Two metre physical distancing within the general community and healthcare and residential settings was introduced at the start of the COVID-19 pandemic as a mitigation measure to prevent transmission of the virus between individuals.  Following the roll out of the successful vaccination programme, expansion of testing and the use of face coverings by the general public, physical distancing is no longer obligatory in the general community.

However, users of community and care at home services are amongst the most vulnerable in society and whilst the COVID-19 pandemic remains a threat, it is recommended that physical distancing remains although reductions from 2 metres to 1 metre or more can now be advised in some areas. This applies to vaccination and testing centres also. 

The maximum distance for cross transmission from droplets has not been fully determined, although a distance of approximately 1 metre (3 feet) around the infected individual has frequently been reported in the literature as the highest area of risk.  By applying physical distancing of 1 metre or more within community and care at home settings, we can help mitigate against risk of transmission via pre-symptomatic and asymptomatic individuals. Physical distancing will continue to be reviewed regularly over the winter season and any changes will be informed by COVID-19 prevalence, and nosocomial transmission data of COVID-19 and other respiratory viruses.

Summary of key points

• Physical distancing of 2m must remain for:
  • the COVID-19 high risk category across all settings
  • for staff when FRSMs are removed
• Physical distancing may be reduced across all areas (including waiting areas) to 1 metre or more with the exception of patients/individuals being managed on the high risk category
• Any individual answering yes to any of the triage questions should be placed in the high risk category which will remain at 2 metres physical distancing
• Physical distancing may be reduced amongst staff to 1 metre or more when FRSMs are in use. If FRSMs are removed for any reason e.g eating, drinking, it is advised that 2 metres or more be obtained to avoid high numbers of staff being identified as contacts should a positive case arise
• Physical distancing may be reduced amongst visitors to 1 metre or more.
• Physical distancing in a patient’s/individual’s own home may be reduced to 1 metre or more when staff are not providing direct care.
• These changes to physical distancing do NOT mean a return to pre pandemic practices. NHS Boards and independent contractors must adapt processes to ensure risk of transmission is minimised.
• This is the minimum guidance – where clinical teams or services decide that maintaining 2 metres is necessary they should be allowed to do so e.g when seeing patients/individuals who are extremely clinically vulnerable.

In order for COVID-19 transmission risk to remain low in community and care at home settings, whilst also recommending a reduction to physical distancing, it is essential that all staff, patients/individuals and visitors to healthcare settings adhere with other pandemic measures which remain in place to mitigate risk including:

• Continued adherence with extended use of facemasks (staff) and face coverings (patients & visitors) unless they have a medical exemption
• Maximise the amount of fresh air entering a room wherever possible. Natural ventilation can be achieved by opening windows, vents and doors (excluding fire doors). Some buildings may have mechanical ventilation systems, these should maximise the amount of fresh air being introduced and minimise the recirculation of air in rooms and throughout buildings.
• Avoidance of non-urgent consultations if symptomatic of suspected/confirmed COVID-19 (NB: clinicians should decide locally which suspected/confirmed COVID-19 patients need to attend for face to face consultations and ensure that where they continue as planned, that appropriate measures are taken to mitigate risk including allocation of an appointment that avoids spending time in the waiting areas and ensure there is a segregated area for high risk pathway patients.
• Continued application of the COVID-19 triage questions.
• Continued adherence with Scottish COVID-19 IPC addenda to ensure COVID-19 transmission risk is reduced in particular the application of Standard Infection Control Precautions (SICPs) and where applicable, transmission based precautions (TBPs).
• Signage should be updated throughout all areas to encourage application of physical distancing

Physical distancing amongst staff in community health and care settings

Physical distancing amongst staff may now be reduced to 1 metre or more across community health and care settings provided FRSMs are in use.

Where staff remove FRSMs for any reason e.g eating, drinking, changing, staff are advised to maintain 2 metre physical distancing.  This is because 2 metres is still used to assess contacts and failure to physically distance by 2 metres or more when not wearing an FRSM may result in high numbers of staff within community and care at home settings being considered as a contact and requiring exclusion from work until they can return as per the appropriate requirements associated with Staff exclusion from work. Staff should be supported by their organisation to remind their colleagues when they drop their guard during application of COVID-19 controls.

Outbreaks amongst staff have been associated with a lack of physical distancing in changing areas and recreational/rest areas during staff breaks as well as car-sharing and it is particularly important to utilise all available rooms and spaces to allow staff to change and have rest breaks without breaching 2 metre physical distancing (recognising that staff will not be wearing FRSM in these areas).  Car-sharing should still be avoided whenever practical and mitigations should remain in place.

Physical distancing in a patient’s/individual’s own home may be reduced to 1 metre or more when staff are not providing direct care.

Staff previously identified as having been on the shielding list may wish to discuss how physical distancing impacts them with their line manager and/or occupational health.

Patients/Individuals in Community health and care settings

Physical distancing amongst patients in community health and care settings (including waiting areas) may now be reduced to 1 metre with the exception of patients with suspected or confirmed COVID-19. This will require triage questions to be undertaken on arrival. Any individual answering yes to any of the triage questions should be placed in the high risk category which will remain at 2 metres physical distancing.   Some community care areas will receive individuals who are considered extremely clinically vulnerable.  In these areas, clinical teams may choose to maintain 2 metre physical distancing. 

Patients must be encouraged not to move around waiting areas and should remain seated until called. Removing toys and books may help prevent children circulating in these areas and instead parents may be advised to bring a toy or book belonging to the child to help keep them occupied during the wait time.  Children should be supported by parents/carers with hand and respiratory hygiene.  Members of the same family/household do not need to physically distance in waiting areas.

Patients should be advised not to attend appointments too early wherever possible in order to avoid spending more than 15 minutes in waiting areas and prolonged exposure.

Avoid face to face waiting arrangements in waiting areas, e.g. chairs back-to-back or side to side will reduce risk.

Residents/individuals living in residential home settings

Residents/individuals who live in residential homes are not expected to physically distance from each other.

Where able, residents should be reminded to report any symptoms of COVID-19 to residential home staff. Staff should remain vigilant for early onset of any symptoms amongst residents/individuals taking account of atypical symptoms and where symptoms do develop, act promptly by isolating the resident/individual in their own room and following guidance within the Scottish COVID-19 addendum as per high risk category.

Staff are also reminded to encourage and where necessary support residents/individuals to perform hand hygiene regularly and practice good respiratory hygiene.

Visitors to community and health care settings

Visitors should maintain 1 metre or more distancing from staff and patients within the healthcare facility. 

Visitors may have touch contact with loved ones (hug/kiss) however are reminded that maintaining 1 metre or more distancing outwith direct touch contact wherever possible will help reduce the risk of transmission of COVID-19 and other respiratory pathogens to them, their loved one and others in the healthcare setting.

Visitors answering yes to any of the triage questions should not visit until after they have completed their self-isolation period.

Building based Day Services

Staff working within building based day services should follow the physical distancing guidance as laid out above.  Physical distancing amongst service users of building based day services is included within Scottish Government guidance on physical distancing which can be found at the following on the Scottish Government website at Coronavirus (COVID-19): staying safe and protecting others.

Patient and service user transport vehicles

Physical distancing may be reduced to 1m between patients/service users and staff unless the patients are on the high risk pathway in which case 2 metre physical distancing should be maintained.