, experience and ways of working of existing teams
  • ensure that these teams are appropriately resourced
  • aim for consistency of approach
  • provide clarity about the roles and responsibilities of individual organisations and teams
  • communicate well and share data and information
  • work collaboratively with those settings affected by outbreaks to ensure effective management
  • continually reflect, learn and improve

 


 

Definitions  Back to top

Suspected cases

These are people with the following symptoms:

  • fever greater than 37.8 C
  • new onset of persistent cough
  • new onset of loss or significant change in smell or taste

Confirmed cases

These are people with a positive laboratory test for viral rna, with or without symptoms.

Contacts

These are anyone in close contact with a confirmed case during the infectious period, where close contact includes any of the following:

  • household contact
  • direct contact
    • face to face contact within one metre for any duration
    • skin to skin contact
    • someone the case coughed on
    • any contact within one metre for more than one minute
  • proximity contact
    • within one to two metres for more than 15 minutes

                 or

    • travelling in a car or other small vehicle or close to the case on a plane

Infectious cases

For the purpose of contact tracing the infectious period is generally:

  • for symptomatic cases from 48 hours prior to the date of onset of symptoms to 7 days after the date of onset of symptoms
  • for asymptomatic cases from 48 hours prior to the date the positive test was taken until 7 days after the date the positive test was taken
  • for the purpose of isolating confirmed cases, where contacts have a high risk of complications - for example care home residents - then as a precaution the period of isolation is 14 days from onset of symptoms or a positive test

 


 

Scope  Back to top

Settings

Settings may include:

  • care settings - including care homes, extra care, supported living, day services, home care, Shared Lives and personal assistants
  • schools, further education, early years and children’s social care settings
  • prisons and prescribed places of detention
  • high risk places, locations and communities
  • community healthcare settings

Incidents

The scope of this SOP is:

  • settings with a suspected or confirmed 'case' of Covid-19 among users and/or staff
  • settings with a 'cluster', defined as two or more suspected and/or confirmed cases among users and/or staff in the same setting with onset during a 14-day period - or an increase in the background rate of absence due to suspected or confirmed cases of Covid-19
  • settings with an 'outbreak', defined as two or more epidemiologically linked suspected and/or confirmed cases among users and/or staff in the same setting with onset during a 14-day period - i.e. the cases have had contact

The remainder of this page will refer to 'incidents' and this includes single cases, clusters and outbreaks where intervention is required to prevent and control an outbreak.

 


 

Identification of incidents  Back to top

Incidents may be identified by the Joint Biosecurity Centre and/or PHE nationally or may be identified through local intelligence. Any organisation that suspects an incident must notify this immediately to the PHE West Midlands Health Protection Team and/or to the council so that appropriate control measures can be implemented.

This SOP does not replace or negate the statutory responsibility of the attending physician to notify cases of Covid-19 to PHE.

 


 

Outline standard operating procedure  Back to top

All new incidents will be risk assessed to determine the actions required. PHE and SCC will notify one another when they receive a report of an incident and with the outcome of the risk assessment.

Where appropriate an incident management team will be called to ensure that collective decisions are taken about outbreak management, and to ensure that control measures are clearly defined and allocated. The range of control measures is set out in the Staffordshire Covid-19 local outbreak control plan.

Incidents will be followed up by the most appropriate agency and with a frequency determined according to risk. PHE and SCC will notify one another if follow up reveals significant new information and will keep one another informed about progress.

Notifications of new incidents to PHE

PHE will:

  • contact the setting and any other partners to gather information and ensure an accurate understanding of the epidemiology and circumstances of the incident
  • carry out risk assessment as soon as practically possible
  • assign a risk rating using the criteria in appendix 1

The risk rating reflects:

  • the epidemiology of the incident - i.e. the number of cases and deaths
  • the circumstances of the incident - i.e. how complex it is to manage
  • the management of the incident - i.e. to what extent control measures are being implemented

Risk rating and further actions:

High risk

  • identify any immediate control measures required and ensure that these are clearly defined and allocated
  • call an incident management team (IMT) as soon as practically possible
  • PHE will follow up and will ensure implementation of control measures

Medium risk

  • identify any immediate control measures required and ensure that these are clearly defined and allocated
  • provide any letters or leaflets to enable the setting to inform contacts
  • notify SCC within one working day about the epidemiology and circumstances of the Incident and any control measures
  • SCC will follow up at around 48 hours post notification by PHE and then subsequently and will ensure implementation of control measures

Low risk

  • identify any immediate control measures required and ensure that these are clearly defined and allocated
  • provide any letters or leaflets to enable the setting to inform contacts
  • notify SCC within one working day about the epidemiology and circumstances of the Incident and any control measures
  • SCC will follow up and ensure implementation of control measures

Notifications of new incidents to SCC

SCC will:

  • contact the setting and any other partners to gather information and ensure an accurate understanding of the epidemiology and circumstances of the incident
  • carry out risk assessment as soon as practically possible
  • assign a risk rating using the criteria in appendix 1

The risk rating reflects:

  • the epidemiology of the incident - i.e. the number of cases and deaths
  • the circumstances of the incident - i.e. how complex it is to manage
  • the management of the incident - i.e. to what extent control measures are being implemented

Risk rating and further actions:

High risk

  • notify PHE immediately
  • PHE will lead management and follow up and will ensure implementation of control measures

Medium risk

  • identify any immediate control measures required and ensure that these are clearly defined and allocated
  • provide any letters or leaflets to enable the setting to inform contacts
  • notify PHE within one working day about the epidemiology and circumstances of the Incident and any control measures
  • follow up at 48 hours:
    • if there are no new suspected or confirmed cases and good progress is being made with implementing control measures then continue to follow up
    • if there are additional new suspected or confirmed cases and/or little progress is being made with implementing control measures then call IMT

Low risk

  • identify any immediate control measures required and ensure that these are clearly defined and allocated
  • provide any letters or leaflets to enable the setting to inform contacts
  • notify PHE within one working day about the epidemiology and circumstances of the incident and any control measures
  • SCC will follow up and will ensure implementation of control measures

Incident management team (IMT)

Where deemed necessary an IMT should be convened as soon as practically possible.

The IMT will ensure a comprehensive and accurate understanding of the epidemiology and circumstances of the incident and agree, document and ensure implementation of the control measures required to minimise the spread of infection and mitigate the wider consequences of the incident - see appendix 3.

The IMT will include a proportionate membership who collectively are able to determine the control measures required and ensure that these are implemented.

The IMT will include a risk assessment and produce a revised risk rating to guide follow up. High risk incidents will be followed up by PHE; medium risk incidents will be followed up by SCC.

Site visits may be necessary to gather the appropriate information and determine the actions required to manage the incident. Services are expected to facilitate these where necessary.

Follow up of existing incidents

Follow up includes monitoring for significant new information about the Incident - for example an increasing number of cases and/or deaths - as well as checking that control measures required to minimise the spread of infection and mitigate the wider consequences of the Incident have been implemented.

Settings should be encouraged to provide any significant new information in relation to the incident to PHE and/or SCC immediately.

Follow up should include regular proactive contact with the setting to check for significant new information and/or progress on implementation of control measures.

High risk

Follow up by PHE: 

  • repeat risk assessment: if there is significant new information and as implementation of control measures is confirmed
  • revise risk rating using the criteria in appendix 2
  • escalation:
    • if there is a lack of progress with implementing individual control measures - raise with relevant organisation
    • if there are serious concerns - for example substantial additional cases or deaths, or poor compliance, substantial delays or difficulties in implementing control measures, or substantial public anxiety and/or media interest - call further IMT
  • de-escalation: if repeat risk assessment changes risk rating to medium risk - refer to SCC
  • reporting: SCC to be notified if follow up reveals significant new information and to be kept regularly informed about progress, including through the weekly review, in order to be able to provide assurance to the Covid-19 Member Led Local Outbreak Control Board

Medium risk

Follow up by local responsible organisation and team:

  • repeat risk assessment: at least weekly or more often if there is significant new information and/or as implementation of control measures is confirmed
  • revise risk rating using the criteria in appendix 2
  • escalation:
    • if there is a lack of progress with implementing individual control measures - raise with relevant organisation
    • if there are additional new suspected or confirmed cases, or poor compliance, substantial delays or difficulties with implementing control measures - call IMT
    • if repeat risk assessment changes risk rating to high risk - notify PHE immediately
  • de-escalation: if repeat risk assessment changes risk rating to low risk – manage accordingly
  • reporting: PHE to be notified if follow up reveals significant new information and to be kept regularly informed about progress, including through the weekly review, in order to be able to provide assurance to Department of Health and Social Care (DHSC)

Low risk

Follow up by local responsible organisation and team:

  • repeat risk assessment: at least weekly or more often if there is significant new information
  • revise risk rating using the criteria in appendix 2
  • escalation:
    • if there is a lack of progress with implementing individual control measures - raise with relevant organisation
    • if repeat risk assessment changes risk rating to medium risk - call IMT
    • if repeat risk assessment changes risk rating to high risk - notify PHE immediately
  • reporting: PHE to be notified if follow up reveals significant new information and to be kept regularly informed about progress, including through the weekly review, in order to be able to provide assurance to Department of Health and Social Care (DHSC)

Incident closed

For individual suspected cases that have tested negative then the incident can be closed.

For clusters and outbreaks with suspected cases that have tested negative then once there are no further cases after 14 days the incident can be closed.

For individual confirmed cases and clusters and outbreaks with confirmed cases where there have been no new confirmed cases due to transmission within the setting for 28 days, all control measures have been implemented, and the risk of infection is considered to be the same as background level for that type of setting then the incident can be closed.

The lead organisation and team will make the determination about incident closure.

Collation and reconciliation of incidents

The PHE West Midlands Protection Team will distribute daily a list of services with 'on-going issues or outbreaks (Covid-19)' in the West Midlands via email to designated officers across local partners.  For the council, this list will be sent to:

Director of Public Health

Local Outbreak Co-ordinating Team

The Covid-19 Local Outbreak Co-ordinating Team will log all new incidents based on information from:

  • new incidents recorded on the PHE West Midlands Health Protection Team daily list
  • other contacts from PHE
  • reports from services (including people who use the service)
  • intelligence from local organisations
  • alerts from national NHS Test and/or the Joint Biosecurity Centre
  • reports from MPs, councillors or the public

Incidents will be logged in a Covid-19 local outbreak Control database. The minimum dataset is set out in the Covid-19 local outbreak control plan.

The Covid-19 Local Outbreak Co-ordinating Team will share a summary of this database daily with the PHE West Midlands Health Protection Team. This will be sent to:

West Midlands 2019 nCoV Cell

Weekly review

Public Health England and Staffordshire County Council will meet weekly to:

  • review all open incidents and exchange any relevant new information
  • review the operation of this SOP and identify any amendments required

 


 

Appendix 1: new incidents risk rating  Back to top

CategoryLow risk ratingMedium risk ratingHigh risk rating
Size and complexity of setting Small settings with few organisations involved in incident management Moderate size settings with more organisations involved in incident management Very large and complex settings with many organisations involved in incident management
 
All prisons and prescribed places of detention will be rated high risk
Number of suspected or confirmed Covid-19 cases and Covid-19 related deaths Single cases (suspected or confirmed) or small clusters (less than 2 cases)
 
No unexpected Covid-19 related deaths
Larger clusters (more than 2 cases) or small outbreaks
 
No unexpected Covid-19 related deaths
Larger outbreaks
 
or
 
One or more unexpected Covid-19 related deaths
Understanding and recognition by the setting of the public health risk Strong: timely notification with good information Adequate: late notification and/or inconsistent information Poor: failure to notify and/or limited or inaccurate information
Adherence to national guidance and local advice for infection control Strong: evidence that setting is adhering to guidance and advice Adequate: lack of evidence or inconsistent adherence to guidance or advice Poor: not adhering to guidance or advice
Business continuity Staffing: safe staffing levels to provide service
 
PPE: not required or required and greater than 7 days supply
 
Management: handling the situation well
Staffing: safe staffing levels but reliant on agency or temporary workers
 
PPE: required and 3-6 days supply
 
Management: some concerns about handling of the situation
Staffing: below safe staffing levels
 
PPE: required and less than 3 days supply
 
Management: not handling the situation well
Media and/or political interest No media or political interest Active local media or political interest Regional or national media or political interest
Other issues related to incident management None or minor Moderate Serious
Overall No category rated amber No category rated red One or more categories rated red

 


 

Appendix 2: repeat risk rating  Back to top

CategoryLow risk ratingMedium risk ratingHigh risk rating
Complexity of setting Small settings with few organisations involved in incident management Medium size settings with more organisations involved in incident management Very large and complex settings with many organisations involved in incident management
Number of suspected or confirmed Covid-19 cases and Covid-19 related deaths No new cases
 
and
 
No unexpected Covid-19 related deaths in the last 14 days
Low or decreasing number of new cases
 
and
 
No unexpected Covid-19 related deaths in the last 7 days
Significant and/or increasing number of new cases
 
and/or
 
Any unexpected Covid-19 related deaths in the last 7 days
Progress of outbreak management Good progress with implementing control measures Some progress with implementing control measures Little progress with implementing control measures
Business continuity Staffing: safe staffing levels to provide service
 
PPE: not required, or required and greater than 7 days supply
 
Management: handling the situation well
Staffing: safe staffing levels but reliant on agency or temporary workers
 
PPE: required and 3-6 days supply
 
Management: some concerns about handling of the situation
Staffing: below safe staffing levels
 
PPE: required and less than 3 days supply
 
Management: not handling the situation well
Media and/or political interest No local media or social media or political interest Active local media or social media or political interest Regional or national media or political interest
Other issues related to incident management None or minor Moderate Serious
Overall No category rated amber No category rated red One or more categories rated red

 


 

Appendix 3: incident management team (IMT)  Back to top

The IMT will ensure a comprehensive and accurate understanding of the epidemiology and circumstances of the incident and agree, document and ensure implementation of the control measures required to minimise the spread of infection and mitigate the wider consequences of the incident.

Membership

Membership should be proportionate to the epidemiology and circumstances of the incident and may include:

  • Staffordshire County Council - responsible team lead, public health consultant, communications, others as required
  • PHE - public health consultant and/or health protection nurse/practitioner, communications if required
  • MPFT - infection prevention and control
  • administration support including loggist
  • senior representative(s) from the relevant setting where appropriate
  • others as required

Input

  • numbers and timing of cases or death
  • risk assessment
  • application of infection prevention and control measures (including access to and use of PPE)
  • contact tracing update
  • information on business continuity including staffing levels
  • information on quality issues
  • information on supplies and availability of consumables
  • information on logistics or practical application of guidance (e.g. building layout, resident / patient / service user population)
  • information on local concerns and any media / social media coverage
  • other relevant information

Outputs

  • Agreed and documented control measures required to minimise the spread of infection and mitigate the wider consequences of the Incident - each with an owner and completion date - including:
    • infection prevention and control measures
    • support for business continuity
    • requirements for testing and arrangements to complete them
    • requirements for contact tracing and and arrangements to complete them
    • effective communications
  • Revised risk rating

 


 

Appendix 4 - further information  Back to top

You may find these web pages useful:

 


 

Printable version  Back to top

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