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

WHO criterion 5: Manage the risk of exporting and importing cases

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

International

Rationale for measures

Importation of new COVID-19 cases now represents the greatest threat to continued success and to avoiding a resurgence later in the year. Health Protection (Coronavirus) (International Travel) (Scotland) Regulations 2020 regulations continue to be important. There are two measures within the regulations (unless exempt for various reasons): the requirement to provide contact details when travelling to Scotland and the requirement to self-isolate for 14 days on arrival to Scotland.

Scottish Ministers have continued to review the health measures closely over the last three weeks and have assessed that there remains a requirement for them in order to reduce the risk of transmission and safeguard health. This decision was reached following a thorough review process and was relayed to the Scottish Parliament on Monday 20 July.

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 colleagues from 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 home nations and, as directed by Ministers, have worked to align amendments to the regulations on a four nation basis where possible.

The UK Government's Secretary of State for Transport has requested regular reviews of the evidence with a view to adding countries to the exemptions list on a weekly basis. While we agree regular review of the data is crucial in order to be able rapidly to remove exempted countries when the data indicates serious concern, our preference remains to add countries to the exemptions list at the formal review points; this will enable us to have a degree of assurance that the data for countries provides evidence of a sustained, positive trajectory and will also provide airlines and travellers a degree of certainty regarding their travel plans. Our next review point is Monday 10 August.

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 two separate mechanisms; a Public Health England risk assessment (outlining where countries sit within the Red, Amber, Green risk rating) and JBC (Joint Biomedical Centre) analysis which provides prevalence point data.

The Scottish Government has requested weekly data from the UK Government from both sources to ensure we are able to review regularly and this flow is working at present.

This is particularly important as virus rates fluctuate and a regular, reliable dataset will allow us to make timely decisions to ensure the importation of the virus continues to stay at a low level. We have also urged the UK Government to publish this data for transparency 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. As Scotland did not exempt Spain from the self-isolation requirement of these regulations at the previous review point, in contrast to the other home nations, particular attention has been paid to the prevalence rates in Spain during this review phase.

Weekly data provided by the JBC since this exclusion had identified a downward turn in prevalence across Spain over a three week period. Following assessment of this data, Scottish Ministers considered the position of Spain to be at a risk level appropriate for Spain to be included on the exemptions list. Subsequently, Spain was added to the exemptions list on Thursday 23 July.

However, further data provided by the JBC on Saturday 25 July, identified that Spanish weekly cases had broadly doubled and that there was an immediate risk of importation of the virus from Spain. It was deemed that this the data showed the risk of importation from Spain was too high for it to remain on the exemptions list. The Scottish Government subsequently announced at 1900 on Saturday 25 July that Spain would be removed from the exemptions list. The change to regulations was implemented at 00:01 on Sunday 26 July. The other UK nations also removed Spain from the exemptions list, with the same implementation date.

Further evidence provided by PHE and JBC in week commencing 27 July identified Luxembourg as an exempt country which had seen a significant increase in cases, moving it from moderate to high risk. Subsequently, the Scottish Government, aligned with the other UK nations, announced on 30 July that Luxembourg would be removed from the exemptions list. This amendment to the regulations was implemented on 31 July.

Further country specific exemptions have been assessed during this period. The importation risk was assessed to be low from the following countries: St Vincent and the Grenadines, Latvia, Estonia, Slovakia, and Slovenia. Aligning with the other home nations these countries have been exempted in our regulations since Tuesday 28 July. Arrivals from all exempt countries and territories are still required to complete the Passenger Locator Form element of these measures.

High risk and moderate risk countries with a significantly higher prevalence rate than Scotland continue to be excluded from the exemptions list. Weekly assessment of the data and evidence provided by Public Health England and the JBC will allow us to continually monitor risk ratings and, where necessary, we will act promptly to remove an exempt country if its risk rating compromises the intention of these regulations.

Sectoral exemptions

There have been no changes to the sectoral exemptions since the last review.

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. Public Health Scotland have commenced follow up calls, offering advice and information to those who are self-isolating. Police Scotland report that, as of 22 July, Police Scotland have received 23 referrals relating to the self-isolation element of these measures with one resulting in a police incident. There has been no enforcement relating to any of these referrals.

Alternative measures

Consideration continues to be given to whether alternative arrangements could be put in place at the international border to reduce the risk of importing new cases of the virus. These have focussed on whether a testing regime could mitigate the risks enough to reduce the need for 14 day quarantine; accepting that the most effective way of mitigating the risk of importation is a well observed regime of 14 day quarantine.

At present it is not considered that there is an alternative package of methods that would manage the risk of exporting and importing cases from communities with high risks of transmission to the extent that the Health Protection (Coronavirus) (International Travel) (Scotland) Regulations 2020 measures do. This will continue to be monitored and assessed, to ensure the most appropriate measures are in place moving forward.

Internal border (Common Travel Area)

Ireland has paused progress through its roadmap out of restrictions at phase 3, delaying a move into the 4th phase until August 10th at the earliest. Several factors contributed to the decision, including the R number for Ireland rising above 1 (currently estimated to be 1.0-1.4), a steadily increasing number of new cases, the 14-day incidence rate increasing from 2.4 per 100,000 people to 3.9 per 100,000 and the rising proportion of new cases being among young people.

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 is considering options to increase resource in ensuring that passengers are complying with rules through follow-up checks and phone calls.

The Irish Government has now 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 contains 15 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 15 countries are on the list Malta, Finland, Norway, Italy, Hungary, Estonia, Latvia, Lithuania, Cyprus, Slovakia, Greece, Greenland, Gibraltar, Monaco, and San Marino.

Intra-UK risk

There is the possible risk of exporting or importing cases from communities with high risk of transmission in Scotland or in the other countries of the UK.

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 lock-down localities in England. 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.

Scotland continues to develop 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 when derived from imported cases, by quickly identifying COVID resurgence, clusters, and outbreaks.

The initial changes within Phase 3 (prior to 30 July) brought 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 Phase 3 criterion continues to be met at this review point. However continuing vigilance is required around the management of importation risk.