Mar 28 2020
As of 19 March 2020, COVID-19 is no longer considered to be a high consequence infectious diseases (HCID) in the UK.
The UK public health HCID group made an interim recommendation in January 2020 to classify COVID-19 as an HCID. This was based on consideration of the UK HCID criteria about the virus and the disease with information available during the early stages of the outbreak. Now that more is known about COVID-19, the public health bodies in the UK have reviewed the most up to date information about COVID-19 against the UK HCID criteria. They have determined that several features have now changed; in particular, more information is available about mortality rates (low overall), and there is now greater clinical awareness and a specific and sensitive laboratory test, the availability of which continues to increase.
The Advisory Committee on Dangerous Pathogens (ACDP) is also of the opinion that COVID-19 should no longer be classified as an HCID.
The need to have a national, coordinated response remains, but this is being met by the government’s COVID-19 response.
Cases of COVID-19 are no longer managed by HCID treatment centres only. All healthcare workers managing possible and confirmed cases should follow the updated national infection and prevention (IPC) guidance for COVID-19, which supersedes all previous IPC guidance for COVID-19. This guidance includes instructions about different personal protective equipment (PPE) ensembles that are appropriate for different clinical scenarios.
Definition of HCID
In the UK, a high consequence infectious disease (HCID) is defined according to the following criteria:
acute infectious disease
typically has a high case-fatality rate
may not have effective prophylaxis or treatment
often difficult to recognise and detect rapidly
ability to spread in the community and within healthcare settings
requires an enhanced individual, population and system response to ensure it is managed effectively, efficiently and safely
Classification of HCIDs
HCIDs are further divided into contact and airborne groups:
contact HCIDs are usually spread by direct contact with an infected patient or infected fluids, tissues and other materials, or by indirect contact with contaminated materials and fomites
airborne HCIDs are spread by respiratory droplets or aerosol transmission, in addition to contact routes of transmission
List of high consequence infectious diseases
A list of HCIDs has been agreed by a joint Public Health England (PHE) and NHS England HCID Programme:
Contact HCID
Argentine haemorrhagic fever (Junin virus)
Bolivian haemorrhagic fever (Machupo virus)
Crimean Congo haemorrhagic fever (CCHF)
Ebola virus disease (EVD)
Lassa fever
Lujo virus disease
Marburg virus disease (MVD)
Severe fever with thrombocytopaenia syndrome (SFTS)
Airborne HCID
Andes virus infection (hantavirus)
Avian influenza A H7N9 and H5N1
Avian influenza A H5N6 and H7N7
Middle East respiratory syndrome (MERS)
Monkeypox
Nipah virus infection
Pneumonic plague (Yersinia pestis)
Severe acute respiratory syndrome (SARS)*
*No cases reported since 2004, but SARS remains a notifiable disease under the International Health Regulations (2005), hence its inclusion here
**Human to human transmission has not been described to date for avian influenza A(H5N6). Human to human transmission has been described for avian influenza A(H5N1), although this was not apparent until more than 30 human cases had been reported. Both A(H5N6) and A(H5N1) often cause severe illness and fatalities. Therefore, A(H5N6) has been included in the airborne HCID list despite not meeting all of the HCID criteria.
Hospital management of confirmed HCID cases
Once an HCID has been confirmed by appropriate laboratory testing, cases in England should be transferred rapidly to a designated HCID Treatment Centre. Occasionally, highly probable cases may be moved to an HCIDTreatment Centre before laboratory results are available.
Contact HCIDs
There are 2 principal Contact HCID Treatment Centres in England:
the Royal Free London High Level Isolation Unit (HLIU)
the Newcastle Royal Victoria Infirmary HLIU.
Further support for managing confirmed contact HCID cases is provided by the Royal Liverpool Hospital and the Royal Hallamshire Hospital, Sheffield.
Airborne HCIDs
There are 4 interim Airborne HCID Treatment Centres in England. Adult and paediatric services are provided by 6 NHS Trusts:
Guy’s and St Thomas’ NHS Foundation Trust (adult and paediatric services)
Royal Free London NHS Foundation Trust, with a paediatric service provided by Imperial College Healthcare NHS Foundation Trust
Royal Liverpool and Broadgreen University Hospitals NHS Trust, with a paediatric service provided by Alder Hey Children’s NHS Foundation Trust
Newcastle upon Tyne Hospitals NHS Foundation Trust (adult and paediatric services)