Coronavirus (COVID-19) asymptomatic testing programme: evaluation - November 2020 to June 2021

Executive Summary

Introduction

This evaluation examines the asymptomatic testing programme in Scotland. It covers the period November 2020 to June 2021. The majority of this programme relies on the use of Lateral Flow Device (LFD) testing, with some use of Polymerase Chain Reaction (PCR) testing in Community Testing and Prisons pathways. The quantitative data highlighted throughout this report therefore focuses strongly on the use of LFDs – where asymptomatic PCR use is discussed will be made clear.

Nine testing pathways that are some of the largest and/or a part of Scotland's critical infrastructure are evaluated: (i) targeted Community Testing; (ii) Early Learning and Childcare settings (ELC); (iii) Health and Social Care Workforce; (iv) Police Scotland and Scottish Fire and Rescue Service (SFRS) high risk staff groups testing; (v) Prison Staff testing; (vi) Schools testing (vii) University and College testing; and (viii) universal testing, with specific research on (ix) the highest risk individuals (previously termed 'shielding') and their households.

It is important to note that the data presented in this report relies on reporting of test results. The picture we have of the asymptomatic testing programme in Scotland relies on individuals reporting all of their results, whether positive, negative or void. There may be further uptake of testing, but individuals do not report results. This issue is reflected on throughout the report.

The public health impact of testing

• In total, between 19 November 2020 and 27 June 2021, 6,650,650 test results were recorded. 14,728 of these were positive cases – 72% of these went on to take a confirmatory PCR and 81% of these were found positive.
• Between 23 November 2020 and 25 June 2021, the number of positive cases identified by LFD testing and confirmed by PCR is 7,271. These are cases that may not otherwise have been detected in the absence of symptoms, or were identified earlier than they otherwise would have been via PCR-based testing once symptomatic.
• Uptake of testing is difficult to measure as we know that not everyone records their test result. The data we do have show that there has been uptake of testing across the pathways and amongst the general population with the universal offer. This data also suggests that uptake and/or reporting may be declining over time, for example, with health care workers, school staff and pupils and other workplaces.
• Workplaces do seem to be a key site of engagement with asymptomatic testing, where the encouragement or requirement to test keeps people testing more regularly and recording results.
• Those testing outwith work settings are more likely to use testing sporadically than as intended (i.e. twice weekly testing).

Attitudes and behaviours

• People are testing for a variety of reasons: for reassurance; to protect others; and for practical reasons.
• People may be less engaged or disengaged with testing because:
  • they do not see themselves as being at high risk from severe illness from Covid.
  • they have concerns about the test itself, such as discomfort or not being convinced of test accuracy
  • a range of practical reasons, such as problems recording results on the portal, lack of time, or confusion about pathways
  • and attitudes towards testing, such as not being clear on the benefits of regular testing or not agreeing with the testing programme.
• The data does not allow robust analysis of whether and when people 'switch' between pathways, but it is clear the number of pathways can cause confusion and people may not always be clear what pathway to record results under.
• When navigating the asymptomatic testing system, the pathway evaluations reported concerns with knowing what testing was available, carrying out tests, and recording test results. There were calls for more (and more accessible) information, reassurance about the accuracy and reliability of tests, and a more streamlined process for recording results.
• People are recording asymptomatic test results, but the data suggest people are more likely to record positive than negative results. More information on why recording negative (and void) results is important may be needed.

Models and delivery

• There is no single model of delivery across the testing pathways, with several different models in place offering different advantages and challenges.
• Clear and streamlined communication tailored to different audiences (including information for children and young people, communication in different formats and via a range of media channels, and to take into account differences between Scotland and England) is key to making any model work.
• Delivery partners felt there could be improved communication between government and themselves, noting a lack of information in some settings and delays in information provision in others.
• Partnership working is key to the success of pathways, with some pathways highlighting the need for greater collaborative working and others noting close working being key to the successful implementation of their pathway.
• Delivery partners have also noted concerns with using the online portal and recording results and that the landscape of testing can cause confusion, potentially affecting uptake.

Research and data

• The individual testing pathways have approached their evaluations in different ways, subject to data availability, time constraints, and reporting requirements to their own governance boards.
• To ensure a level of consistency across all pathways, minimum data requirements were agreed with the Scottish Government's Testing Programme Board, for each evaluation to report (as far as possible from available data).
• The extent and quality of data varies by pathway. Much of the data was set up for operational and not evaluation purposes.
• The data here presents the picture to mid/end June 2021, but the overall testing programme itself is complex and rapidly evolving so the situation will have changed since.
• The testing covered within this evaluation is asymptomatic testing and includes both LFD and PCR testing. It is now becoming clear that people may use LFD tests when they have symptoms, either instead of following the guidance to book a PCR test or before doing so. We do not have a way as yet of disaggregating the data to identify where this is the case.