Coronavirus (COVID-19): framework for decision making - overview of public engagement

11. Test, Trace, Isolate, Support

The Scottish Government 'pre-seeded' an idea on the platform as a prompt for discussions about the 'Test, Trace, Isolate, Support' strategy (TTI).^[19] This prompted discussions on the TTI strategy- including support, scepticism, and suggestions for how the strategy could be made most effective. It also prompted wider conversations about reducing barriers to testing within Scotland. The merits of a UK-wide approach to testing were discussed - including the use of a contact tracing app. Views were also shared on the need for increased antibody testing capacity.

Test, Trace, Isolate and Support Strategy

Many respondents indicated their support for the TTI strategy and felt that it represents the right way forward. However, it was clear that some support from respondents was also accompanied by a frustration that such a strategy had not been implemented consistently from the outset of the pandemic.

There was support behind the notion that testing should be available to all. Many respondents were supportive of mass testing of the entire population. It was argued that a mass testing exercise is essential for economic recovery, and necessary due to the large proportion of asymptomatic carriers. Others focussed on increasing testing capabilities in certain key locations - such as airports - to prevent new cases being imported from abroad.

There was also debate among respondents about how the TTI strategy should co-exist alongside other social restrictions. For many respondents, it is essential that TTI is in place and functioning before any restrictions are eased. However, there was a view that once TTI is in place, it could be introduced in tandem with the relaxation of certain social restrictions - for example, increased amounts of contact with family, friends, or small 'bubbles.' Some took a less cautious outlook, and felt that the introduction of TTI could mean that social distancing can be stopped completely.

"TTI needs to be in place and is essential prior to any lifting of any lockdown restrictions."

Others disagree with social restrictions being eased as the TTI strategy comes into effect. They feel it is too early and risky to ease lockdown, even with TTI in place.

Respondents made a number of suggestions about how the TTI strategy should work in practice. These included suggestions that:

• individual households should keep track of their own "infection chain"
• testing must be offered locally at community level
• a TTI tracing app could be combined with manual tracing, with assistance from furloughed workers or volunteers.
• people should carry "passports" or "cards" once tested and this would enable those who are sick to isolate and those who are well to return to "normal."
• testing should be co-ordinated as quickly as possible - so that people do not get negative results, but actually then contract the virus during the time they were waiting for those results.

A small number of respondents argued that TTI should be backed up with legislation, and that the requirement to isolate if ill must be compulsory and policed, while others raised human rights concerns in regards to this. Similarly, there was a suggestion for enforced centralised isolation for those who tested positive for the virus - but others again raised human rights concerns around this, as well as highlighting how this could put people off self-reporting. It was also argued by some respondents that TTI won't be effective unless borders are closed or entrants quarantined or must isolate for 14 days.

Several respondents raised concerns around the economic impact on individuals who have to self-isolate as part of TTI, as some may have to do so repeatedly and may suffer financially. There is a concern that the requirement to isolate will disproportionally affect vulnerable and lower income groups. It was argued that unless financial support is available, many will not isolate.

There were calls for the Scottish Government to work with employers, unions, and workers to ensure fair work principles and protections are in place for people who have to self-isolate. This should also apply to those who are self-employed.

Alignment with UK

Many respondents feel a UK-wide approach must be taken in terms of TTI for consistency, as doing otherwise would lead to confusion and complications for populations - especially those that live near the Scotland-England border.

"Please agree with UK government approach, having differing systems will cause confusion."

However, there is not universal agreement for consistency between the UK and Scottish Governments. Some feel the UK approach is unsatisfactory and that the Scottish Government should continue with their own approach for minimising the future transmission of the virus. Amid discussions that often cited the approaches of other nations, a number of respondents highlighted the New Zealand approach to reducing transmission. ^[20]

Use of a contact tracing app

Many respondents spoke positively about the use of a digital app to facilitate contact tracing - especially if it was a UK-wide project.

However, a large number of respondents raised ethical and logistical concerns about the app. A recurring concern was around privacy and data protection, with many respondents emphasising that they would not feel confident or comfortable using such an app until these privacy concerns were addressed by the Scottish Government. Other concerns included potential low take-up rates and some therefore felt that decisions to lift any restrictions should be dependent on a certain percentage of the population being registered on an app. Others shared worries about accessibility and a reliance on self-reporting.

"The privacy issues need to be fully addressed explained and again informed choices allowed to be made. I would probably use it but would want to have knowledge about what exactly the risks are both to my security and privacy."

"I am a pensioner and find technology confusing. I do not take my phone out with me but just use it at home. I don't know anything about Bluetooth but would worry about my security of passwords for banking. Think a lot of people like me will find this hard."

There were also reservations about the possibility that a contact tracing app could be vulnerable to biases which may only reinforce inequalities. There was a view that an app could exclude the elderly, the homeless, other vulnerable groups, or those with incompatible devices.

"The use of mobile phone apps would exclude a large amount of non-technical people including the elderly and those on low incomes, many of whom do not own mobile phones or Bluetooth enabled mobile phones. In addition many people may choose not [to] download apps due to security / privacy issues and the excessive drain on their mobile phones battery."

Nevertheless suggestions to make the app more effective included:

• linking phones to medical records
• having the functionality to book tests through the app
• getting results via the app
• automatically alerting people if they need to self-isolate
• addressing privacy concerns

Antibody testing

Many saw antibody tests as a crucial part of the overall picture for Coronavirus (COVID-19) testing. Some called for antibody testing to be made more routinely available. While others took a stronger view, advocating that the success of TTI was dependent on the availability of high-quality antibody tests to the entire population.

There was a broad agreement for the idea that people who are confirmed to be immune could be given "immunity cards."