Coronavirus (COVID-19): Scotland's route map - supporting evidence for the 30 July 2020 Review

Introduction

Scotland's Route Map, published on 21 May, describes an evidence-led, transparent and phased approach to easing 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 high-risks 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 fact of 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.

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 30 July.

The data on the R value and infectious pool is sourced from Coronavirus (COVID-19): modelling the epidemic in Scotland (Issue No 11) published on 30 July. This sets out Scottish Government modelling of the spread and level of COVID-19 using data from the week up to 24 July 2020 using epidemiological modelling.

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 26 July 2020.

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 30 July review to inform the relevant decisions (more recent data may have been published since then).

Evidence on Phase 4 criteria

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. His advice is as follows:

"The significant public health threat posed by SARS-CoV-2 persists. This threat has reduced over the period since non-pharmaceutical countermeasures were put in place but in the absence of definitive treatments or vaccine and an estimated population exposure of around 5% to this point, it is a threat that may strengthen as society re-opens. The proportion of tests reported as positive continues to suggest that controls remain effective, but at this stage this data does not yet fully reflect the impact of some of the more recent changes in restrictions that establish more opportunities for society to meet. The prevalence of COVID-19, however, remains very low, and whilst we should not become complacent in our approach there is much encouragement to be taken from the low impact of changes to this point in time. Over the next period we should continue to seek evidence that levels of nosocomial and care home infections are negligible and that community transmission remains suppressed to very low levels."

On this basis the Scottish Government has taken the view that the conditions to move into Phase 4 have not been met at this review point.

It is possible that we will remain within Phase 3 for a significant period of time, but that will be subject to regular review.