Coronavirus COVID-19: latest advice and resources for staff posted: 10 March 2020 updated: 16 March Sections: Overview Useful websites and contacts Identifying potential risks Preventing the spread of the virus How we ask the key questions Staff Volunteers and visitors Guests Responding to potential risks Self-isolation for homeless people Protective equipment New 16 March: Advice on serving meals Partner drop-ins 1. Overview We have taken a considered view and decided to continue delivering our caseworker service for as long as is operationally possible and to keep our night shelters open until the final night on 5 April as planned, if this possible, albeit on a reduced basis and with precautions in place. This page details some of the changes we have made. So that we can keep delivering our vital core shelter service, we made some difficult decisions on 16 March that slim down our service delivery to minimise the risks to all. These decisions are: We will not be accepting any new guests into the shelters. Our waiting list is now closed, and all guests on the waiting list have been contacted. We will not be accepting any guests on a “one night only” basis. Only guests who are currently on our shelter attendance list will be able to stay. Starting from 16 March, we will not be providing a “dinner only” service. On 16 March, we will provide takeaway food to “dinner only” guests and a flyer informing them that there will be no dinner only service, including no takeaway food, for the remaining three weeks of our shelter season. Please know we are keeping a constant watch on government guidance and adapting our precautionary and preventative measures. The risk to the UK has now been raised to "high". Furthermore, homeless people staying in night shelters are at increased risk of all viral infections due to their close proximity to others in the night shelter environment. 2. Useful websites and contacts Glass Door staff should speak to Megan Preston ([email protected] or 020 7351 4948), or the on-call manager during shelter operation hours, if they have questions or need support. Key websites for covid-19 NHS 111 coronavirus online screening (takes 1 minute to complete on a smart phone): https://111.nhs.uk/service/COVID-19/ Government advice for covid-19 (updated daily at 2pm): https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public 3. Identifying potential risks Know the symptoms The main symptoms are: cough, high temperature, shortness of breath. Someone will not know the difference between cold and flu and COVID-19 unless they are tested. Only people with symptoms can be tested (for test accuracy reasons), but people without symptoms could still be carrying the virus. It’s therefore important to ask people about other risk factors (see Key questions to ask everyone below). Key questions to ask everyone Do you have a cough, high temperature (feeling hot to touch on the chest or tummy) or shortness of breath? Have you lived with or had close contact with someone who has a confirmed case of coronavirus? What to do if someone says Yes to one of the key questions Yes to Q1: Any volunteer, visitor or staff member who answers “yes” to Question 1 must not attend our services and should consult the government website for further instructions, including whether a call to NHS 111 is needed. Any staff member who answers “yes” to Question 1 must not attend our services until they have consulted their line manager. Any guest who answers yes to Question 1 should consult NHS 111 for advice, except if they have a cough which is not a “new continuous cough”. If you are unsure, err on the side of caution and consult NHS 111 for advice about if the guest is a risk. Yes to Q2: Any guest, volunteer, visitor or staff member who answers “yes” to Question 2 must not attend our services and should consult the government website for further instructions, including whether a call to NHS 111 is needed. note: the key questions above are available as a double-sided A5 laminated guide. Shelter Managers: please keep a copy by the shelter entrance and volunteer sign-in sheet and ask all new guests and all volunteers and visitors daily, as soon as they arrive. 4. Preventing the spread of this virus Facts are still emerging about the virus but it’s possibly transmitted by droplets in the air from coughing and sneezing, and by touching your face, nose and mouth. Government advice The main action everyone should be taking in response to coronavirus is to regularly wash their hands for 20 seconds and cover their mouth with a disposable tissue when sneezing or coughing. NHS advice The NHS advises to follow general infection control measures: Wash your hands regularly with soap and water, for 20 seconds – use hand sanitiser gel if soap and water are not available Cover your mouth and nose with a disposable tissue or your sleeve (not your hands) when you cough or sneeze Put used tissues in the bin straight away Avoid contact with people who are unwell or showing symptoms of respiratory illness, such as coughing and sneezing Do not touch your eyes, nose or mouth if your hands are not clean Practical things you can do Good hygiene protects against all types of illnesses, not just COVID-19. Ensure washrooms are supplied with antibacterial soap and paper towels Make hand sanitising gels and tissues available to all Clean tables with an antibacterial spray both before and after meals Clean other surfaces with an antibacterial spray before preparing food Remind guests to wash their hands before meals Keep hand sanitising gel by the entrance and registration point Put-up posters reminding people to wash their hands (such as the government issued NHS coronavirus public info A4 poster) In Glass Door night shelters, staff should spray roll mats weekly and make sanitising spray available for guests to use on their mats daily Shopping list Glass Door are providing: antibacterial soap in bathrooms, tissues, paper towels, antibacterial cleaning sprays and 60%+ alcohol hand sanitising gel. If stocks allow, we will purchase some N95 masks – a small number as we’re unlikely to need them and stocks are low for medical professionals who do. Alcohol hand sanitising gels Hand sanitising gels are most effective if they are above 60% alcohol content. If your service has guests with alcohol or substance misuse issues, use of these products should be supervised. Services may choose to use larger bottles for ease of monitoring their whereabouts, though these are in short supply. Antibacterial products Antibacterial products won’t work any better than regular cleaning and sanitising products against Covid-19 and other viruses, as they fight bacteria not viruses. However, antibacterial products are still a good choice for a service environment to prevent the spread of other kinds of illnesses. 5. How we ask the key questions Staff All Glass Door staff have received this guidance and should consult their line manager before coming to work if they have recently been to an area with a serious outbreak (category 1 or 2) or have reason to believe they may have the virus. Volunteers and visitors In Glass Door night shelters, all Volunteer Coordinators should be asking their volunteers the key questions (see Key questions to ask everyone section) by text or email before they attend each shelter shift. Volunteers should be asked again as soon as they arrive at the shelter. Shelter Managers should also remind volunteers about the key questions and hygiene standards during the volunteer briefing. All other Glass Door volunteers should be asked the key questions by text or email from their supervisor before their shifts, whether they volunteer in our office, at Women’s Group or supporting the casework team. Volunteers and visitors must NOT attend a Glass Door service if they have recently been to an area (category 1 or 2) with a serious outbreak or have reason to believe they may have the virus. See Key questions to ask everyone. Guests In Glass Door night shelters, all Shelter Managers will keep a laminated copy of the list of Key questions to ask everyone by the entrance to serve as a reminder to existing guests, and new guests will be directly asked the questions at the door, before they are admitted inside the shelter. An appropriate equivalent of this arrangement will be implemented for Women’s Group. We are purchasing heat sensor thermometers to help us identify guests who may have a fever on arrival at the night shelter. All guests have received a text message instructing them not to come to the shelter if they have a new continuous cough and/or a high temperature. 6. Responding to potential risks What to do if you suspect a guest, volunteer or colleague could be infected: If someone is present at your service and has answered “yes” to one of the key questions (see “Key questions to ask everyone” section), they should immediately leave the service and follow government and NHS 111 advice. Do not call an ambulance. They should not go to a pharmacy, GP surgery or hospital. They should not take public transport or a taxi. If the person that you suspect could be infected is homeless, if possible, support them to find a place to temporarily self-isolate while they consult NHS 111. This could be a space that is away from your service’s other guests, such as an enclosed room or outside if there is no enclosed room available, and arrange for them to consult NHS 111 from there. Initially, you can use the NHS 111 online screening (https://111.nhs.uk/service/covid-19) to check whether they need to then make an NHS 111 phone call. A staff member could support them with the phone call to ensure that NHS 111 are aware this is a homeless person with no home in which to self-isolate. Please note that calling NHS 111 could require waiting for a call back (3.5 hours in our recent case). While maintaining a distance of 2 metres, use the phone’s loud speaker function to avoid sharing a phone with a potentially infected person. Any staff members, volunteers or guests who have been in close contact with the potentially affected person should wash their hands for at least 20 seconds (see “NHS advice” section). Following the NHS 111 phone call, you should have clarity on whether the individual is: Able to remain in your service In need of testing (in which case the NHS 111 service will arrange this, including things like safe transport to hospital by an ambulance team in protective suits if NHS 111 deems it necessary – as before, do not call an ambulance) Advised to self-isolate (see “Self-isolation for homeless people” section) 7. Self-isolation for homeless people What to do if NHS 111 advises a homeless person should self-isolate So far, there are no known cases of a homeless individual needing to self-isolate (noting the exception of a false alarm where the NHS 111 service was overly cautious about a Glass Door shelter guest, before this advice was retracted by Public Health England). Medical professionals continue to advise us that a homeless person needing to self-isolate is deemed unlikely to occur at present. There are some recommendations below for what you should do if this unlikely situation did occur. If an individual has recently returned from an affected foreign country (locations and time periods as advised by PHE/govt information and NHS 111 service), they may be advised to self-isolate for a set time period. This is a form of voluntary quarantine at home. For many homeless individuals, this is impossible, and Glass Door and other charities in the sector have raised this with the government and Public Health England. Our caseworkers may be supporting people staying in non-shelter forms of accommodation for homeless people, such as hostels, in which an individual may be able to self-isolate. In cases where there are facilities available to isolate them in a room, and they will be able to receive takeaway food deliveries, they should self-isolate. For shelters and other forms of accommodation where it is not possible for an individual to self-isolate, staff should consult the London Coronavirus Response Cell/Centre (LCRC) for advice on supporting the individual to find a solution to this self-isolation problem. There is a London Health Isolation Centre near Heathrow. In the case of a homeless individual needing to self-isolate, this may be a potential solution, according to LCRC. Others may be hostels with “safe zones” or isolated private rented sector accommodation. A decision about appropriate action would be made on a case-by-case basis, with a multi-agency approach to finding a solution. Glass Door night shelter staff can contact the on-call manager for support with contacting the LCRC. Individuals who have been advised by NHS 111 to self-isolate but not get tested should be excluded from shelter services until the end of the time period advised by NHS 111 or until such a time as they have developed symptoms and been tested. Getting a test while the individual does not have symptoms, in the hope of ruling the virus out and being able to welcome them into a shelter service, is not helpful. This is because the testing is likely to result in a false negative until symptoms present. Anyone who has been advised to self-isolate should not take any form of public transport or taxi, and should not go to a GP surgery, pharmacy or hospital. 8. Protective equipment Gloves Our main recommendation is regular, thorough hand washing. We have always carried disposable gloves on our vans so shelter volunteers are welcome to use these if they wish. If you choose to wear gloves, be careful not to touch your face and change gloves regularly. Face masks We will not be providing volunteers with face masks because these should only be used by symptomatic individuals or by those caring for symptomatic individuals in clinical settings. There is a shortage of these for the medical staff who need them so it is unhelpful for those who don’t need them to purchase them. According to the World Health Organisation, healthy people should only use a face mask if they are caring (usually in a medical setting) for someone who has a suspected case of coronavirus. “Facemasks are not recommended as an effective means of preventing the spread of infection. They play an important role in clinical settings, such as hospitals, but there’s very little evidence of benefit from their use outside of these settings.” (source: gov.uk 16th March 2020). World Health Organization guide: When and how to use and dispose of face masks Any volunteer who doesn’t feel comfortable volunteering at this time should not come. 9. Meals advice We have disposable plates and cutlery available on all shelter vans, so we will move to using these instead of crockery that would need to be handled and washed. If your shelter is spacious, you may be able to space guests out a bit more than usual at the dinner table, but we appreciate that some venues are very tight and this will not be possible. Unfortunately we’re advising that volunteers do not sit and eat with guests at this time. 10. Our partner daytime drop-ins Some of our partner daytime drop-ins are closed due to the virus. We will be keeping a list of those that are open and closed and will share with staff, partners and the public when available. While drop-ins are closed, our caseworkers will continue to provide a service to our guests by meeting some of them in public spaces like cafes while this remains possible.