1. Current position
Progression of the virus in Scotland
Our society is facing the biggest challenge of our lifetime, with the way in which we live our lives significantly restricted by COVID-19. The virus continues to pose a serious threat to public health in Scotland. The Scottish Government is doing everything it can to suppress the virus and will not change restrictions until it is safe to do so. A second surge in infection would cause further harm to our health, society and economy. To judge whether and when restrictions can be changed, we will consider a range of evidence on the progress of the pandemic in Scotland.
As transmission of the virus reduces, as a result of effective responses, we expect to see stabilisation followed by a decline in the observed measures of the epidemic. Our most recent data for Scotland show there has been a welcome, sustained decline in new COVID-19 cases, hospital admissions, ICU admissions and deaths. Data is published every day on the Scottish Government Coronavirus webpages https://www.gov.scot/coronavirus-covid-19/
The restrictions that have been imposed have been extensive but necessary in order to bring down transmission. They have enabled us to prepare for the next phases, where we are better able to identify where the infection is, to give extra protection where protection is needed (shielding the vulnerable and protecting key workers) and to create safer environments (through preparing workplaces and public spaces and delivering Personal Protective Equipment (PPE) where needed). People and communities across Scotland have played an important part in this, and continue to do so, including through maintaining physical distance and hygiene. However, the virus is still with us, and will be for some time to come.
Significance of both the R number and the number of cases
There has been a lot of discussion about the R number - this is the rate of reproduction and it tells us the average number of people that would be infected by one individual with the virus. If R is 2, then two people would be infected by one person on average. If R is above 1, it shows that the virus is spreading in the population and, if it is below 1, the virus is declining in the population.
The R value is calculated through modelling the path of the virus, using data on cases and deaths and, as such, it is an estimate with a level of uncertainty. R is currently estimated to be between 0.7 and 1.0 for COVID in Scotland. At the start of lockdown, we think it was between 4 and 6. So that is real and very positive progress. We've also seen our estimate of the number of infectious people, currently 25,000, start to fall in recent weeks. It is vital that we keep the R number below 1 and see the number of infectious people continue to fall as, if we do not, the virus will quickly spread again and any relaxation of lockdown conditions will most likely have to be reversed. An increase beyond 1 would risk exponential growth in the number of cases, hospitalisations and deaths causing very significant harm to Scotland's health, society and economy. That is why the Scottish Government is exercising such care and caution.
For now, our advice remains to Stay at Home, except for essential work that can't be done at home, going out for food and medicine, or for exercise. When it is necessary to be outside, our advice is to stay two metres from people from other households, and to wear a face covering in enclosed spaces like shops or public transport. And we continue to recommend thorough and regular hand washing. These measures helped us break the chain of transmission and reduce the number of COVID cases, hospital admissions and deaths.
Breaking the Chain of Transmission
We are making progress.
However, too many people are still dying, and the situation in care homes - despite the extraordinary dedication of our care workers - remains a serious concern, so we have to be very cautious in our approach to transitioning out of lockdown.
There is some evidence that the current R number in Scotland is slightly above that elsewhere in the UK, though comparative estimates depend on models used and are subject to a significant degree of imprecision and variation over time as new data become available. If the R number is higher, this perhaps reflects the fact that our first cases came later than England's and so we may be at a different – and slightly earlier - stage of the infection curve. Differing population characteristics of Scotland relative to other parts of the UK, such as age structure and population density will also affect the measurement of R.
Our current assessment is that progress, while real, is still fragile - and that our room for manoeuvre remains limited. That is why we have so far stuck with the lockdown restrictions, making only one small change to guidance to allow people to leave their homes for the purpose of exercise more than once a day. We also want to have a test, trace, isolate, support system - Test and Protect - in place before we significantly ease restrictions.
We will continue to monitor the evidence very closely and on an ongoing basis. As we hopefully see more evidence of a downward trend in the virus, we will consider further changes as set out in this document – but we will do so on a very careful and gradual basis.
Box 1: What affects the reproduction number R?
The reproduction number (R) is affected by several factors:
the underlying infectiousness of the organism;
how long people who have Covid can infect others;
the number of people in the population that the affected patients are in contact with and how intense that contact is.
Assuming there is a level of immunity once you have had the virus, R should decrease over time: as people become infected in a population there are fewer susceptible people left as they are either infected, have recovered, or have died.
If policies have the effect of reducing the number of people someone comes into contact with, that would in turn reduce R.
Test and Protect
A key aspect of our strategy is the "test, trace, isolate, support" approach - or Test and Protect as we are now calling it. We will test people in the community who have symptoms consistent with COVID-19. We will use contact tracing, a well-established public health intervention, to identify the close contacts of those cases, who may have had the disease transmitted to them. We will ask those who test positive and their close contacts to self-isolate protecting themselves and others from transmitting the virus further. We will provide information to the public about increases in transmission and significant clusters of cases. And we will make sure that support is available to help people isolate effectively.
However, it is important to stress that Test and Protect will be most effective when levels of infection are low – lower than now – and stay low, and that its success relies on all of us knowing and agreeing what to do if we have symptoms, and being prepared to self-isolate when advised to do so.
As we lift restrictions, we will need to put in place public health measures to stop cases becoming clusters, clusters becoming outbreaks, and outbreaks becoming an uncontrolled peak that would require a return to lockdown to avoid enormous loss of life and an overwhelming of our health and care system - that is what Test and Protect is all about.
Learning from our international partners
We set out in our Framework for Decision Making that we will draw on WHO, European, UK, Scottish and wider international expertise to understand the virus and our responses to it.
Many countries have begun to lift physical distancing restrictions and there will be a time lag between lifting and seeing the impact. It is important to remember, however, that each country's experience of the virus is different and we need to consider Scotland's population and characteristics as we apply lessons.
COVID-19 related restrictions currently in place Scotland
The Scottish Government has taken decisive action to address the pandemic, imposing measures to restrict public gatherings, business activity and requiring people to stay at home unless it is absolutely essential to go out, in order to protect public health and protect the NHS. The Health Protection (Coronavirus) (Restrictions) (Scotland) Regulations 2020 came into force on 26 March to allow enforcement of those measures in recognition of the threat posed to public health from the coronavirus. The Regulations, unless amended, will expire after a period of six months from the date they entered into force. They placed unprecedented restrictions on the movement of people and the operation of businesses across Scotland and have a huge impact on Scotland's way of life.
Due to the extraordinary nature of the restrictions placed on Scottish society, Scottish Ministers have provided for a statutory review of the need for restrictions and requirements contained in the Regulations. Such a review must take place at least once every 21 days.
The physical distancing measures in place in Scotland – a mixture of regulations and guidance can be found in the Framework for Decision Making: Further Information. As of Monday 11 May we removed the once-a-day limit on exercise from guidance.