Isolation for people with Covid-19 in England: Follow the guidance carefully

The UK government has announced that people in England self-isolating because of a Covid-19 infection will be able to end their isolation period after 5 full days instead of the previous 7 days if they test negative on both day 5 and day 6 with a lateral flow test and do not have a temperature. The change comes into force on Monday 17 January 2022. What are the implications of the government’s decision to reduce the isolation period to 5 days for people in England with Covid-19? In summary, it’s a pragmatic step with some benefits but there are also some caveats and concerns that the government needs to address.

A shorter isolation period will allow people to return to work, education and social activities more quickly than the previous 7-day or 10-day isolation periods that we had in England. This will help address workforce shortages in the economy and will also allow children and students to resume their education. A shorter isolation period may also lead to greater compliance, as many people do not comply with longer isolation periods.

But some people will remain infectious after 5 days, so there are risks from this policy. A lateral flow test will identify many of the people who are infectious but some will be missed by the tests. It’s essential therefore that people also focus on their symptoms and not just rely on the results of their lateral flow tests. We need to remember the expression that doctors have: “Treat the patient and not the test result.”

If you remain unwell after 5 days – for example., if you have a high temperature or a bad cough – you should continue to isolate. Although many people of working age will have a mild infection – particularly if fully vaccinated – some people will have a more prolonged illness. The government does not mention cough as one of the symptoms that should lead to a longer isolation period – probably because a cough can persist for some time after a respiratory infection. If you feel well and have a mild cough, that is acceptable. But if you have a severe cough, you should consider extending your isolation period to longer than five days.

People should also not rush back to work and other activities too quickly. Take the time you need to fully recover from your illness before you return to work or education. Everyone is different and we recover at different speeds from an illness. This is irrespective of the results of your lateral flow tests. Base your recovery on how you feel and not just on your test results.

The government’s new policy is largely based on one modelling study which estimated that people with negative lateral flow tests on day 5 & day 6 are as likely to be infectious as people after a 10-day isolation period (7% v. 5% is the government’s estimate). Ideally, we would have stronger evidence from real-world studies about people’s infectivity after different isolation periods (5, 7 & 10 days) and what extra information is obtained about infectivity from lateral flow tests. But this research would take some time to complete and review. The government has therefore taken the decision to act now – but it must assess the impact of its new policy and collect the data needed to do this.

We need careful evaluation of the new shorter isolation period to ensure that people are following the guidance on self-testing and symptoms, and not ending their isolation period too early, and thereby putting others at risk of infection. We also need to consider how the guidance would be applied for people dealing with clinically vulnerable people. This would include guidance for NHS staff, those working in care homes, and people providing social care.

Finally, would you want to share a room with someone who was 5 days past the start of their Covid-19 infection and who was coughing all over you? Follow the guidance, particularly on symptoms, and don’t just rely on the results of the lateral flow tests to predict how infectious you are to avoid placing others at risk of infection.