WHO criterion 2: Sufficient public health and health system capacities are in place
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 and Protect
On 4 May Scottish Government published its paper COVID-19 - Test, Trace, Isolate, Support (TTIS) setting out the approach to controlling the spread of coronavirus in the community. The public-facing name for the TTIS strategy is Test and Protect. It is a public health approach to supporting the management of outbreaks of infectious diseases. It is used to interrupt chains of transmission in the community.
Test and Protect was introduced across all Health Boards from Thursday 28 May, at which point over 2,000 staff from the NHS Boards across Scotland were available. As of 3 June, 822 staff started contact tracing, with a further 1185 ready to be deployed on demand. A further 150 staff from Public Health Scotland and National Services Scotland are in place to establish the nationally co-ordinated team. All health boards now have access and are using the digital tools to support contact tracing.
Test and Protect relies on disease prevalence being low, as well as high levels of public compliance with public health advice including hand and respiratory hygiene, physical distancing and awareness of symptoms.
The fewer close contacts each confirmed case has, the more straightforward contact tracing will be, and the less likely it will be that disease transmission has occurred. As part of Test & Protect, Public Health Scotland is publishing initial national data on the number of index cases and contacts traced, with the first dataset published on 10 June. In weeks to come the intention is to publish further detailed, regional data too.
Our approach to testing is focussed on saving lives and protecting the vulnerable, rolling out Test and Protect to interrupt chains of transmission in the community, and continuing the vital surveillance work to support our understanding of the disease in Scotland. This is enabling us to continue to expand eligibility for testing, and ensure the necessary capacity exists to support Test and Protect, and we are continuing to model what capacity is required in the system to ensure that capacity meets demand and to avoid delays anywhere in the system.
Now Test and Protect has been rolled out, we will continue to work with partners to increase testing pathways in the community to widen availability for citizens. Our health protection teams are experienced in contact tracing across UK and international boundaries. Those teams will continue to work with their counterparts in other areas to deliver effective contact tracing services. We have confidence that people will recognise the importance of taking part, in order to protect themselves and each other, just as they have with lockdown.
Since the start of the outbreak we have significantly increased our testing capacity –our current normal weekday capacity is now more than 28,500 and we continue to work with colleagues to increase this capacity. General access to testing for those outside the NHS and social care system is via the drive through and mobile units which use the Glasgow Lighthouse Lab, which accounts for around half of Scotland's capacity and usage is determined by public demand for tests.
Where there are outbreaks, these are investigated through a risk assessment which takes into account patient confidentiality, public health needs and individual consent issues. Each incidence is judged individually. There is scope to make the public aware of incidences where appropriate. Anonymised information is used if it is practicable to do so and if it will serve the purpose, and index cases are always asked for permission to disclose their personal details.
We have introduced new reporting processes for boards which will give us more robust data on testing for key workers and staff, hospital and care home testing, which will help inform local and national planning and allow us to see where there are gaps.
We are continuing to work closely with Board Chief Executives and Directors of Public Health to ensure access to resources to increase testing capacity including Mobile Testing Units and UKG Social Care Testing Portal.
Health Boards and NHS National Services are working hard to manage demand across different geographies and maximise daily capacity. This includes using real time data to allow variances in capacity and demand to be managed. We are also working with NHS Boards and health care partners on restarting health care services meaning that capacity is required for additional testing as a result.
The Route Map states that "we will provide information to the public about increases in transmission and significant clusters of cases." Senior Medical Officers (SMOs) have been asked to advise the clinical view on public sharing of information on outbreaks as an expanded Test and Protect approach is implemented.
The Digital Health & Care Institute (DHI) has developed a tool that is configured to integrate with the existing data infrastructure in Scotland and support local teams to make contact tracing less resource intensive. The tool will allow local teams to input contact details directly into the contact tracing digital infrastructure, and to use this to record that contacts have been traced. All Boards received the tools by 28 May.
During June this tool will be enhanced to make it available to people who have tested positive so that they can assist the contact tracing teams by recording details of their contacts. We also recognise that not everyone in Scotland will want, or be able, to use digital technology in this way, and so we are working to ensure that telephone support will be available for everyone who needs it.
Between 28 May and 14 June, 992 cases (positive test results) were identified for Test & Protect, from which 1,239 contacts have been traced. 891 cases have completed contact tracing. This means about 1.25 contacts per person have been traced.
The number of contacts traced per person is below early estimates of the number of contacts a person has. This could be due to:
- The definition of a contact for the purpose of Test & Protect is different to the definition used in the preceding literature used to develop the planning models;
- Given that lockdown measures remain in place, index cases are naturally meeting fewer people;
- Those engaging with the system are not fully reporting all contacts.
A sustained decline in transmission has allowed the implementation of a robust system of testing on the basis of significantly expanded capacity. Fast, well trained and effective contact tracing teams are in place; outbreak reporting and monitoring systems have been agreed and implemented; and data systems have been established to ensure that contact tracing is as reliable, rapid and effective as possible. We may be seeing lower than actual levels of symptomatic people booking a test so work is underway to better inform and motivate such people to be tested, in addition to work to make test sampling easier.