Eradicating inconsistencies in isolation guidance for NHS healthcare workers.

The UK Government COVID-19 guidance for households with possible coronavirus infection clearly states that any person with COVID-19 symptoms or a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test result should self-isolate for 10 days from the onset of symptoms or from a positive test. For those living with that person, they should self-isolate for 14 days from the onset of the other person's symptoms or positive result. The government guidance for healthcare workers and their household members or contacts notified through NHS Test and Trace is the same as for the rest of the general public.

However, there are significant inconsistencies in the guidance for staff between different NHS trusts. As an example, in two unnamed South Thames deanery trusts, separated by no more than 40 miles, symptomatic members of staff at one trust should self-isolate for seven days, but in the other, symptomatic staff must self-isolate for 14 days. These gross discrepancies in the isolation periods for health workers who are symptomatic or have a positive COVID-19 test are concerning. Two neighbours who work at different trusts may become symptomatic with COVID-19 on the same day, but have a whole week's difference in their isolation periods. There is evidence to suggest that isolation periods should be even longer than 14 days. The European Centre for Disease Prevention and Control has produced guidelines stating that severely affected patients with COVID-19 can shed SARS-CoV-2 for 20 days from the onset of symptoms and isolation periods should reflect this.

Why there are differences between trusts remains uncertain, but it is not unreasonable to suggest that there are economical and political motives at hand rather than clear scientific evidence. There could well be a compromise between protecting staff from COVID-19 infection and providing enough staff availability to ensure patient safety and appropriate resource allocation.

The lack of consistency in guidance for healthcare workers between NHS trusts and the government could result in apprehension among staff members. There will also be growing uncertainty about how guidelines will change in the near future, with the development of licenced vaccinations and innovative diagnostic tools such as lateral flow tests. Such resources will be imperative in coming through this fight against COVID-19. However, the UK government must create clear, up-to-date, national guidance for healthcare workers that incorporates advice on vaccinations and results of both PCR and lateral flow testing. These guidelines must be used consistently by all trusts throughout the NHS.