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

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

International

Importation of new COVID-19 cases represents one of the greatest threats to continued control of the virus - that is why the Health Protection (Coronavirus) (International Travel) (Scotland) Regulations 2020 regulations continue to be so important. There are two measures within the regulations (unless an exemption applies): the requirement to provide contact details when travelling to Scotland and the requirement to self-isolate for 14 days on arrival to Scotland. Guidance on these regulations is available here.

Review

Scottish Ministers have continued to review the health measures closely over the last three weeks and have assessed that there remains a requirement for these regulations to remain in place. This decision was relayed to the Scottish Parliament on Tuesday 22 September, as Parliament was closed on 21 September, via a Government Initiated Question (GIQ). The next review point is Monday 12 October.

Evidence base

We continue to assess country specific exemptions (often referred to as air bridges or travel corridors) on a weekly basis. The data we use to establish an evidence base for consideration is provided by the UK Government and comes through a Public Health England (PHE) risk assessment (outlining where countries sit within the Red, Amber, Green risk rating) and Joint Biosecurity Centre (JBC) analysis which provides data on the number of cases in the countries. Changes are made with great urgency to ensure public health is not compromised in Scotland. We are not required to wait for the formal review date to make these amendments to the regulations.

The data provided by the JBC and PHE is owned by the UK Government. We continue to urge the UK Government to publish the data transparently 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, with lower infection rates than Scotland. All arrivals and returnees from exempt countries are still required to provide contact details through the Passenger Locator Form (PLF) and Public Health Scotland use this information from the PLF to contact the individual if they, or someone they have travelled with develops coronavirus symptoms.

If there is clear evidence of risk we will take action to remove a country or territory from the exemption list if necessary to safeguard public health. The decision to remove a country must be made on public health grounds.

Since the previous update, there have been further additions and removals to the exemptions lists. The week beginning the 7 September the Scottish Government removed Hungary and La Réunion from the exemption list on the basis of evidence of a significant rise in cases. The other UK nations also announced the removal of Hungary and La Réunion. In addition they also announced the removal of mainland Portugal and French Polynesia. There was also a four nation agreement to add Sweden to the exemption list. These changes were implemented on 12 September.

Across the four nations there was agreement to remove Slovenia and Guadeloupe and to add Singapore and Thailand to the exemption list on the basis of evidence about changes in rates of the virus. These changes came into force on 19 September. The following week all four nations removed Denmark, Iceland, Slovakia and Curacao from 26 September.

We will continue to closely monitor the situation and if the evidence suggests an exempt country may provide increased risk, we will not hesitate to reinstate quarantine arrangements, as has been the case with several countries. It is clear that the situation can change very quickly and immediate action is likely to continue to be required – there have been times where there has been a divergence in approach across the four UK Governments as they make their own decisions based on the balance the risk of imported transmission in relation to their own virus rates.

Sectoral exemptions

The UK Government announced a number of changes to sectoral exemptions which came into force on 26 September. The Scottish Government will continue to assess the sectoral exemptions and where it is considered that there is a clear basis for an exemption and that the changes would not negatively impact on the rationale behind the regulations or present a risk to public health then we will make changes. Similarly we will continue to review all of the exemptions as part of our ongoing review process and will not hesitate to make changes if evidence suggests that any of the current exemptions pose a risk to public health. We continue to work with partners to ensure that there is appropriate advice and guidance available to sectors who have exemptions from the requirement to self-isolate.

Compliance

Work continues to improve and streamline the Passenger Locator Form which should allow for greater compliance. We are in regular contact with Border Force through weekly updates and with any operational challenges they are experiencing.

Passenger arrivals into Scotland are provided by the Home Office to Public Health Scotland (PHS). Public Health Scotland contacts all individuals via email, who require to self-isolate, on return from a country that is not exempt from quarantine. The National Contact tracing centre subsequently contacts a sample of those individuals. Up to the end of July, the National Centre has been averaging around 600 contacts per week. Up to 13 September 5,509 individuals have been contacted so far, with 4,269 successful contacts made. Scottish Ministers have agreed to provide further resource to Public Health Scotland to enhance capacity for follow up calls offering advice and guidance to people self-isolating on return. Public Health Scotland can also refer concerns they have to Police Scotland for further investigation.

Intra-UK risk

There is a risk that the virus will be exported from communities with higher prevalence in Scotland and elsewhere in the UK to communities with lower prevalence. Tourism to Scotland has opened (including all holiday accommodation), which means that citizens from other parts of the UK can now travel to Scotland.

A practical approach for managing transmission to and from communities with high rates of transmission in the rest of the UK is to rely on systems for instituting local lockdowns being developed in each country. The UK Government 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 lockdown localities in England. On 31 July, the UK Government introduced stricter lockdown rules for parts of northern England following evidence of increased transmission. 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. Following an increase in the number of cases in the Aberdeen City Council area, restrictions on travel, indoor gatherings and hospitality were introduced on 5 August. Restrictions were introduced in Glasgow, East Renfrewshire and West Dunbartonshire from 2 September and extended to East Dunbartonshire and Renfrewshire on 7 September.

Scotland is developing 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 those derived from imported cases by quickly identifying COVID resurgence, clusters, and outbreaks.

Phase 3 brought further gradual re-opening, resumption and scaling up of economic and social interactions. Those changes were 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 that we reduce importation risk to an acceptably low level.

On the basis of the evidence summarised above, the assessment is that this criterion has been met at this review point. However, continuing vigilance is required around the management of importation risk.