Coronavirus (COVID-19) - testing strategy: update - March 2021

1. Strategic context

Scotland's overall current pandemic strategy is set out in Coronavirus (COVID-19) Scotland's Strategic Framework Updated, published on 23 February 2021. That strategy remains to suppress the virus – driving the number of cases to the lowest possible level – to support the resumption of life as close to normal as possible. 

Scotland's COVID-19 Testing Strategy contributes to this overall pandemic strategic intent. It is one of six main tools described in the Strategic Framework alongside: vaccination; protective measures including non-pharmaceutical interventions like physical distancing and face coverings; border control measures (which also include testing); adherence support measures (including support for self-isolation); and wider care and support to mitigate the harms caused by the pandemic.

The Strategic Framework stresses two key points: that the overall goal remains suppressing the virus to as close to elimination as possible, as that remains the best way to minimise all the harms caused; and that, given the nature of the virus, we are likely to ultimately have to live with COVID as a permanent feature of our lives.

The implications of this for testing are twofold: first; that as we work to suppress the virus to as close to elimination as possible, and keep it there, we will actively seek out every possible case using all of our now advanced testing capabilities to their optimal potential; and second; that testing for COVID-19 is likely to become a permanent feature in our lives – though one whose form will continue to change and adapt as the pandemic, and the virus itself, does.

In addition, given the strategic intent is to support the resumption of life as close to normal as possible, testing will increasingly play a role in supporting wider social and economic goals, by further reducing transmission risks through active case finding as we return to variable levels of restrictions across Scotland. 

It remains critical to repeat the emphasis of the original Testing Strategy that testing, on its own, does not stop the virus spreading; it only provides information that can support us to take action to stop transmission. It is one of many interventions that will continue to be necessary in various forms for a considerable period of time. Ensuring there is sufficient support for isolation – and that those who require this support know it is there and can easily access it – is critical in creating the conditions that actually stop the onward spread of the virus. 

And, as has been the case since the beginning of the pandemic, our overall testing strategy will continue to adapt to both the pandemic conditions facing us, and the technology and capability at our disposal.

It remains critical that people and communities continue to engage with testing as welcome progress is made in the vaccination programme. Isolating and booking a test as soon as symptoms develop, or engaging with routine testing programmes where they are established, or engaging in targeted community testing and isolating if positive, will all continue to play a critical role in supporting our overall aim of suppressing the virus to the lowest levels possible.

We will also deliberately build on the significant diagnostics infrastructure now developed in Scotland and invest further in specific testing capabilities – for instance, whole genome sequencing – in order to intentionally build a legacy from this experience that will leave Scotland in a better position to deal with a range of other infectious disease challenges and future health threats, including future pandemics. 

Scotland's Testing Strategy as published on 17 August 2020 set out a group of principles that continue to guide our approach to testing. They are set out again below.

Testing Strategy – Principles

1. Testing is part of our overall public health approach designed to minimise transmission of the virus, in line with our overall strategy of driving the number of cases of COVID-19 in Scotland to the lowest levels possible and maintaining that level.

2. Our priorities for testing are informed by scientific, clinical and public health advice from our expert advisory structures. All people moving to care homes from hospital or the community are also tested prior to admission.

3. Our approach to testing, including prioritisation, is flexible and adaptable to the prevailing conditions of the pandemic at any time, and informed by expert advice.

4. Our approach to testing takes full recognition of the limitations of testing (particularly at low levels of disease prevalence) as well as the opportunities of testing.

5. Our overall priority at this stage of the management of the disease is rapid identification and testing of people with symptoms.

6. Asymptomatic testing will increasingly be used on a risk-based approach to both minimise transmission through active case finding and to reduce harm to individuals at high risk.

7. The deliverability of any new testing priorities and pathways will be considered at an early stage to maximise successful implementation.

8. The capacity to accurately and efficiently record, report, interpret and respond to every test in a timely manner is critical.

9. Our approach to testing will aim to continually improve access to testing – both the ease with which people can access a test (or routine testing if appropriate), and the speed with which they obtain results.

These principles were reviewed as part of the Clinical and Scientific Review of the Testing Strategy, published on 23 October 2020. The importance of access to testing was stressed in that review, with the ninth principle added to reflect this.

The rest of this update is structured to mirror the original strategy. Section 2 updates why we test – outlining six purposes for testing at an individual, community and population level. Section 3 updates how we test – including new capacity that enables more widespread rapid testing and crucial new technology in surveillance that the Scottish Government is investing in to ensure we are in the best position possible for the critical next phase of the pandemic where the risk is of new variants undermining progress. Section 4 updates who we test – outlining the significant expansion in routine testing since the October review of the strategy, and looking ahead to the next phases as Scotland exits lockdown.