Coronavirus (COVID-19): Route Map - supporting evidence for the 22 September 2020 review

WHO criterion 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.

Test & Protect

Test and Protect - the public-facing name for the test, trace, isolate and support (TTIS) strategy and our direct response to criterion 2 – launched on 28 May. This system relies on disease prevalence being low, balanced with high levels of public compliance with public health advice including hand and respiratory hygiene, physical distancing, awareness of symptoms, and self-isolating when required to do so.

The COVID-19 testing strategy for Scotland covers testing for the following reasons:

• whole population testing of anyone with symptoms (Test & Protect);
• proactive case finding by testing contacts and testing in outbreaks;
• protecting the vulnerable and preventing outbreaks in high risk settings by routine testing;
• testing for direct patient care, to diagnose and to treat, and to support safe patient care as NHS services restart; and
• surveillance to understand the disease, track prevalence, understand transmission and monitor key sectors.

Our data demonstrates that the system has reached 98% of index cases and 97% of close contacts between 22 June and 20 September. The Protect Scotland proximity tracing app is issuing close contact alerts, potentially speeding up the process and identifying potentially previously unknown contacts.

Policy interventions

Our approach to testing is focussed on saving lives and protecting the vulnerable, rolling out Test and Protect to interrupt chains of transmission and continuing the vital surveillance work to support our understanding of the disease in Scotland.

We have published guidance about the collection of visitor contact details, to assist Test and Protect, for sectors where there is an increased risk of exposure. We have made it mandatory for food and drink hospitality settings to collect visitor contact details, and to share these with NHS Test and Protect if relevant, to support contact tracing.

In early October we will set out further detail of the financial support we will offer to people on low incomes who are asked to self-isolate.

Local Outbreaks

Managing Public Health Incidents (MPHI) has been updated to reflect the experience of dealing with coronavirus. The Protect Scotland app, which was launched on 10 September, signposts to local guidance, which provides a holistic approach to public communication.

Systems

NHS testing is available in all 14 Health Boards and we will soon activate a series of larger Regional Hubs. We now have active weekday NHS lab capacity of over 10,000 tests a day. In addition, we have access to the UK Government Lighthouse Lab Network (LLN), Scotland receives a population-based share of this capacity, currently approximately 12,000 per day. We are working with the UK Government to continue to build laboratory processing capacity to approximately 65,000 tests between NHS Scotland laboratories and the LLN.

The UK Government has established 6 Regional Testing Centres and a pool of 18 Mobile Testing Units in Scotland. We are also establishing 22 walk-through test sites which will support sampling capacity for areas with low car ownership.

Routine testing of care home staff is being migrated to the NHS laboratories to allow the UK LLN to support other sampling routes.

Testing of symptomatic individuals was expanded to include children under 5 years of age on 22 July.

We are working closely with Public Health Scotland to support NHS Boards to continue to build local capacity, including delivering support at a national level in the form of a National Contact Tracing Centre (NCTC). The NCTC was rolled out across all Boards by 17 July. As case numbers have been increasing, we have increased resourcing for the National Contact Tracing Centre.

Contact Tracing App

The Proximity tracing App named Protect Scotland was launched on 10 September, and has been downloaded by over 20% of the population, In the first 18 days over 1,200 people were advised to self-isolate after being in close contact with someone who has tested positive.

The Scottish Government continues to engage with the Republic of Ireland and Northern Ireland, with a view to Protect Scotland working with their respective proximity apps, with 'interoperability' expected in the next couple of weeks, subject to the necessary agreements being in place.

The App produces aggregated and anonymous Scotland-wide metrics that will enable the Scottish Government and Public Health Scotland to better understand the spread of the virus and plan accordingly, in particular:

• The total number of App users
• The total number of instances where an App user has registered a positive test result and has consented to upload the encrypted anonymous random codes that will be used to alert other App users that they have been in close contact with(this is also referred to as 'uploading diagnosis keys')
• The total number of alert notifications triggered (this is also called 'exposure notifications').

Data (valid as at 21 September)

6,851 individuals (7,642 cases) were recorded in the contact tracing software and 34,201 contacts have been traced.

The average number of contacts per positive case was 1.49 initially; this is what we should expect to see during Phase 1 and 2 of lockdown restrictions. This is now 5.0.

A sustained decline in transmission allowed the implementation of a robust system of testing on the basis of expanded capacity. We may be seeing lower than actual levels of symptomatic people booking a test so work is underway to better inform and motivate people to be tested.

Funding

We have confirmed funding of £1.1 billion to address financial pressures arising in response to COVID-19 across the Health & Care sector. This funding ensures the sector will continue to receive the support required to deal with the additional challenges of the pandemic, whilst still delivering the vital health, social care and hospital-based services the public rely on every day.

We will undertake a further substantive funding allocation in January. This will provide the opportunity to better understand the implications of COVID across the sector for the remainder of this financial year and ensure frontline services continue to have the funding they require.

In conclusion:

Test and Protect's contact tracing system has been introduced across all health boards using established and effective contact tracing techniques. As case numbers have risen, we have continued to invest in our National Contact Tracing Centre and Health Boards to ensure staffing can meet demand over the coming period, and ensured mutual aid arrangements are in place between health boards which means that support is in place to meet local surge demand.

On the basis of the evidence summarised above the assessment is that this Phase 3 criterion continues to be met at this review point.