WHO criterion 5: Manage the risk of exporting and importing cases
WHO criterion 5: Manage the risk of exporting and importing cases from communities with high risks of transmission.
As the community transmission of COVID-19 decreases in Scotland, the importance of managing the risk of imported cases increases. The Scottish Government has worked with UKG and the other Devolved Administrations (Northern Ireland Executive and Welsh Government) to introduce public health measures at the UK border to address this risk.
The Scottish Government has been supportive of such measures from the outset and has consistently highlighted the importance of implementing them on a four nation basis as far as possible. These measures were introduced to all individuals arriving in the UK from Monday 8 June. With the reduction in domestic transmission rates and the continuing requirement to keep the R number under 1, the risks to public health from imported transmission remain significant.
The Health Protection (Coronavirus) (International Travel) (Scotland) Regulations 2020 came into force on Monday 8 June.
Under the regulations, anyone who arrives in Scotland from outwith the Common Travel Area (or who has been outwith the CTA in the last 14 days) is required to comply with the following measures;
- They need to provide their journey and contact details when travelling to the UK by completing a passenger locator form.
- They are not allowed to leave the place they are staying for the first 14 days after their arrival in the UK except in very limited situations (known as 'self-isolating')
The regulations apply to people regardless of whether they are residents of Scotland or visitors. The regulations laid in the four nations attempt to align as much as possible. However, there are some differences contained within the Scottish Government regulations, including differences in the enforcement of the measures; the exemptions list and the self-isolation requirements. The Scottish Government coronavirus website provides guidance on how these measures apply to arrivals in Scotland.
Duties are also placed on transport operators to provide passengers with information, both before booking and throughout the passenger journey, by the Health Protection (Coronavirus, Public Health Information for Passengers Travelling to Scotland) Regulations 2020.
An individual arriving in Scotland from abroad must state where their accommodation is on the passenger locator form and travel straight to that accommodation, preferably by private transport. They must self-isolate for 14 days and only leave that accommodation in limited specified circumstances. If they live with others who have not been out of the country in the previous 14 days they should - as per the regulations unless subject to a specified list of exemptions - minimise their contact with them and, if they require help buying groceries, other shopping or picking up medication they should, where possible, ask friends or relatives or order a delivery.
In aviation there is currently minimal passenger demand, although we are beginning to see some airlines slightly increase the number of flights they are operating – we are currently seeing 200 passengers a day arriving from international locations into Scottish airports. We are also seeing relatively high initial compliance rates with 70-80% of passengers completing the information requirement before travel, and the remainder doing so at Border Control. The introduction of these public health measures is expected to limit the volume of international travel to and from the UK, reducing the risk of imported transmission. As we move towards the traditional holiday period a removal of the border public health measures could result in a significant increase in traffic.
In terms of the internal border (including the Common Travel Area) there are currently a relatively low number of cases in Ireland (9 positive cases on 9 June) and deaths (38 over the seven days to 9 June). This points to the effectiveness of the prevention methods in Ireland. Similar measures for international arrivals have been deployed in Ireland. On arrival into Ireland all passengers are required (by law) to submit a COVID passenger locator form, which may be used by the health authorities in order to verify passenger location in the country. Failure to complete the form can result in a €2500 fine. The Irish Government requests that everyone arriving in Ireland should self-isolate in a 14 day quarantine, but it is not at, this stage, a legally enforceable requirement.
The combination of the border health control measures in place in the UK and Ireland and the data on infections in Ireland lead us to assess that the risk of importing cases from outside the UK is being effectively managed.
In the event that a community with high risk of transmission developed within the UK, there is the possible risk of exporting or importing cases to and from that community, whether in Scotland or in the other countries of the UK. Guidance currently in place in Scotland suggests only local travel (broadly within 5 miles) for recreation. Additionally, the regulations provide that a person who carries on a business of providing holiday accommodation (including self-catering accommodation) must cease to carry out that business unless certain exemptions apply. These restrictions will have the effect of limiting to some degree long distance travel within and to and from Scotland throughout the duration of Phases 1 and 2, thus limiting to some extent transmission between communities.
A practical approach to managing transmission to and from communities with high rates of transmission in the UK could be to rely on systems for instituting local lockdowns being developed in each country. In the event of a significant local outbreak in Scotland, Ministers have Regulation-making powers under the Coronavirus Act 2020 that would allow the re-imposition of lockdown restrictions on a local or regional basis within Scotland if necessary, thus managing the risk of exporting cases from high risk communities to other parts of Scotland or the UK. A similar approach in other countries of the UK could manage the risk of exporting cases from high risk communities there and the UK Government is looking at this as part of the Joint Bio-Security Centre arrangements in England. The variation in infection rates across communities within the UK at this review point is not sufficient to cause significant immediate concern.
As Scotland transitions to the next phase of the COVID-19 pandemic, we are developing a responsive system of community surveillance for COVID-19 direct and indirect impacts 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 all kinds of 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 enable appropriate response to those signals and emerging risks. This will allow 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 manage the spread of COVID-19 in Scotland including when derived from imported cases by quickly identifying COVID resurgence, clusters, and outbreaks.