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

WHO criterion 5: Manage the risk of exporting and importing cases from communities with high risks of transmission

As noted above, the information in this section was updated to inform the 20 August review. Developments are likely to have taken place since that time.

International

Importation of new COVID-19 cases continues to represent one of the greatest threats to continued success and to avoiding a second wave of the virus later in the year – that is why the Health Protection (Coronavirus) (International Travel) (Scotland) Regulations 2020 regulations continue to be so important. There are two measures within the regulations (unless an exemption applies): the requirement to provide contact details when travelling to Scotland and the requirement to self-isolate for 14 days on arrival to Scotland.

Review

There is a requirement for Scottish Ministers to formally review these measures every 21 days. This review phase has again been led by a cross Scottish Government working group (comprising External Affairs, Health, Justice, Legal, Migration and Transport) who have assessed both the impact of the regulations and the ongoing need to implement these regulations. Officials are also involved in weekly Operational and Implementation meetings with the other UK nations and, as directed by Ministers, have worked to align amendments to the regulations on a four nation basis where possible.

Scottish Ministers have continued to review the health measures closely over the last three weeks and have assessed that there remains a requirement for these regulations to remain in place. This decision was relayed to the Scottish Parliament on Monday 10 August via a Government Initiated Question (GIQ). The next review point is Monday 31 August.

We continue to review the country exemptions list on a rolling basis. Using data provided by Public Health England and the Joint Biosecurity Centre (JBC), we have engaged in a four nation weekly cycle to identify countries which may need to be added or removed from the country exemptions list. Changes are made with great urgency to ensure public health is not compromised in Scotland. We are not required to wait for the formal review date to make these amendments to the regulations.

Evidence base

The main focus of this review phase centred on country specific exemptions (often referred to as air bridges or travel corridors). The data we use to establish an evidence base for consideration is provided by the UK Government and comes through a Public Health England (PHE) risk assessment (outlining where countries sit within the Red, Amber, Green risk rating) and Joint Biosecurity Centre analysis which provides data on the number of cases in the countries.

We have been working with UK Government, the Joint Biosecurity Centre, Welsh and Northern Ireland colleagues to agree a regular process for considering additions or removals to the list of countries where travellers are exempt from the self-isolation element of the border health measures. The process has continued to evolve and the quality and level of information that we are receiving from the JBC is improving.

As part of this process JBC prepares a weekly 'watchlist'. Watchlist countries are those countries currently on the exemption list where the 7 day cases per 100,000 population is above 20, where there has been a significant increase in cases suggesting a rapidly changing situation or it appears that the risk assessment for a country may be about to shift (because of a worsening or improving situation).

The JBC then undertakes a closer analysis of the countries identified on the watchlist. This fuller analysis, coupled with the Public Health England risk rating, provides the evidence base for any decisions to change travel advice or to remove countries from the exemption list. We have pressed the UK Government, supported by the other devolved administrations, to follow this release of evidence with a consistent weekly four nations ministerial meeting to discuss exemptions. While meetings have taken place, work continues to ensure these arrangements are in a place on a weekly basis.

Further work is also required to align the nations in terms of announcements and implementation of these changes but all four nations have committed to aligning as much as possible. The data provided by the JBC and PHE is owned by the UK Government. We continue to urge the UK Government to publish the data transparently and to provide evidence of effective decision making.

Country specific exemptions

On Friday 10 July, the Scottish Government exempted 57 countries and territories (plus 14 UK overseas territories) from the requirement to self-isolate on arrival in Scotland. These countries and territories were deemed to be low or moderate risk, with lower infection rates than Scotland. All arrivals and returnees from exempt countries are still required provide contact details through the Passenger Locator Form.

There have been several changes to the list in since 10 July, with the addition of Spain on 23 July followed by its subsequent removal from the exemptions list on 26 July. Luxembourg was also removed on 31 July. Both these decisions were based on evidence which highlighted a rapid growth in cases across the respective countries. We have also added countries to the exemption list who have moved into the low risk (green) category; on 28 July Estonia, Latvia, Slovakia, Slovenia and St Vincent and Grenadines were added to the exemption list on this basis.

The weekly cycle data provided by the JBC continues to highlight areas of concern. In the week commencing the 3 August, significant concerns were raised with the situation in Andorra, The Bahamas and Belgium, with all three countries showing weekly virus rates of well over 20/100k (by comparison the UK rate was sitting at 6.7/100k and Scotland's 0.5/100k) . It was therefore agreed across the four nations that these three countries represented a significant risk of imported transmission and steps were taken to exclude them from the exemptions list. In the cases of Andorra and The Bahamas, the rise in infection was strongly linked to arrivals from Spain and the US respectively, highlighting the risk from importation of infection. These exclusions were implemented on Saturday 08 August.

The data provided by the JBC/PHE also highlighted that Brunei and Malaysia are countries that can currently be considered low risk. Brunei have not reported a case since 8 May and Malaysia's weekly case rate per 100K is 0.3. Both countries were therefore added to the exemptions list on Tuesday 11 August. These additions and exclusions were implemented across the four nations.

In the week commencing 10 August, significant concerns were raised with the situation in France, Monaco, The Netherlands, Malta, Aruba and the Turks and Caicos Islands, with all six countries showing significant increases in their weekly virus rates to levels that far exceed Scotland's 0.5/100k. It was therefore agreed across the four nations that these three countries represented a significant risk of imported transmission and steps were taken to exclude them from the exemptions list. These exclusions were implemented on Saturday 15 August.

(Please note: the following contains some information from after the 20 August Review but is included for completeness here.) The latest JBC/PHE data, week commencing 17 August, identified significant concerns regarding the rise in cases in Austria, Croatia, Switzerland and Trinidad & Tobago. Across the four nations there was agreement to remove Austria, Croatia and Trinidad & Tobago, and the Scottish Government also decided to exclude Switzerland due to concerns over the increase in their weekly virus cases in comparison to Scotland. The other UK nations have not removed Switzerland. There was also four nation agreement to add Portugal to the exemptions list, as evidence over a number of weeks has highlighted a reduced number of cases across the country. These changes were implemented on Saturday 22 August.

We will continue to closely monitor the situation and if the evidence suggests an exempt country may provide increased risk, we will not hesitate to reinstate quarantine arrangements, as has been the case with several countries. It is clear that the situation can change very quickly and immediate action is likely to continue to be required. The UK Government continue to be interested in the potential for adopting a regional approach to the assessment of risk but recognise the challenges. We are continuing to highlight issues and concerns as the thinking evolves. Other issues for future consideration include the treatment of hub airports where individuals from an exempt country transit though a hub airport in a non-exempt country and therefore need to self-isolate on arrival in Scotland. Some countries, including Ireland, have put in place measures to exempt hub airports.

Sectoral exemptions

There have been no changes to the sectoral exemptions during this 21 day review cycle. Neither the UK Government, the Welsh Government nor the Northern Ireland Executive has proposed new categories for exemption and there have been no proposals from within the Scottish Government.

We continue to work with partners to ensure there is appropriate advice and guidance available to sectors who have exemptions from the requirement to self-isolate. We continue to review these exemptions as part of our ongoing review process and will not hesitate to make changes if evidence suggests that any of the current exemptions pose a risk to public health.

Compliance

Border Force continue to carry out spot checks on arrivals at the border to ensure they have completed the Passenger Locator Form. Passenger compliance continues to be high. However, we are receiving reports from Border Force that the level of compliance is falling and Border Force staff are facing hostility from travellers when seeking to enforce measures. As of 5 August, published data shows that Police Scotland made 58 referrals to the Home Office to check on the self-isolation and exemption status in relation to reported breaches of the requirements and have issued one Fixed Penalty Notice.

Passenger arrivals into Scotland are provided by the Home Office to Public Health Scotland (PHS). PHS then take a sample of those passengers who are required to quarantine and pass the data to NHS National Services Scotland, which runs the National Contact Tracing Centre. Up to the end of July, the National Centre has been averaging around 600 contacts per week. Until 16 August, 3,614 individuals have been contacted so far, with 2,498 successful contacts made.

The UK Government are proposing an enforcement action plan which looks at increase enforcement of border measures. We continue to monitor this closely and, whilst acknowledging the need to ensure compliance with these measures, must ensure that any further enforcement measures are suitable for the conditions set by our external partners.

Work has also commenced on improvements to the Passenger Locator Form, both to improve the efficiency of the form and to look at alternative ways of ensuring the data from the form can be used to strengthen the aim of the regulations. The Scottish Government have been involved in the working group assessing proposed improvements and are working with stakeholders including Police Scotland and Public Health Scotland (PHS) to ensure the revised form meets our requirements.

Alternative measures

Consideration of alternative arrangements at the border continue, including testing on arrival. At the moment, however, 14-day quarantine remains the most effective way to minimise the risk of importing new cases from overseas.

Internal border (Common Travel Area)

Having paused progress through its roadmap out of restrictions at phase 3, the Irish Government brought in new restrictions to combat the recent increase in Covid-19 cases. Public health officials warned that "multiple significant outbreaks associated with workplaces, households, and social activities" were now spread across the country, giving Ireland the 4th fastest growth rate in cases over the past 14 days in the EU, and an R rate of 1.6. Ireland's rate of cases per 100,000 over 14 days to 19 August is 25.4.

The Government has responded to the increase prevalence and spread by reimposing tighter restrictions and introducing new measures. These include extended local lockdowns in three counties, advice the public should avoid public transport, reintroduction of working from home unless essential or critical, lowered limits for indoor (6) and outdoor (15) gatherings, tightened requirements for the wearing of facemasks, and sports reverting to behind closed doors. The government is also committed to legislating to enforce the measures and to bringing forward a new Roadmap for Resilience and Recovery in advance of 13 September setting out a plan for balancing the public health, economic and social aspects of living with C-19.

The Irish Government is continuing to advise against all non-essential international travel. All incoming passengers arriving at ports and airports are legally required to submit passenger locator information and requested to self-isolate for a 14 day quarantine period. The government are considering options to increase resource in ensuring that passengers are complying with rules through follow-up checks and phone calls.

The Irish Government has published a 'green list' of countries for whom quarantine travel restrictions will not be required. Travellers coming to and from these locations will not be required to isolate upon entry to Ireland. The list has been reduced to just 10 countries and is based on European Centre for Disease Control data. Countries with similar or lower prevalence of the virus are included, with countries with higher incidence not (including UK, US, France, Spain). The 10 countries on the list are Finland, Norway, Italy, Hungary, Estonia, Latvia, Lithuania, Slovakia, Greece and Greenland. On 19 August the government deferred a decision to remove Greece from the green list, and asked public health officials to provide further data.

Intra-UK risk

There is a risk that the virus will be exported from communities with higher prevalence in Scotland and elsewhere in the UK to communities with lower prevalence. Tourism to Scotland has now opened up (including all holiday accommodation), which means that citizens from other parts of the UK can now travel to Scotland.

A practical approach for managing transmission to and from communities with high rates of transmission in the rest of the UK is to rely on systems for instituting local lockdowns being developed in each country. The UK Government has, on 17 July, published a COVID Contain Framework for local decision making with statutory guidance which sets out greater powers for councils to take action to address local outbreaks. This includes clear instructions that people should not travel outside of lockdown localities in England. On 31 July, the UK Government introduced stricter lockdown rules for parts of northern England following evidence of increased transmission. This should have the effect of limiting travel from those areas to Scotland (and anywhere else).

In the event of a significant local outbreak, Ministers have regulation-making powers under the Coronavirus Act 2020 that would allow Ministers to re-impose lockdown restrictions on a local or regional basis within Scotland if necessary, thus managing the risk of exporting cases from high risk communities. Following an increase in the number of cases in the Aberdeen City Council area, restrictions on travel, indoor gatherings and hospitality were introduced on 5 August.

Scotland is developing a responsive system of community surveillance for COVID-19 at national, regional and local level. This approach will utilise a range of existing data sources and build on the existing community of expertise across Scotland.

The enhanced surveillance approach will gather routine and new data. In the community this is gathered from various places including citizens, households, closed settings, primary healthcare, occupational groups and age groups. These data will be monitored closely for trends and also linked to other data sources to enable a fuller picture to be understood of COVID-19 across the population – this will allow identification of signals that the severity, transmission, or impact is worsening in the population and then to be able to respond appropriately to those signals and emerging risks. This supports rapid implementation and action on the ground (including through Test and Protect) by the right actors at the right time.

The development of this surveillance system will help to minimise the spread of COVID-19 in Scotland including those derived from imported cases by quickly identifying COVID resurgence, clusters, and outbreaks.

Phase 3 is bringing further gradual re-opening, resumption and scaling up of economic and social interactions. These are necessary to mitigate the overall harm caused by the pandemic and involve sometimes delicate and difficult balances. They also reflect our legal obligation to retain restrictions for no longer than they are deemed proportionate. However this gradual easing of restrictions increases transmission risk. Cross-border movements of people and goods will continue and increase as we ease restrictions. Consequently, it is essential to our plans for a sustainable recovery and to the objective of aspiring to as close to elimination of the virus as possible that we reduce importation risk to an acceptably low level.

On the basis of the evidence summarised above, the assessment is that this criterion has been met at this review point. However, continuing vigilance is required around the management of importation risk.