Coronavirus and self-isolation after being in contact with a positive case in England: 1 March to 6 March 2021

• Data collected from 1 March to 6 March 2021 show that the majority (90%) of respondents who were required to self-isolate after being in contact with someone who has tested positive for the coronavirus (COVID-19) reported being fully adherent to self-isolation requirements throughout their 10-day self-isolation period.
• Of respondents who reported non-adherent behaviour, 33% reported allowing one or more visitors into their homes and 22% reported leaving home for a medical reason other than getting or returning a COVID-19 test (for example, a doctor’s appointment).
• Contact with non-household members was a non-adherent behaviour reported by 6% of all respondents.
• Over half (52%) of respondents who had downloaded the NHS Test and Trace app received a notification by the app telling them to self-isolate; of these people, 14% received the app notification at least a day before any other sources.
• Approximately a third (32%) of respondents reported that self-isolation had a negative effect on their well-being and mental health, and 28% of respondents reported having lost income because of self-isolation.
• The Test and Trace Contacts Insights Survey was undertaken in response to policy questions on the level of adherence to self-isolation requirements of those who have been notified by the NHS Test and Trace service to self-isolate, having been in contact with someone who had received a positive test result for COVID-19, and other information.

Statistician's comment

"Although it’s a legal duty, self-isolation does disrupt day-to-day life, and we can see that there are key side effects of self-isolation such as worsening mental health and loss of income. Despite this, our analysis shows that a majority of people report fully adhering to the rules throughout their self-isolation period. This behaviour is vital in preventing the spread of COVID-19 and keeping people safe."

Tim Gibbs, Public Services Analysis Team, Office for National Statistics
Follow the Public Services Analysis team on Twitter: @HughStick

In England from December 2020, there is a legal duty to self-isolate for 10 days if you live in the same household as a person who has symptoms of the coronavirus (COVID-19) or who has received a positive test result, or if you have been in close contact with, but do not live with, a person who has tested positive for COVID-19. Prior to this, from September 2020, the legal duty was to self-isolate for 14 days.

This may include contact with people in a person’s support bubble. This legal duty was introduced to enforce existing rules around self-isolation to prevent the spread of the coronavirus.

Data on the self-isolation behaviours of individuals who tested positive for COVID-19 are available in Coronavirus and self-isolation after testing positive in England: 1 February to 13 February 2021.

The data presented in this bulletin were collected from individuals (“contacts”) who had been identified as a contact of someone who had tested positive for COVID-19. The data were collected at the point when the contacts had recently reached the end of their self-isolation period.

These data were collected from 1 to 6 March 2021 during a period of national lockdown, when the legal duty to self-isolate had been in place for more than four months. More information on identifying this group of people, self-isolation, and collecting the data can be found in the Glossary and Measuring the data sections.

The majority (90%) of respondents to the survey reported being fully adherent to self-isolation requirements throughout their whole self-isolation period. Approximately 1 in 10 people (9%) reported at least one activity during their self-isolation that was not adherent to self-isolation requirements.

Non-adherence with self-isolation legislation is illegal unless there are exceptional circumstances such as emergency medical reasons. More information on adherence to self-isolation requirements can be found in Measuring the data.

Non-adherent reasons for leaving the home included medical reasons other than getting or returning a COVID-19 test, for outdoor recreation or exercise, and to go to the shops for groceries, toiletries, medicine, or other items (Figure 1).

Overall, 9% of respondents reported non-adherent behaviour at some point during their self-isolation period. This non-adherent behaviour took place for 3% of respondents during the first 24 hours after being contacted to self-isolate, while 7% reported non-adherence during the period after the first 24 hours until the end of the self-isolation period.

To understand the risk of the coronavirus (COVID-19) spreading, respondents were asked whether, at any point during the period they were required to be self-isolating, they had contact with non-household members. In the first 24 hours from receiving notification to start self-isolating, the majority (97%) had no contact with non-household members. For the period after the first 24 hours until the end of the isolation period, 95% had no contact with non-household members.

A minority (6%) of respondents had contact with non-household members at some point during the whole isolation period.

Of those who had contact with non-household members at some point during their isolation period, the majority (70%) had contact somewhere outdoors. Of those who had contact with non-household members, 1 in 3 (33%) had contact in the form of visitors to their home, excluding people visiting for personal care. (Please note, those that reported they had visitors to their home was represented by a sample count of less than 30.)

Approximately two-fifths (42%) of respondents developed symptoms of the coronavirus (COVID-19). Of those who reported developing symptoms, half (50%) already had symptoms prior to being contacted and 43% developed symptoms less than a week after being contacted by Test and Trace or via the app.

Symptoms that were most frequent were headaches and fatigue, which were experienced by 66% and 63% of those who developed symptoms respectively.

Of all respondents who were fully adherent with self-isolation requirements throughout their whole isolation period, 21% had symptoms before being contacted by Test and Trace, and 1 in 5 (20%) developed symptoms on the same day or after being contacted.

Of respondents who developed symptoms at any point, 9 in 10 (90%) were fully adherent to the self-isolation requirements throughout their whole isolation period. Similarly, of those who tested positive for COVID-19, 90% were fully adherent to self-isolation requirements throughout their whole isolation period.

More than half (59%) of all respondents have taken a test for COVID-19 since being contacted by NHS Test and Trace. Half (50%) of those who were tested went on to receive a positive test result for COVID-19. In total, 29% of all respondents went on to test positive for COVID-19.

Respondents were asked about their interpretation of the requirements for self-isolation to determine how well they understood self-isolation requirements. More than two-thirds (69%) fully understood the requirements. The remaining 31% of respondents either misunderstood or were unsure of the requirements. These respondents provided one or more incorrect interpretation, or one or more “don’t know” answer. More information on understanding of self-isolation requirements can be found in Measuring the data.

The activity that was most likely to be reported by respondents as allowed during self-isolation was going out for medical reasons other than getting or returning a COVID-19 test, for example, a doctor’s appointment (13%) (Figure 2).

Attending routine medical appointments, such as doctors’ appointments, is not allowed during self-isolation but there are exceptions for medical emergencies. Those who reported that this activity was allowed may have been referring to this exception, so it is possible that understanding of guidance is higher than reported here.

More than a third (37%) of all contacts mistakenly believed they could not go out to get or return a COVID-19 test during self-isolation. Answers to the question asking people if they believed they could go out to get a COVID-19 test during self-isolation were not factored into the measure of understanding, as misunderstanding this rule would not prevent the respondent from correctly following the requirements.

Most respondents (83%) agreed that “it was easy for me to self-isolate”. Approximately a third (32%) of respondents reported that self-isolation had a negative effect on their well-being and mental health. But, the average life satisfaction score for all respondents was 7.3 (out of 10)¹, which is significantly higher than the life satisfaction of the general adult population in England, at 6.7²,³ (Opinions and Lifestyle Survey (COVID-19 module), England, between 3 March 2021 and 7 March 2021).

Just over a quarter (28%) of respondents reported a financial impact in the form of lost income because of self-isolation. Of those who had been working prior to self-isolation (either in or outside the home)⁴, 15% were not paid during the isolation period. A further 7% received only statutory sick pay (Figure 3).

Notes for: Ease and impact of self-isolation

1. Estimates for “all respondents” are calculated from the Test and Trace Contacts Insights Survey between 1 and 6 March 2021, and represent those required to self-isolate after being in contact with someone who had tested positive for the coronavirus (COVID-19) who responded to the survey.
2. Estimates for the “general population” are calculated from the Opinions and Lifestyle Survey (COVID-19 module) between 3 March 2021 and 7 March 2021, and represent the English population.
3. Please note that these two surveys have different data collection methods, therefore should not be compared directly but can be considered in reference to each other.
4. This includes those who were in full-time or part-time paid work, or self-employed, including being part of the Self-Employed Income Support Scheme (SEISS) when they began self-isolating.

Approximately half (51%) of all respondents had downloaded the NHS Test and Trace app. Approximately half (52%) of those who had downloaded it received a notification by the app telling them to self-isolate.

Of those who received an app notification telling them to self-isolate, 14% received the notification at least one day before they were notified by other sources (Table 2).

The majority (95%) of all respondents who received an app notification did not leave home for any reason in the first 24 hours after being asked to self-isolate.

Self-isolation

Self-isolation refers to not leaving your home because you have been informed by NHS Test and Trace that you are a contact of a person who has had a positive test result for the coronavirus (COVID-19). You must stay at home and complete 10 full days of isolation. It is a legal requirement to self-isolate if you have been notified to by the NHS Test and Trace service. Your isolation period includes the date of your last contact with them and the next 10 full days. If you develop symptoms, stay at home and arrange to have a PCR test for COVID-19.

In addition to staying home, if you are self-isolating you should not receive visitors, unless the purpose of the visit is to provide essential care.

For further information please see NHS guidance When to self-isolate and what to do.

Lockdown

On 5 January 2021, the UK government announced a further national lockdown for England. On 22 February 2021, the UK government published a four-step roadmap to ease lockdown restrictions in England.

Survey information

The Test and Trace Contacts Insights Survey was compiled in response to policy questions on the level of adherence with self-isolation requirements, the prevalence of behaviour that poses a risk of transmitting the coronavirus (COVID-19), and the impact of self-isolation on well-being and finances. It was produced, run and analysed in a collaboration between the Department for Health and Social Care (DHSC), Public Health England (PHE) and the Office for National Statistics (ONS).

This survey was specifically designed to obtain information on people who have been identified as a contact of someone who had tested positive for COVID-19 and who are at the end of their 10-day self-isolation period. ONS experts were consulted on questionnaire design.

The survey respondents were randomly selected from a list of adults (aged 18 years or over) who had been notified as being in contact with someone who has tested positive for COVID-19 and were required to begin self-isolation on 19 February 2021 or 22 February 2021. Respondents were contacted by telephone and all answers are self-reported.

This is the first bulletin in this series. This wave of the survey is a pilot that will be used to improve the quality of information in future waves. The statistics contained in this bulletin are Experimental Statistics.

Estimates for Wave 1

The first wave of data was collected between 1 and 6 March 2021. The sample size was 1,212. The sample was stratified to be representative of the age, sex and regional distribution of the population being sampled.

Percentages in this report are based on weighted counts that are representative of the population of adults (aged 18 years or over) notified as being in contact with someone who has tested positive for COVID-19 between 1 February 2021 and 28 February 2021 and are adjusted to address age, sex and regional bias in responses.

Significance testing and confidence intervals have been used to test for differences. Where a difference is statistically significantly different, we can be more confident that the difference really exists.

Of those potential respondents who were successfully contacted by an interviewer, the response rate was 54.8%. When including cases where contact was attempted but not made, the response rate was 18.8%. As with all surveys, these estimates have an associated margin of error.

Identifying individuals at the end of their self-isolation period

Respondents were randomly sampled through the Contact Tracing and Advice Service (CTAS) database, held by NHS Test and Trace. This list was created by NHS Test and Trace to record information about people who have been in contact with someone who had tested positive for COVID-19. The sample was limited to those who had provided a valid phone number and who had been entered onto the CTAS database at the point of sampling.

The majority (95%) of respondents were interviewed within four days of the end of their self-isolation period, in order to minimise recall bias. The longest time between the end of self-isolation and interview was 6.5 days.

Understanding self-isolation requirements

Respondents to the survey were asked what activities they believed were allowed during self-isolation (from a list of reasons for leaving the home) and how long they believed someone must self-isolate after testing positive. For the purpose of this analysis, respondents were categorised as having fully understood self-isolation requirements if they:

• did not select any reason for leaving the home not permitted during self-isolation (such as going to work or to the shops)
• reported a number between 10 and 14 days for the required number of days that someone must self-isolate after notification

This range above 10 days was included in order not to discount those who believed it necessary to self-isolate slightly longer than stated in current requirements. Those who reported a number above 14 were counted as having misunderstood the requirements.

Some reasons for leaving the home are permitted in exceptional circumstances (such as medical emergencies). Those who reported that certain activities were allowed may have been referring to these exceptions, so it is possible that understanding of guidance is higher than reported here.

Adherence to self-isolation requirements

Respondents were categorised as having adhered to self-isolation requirements if they:

• did not leave their home during self-isolation, except to get or return a test for coronavirus (COVID-19)
• did not receive any visitors during self-isolation, except for visitors supporting their personal care

Individuals who left their home or had visitors for other reasons may have been adherent with the requirements if they did so because of exceptional circumstances. This means a small number of individuals may be mis-categorised as non-adherent.

Adherence is measured until the end of self-isolation, or until the point of the survey if isolation has lasted beyond 10 days because of continued symptoms.

Contact with non-household members

For the purpose of this analysis, contact with non-household members was defined as either physical contact for any length of time or being within two metres (six feet) of someone for at least a few minutes during a trip out of the house. Having visitors to the home was also counted as contact with non-household members if these visitors were not providing personal care.

The main strengths of the Test and Trace Contacts Insights Survey include:

• timely production of data and statistics that can respond quickly to changing needs, as the questions included are reviewed for each wave
• the sample was stratified to be representative of the age, sex and regional distribution of the population being sampled and percentages are based on weighted counts representative of the population
• quality assurance procedures are undertaken throughout the analysis stages to minimise the risk of error
• confidence intervals have been used to determine whether differences across time periods and groups are statistically significant

The main limitations of the Test and Trace Contacts Insights Survey include:

• because of the limited period in which fieldwork took place, it is difficult to reach a large number of people and therefore the overall sample size for the survey is limited
• the behaviour of respondents during self-isolation is self-reported and may be subject to recall-bias, which influences how accurately respondents are able to recall past events and experiences; most interviews took place within four days of the end of self-isolation to reduce this bias
• the Experimental Statistics presented in this bulletin contain uncertainty; as with all survey data based on a sample, there is an element of uncertainty as they are susceptible to respondent error and bias
• because of the nature of the target population, in which a large proportion of contacts self-isolating are members of the same household, it is possible that the sample could include multiple members of the same household