Coronavirus (COVID-19): Scotland's Strategic Framework update - June 2021

Our future strategy

Overview

We set out the strategic intent of our COVID-19 Strategic Framework in October 2020, which in turn continued the principles and approach set out in our Coronavirus (COVID-19): Framework for decision making publication, from April 2020.

In our February 2021 Strategic Framework Update, we reaffirmed our strategic intent:

Our strategic intent remains to suppress the virus to the lowest possible level and keep it there, while we strive to return to a more normal life for as many people as possible.

We also outlined how the following six tools would work together to suppress the virus to enable a return to more normality. These tools and the associated phases are shown at Figure 4 below:

1. The quickest practical roll-out of our vaccination programme

2. The most effective use of Test and Protect

3. Applying proportionate protective measures (rules and guidance)

4. Effective measures to manage the risk of importation of the virus

5. Supporting individuals, businesses and organisations to adhere to protective measures

6. Providing care and support to mitigate the harms of the crisis

We are not yet in the final phase of the Strategic Framework depicted in Figure 4, where COVID-19 ceases to be such a significant threat to public health, but that remains our goal longer-term.

Figure 4: Phasing of the Strategic Framework

• Gradual easing of some restrictions within Level 4, including ongoing reopening of schools.
• Return to varying levels of restrictions, enabling ongoing suppression of the virus.
• Levels measures lifted and some baseline measures remain to help people, businesses and organisations to manage transmission risks.
• Vaccines protect health and reduce transmission
• Effective use of Test & Protect to suppress the virus and protect public health
• Proportionate protective measures suppress the transmission of the virus
• Reduced importation of the virus through effective border measures
• Support provided to people, businesses, and organisations to adhere to protective measures
• Provide care and support to mitigate the wider harms of the crisis
• COVID-19 no longer poses a significant threat to public health, but some ongoing public health measures likely to remain in place.

Please check Coronavirus in Scotland to ensure you are viewing the most up-to-date information and guidance about coronavirus

We saw good progress in the first part of this year in suppressing the virus in Scotland and reducing the harm caused by it through deploying these six tools in a coordinated manner.

Figure 5 shows the impact that interventions have had in controlling the spread and health consequences of the virus. It also shows that, while cases have been rising throughout May and June, the number of admissions to hospital and deaths have so far remained fairly low. This improved picture can be attributed to the protective measures in force alongside the roll-out of the vaccination programme.

Sources: Cases from PHS Daily Dashboard, hospitalisations from PHS weekly statistical report, deaths from NRS

From November 2020, consistent with World Health Organisation (WHO) guidance, we deployed our system of protective levels to allow flexible and proportionate restrictions to be applied quickly and explained as clearly as possible. Changes to restrictions to date, as shown in the above chart, have been guided by various epidemiological indicators^[6] and by consideration of impacts on the "Four Harms": the direct harm to health and life caused by the virus, and the indirect effects of both the virus and measures to suppress it on wider health and healthcare systems, society, and the economy. Navigating the right course through this pandemic has involved taking difficult decisions that take account of these various, inter-related harms so as to minimise overall harm. Whilst we have sought to minimise the broader harms overall, this has always been subject to the necessity to suppress the virus. Fundamentally, this approach will continue, but as more of our population receives full vaccination protection, a re-balancing of the elements of our response is both proportionate and necessary to reflect the current state of the pandemic relative to the wider health, societal and economic impact across Scotland.

Since our protective levels were first designed, we have adjusted them over time to take account of the cumulative impact of restrictions, to changes in our understanding of the virus – and our responses to it – and to ensure they remain a necessary and proportionate response to the threat of a level of infections which would overwhelm the NHS and cause significant loss of life. Without these restrictions, morbidity and mortality would have been much higher in Scotland.

Our COVID-19 response remains a race between the virus and the vaccines. We have seen successive new variants rise to dominance in Scotland, including those now known as Alpha and Delta. Each has been more transmissible than previous strains, meaning that a given level of protective measures has less suppressive effect. Since early 2021, this has to some extent been countered by the growing effect of vaccination. More recently, however, the Delta variant has pulled ahead of the effect of vaccines and general protective measures. This has resulted in surges of new cases in an increasing number of areas in Scotland. Enhanced public health measures, including testing, contact tracing and accelerated rollout of vaccination, have been helpful in managing many of these outbreaks, but the situation remains precarious as we navigate the transition from the rise of the Delta variant to the completion of our vaccination programme.

We will continue to monitor the pattern of new cases throughout Scotland and to support enhanced local public health measures to manage outbreaks. As we have done at earlier points in the pandemic, if it becomes necessary to apply specific restrictions or higher levels of general protective measures while vaccination continues, and if we judge that to be justified and proportionate in the face of the harm caused by the virus, we shall do so.