EXPLAINER: NPHET's new advice on two-week movement restriction for Covid-19 close contacts

Health Information and Quality Authority issue recommendation

Conor Ganly

Reporter:

Conor Ganly

coronavirus covid-19

Close contacts of somebody with a positive test have to restrict their movement for two weeks.

The 14-day movement restriction on the close contacts of people who have tested positive for Covid-19 should remain in place if testing is not changed, according to the Health Information and Quality Authority (HIQA).

The authority says has today published the advice it submitted to the National Public Health Expert Team (NPHET) to support its response to COVID-19. 

HIQA says current recommendations in Ireland are that close contacts of a COVID-19 case should be tested for COVID-19 and restrict their movements for two weeks. It says it was asked by NPHET to undertake a review to identify if the current evidence supports this duration remaining at 14 days.

HIQA says it examined the available evidence on the incubation period (the time from exposure to symptom onset) of COVID-19. It says the review of the incubation period concluded that in the absence of testing, a 14-day period of restriction of movements is likely to capture 95% of individuals who will become symptomatic.

Dr Máirín Ryan is  HIQA’s Director of Health Technology Assessment and Deputy Chief Executive.

“Without changes to the current testing strategy, we advised NPHET that the 14-day period of restriction of movements should remain. It is essential that people who are exposed or potentially exposed to COVID-19 restrict their movements to minimise community transmission as it has been shown that people with no symptoms can spread the infection,” she said.

A statement said NPHET also asked HIQA to explore the potential impact of testing to reduce the period of restricted movements for close contacts of a COVID-19 case from 14 days. Based upon a modelling exercise, HIQA says its advice concluded that any testing strategy to reduce the period of restricted movements from 14 days presents an increased risk of transmission. It says an increased risk in transmission may not be acceptable when considering current levels of community transmission in Ireland.

Dr Máirín Ryan added: “If, at a later stage in the response, changes are made to the current testing strategy for those restricting movements, these changes need to come with a clear communication strategy. It is important that people understand the reasons for the two tests and the implications of receiving a ‘not detected’ first test result, as many people at this early stage may still be in the incubation phase of the disease. Irrespective of any changes, it is vital that people continue to adhere to all COVID-19 public health guidance”.

The documents are available here

EXPLAINER

HIQA says restriction of movements is defined as separating and restricting the movements of people who may have been exposed to COVID-19 as a precautionary measure that they might have the disease. It adds that this is distinct from 'self-isolation' defined as separating those with symptoms of, or diagnosed with COVID-19, from people who are not infected, to prevent transmission.

HIQA explains that the recommended duration of restricted movements is 14 days for individuals identified as close contacts of a COVID-19 case. Close contacts are offered testing on the day they are identified (‘Day Zero’) with a second test offered seven days after last exposure to the COVID-19 case (‘Day 7’). These tests are conducted for contact tracing purposes. A negative result should be interpreted as ‘SARS-CoV-2 not detected’ rather than ‘not infected with SARS-CoV-2’, therefore, individuals must continue to restrict their movements for the full 14-day period regardless of a not-detected test result.

Anyone travelling to Ireland from another country is also advised to restrict their movements for 14 days; this includes citizens and residents returning to Ireland.

HIQA says international recommendations from 22 countries and four agencies were reviewed and show that the 14-day period recommended in Ireland is consistent with current international policy, where a 14-day period of restricted movements is widely recommended, with some countries advising 10 days.

BACKGROUND

Since September 2020, HIQA says it has provided evidence-based advice in response to requests from NPHET. HIQA says its advice to NPHET is informed by research evidence developed by HIQA’s COVID-19 Evidence Synthesis Team, with expert input from HIQA’s COVID-19 Expert Advisory Group. 

The authority says the topics HIQA researches are outlined and prioritised by NPHET to ensure that they have rapid access to the best available evidence relevant to the SARS-CoV-2 outbreak.

HIQA says its COVID-19 Evidence Synthesis Team produces a variety of outputs including rapid health technology assessments, scoping reports, rapid reviews of public health guidance, and evidence summaries, supplemented by an evidence-to-advice framework to guide the development of advice, where appropriate.

HIQA adds that the COVID-19 Expert Advisory Group is a multidisciplinary group, comprising nominated representatives from the relevant clinical specialities and areas of expertise, methodology experts, and public representation.