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

Test and Protect

The Test and Protect system continues to provide three of the key public health interventions that have been vital in minimising the health and broader harms caused by COVID-19: testing, contact tracing and supporting self-isolation. As the evidence base relating to COVID-19 has grown, the Test and Protect system has evolved to ensure that each of these three interventions adapts to reduce transmission and minimise health and other harms.

The successful delivery of the vaccination programme throughout 2021 has fundamentally shifted the risks that COVID-19 poses to the wider Scottish population. Weekly vaccine surveillance research continues to show that people who have been fully vaccinated are much less likely to be infected by coronavirus and, if they are infected, are less likely to transmit the virus to others or to experience severe illness, hospitalisation or death. Levels of vaccination across the population, and therefore levels of protection, are high.

As this shift in risk has occurred, consideration of the appropriate balance between protecting public health and minimising the harms caused by interventions has led to a number of changes to Test and Protect including:

• revised isolation guidance for fully vaccinated adults and for young people aged under 18 identified as close contacts after receiving a negative PCR result;
• revised contact tracing guidance for educational settings to identify higher and lower risk contacts and issue appropriate public health advice to each;
• digital innovation within the contact tracing system to ensure that resource is allocated to enable telephone contact tracing for highest risk settings and increasing uptake of digital channels for lower risk cases and contacts.

As we enter winter, Test and Protect will continue to play a significant role in contributing to reducing transmission, in line with evidence on the changing balance of risks and harms. Test and Protect will continue to evolve to transition towards a future strategic approach from spring 2022, with a longer-term focus on recovery and managing COVID-19 as an endemic disease.

Next stages of Test and Protect

Test and Protect is expected to continue to play a significant role in reducing transmission as we transition from the acute to the endemic phase of managing COVID-19. There are likely to be three strategic phases in autumn, winter, and spring – as set out in Figure 7.

Figure 7: Test and Protect phases

Respond – Autumn: Continue to contribute to suppressing transmission.

• Build and maintain testing and contact tracing system resilience to manage peaks in demand as restrictions ease.
• Maintain asymptomatic testing pathways across economy, learning, justice, health and social care and wider Universal Offer.
• Test and Protect to mitigate COVID-19 risks and support COP26 as a COVID-19 safe event.

Respond – Winter: Likelihood of high symptomatic demand from higher prevalence of winter illnesses.

• Keep all PCR testing sampling and lab capacity in place.
• Extend Multiplex testing in clinical settings to support treatment and infection prevention and control and patient flow.
• Mitigate risk of variant of concern emergence, including ongoing genomic sequencing and surveillance, including at the border.
• Maintain contact tracing system resource to deliver digital focused service ensuring system resilience.
• Maintain community surveillance programmes.

Recover – Spring: Based on lower prevalence and emerging endemic pattern.

• Management of pockets of enduring transmission.
• Outbreak management including health protection team led contact tracing in high risk settings.
• Ongoing surveillance and sequencing (including wastewater testing).
• Maintain testing and infrastructure to level appropriate for managing endemic COVID-19.

Testing

Testing to find cases remains a key part of the strategic intent for the testing system into the start of winter to identify cases, both in asymptomatic and symptomatic people, and to ensure they receive public health guidance to isolate and reduce transmission.

It is anticipated that due to increased prevalence of other winter illness and viruses there will be significantly increased demand for testing from people whose symptoms are caused by viruses other than COVID-19. To manage this expected increased demand, existing PCR testing sampling and lab capacity will remain in place. In supporting NHS recovery and minimising COVID-19 risks in health settings, testing will be extended in clinical settings.

As set out in the Scottish Government Testing Strategy, there may also come a point – at lower levels of disease prevalence and high population level protection from vaccination – where, on balance, the benefit of routine asymptomatic testing has reduced and when there is less of a rationale for asymptomatic testing of otherwise healthy people. We will continually review the evidence and make decisions on the continuation or pausing of different asymptomatic programmes as the evidence base on vaccination coverage and effect continues to build.

Testing capacity may vary moving into spring 2022 as part of the recovery phase, with sufficient resource and capacity required to support requirements for testing as COVID-19 becomes an endemic disease. Ensuring capacity for genomic sequencing and surveillance will be key to providing intelligence, and minimising the risk of vaccine escape or increase in serious disease that potential variants of concern may cause. This 'steady-state' testing system will continue to ensure sufficient resource to manage COVID-19 as an endemic illness and to minimise transmission in areas of disproportionately high prevalence.

Contact Tracing

Entering the winter period, contact tracing will continue to develop the usage of digital contact tracing channels with a targeting of public health resource towards areas of highest risk. Contact tracing was key in ensuring that COVID-19 risks were minimised as part of delivering COP26 as safely and as 'in person' as possible. Recent digital enhancements to the contact tracing system have ensured that the service is resilient and prepared to respond to high levels of case numbers through late autumn and early winter, should case numbers increase.

As part of the transition into the spring 'Recovery' phase, increased use of digital contact tracing channels, with public health resource predominantly targeted at higher risk settings, will continue to ensure the system is robust and also delivers an effective intervention to minimise public health risks. The shift into spring 2022 will see continued prioritisation of higher risk cases and contacts, increased use of locally led health protection team contact tracing and a likely refocus of centrally-led services, reflecting the changing risks that COVID-19 poses across different groups of the wider population.

Support for Isolation

Isolation support services including financial and practical support have been key to reducing and removing the barriers that people may experience when asked to self-isolate. These services, delivered by local authorities locally, continue to be available to people self-isolating. Following recent changes to isolation guidance, meaning fewer people are required to isolate as vaccination coverage has increased, it is anticipated that demand for these services will reduce over the winter phase.

It is anticipated that COVID-19 will have disproportionately high prevalence within areas with higher populations of low-income households, black and minority ethnic communities and disabled people. Support provided to people who may be required to self-isolate into spring 2022 will focus on ensuring that where the harms caused by isolation as an intervention disproportionately affect certain groups of the population, the strategic focus is to minimise these differential impacts.

The Self-Isolation Support Grant remains in place and provides a £500 grant to low-income workers who cannot work from home and face a loss of income as a result of self-isolation. To the end of September 2021, 43,458 grants had been paid. Following previous changes to the eligibility criteria for the Grant to extend it to parents of a child who is required to self-isolate, carers, and people earning up to the Real Living Wage, we adjusted the rules in October 2021 to ensure that the UK Government's removal of the £20 uplift to Universal Credit does not exclude anyone from receiving the Grant who would have qualified previously. We have also changed the eligibility criteria in in relation to contacts who have been fully vaccinated to align with self-isolation requirements.