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Covid Incident Standard Operating Procedure

Purpose  Back to top

The purpose of this SOP is to describe how Staffordshire County Council (SCC) will ensure an effective response to Covid incidents. The SOP should be read in conjunction with the Staffordshire Covid local outbreak management plan. Our key principles are set out in the Local Outbreak Management Plan.

 


 

Definitions  Back to top

Suspected (possible) cases

These are people with the following symptoms:

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

Confirmed cases

These are people with a positive laboratory test for viral RNA (ribonucleic acid), with or without symptoms.

For the purpose of identifying close contacts the infectious period is:

  • For symptomatic confirmed cases from 48 hours prior to the date of onset of symptoms to 10 days (14 for care home residents) after the date of onset of symptoms OR until fever has resolved, whichever is later.
  • For asymptomatic confirmed cases from 48 hours prior to the date the positive test was taken until 10 days after the date the positive test was taken.

Close 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

 At 19 July 2021 the legal requirements for isolation are:

  • For people with one or more of the three main symptoms of Covid: until they can get tested and have a result.
  • For confirmed cases: for 10 days starting the day after the onset of symptoms; or if asymptomatic then for 10 days starting the day after the date the positive test was taken (14 days for care home residents and patients who have been admitted to hospital); AND until at least 48 hours free of fever (without medication to reduce fever).
  • For close contacts: for 10 days
  • For household contacts: commencing the day after the case’s onset of symptoms; or if the case is asymptomatic then commencing the day after the date the positive test was taken;
  • For other direct and proximity contacts: commencing the day after the last contact with the case.

The expectation is that from 16 August 2021 only those close contacts who are unvaccinated adults will need to isolate. Adults who are more than 2 weeks post vaccination, and children under 18, will be advised to take a PCR test.

Other exemptions exist where part of a specific vaccination research trial and/or a Daily Contact Testing (DCT) pilot.


 

Scope  Back to top

This standard operating procedure covers management of:

  • Cases - either:
    • Issues: a single suspected case in a setting; or
    • Exposures: a single confirmed case in a setting.
  • Clusters: two or more suspected and/or confirmed cases in the same setting with onset during a 14-day peroid in the absence of an epidemiological link - i.e. they appear to have arisen independently rather than through spread of infection within the setting; or an increase in the background rate of absence due to suspected or confirmed cases of Covid.
  • Outbreaks: two or more epidemiologically linked suspected and/or confirmed cases in a setting with onset during a 14-day period - i.e. the cases have had contact with each other or with another common source of infection, indicating spread of infection within the setting.
  • Community spread: refers to an increased number of sporadic or linked cases within the community.

Settings

Settings 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

 


 

Identification and initial management 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 (PHEWM) 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.

Notification of new incidents to PHEWM

Incidents may be notified to PHEWM by the Joint Biosecurity Centre and/or PHE nationally, or by local organisations.

Where capacity allows, PHEWM may contact the setting and any other partners to gather information and ensure an accurate understanding of the epidemiology and circumstances of the Incident.

PHEWM will carry out a risk assessment and determine whether the Incident meets their Escalation Category based on:

  • High attack rates of suspected or confirmed Covid-19 cases and/or high numbers of associated deaths;
  • Whether there is adequate understanding and recognition of the public health risk associated with the situation;
  • Whether national guidance for control of the outbreak is being followed, and local advice is consistent and well understood;
  • Where internal management of the care home, including staffing levels and provision of PPE, are causing concern;
  • The extent to which coordination and communication across agencies is, in our view, adequate for control of the situation;
  • Significant media and/or political interest; and/or
  • Other factors.

Based on this PHEWM will determine whether to lead management and follow up of the Incident or refer it to SCC. Where PHEWM is leading then SCC will act in support of Incident management. Requests for specialist IPC and/or testing support from MPFT will be made by SCC, unless in exceptionally urgent circumstances, in which case PHEWM can request this support directly.

Where capacity is unavailable, PHE may refer the Incident directly to SCC.

PHEWM will distribute daily a list of ‘On-going Issues / Outbreaks (Covid-19)’ in the West Midlands’ via email to designated officers across local partners.  For the Council, this list will be sent to:

PHEWM and SCC will meet regularly to review all open Incidents and exchange any relevant new information. This is in place of an invitation to the Covid Health Protection Board (HPB), however PHEWM will be invited to a specific HPB should it be deemed necessary.

PHEWM will also notify SCC immediately if follow up reveals significant new information.

Identification, notifications and referrals of new incidents to SCC

Incidents may be identified through local contact tracing or other local intelligence, may be notified by local organisations, or may be referred from PHEWM. All Incidents should initially be reported to the SCC Covid-19 Local Outbreak Co-ordinating Team.

The SCC Covid-19 Local Outbreak Co-ordinating Team will:

  •  Log the Incident; and
  • Allocate it to the most appropriate Responsible Team, depending on the setting.

Incidents will be logged in a Covid-19 Local Outbreak Control database. The minimum dataset will include:

  • Date and time of first report received by Council
  • Nature of Incident (case, cluster, outbreak, community spread)
  • Setting
  • Number of suspected and confirmed cases
  • Date of first onset of symptoms of suspected and confirmed cases
  • Number and date of any associated deaths
  • Date and time of Risk Assessment(s)
  • Current Risk Rating
  • Date and time of Incident Management Teams where held
  • Summary of control measures
  • Progress updates
  • Other pertinent information
  • Date and time of closure

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
Telephone: 0344 225 3560 option 2
Email:wm.2019CoV@phe.gov.uk

The Responsible Organisation and Team will usually be:

  • Care settings: County Council Care Commissioning Team.
  • Education, Early Years and Children’s social care settings: County Council Education and Early Years Covid Outbreak Management Team–includingHealth, Safety and Well-being and Education Strategy and Improvement Teams.
  • Prisons and other prescribed places of detention: PHE Health Protection Team supported by County Council Public Health and Prevention Team.
  • High risk places, businesses, and communities: District and Borough Council Environmental Health Teams.
  • Community healthcare settings: County Council Public Health and Prevention Team and Clinical Commissioning Groups.

The Responsible Team 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 the relevant Appendix.
  • Make requests for specialist IPC and testing support to MPFT on behalf of SCC and PHWM.

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; and
  • 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.
    • PHEWM will determine whether to lead management of the Incident or for it to remain with SCC.
    • Identify any immediate control measures required and ensure that these are clearly defined and allocated.
    • Call an Incident Management Team.

  • Medium Risk:
    • Identify any immediate control measures required and ensure that these are clearly defined and allocated.
    • Provide any letters / 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 an Incident Management Team.

  • Low risk:

In Step 1 – 3 of the Government Roadmap actions include:

    • Identify any immediate control measures required and ensure that these are clearly defined and allocated.
    • Provide any letters / 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 and ensure implementation of control measures.

In Step 4 of the Government Roadmap actions may also include:

    • Monitoring only of single cases related to a setting (unless deemed higher risk or requiring for further control/investigation)

 

Incident Management Team (IMT)  Back to top

The IMT will ensure a comprehensive and accurate understanding of the Incident by all relevant partners, and agree, document, allocate and ensure implementation of the multi-agency control measures required to minimise the spread of infection and mitigate the wider consequences of the Incident. The range of control measures is set out in the Staffordshire Covid-19 Local Outbreak Control Plan and may include:

  • Infection prevention and control measures.
  • Support for business continuity.
  • Requirements for testing and arrangements to complete them.
  • Requirements for contact tracing and arrangements to complete them.
  • Effective communications.

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

  • SCC: responsible team lead, public health consultant, communications, others as required;
  • PHE: public health consultant and/or health protection nurse/practitioner, communications if required.
  • District and Borough Councils: as required forHigh risk places, locations and communities.
  • CCGs: for Incidents in care and community healthcare settings, and for all High-Risk Incidents.
  • MPFT: Infection Prevention and Control where enhanced testing is likely to be required.
  • Police: where there is the possibility of public order issues.
  • Administration support including Loggist.
  • Senior Representative(s) from the relevant setting where appropriate.
  • Others as required.

Input to the IMT will typically include details of:

  • Numbers and timing of cases / deaths.
  • 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/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.

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

Outputs from the IMT will typically include details the 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 – including isolation and cohorting; closure of settings – either full or partial; ‘Deep cleaning’; additional PPE.
  • Support for business continuity including management and staffing.
  • Addressing quality and safeguarding concerns.
  • Contact tracing.
  • Testing.
  • Support for self-isolation.
  • Enforcement.
  • Communications.

IMTs will include an assessment of risk and assessment of Covid response, mitigations and actions.

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 PHEWM 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:

  • 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 – then manage accordingly.
  • 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 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;
  • De-escalation: close Incident once criteria met – see Incident Closed criteria below.
  • 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 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.

 


 

Variants and Mutations (VAM)  Back to top

Over the course of the Covid-19 pandemic, new Variants of Concern (VOCs), Variants Under Investigation (VUIs) and Mutations of Concern (MOCs) for SARS-CoV-2 will continue to be identified.

Strategies to effectively detect, investigate and control variants and mutations (VAM) are constantly being developed and refined across the UK. To date this has included the development of a national routine surveillance programme and an enhanced public health response to detect and control transmission of VAMs.

The West Midlands Heath Protection Team (WMHPT) have devised a WMHPT and local authority SOP which includes details of how VAM will be manages. The SOP provides an overview of the processes and actions involved in VAM case investigation and management and details the responsibilities for the WMHPT and, where agreements are in place, for the local authorities, for each specific VOC/VUI/MOC.

If the Council identifies an outbreak/cluster of S gene positive cases linked to a high risk setting, further discussion with WMHPT may be indicated.

If existing or new close contacts are identified as part of the case investigation and enhanced contact tracing, then depending on the risk assessment they may require a PCR test according to the following guidance: 

  • Symptomatic contacts, regardless of length of time post exposure: should access testing using usual symptomatic testing services.
  • Asymptomatic close contacts (of all VOC/VUI/E484K cases), including all household contacts: PCR test up to 10 days post last exposure (ideally day 8 post last exposure) using national PHE process or locally agreed process.
  • Asymptomatic other contacts (of all VOC/VUI/E484K cases): PCR test up to 10 days post last exposure  (ideally day 8 post last exposure) using national PHE process or locally agreed process, where there are strong grounds to suggest a significantly elevated risk of infection.
  • Asymptomatic contacts of S-Gene + cases: PCR test up to 10 days post last exposure (ideally day 8 post last exposure) using national PHE process or locally agreed process.

Enhanced Local Response

The West Midlands Heath Protection Team (WMHPT) have devised a WMHPT and local authority SOP which includes details of how variants and mutations (VAM) will be managed. The SOP provides an overview of the processes and actions involved in VAM case investigation and management and details the responsibilities for the WMHPT and, where agreements are in place, for the local authorities, for each specific VOC/VUI/MOC.

The definition of a contact of VOC/VAM/MOC cases are defined in the same way as other Covid cases. This is nationally defined.

Currently the Delta variant is the more prevalent variant in the UK. The data released by PHE indicates that over 95% of new Covid-19 cases in the UK are now the Delta variant, which continues to show a significantly higher rate of growth compared to the Alpha variant.

Who has a legal duty to isolate?

  • Anyone who tests positive for Covid
  • Anyone who has one of the 3 main symptoms of Covid (whilst awaiting PCR test result)
  • Anyone who is identified as household, close or proximity contacts of a positive case (according to above definition) and who is advised to isolate by NHS Test and Trace or Staffordshire County Council on their behalf.

Who needs to get a PCR test?

  • Anyone who has one of the 3 main symptoms of Covid must get a test and must isolate whilst awaiting a result.
  • Anyone who has one of the wider ‘precautionary’ symptoms is advised to get a test.  There is no requirement to isolate whilst awaiting result.
  • Close contacts of positive cases are not required to get a test but may get a test during the period of up to 10 days post-last exposure to determine whether they have been infected. Note that they must complete their period of isolation irrespective of the results.
  • Other asymptomatic contacts* of a positive case may be recommended to get a test in some circumstances for the purposes of enhanced case finding.  There is no requirement to isolate whilst awaiting result.

PCR testing of asymptomatic contacts may be recommended in some outbreaks based on the risk of widespread transmission of infection. This will be determined based on the overall number of cases as well as the potential for infection, either directly via aerosol/large droplets or indirectly through contaminated surfaces.  Consideration should also be given to those at risk of infection, their age and likely vaccination status. Examples might include (but not limited to) nearby exposure to a positive case such as:

  • All staff working in the same premises as another staff member (during their infectious period);
  • Teaching staff who have spent several hours in a classroom with a pupil;
  • Gatherings where interactions are not monitored or individuals not easily identifiable;
  • Gatherings where it is known, or believed, that multiple members are likely to be unvaccinated such as school trips/parties.

Staffordshire County Council has agreed to: 

  • Undertake the case investigation and enhanced contact tracing of high, medium and low priority cases.
  • Support the WMHPT to undertake case investigation and enhanced contact tracing, where it has not been possible for the WMHPT to contact a case and/or setting.
  • Work in partnership with the WMHPT to identify additional control measures or interventions (as part of an IMT process) for complex cases or outbreaks/clusters.

Targeted local surge response

Targeted local surge response may include engaging with local settings and encouraging or providing testing opportunities, isolation of individuals, enhanced contact tracing, or any other relevant activity. 

The decision to enact a local surge response will be dependent on the outcome of a risk assessment and will be informed by the Staffordshire LRF testing protocol. Risk assessment may consider (but is not limited to):

  • vaccination status
  • rate of transmission/incidence in the community
  • testing positivity rates
  • transmission across settings/groups/communities
  • isolation compliance; and
  • any other relevant local intelligence.

 

Covid Health Protection Board  Back to top

The Health Protection Board (HPB) provides day to day co-ordination of the Covid response for Staffordshire. Membership includes relevant teams from the County Council as well as District and Borough Councils and the NHS, with the Public Health England Health Protection Team invited. Outline terms of reference are to:

  • Develop and continually review the Local Outbreak Management Plan.
  • Ensure that appropriate and up to date Standard Operating Procedures (SOPs) are in place for Incident management.
  • Oversee surveillance and management of Incidents.
  • Consider issues escalated from Incident Management Teams and identify additional support required to address these.
  • Provide assurance about management of Incidents.
  • Reflect on learning from Incidents to identify improvements for future management and amend SOPs accordingly and/or identify additional capacity requirements.

 

Annex 1: 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 Large and complex settings with many organisations involved in incident management
Number of suspected or confirmed Covid-19 cases and associated deaths Single cases or small clusters with no evidence of spread of infection within the setting

Outbreaks with no new cases due to spread of infection within the setting in the last 14 days

No unexpected Covid-19 related deaths in the last 14 days
Larger clusters

Outbreaks with low or decreasing number of cases due to spread of infection within the setting
 
No unexpected Covid-19 related deaths in the last 7 days
Outbreaks with high or increasing number of cases due to spread of infection within the setting
 
Unexpected Covid-19 related deaths in the last 7 days
Variants No Low Priority (1)
VOC/VUI confirmed

Low S-Gene positivity rate or no new cases in the last 7 days
Medium Priority VOC/VUI (2) presumed or confirmed

S-Gene positivity rate stable over the last 7 days
High Priority (3) VOC presumed or confirmed

S-Gene positivity escalating/high
Background compliance with Covid-19 control measures Good compliance prior to the incident Some compliance prior to the incident Poor compliance prior to the incident
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 incident 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 incident
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, social media or political interest Active local media, 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 more than one category rated amber No more than one category rated red Two or more categories rated red

 


 

Annex 2: Useful Links  Back to top

You may find these web pages useful:

 


 

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