Staying vigilant and responding to COVID-19 symptoms
ELC settings should ask staff and parents and carers to be vigilant for the symptoms of COVID-19, and to understand what actions they should take if someone develops them, either onsite or offsite. It is essential that people do not attend a setting if symptomatic. Everyone who develops symptoms of COVID-19 must self-isolate straight away, stay at home and arrange a test via the appropriate method.
The key COVID symptoms are:
- new continuous cough
- fever/high temperature
- loss of, or change in, sense of smell or taste (anosmia)
All staff and parents and carers should be advised that anyone with these symptoms should not attend, or should be asked to return home. They should also be told to follow Test and Protect procedures.
All staff working in and with settings should be supported to follow up to date health protection advice on household or self-isolation and Test and Protect procedures if they or someone in their household exhibits COVID-19 symptoms, or if they have been identified by NHS contact tracers as a close contact of someone with the virus. Guidance on this is available from NHS Inform, Parent Club and gov.scot.
The National Clinical Director has also written an open letter to parents and carers providing guidance on how COVID-19 symptoms differ from those of other infections circulating at this time of year.
Changes to the rules on self-isolation for contacts of positive cases were made on 9 August. These changes were made because the health risks that arise when people are in contact with others who test positive have changed significantly, most notably due to vaccination. Vaccine uptake is very high, particularly among individuals who are at greater risk of harm from Covid-19, and the vaccines are highly effective at preventing severe disease (with 96% effectiveness against hospitalisation for the Delta variant). Children and young people have a very low risk of health harm from Covid-19, and children and young people with asymptomatic infection are at a relatively low risk of transmitting Covid-19 to adults. This means that the risk environment has changed significantly, and our approach to managing Covid-19 is evolving to reflect that.
Since we moved beyond level 0, close contacts aged over 18 years and 4 months who are double vaccinated - with at least two weeks having passed since the second dose - have been able to end self-isolation if they take a PCR test that comes back negative.
There is also no blanket requirement for children aged under 5 who are close contacts of positive cases to self-isolate, provided they do not display any symptoms or test positive for COVID-19. This applies regardless of whether the close contact is with a case in the ELC setting, household or elsewhere. Children under 5 years are encouraged but not required to take a PCR test. This is the advice in the guidance for households with possible coronavirus infection on the Test and Protect website However, their exemption from self-isolation requirements should not be made conditional on this. This reflects the lower risks of infection and transmission in this age group, the fact that younger children may find it harder to tolerate testing and the significant and sustained educational harms that result from current self-isolation policy. It aligns with the advice of the Advisory Sub-Group and the views of the Chief Medical Officer.
Close contacts for those aged over 5 but under 18 years and 4 months will be released from the requirement to self-isolate subject to a negative PCR test, provided they do not display any symptoms or test positive for COVID-19 . This would mean that close contacts over the age of 5 but under 18 and 4 months will be advised to book a PCR test as soon as possible, and only end self-isolation and return to ELC if they receive a negative PCR test result.
Key points to ensure that parents, carers and staff are aware of are as follows:
- staff, children or young people who develop the symptoms of COVID-19, or who test positive using PCR or LFD tests, must self-isolate immediately in line with NHS guidance.
- everyone who develops symptoms of COVID-19 – a new, continuous cough; fever or loss of, or change in, sense of smell or taste - must self-isolate straight away, stay at home and arrange a test via the appropriate method (see below). This applies to adults and children.
- with the exception of those aged under 5, people who live in the same household as a person with symptoms must self-isolate straight away and stay at home. These people should not attend settings.
- parents/carers who are self-isolating while they wait for the results of their PCR test, or who have received a positive PCR test should not leave the house to bring children to or from settings. They should make arrangements for someone else to do this on their behalf or, if that’s not possible, children should stay home with parents/carers.
- all close contacts should to take a PCR test. Children under 5 years are encouraged but not required to take a PCR test.
- from 9 August 2021, for those aged 5 and over and under the age of 18 years and 4 months, and for adults who have received both doses of the vaccine, the self-isolation for close contacts can end on receipt of a negative PCR test result. Until then, a negative PCR result doesn't replace self-isolation and they must still complete the 10 day isolation period recommended for contacts, as they may still be incubating the COVID-19 virus.
- it’s not the responsibility of managers to check whether close contacts who return to work after a negative PCR test have been fully vaccinated. Managers should assume that staff are following the self-isolation advice available on NHS Inform. There is a useful decision aid at following link: When and how long to self-isolate due to coronavirus | NHS inform
- any contact who has a positive test during their isolation period will be managed as a case and subject to contact tracing.
- ELC setting staff who opt to undertake asymptomatic testing, as part of their workplace testing programme, do not need to self-isolate while awaiting results, as long as no symptoms develop (however, as set out above, if they are a close contact of a symptomatic or confirmed case, they will need to self-isolate and take a PCR test). If their asymptomatic test is positive, the member of staff must isolate until a confirmatory PCR is received, even if they are without symptoms. If their asymptomatic test is negative, they can remain at work unless symptoms develop but must still adhere to all mitigations
- if the PCR test is positive, the person must remain in isolation until 10 days from symptom onset, or longer if symptoms persist or 10 days from the test date if there are no symptoms. The date of onset of symptoms (or of test, if asymptomatic) is to be considered day 1 of 10
- everyone who tests positive for COVID-19 will be put in touch with the local contact tracing team so that other close contacts can be identified. With the exception of those aged under 5, all close contacts who are in the same household as confirmed cases must self-isolate immediately and take a PCR test
- everyone who needs to self-isolate as close contacts of confirmed cases must continue to do so for 10 days from their last day of exposure to the case. In a household, the 10 days starts on the date of symptom onset in the first case
- unless otherwise advised by Test and Protect or local Incident Management Teams, where staff do not have symptoms but are self-isolating as a close contact of a person who is a confirmed case, other people in their household will not be asked to self-isolate along with them
If a close contact has had a positive PCR test in the last 90 days, they do not need to do another PCR test to be exempt from self-isolation, provided they are fully vaccinated and remain asymptomatic. This is because while you may no longer be infectious, a PCR test repeated within 90 days, can detect fragments of coronavirus genetic material that have not yet left your system. This means, you can still get a positive test result several weeks after you have had coronavirus and are no longer infectious.
Staff can book a test through www.nhsinform.scot, the employer referral portal (for staff only – see below) or, if they cannot get online, by calling 0800 028 2816. Parents and carers can book a test on a child’s behalf.
Settings, other than in those areas detailed in the following paragraph, will also be able to register their symptomatic staff as category 3 key workers under the employer referral portal, to ensure priority access to testing. The nature of this portal is to prioritise tests and appointments over the general public. This route directs individuals through to a Regional Test Centre or Mobile Testing Unit (whichever is nearer). For those who cannot access an RTC/MTU (if they do not have access to a car or live too far away), they can order a home test kit.
For settings in Orkney, Shetland and Eilean Siar, there are different routes to accessing a test in your local areas. ELC settings in these areas should liaise with their local Health Boards to ensure priority access to symptomatic testing for ELC setting staff.
Unless staff are symptomatic, they are a close contact of a positive case or are advised to get a test by a healthcare professional, then testing is not a requirement. However, if members of staff are concerned that they have been at risk from infection, then they may request a test whether or not they have symptoms.
Staff should make such requests via their employer, who can book a test for them using the employer portal, or for staff in Orkney, Shetland and Eilean Siar, can advise staff on the testing arrangements with their local health board.
If they have been identified as a close contact they must self-isolate and take a PCR test.
If a child develops symptoms of COVID-19 while in the setting, a ventilated space must be available for the child to wait in until they can be collected by their parent/carer. Where space allows, you should prevent contact with any other children in the setting. Ensure that guidance on the use of PPE is followed. Care must be taken however to ensure the appropriate levels of supervision of all children.
Self-isolation and contact tracing has been produced for schools and registered childcare settings to provide more detail on these changes.
Staff and parents who are smartphone users should be encouraged to download The Protect Scotland contact tracing app to help suppress the spread of COVID-19.
Managers and staff must be aware of Test and Protect arrangements should someone become unwell. If a member of the staff team has symptoms, they must self-isolate and not attend the setting, and must contact the NHS to arrange to be tested at 0800 028 2816 or www.nhsinform.scot. You can find more information on the COVID-19 Test and Protect webpage.
All ELC settings are considered complex settings and cases will be prioritised and escalated to specialist local Health Protection Teams.
Staff, including peripatetic and temporary staff, should be advised to tell their line manager as soon as they receive a positive test result.
Settings should ask parents whether their child has tested positive for COVID-19 when parents are reporting absences, and parents should be prompted to mention any positive tests when leaving messages about absences (including via automated systems). Parents will also be prompted to report the result to the setting by the online contact tracing form that all people testing positive are sent as soon as their test results are received. If called by a contact tracer, the person testing positive will again be prompted to inform their childcare setting. In some circumstances, if a contact tracer requires to contact the setting directly, they will also inform the setting of the positive case. In this way, there are multiple routes and prompts to help ensure settings are alerted to positive cases as soon as possible after a member of staff or child tests positive.
If a parent/carer or staff member is contacted by a contact tracer and told to self-isolate for 10 days, the person should leave the setting to self-isolate at home straight away and, if possible, wear a face covering on route and avoid public transport if symptomatic. We have published advice for employers on how to support people who are asked to self-isolate.
The approach to contact tracing was adjusted from 9 August 2021 to reflect the evidence and data on risks of infection and transmission amongst close contacts in this age cohort. Test and Protect will assume responsibility for contact tracing and focus on identification of particularly close, prolonged contacts, primarily in household or social settings. When positive results are reported to childcare settings by staff and parents/pupils, it can help support the process if they take the opportunity to encourage those staff and parents to engage with the Test and Protect process and complete the online form as soon as possible.
Normal contacts in the ELC environment will not generally be considered as close contacts, unless index cases identify exceptional circumstances, such as having worked or socialised very closely with someone (including having shared a car). Setting staff will therefore not usually require to be involved in contact tracing. Unless there are exceptional circumstances, there will not be a requirement to isolate whole groupings of children as has previously been the case.
ELC providers must continue to keep clear records of children, adults and staff attending their settings, and of the composition of groups undertaking activities. These records will help to settings to target ‘Warn and Inform’ letters to parents and staff in the event of a positive case in the settings (see below) and to ensure rapid response and contact tracing should the index cases identify exceptional circumstances. This will also enable employers to maintain records on staffing capacity in individual settings and to make judgements about whether it will be necessary to close settings temporarily due to high levels of staff absence. All providers should plan as much as possible to minimise the operational impact of individual staff or groups of staff being required to self-isolate.
If, following confirmation of a child testing positive, the setting feels that a staff member is, or may be, a high risk contact because they have had unusually close or prolonged contact with that positive case in line with the examples set out below, AND the relevant staff member has not to date received notification via the Test and Protect system, the setting can contact their local Health Protection Team. They will provide advice on whether the individual is in fact a high risk contact and what action should be taken. NB: Before doing so, settings should ensure they have noted the examples of what would constitute unusually close or prolonged contact set out here:
Unusually close or prolonged contact does not include ‘business as usual’ contacts in the setting where the relevant mitigations are being followed (e.g. working in the same room as a positive case). Examples of unusually close or prolonged contact may include repeat toileting using hoist equipment for a child with ASN when PPE has not been used, or overnight stays.
Warn and Inform letters
In the event that settings are informed of a positive case or cases amongst their staff or children, they should contact parents/carers and staff and direct them to either the Warn and Inform letter for parents/carers or for staff (both are attached as a supporting document to this guide) or the Warn and Inform letter for staff which provides further information, and:
- advises them to be particularly vigilant for symptoms and to self-isolate and book a test if they become symptomatic
- asks them and their children to follow particularly closely the mitigations in guidance
- strongly encourages staff to continue testing and recording results regularly as part of the asymptomatic testing offer, as well as advising households to take advantage of the universal testing offer
The letter to parents/carer should be sent to parents/carers of children who had contact with the positive case, for example, as part of the same cohort or room.
The letter to staff should be sent to staff members who had similar contact with the positive case.
Settings do not need to issue multiple letters to the same parents/staff if there are multiple cases in the same class during an outbreak. In these circumstances, however, they may wish to keep parents, pupils and staff informed regularly of key developments (e.g. of any advice received from local Health Protection Teams, or updates on further positive cases or case numbers).
Outbreak management in all settings is led by NHS Health Board health protection teams (HPTs).
The procedures for incident management are well established (Managing Public Health Incidents) and are undertaken in partnership with settings, local authorities and Public Health Scotland (as required).
Settings should ensure that they know how to contact their local HPT and their designated person for doing so is often the Head Teacher or setting manager.
Settings should ensure they are aware of the following definitions:
Single cases will be identified by Test and Protect and higher risk close contacts will be identified through them too. Settings are no longer to contact HPTs to notify of every single confirmed case in a setting. However, managers must notify the Care Inspectorate in the event of a first suspected case and all confirmed cases of COVID. Notifications and guidance are available through eForms.
Settings should contact their local HPT if a cluster is identified. A cluster is two or more unlinked (or link unknown yet) test-confirmed cases of COVID-19 among individuals associated with a specific setting with illness onset dates within 14 days.
The HPT can provide advice to assess any links between cases, undertake risk assessment and discuss further action. Following this an outbreak may be declared, usually through an Incident Management Team (IMT). An outbreak is two or more linked test-confirmed cases of COVID-19 among individuals, associated with a specific setting within 14 days.
Where necessary an IMT will be established to manage the outbreak. An IMT is a multidisciplinary, multi-agency group with responsibility for investigating and managing the outbreak. The HPT will chair the IMT and representatives from the setting and, if relevant, the council will be invited to join.
Settings may be asked to support an outbreak investigation by:
- attending an Incident Management Team (IMT) meeting
- communicating with children, parents/carers, staff and the media
- implementing appropriate enhanced infection, prevention and control measures and support for contact tracing as recommended by the HPT or IMT
ELC and other childcare facilities remain settings of low risk for COVID-19. Usually settings continue to operate during outbreaks. On occasion it may be necessary to temporarily close a setting or part of a setting in order to implement control measures or for operational reasons. Any decision on this should be determined through the IMT.
Settings should maintain records to support outbreak identification and investigation, including attendance records and reasons for absence. When information sharing is needed during management of an incident there is a duty to both protect and share personal information between those participating in the IMT such as test results and contact details. These requirements are set out in Annex E of Management of Public Health Incidents. The sharing of information must be facilitated respecting the principles of confidentiality and relevant legislation. To support this, Data Protection Impact Assessments should be in place for all partner organisations.
It is for local Health Protection Teams to consider individual risks for any staff or children.
There may also be circumstances in which, based on clear evidence and public health considerations, or other relevant factors (e.g. minimum staffing requirements) specific settings require either to close for a defined period of time. This will closely involve local authorities and local Public Health Teams. All such decisions will continue to be made by local incident management teams working in partnership, and on the independent advice of local Directors of Public Health, who will take full account of safety and wider public health considerations in line with their statutory duties. Similar decisions may require to be taken by local authorities and/or setting managers where staffing constraints (e.g. due to self-isolation or shielding) or other matters make such a move unavoidable.
Scotland has an excellent programme of community surveillance. This allows us to monitor actively trends in the pandemic, both nationally and more locally.
There is also specific surveillance in respect of schools and children/young people. This draws on COVID-19 related information from a range of sources and covers all school ages and ELC settings.
We are also launching an additional surveillance programme which will see antibody testing for substantial numbers of educational staff volunteers to identify the prevalence of COVID-19 antibodies over time.
Taken together, these sources will allow regular reporting on indicators such as: overall incidence and swab positivity for Scotland; incidence and swab positivity for children; number and proportion of cases that are among education workers; hot spots by local authority area; number of clusters or outbreaks that are under investigation within educational settings; levels and changes in antibodies in educational staff; and, if feasible, asymptomatic transmission among older children and school workers.
These data will inform decision-makers at different levels as they consider any adjustments to make to arrangements – including this guidance – or any investigations to be conducted at certain localities to explore what local responses are required.
In the 2020-21 and 2021-22 academic year, there has been an expectation at national level that HNC Childhood Practice students and trainee teachers will continue their placements. To support colleges and childcare settings to offer placements to HNC students in academic year 2021-22, SSSC have published an Employer Toolkit to provide further information to support placement providers, students and centres to support the safe return of students to placements. The toolkit provides guidance and links to more information to support the safe completion of the placement element where possible. It also contains links to risk assessment tools, current national guidance, frequently asked questions and an example contract. Read the toolkit.
In addition, the Scottish Government has now established a Learner Journey Ministerial Task Force, comprising representatives from colleges, universities, students and unions, to consider the challenges that colleges and universities face this academic year in delivering practical learning across all subjects with a placement element, including the HNC Childhood Practice. The immediate priority for the task force is to help students complete their courses and move into further study or employment. The task force will also consider arrangements if some students need to defer a part of their course. For HNC Childhood Practice courses, we continue to encourage colleges and employers to work together to identify placements for students which will enable them to complete their course by the end of the academic year.