Reducing self-isolation to five days for positive Covid casescould increase the infection risk for vulnerable patients in hospital if the approach is not completely safe, a senior NHS leader has said.
Since 22 December, people in England who test positive for Covid can cut their self-isolation period from 10 days to seven if they have a negative lateral flow test on day six and day seven and no high temperature. Scotland, Wales and Northern Ireland have stuck with the 10-day rule.
However, pressure has been rising on the government to consider further cutting self-isolation to five days, with some experts tentatively backing the idea. It has also gathered momentum within the hospitality industry, but they still believe it is the job of scientists to ascertain the move’s safety.
Now Chris Hopson, the chief executive of NHS Providers, has weighed into the debate, suggesting the decision is far from simple – even if it might help tackle staff absences in the NHS.
“Covid-19 keeps throwing up policy decisions requiring difficult judgments between competing objectives. Reducing Covid isolation from seven days to five is another one of these,” he wrote on Twitter.
In a series of tweets, Hopson noted one consideration is high staff absences due to self-isolation across the economy, including in the health service.
“If staff absence rates and care quality/patient safety risk rise, pressure for a change to the isolation period will, inevitably, rise as well,” he said.
However, Hopson noted that a shift to a shorter self-isolation period could be problematic if it increases the risk of hospital-acquired Covid infections. And if people do remain infectious after five days of self-isolation, there could be a rise in community infection rates – a concern given the uncertain impact of Omicron on older populations.
Another issue is that there have been disruptions in the availability of lateral flow and PCR tests.
“A policy based on people needing negative PCR or lateral flow test results to exit isolation requires rapid, reliable and widespread access to those tests. This is not, currently, consistently the case,” he wrote.
Hopson added there is considerable debate within the scientific community as to whether, or to what degree, people with Omicron are infectious after five days.
Leading figures in the hospitality industry, where festive takings have been down by as much as 60%, said a shorter isolation period could relieve some of the pressure on the struggling sector.
Phil Urban, the chief executive of the 1,700-strong pub and restaurant group Mitchells & Butlers, which owns the Harvester and O’Neill’s chains, stressed that it was for the government’s scientific advisers to determine the length of the Covid isolation period.
But he said a shorter gap would help the industry. “If people are isolating who are fine otherwise, the shorter the time period, the better it is. That would certainly be helpful.”
The trade body UK Hospitality said a shortage of tests meant the industry was being hit by a double whammy of staff taking longer to come back to work and customers staying away. “We’re kind of agnostic [on five-day isolation] because it’s so far out of our sphere of expertise,” said the chief executive, Kate Nicholls.
“It’s welcome news that they’re looking at it but we’d only want that if it was safe. We do need to make sure that we have a continued ready supply of lateral flow tests.”
The US has recently announced it is moving to a five-day self-isolation period for those with Covid but no symptoms – albeit with mask-wearing for a further five days. However, some experts have criticised the move as the US does not require people to have negative Covid tests before exiting self-isolation.
Lawrence Young, a virologist and professor of molecular oncology at Warwick medical school, said the time to becoming and remaining infectious varies from person to person, and by variant, with some evidence suggesting it takes only two to three days between infection and becoming infectious with Omicron.
“This infectious period can occur before the onset of symptoms and last for between two and three days after you become symptomatic,” he said.
Young added that the current seven-day plus testing approach adopted in the UK is sensible and provides a margin for person-to-person variability. But, he added: “Reducing the self-isolation period to five days without robust evidence is a concern and could only be introduced with the strict enforcement of lateral flow testing.”
A paper by scientists at the UK Health Security Agency, yet to be peer reviewed, suggests that relying on two negative lateral flow tests alone would risk a high proportion of people being released while still infectious due to false negatives, suggesting a mandatory isolation period is also necessary.
“A mandatory isolation period of longer than seven days will not provide much more safety but lowering this mandatory isolation point will increase the percent of ‘false releases’ dramatically,” said the team.
A government spokesperson said: “There are no further changes to the isolation period planned at this time, but we keep all rules under review based on the latest health data.”