Reducing the covid-19 isolation period in England: a policy change that needs careful evaluation
BMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o184 (Published 21 January 2022) Cite this as: BMJ 2022;376:o184All rapid responses
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Dear Editor
In our context in Nepal we have made the observation that Covid-19 antigen tests tend to remain positive for longer in individuals in their first infectious period as compared to those who have had a prior Covid infection in previous waves:
The Gurkha Welfare Trust (GWT) provides primary healthcare services to around 20,000 ex-Gurkha veterans in Nepal, from 21 health centres and two residential homes. Because almost all our patients are elderly and therefore very vulnerable to Covid-19, we have been implementing strict Covid control measures, which also include mandatory at least weekly testing of all 500 GWT staff during periods of high community transmission. During the Delta wave in Nepal (May to July 2021), GWT identified 95 infections among staff. During the Omicron wave (Jan 2022) over 220 staff members have become infected. By this time, all staff had had at least two doses of vaccines, most 6-9 months ago, and a few had had booster doses in January. (Unfortunately, we were unable to start offering booster doses before Jan 10, which was the week that the Omicron variant started spreading rapidly in Nepal.)
In the first wave, the mandatory isolation period was set at 14 days, reduced to 10 days by the second (Delta) wave, and following recommendation by both Nepal and UK governments, this was further reduced to 7 days before the Omicron wave.
We re-test all staff at the end of their isolation period before their return to work. Nursing managers in the residential homes have observed that almost invariably, staff members who had NOT been infected with Covid-19 during previous waves still tested positive on day 8, and had to extend their isolation period, while those who had had a previous infection in the first or second waves tested negative and were able to return to work after 7 days of isolation.
In a context where testing is inconvenient, expensive or difficult to access, it may be appropriate to vary the initial mandatory period of isolation according to whether the individual in question has had prior episodes of Covid-19 infection in previous waves.
Competing interests: No competing interests
Re: Reducing the covid-19 isolation period in England: a policy change that needs careful evaluation
Dear Editor
I thank Dr Gerda Pohl and colleagues for their response to my article, based on their experience with the Gurkha Welfare Trust, which provides primary healthcare services to around 20,000 ex-Gurkha veterans in Nepal. Firstly, let me start by commending the Gurkha veterans for their long-standing contribution to the British Army. Gurkhas have been renowned for decades for their courage and military discipline.
Dr Pohl and colleagues provide interesting new data showing that some people may remain infectious after a 7-day isolation period, particularly if they have not had a previous Covid-19 infection. Their data reaffirms the need to monitor the impact of changes in Covid-19 policies in England on areas such as infection rates, hospitalizations & deaths. There is also a need to identify any outbreaks that may have been triggered by the early ending of isolation in people who have had a recent Covid-19 infection. This becomes even more important now that England may soon end its mandatory legal isolation period for people who test positive for Covid-19.
Competing interests: No competing interests