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

5. Conclusion

The strategic approach to testing necessarily adapts to the pandemic conditions facing us and the technology at our disposal. It is likely a further update will be required in the coming months.

The response to minimising transmission of COVID-19 has required population-wide measures in one of the largest public health interventions in a century. This has included the successful recruitment and roll-out of a specialised contact tracing workforce to deliver a critical public health intervention, with the requirement that large numbers of people who develop symptoms of the virus, test positive or have been in close contact with people who have tested positive, do not leave their place of accommodation for a prescribed period.

While this strategy update has focussed on developments in testing; we know that testing does not – in and of itself – reduce transmission of the virus. It provides information that can support action that reduces that transmission – action that includes contact tracing and supporting the isolation of positive cases. Contact tracing and supporting isolation as interventions have also required regular adaptation to the conditions of the pandemic to date, and will require ongoing flexing as the pandemic moves through future stages.

Contact Tracing

Within the wider Test and Protect intervention for Scotland, our contact tracing system continues to play a key strategic role in the pandemic response.

The contact tracing system has, since the inception of Test and Protect in May 2020, worked to reduce community transmission of the virus by identifying and isolating individuals at high risk of being infected because of close contact with positive cases. We have throughout prioritised, and will continue our commitment to enhance quality and user experience within the system, alongside ensuring the system is able to manage demand and that timely interventions continue to take place.

While contact tracing is underpinned by national strategy, the service is predominantly locally led and informed by local public health expertise, with support provided at a national level by strategic and delivery partners.

The key strategic objectives of the intervention are: 

• tackling local outbreaks by identifying and interrupting chains of transmission in a timely manner; 
• supporting compliance with self-isolation through follow-up communication; and
• acquiring ongoing intelligence on transmission patterns to inform local understanding of risk and to keep case numbers as low as possible (i.e. enhanced backwards tracing as a priority deliverable when capacity allows).

Typical 'forwards' contact tracing is concerned with identifying the close contacts of confirmed positive cases who have been exposed to infection to advise them to isolate in case they are infectious. Enhanced 'backwards' contact tracing refers to efforts to identify the source of the infection of the case being investigated, and identify possible commonalities in this source with other cases, which can help, both, investigate if there are further cases associated with the same source, and, add to the evidence base of settings or situations that are transmission risks. 

As we move forward into the next phase of the pandemic response, the priority is that the system is able to continue to cope with differing levels of local and national prevalence of the virus. This enables the intervention to be proportionate in achieving the aim of minimising the spread of the virus, by drawing on the experiences and expertise built up during pandemic to date. As the next phases of the pandemic are likely to be characterised by clusters and outbreaks, cluster based backwards contact tracing – as has already been the practice in Scotland – will continue in importance.

Support for Isolation

Testing and contact tracing are only successful in actually reducing transmission if people are able to isolate until they receive their test result, continue to isolate if positive, or are able to isolate if advised to do so by a contact tracer. For a significant proportion of the population this requires a range of practical and financial support. 

Support measures delivered to provide additional assistance to people self-isolating, where required, include:

• the provision of practical support including access to food and medication, when people self-isolating are not able to access these;
• the provision of financial support for people self-isolating in low-income households, who lose income as a result of self-isolating; and
• providing access to local support services for people self-isolating including through the third sector and statutory services.

To date, the isolation support strategy has intended to increase levels of compliance with public health advice related to the need to self-isolate by recognising that most people want to comply but that practical and financial barriers may prevent them doing so. The evidence base on levels of compliance with self-isolation is mixed over time – most recent research by University College London published in January 2021 found relatively high compliance with around 80% of close contacts of a positive case isolating entirely in line with the guidance.

As the roll-out of the vaccination programme continues, the evidence base for the efficacy of the vaccine in reducing transmission develops and prevalence of the virus reduces, it will be necessary to evaluate the isolation support offer more broadly to ensure it remains fit for purpose. There is a significant opportunity to consider what the future of support for people self-isolating requires in relation to COVID-19 and, in utilising the substantial evidence base developed as a result of the pandemic, to consider how this public health intervention should operate broadly. 

In considering the short- and medium-term needs for isolation support the Scottish Government will:

• utilise Scotland-specific research information to ensure the views of people with lived experience of self-isolation continue to be represented in the development and delivery of policy interventions; and
• continue to work with delivery partners and local authorities to ensure there is adequate resource to continue delivering support for people self-isolating, and to deliver increased capacity should progress made in reducing transmission be reversed.

As part of the longer-term strategy for self-isolation, the Scottish Government will:

• consider how the powers set out in the Public Health etc. (Scotland) Act 2008 and the experience of COVID-specific self-isolation support could deliver an effective self-isolation support model in future related to any future public health interventions;
• analyse the substantial body of research and evidence relating to self-isolation, including Scotland-specific research information, to consider how to deliver the most effective interventions for any future public health interventions; and
• utilise feedback from support services and the views of people with lived experience of self-isolation to consider further how to ensure that support provided to people self-isolating enables them to comply with self-isolation in a way that ensures their practical, financial and emotional needs are met.

Test and Protect will continue to play a key role in suppressing the virus to the lowest possible level in Scotland and keeping it there, while we strive to return to a more normal life for as many people as possible. Continuing to invest in every part of test and protect – testing, contact tracing and supporting isolation – is key. Building on our experience and intentionally developing our capability in whole genome sequencing and other forms of testing will also leave Scotland with a legacy that means we are better prepared for future health threats – by continuing to build a world-class public health system.