Coronavirus (COVID-19): Scotland's Route Map - supporting evidence - 20 August 2020 review

Introduction

Scotland's Route Map, published on 21 May, describes an evidence-led, transparent and phased approach to varying restrictions. To judge whether and when restrictions can be changed, a range of evidence will be considered on the progress of the pandemic in Scotland including what we know about the reproduction rate of the virus and data on the number of infectious cases.

We are currently within Phase 3 of our Route Map and the criteria for entering Phase 3 were:

• R is consistently low and there is a further sustained decline in infectious cases.
• WHO six criteria for easing restrictions must be met.
• Any signs of resurgence are closely monitored as part of enhanced community surveillance.

Box 1 below shows the relevant WHO criteria:

Box 1: World Health Organisation: six key criteria for easing restrictions

1. Evidence shows that COVID-19 transmission is controlled.

2. Sufficient public health and health system capacities are in place to identify, isolate, test and treat all cases, and to trace and quarantine contacts.

3. Outbreak risks are minimized in high vulnerability settings, such as long-term care facilities (i.e. nursing homes, rehabilitative and mental health centres) and congregate settings.

4. Preventive measures are established in workplaces, with physical distancing, handwashing facilities and respiratory etiquette in place, and potentially thermal monitoring.

5. Manage the risk of exporting and importing cases from communities with highrisks of transmission.

6. Communities have a voice, are informed, engaged and participatory in the transition.

The criterion which must be met before a move into Phase 4 is as follows:

"[The] virus is no longer considered a significant threat to public health."

This demanding condition reflects the risks associated with the easing of restrictions that would take place in Phase 4 in the event that the virus continued to represent a public health threat.

Supporting evidence for the move into Phase 1 was published on 28 May; for the move into Phase 2 on 19 June; and for Phase 3 on 14 July. Supporting evidence for the decision to remain in Phase 3 was also published on 4 August.

This current document has been completed by the Scottish Government to inform decisions about timings of changes within Phase 3 as set out at the review point on 20 August.

The data on the R value is sourced from Coronavirus (COVID-19): modelling the epidemic in Scotland (Issue No 14) published on 20^th August. This sets out Scottish Government modelling of the spread and level of COVID-19 using data from the week up to 14^th August 2020 using epidemiological modelling. The latest data on the infectious pool is sourced from Coronavirus (COVID-19): modelling the epidemic in Scotland (Issue No 13) published on 20^th August.

The evidence on supplementary measures has been compiled from a range of data sources including the daily data published on the Scottish Government Coronavirus (COVID-19): daily data for Scotland web page and from weekly reports published by Public Health Scotland and National Records of Scotland. This evidence is based on the available published data at 20 August.

Evidence of progress against each of the Phase criteria is set out below.

The data set out in this publication are those that were available ahead of the 20 August review to inform the relevant decisions (more recent data may have been published since then).

Progress against Phase 3 criteria

Evidence on the achievement of the Phase criteria has been gathered from across the organisation. The information below represents a summary of those reports.

Evidence on Phase 4 criteria

To progress to Phase 4, the following criterion needs to be met:

"The virus is no longer considered a significant threat to public health."

The Chief Medical Officer provides advice on whether this criterion has been met. He has confirmed that in his view the Phase 4 criterion has not been met. This judgement reflects both domestic and international data on the progress of the epidemic. Since the last review, there have been increased numbers of local outbreaks and some early signs of increasing disease activity. Key conditions remain to be met that would support a judgement that the disease no longer represents a significant threat to public health, such as the roll-out of an effective vaccine programme and/or development of effective treatments for the virus that significantly reduced public health risk.

Performance against Phase 3 criteria

The phase criteria in the Route Map have been set to ensure safe progress between phases and confidence in the ensuing re-opening of the economy and broader society. The Phase 3 criteria were judged to have been met at the 9^th July review point, enabling the move to Phase 3 thereafter. Meeting those criteria involved suppressing the virus to low levels through a sustained decline in infectious cases and a consistently low R number. Given the degree of suppression that has already now taken place, it is difficult to continue to further reduce infectious cases. Moreover, we know that the R-number becomes volatile at low prevalence rates making it more difficult to keep consistently low at the national level when it becomes susceptible to localised outbreaks and a relatively small number of infections. Nevertheless we continue to monitor performance against these two aspects of the phase criteria and against the broader WHO conditions that also form part of the phase criteria.