COVID-19: testing during periods of low prevalence
Explains the purpose of ongoing testing and sets out who is currently eligible for access to testing and when tests should be used.
The role of testing
As set out in the Living with COVID-19 strategy, the government’s objectives in this phase of the coronavirus (COVID-19) response are to increasingly enable the management of COVID-19 in line with other respiratory illnesses, whilst protecting and treating those who are most vulnerable to more serious outcomes.
Testing of residents, patients or staff who are symptomatic or to manage an outbreak in high-risk settings will continue throughout 2022 to 2023. At times (for example during periods of high prevalence, when transmission of COVID-19 from the community is more likely) asymptomatic testing may also be deployed in some settings.
Individuals and settings continue to be protected by COVID-19 vaccination (including boosters), population immunity from infection and, for individuals at higher risk of severe illness in high-risk settings, ongoing availability of symptomatic testing. This will continue to provide vital protection against outbreaks in these settings and those who are at highest risk of serious illness will continue to be able to access testing and treatments for COVID-19.
Current testing proposals
Routine asymptomatic testing will be paused from 31 August. Specific operational guidance will continue to be provided to different settings providing details of the types of tests and how these should be used.
The government continues to utilise both polymerase chain reaction (PCR) and rapid testing via lateral flow device (LFD) tests. The majority of testing is now conducted by LFD tests. PCR testing is only advised in certain circumstances, typically in the NHS where there is direct access to a laboratory that can provide rapid results.
Where symptomatic testing is recommended, this should be based on the current list of COVID-19 symptoms.
Testing currently recommended in NHS settings
| Situation | Type of test |
|---|---|
| Symptomatic high risk patients identified for COVID-19 monoclonal antibody and antiviral treatment | PCR or LFD |
| Symptomatic patients for clinical diagnostic pathway |
PCR Primary care testing may also use LFD |
| Early release from self-isolation for patients in acute settings | LFD testing from day 5 onwards to get 2 negative tests |
| Early release from self-isolation for patients in acute settings | LFD testing from day 5 onwards to get 2 negative tests |
| Symptomatic or immunocompromised maternity patients who are admitted for elective or emergency care | PCR on site |
| Symptomatic or immunocompromised elective care patients prior to acute day case/overnight pre-admission | LFD home testing |
| Transfers into or within hospital for immunocompromised patients | PCR on site |
| Discharge patients to care homes/hospices | PCR unless they have been positive for COVID-19 within 90 days – then it is an LFD test |
| Symptomatic NHS staff and staff in NHS-commissioned Independent Healthcare Providers (including return to work testing) | LFD home testing |
| Outbreak testing in healthcare settings | Both PCR and LFD in specified protocol |
Local healthcare organisations, with appropriate advice (including from Medical Directors, Nursing Directors or Directors of Infection Prevention and Control), may exercise local discretion to continue testing for specific individuals or cohorts in line with broader infection prevention and control measures, for example to asymptomatically test staff or patients who are at higher risk of serious illness from COVID-19 and/or may be in contact with patients who are at higher risk of serious illness from COVID-19.
Testing currently recommended in care services (adult social care and hospices)
| Situation | Type of test |
|---|---|
| Admission testing from the community for care homes and hospices | PCR unless they have been positive for COVID-19 within 90 days – then it is an LFD test |
| Symptomatic adult social care and hospice staff (including return to work testing) | LFD home testing |
| Symptomatic care home, extra care and supported living and hospice residents | LFD |
| Early release from self-isolation for residents in care homes and hospices | LFD |
| Rapid response testing in care homes, high-risk extra care and supported living settings, and hospices | LFD |
| Outbreak testing in care homes | Both PCR and LFD in specified protocol |
Adult social staff includes staff of care homes, homecare organisations, eligible extra care and supported living services, eligible adult day care centres, personal assistants, Shared Lives carers, Care Quality Commission (CQC) inspectors and social workers as defined in COVID-19 testing in adult social care.
Testing currently recommended in other non-healthcare settings
Other settings include prisons, young offender institutions, secure training centres, IRCs, asylum reception centres, asylum hostel accommodation, residential special educational needs and disability (SEND) settings, defence detention, defence healthcare, night shelters, outreach services, domestic abuse refuges, respite rooms, homeless shelters and temporary accommodation.
| Situation | Type of test |
|---|---|
| Reception testing in line with public health advice for symptomatic prisoners of prisons and IRCs | LFD |
| Symptomatic testing in prisons; night shelters; homelessness services, hotels and other temporary accommodation; other outreach services including day centres; domestic abuse refuges; respite rooms; IRCs, asylum reception centres and asylum hostel accommodation; defence healthcare (including return to work testing) | LFD |
| Outbreak testing in prisons; night shelters; homelessness services, hotels and other temporary accommodation; respite rooms; IRCs, asylum reception centres and asylum hostel accommodation; SEND residential settings; defence detention | LFD |
Detailed setting specific guidance will be published shortly. There may be exceptions where local health protection teams advise temporary asymptomatic reception testing in certain circumstances. In these instances health protection teams will provide advice directly to settings.