Coronavirus (COVID-19): framework for decision making

Sets out challenges Scotland faces and outlines the approach and principles that will guide us as we make decisions about transitioning out of the current lockdown arrangements.

This document is part of a collection

Section 4: Framework for Decisions

  • We want to ease restrictions but must be prepared for them to be reimposed as well as lifted.
  • Any lifting of restrictions will rely on high levels of support and compliance from the whole population with any continued physical distancing.
  • We will be open and transparent about the evidence we have.
  • We will consider how our decisions impact on all parts of society.

It is important that there are clear criteria to guide decisions on whether to maintain, tighten or relax the lockdown. There is a process in place to guide us. We will follow the evidence and apply judgement to it. We will consider the advice from experts across science, public health, the economy, and beyond. Our Chief Medical Officer's Advisory Group, in alignment and discussion with the advisory structures in other parts of the UK including SAGE, is advising us on the public-health impacts of the crisis and how to mitigate them. We are also able to draw on the range of economic and social policy expertise from the across government and beyond to inform our decision making.

While we will continue to operate within a four nation UK framework and align our decisions as far as possible, we will take distinctive decisions for Scotland if the evidence tells us that is necessary.

The evidence we now publish daily on cases, hospitalisations, ICU admissions and deaths will tell us if community transmission is controlled. The following chart shows the trend in recent weeks of daily numbers of COVID-19 patients in hospital. There are signs it has plateaued. The capacity of our health and care system to care for our people when any restrictions are lifted will be a factor. Evidence on the impact on the economy and society, in particular more at-risk communities, will also be critical to any decision making.

Figure 2 – Daily Number of COVID-19 Cases in Hospital
the figure shows how many people are in hospital with confirmed, or suspected, cases of Covid-19. Starting on the 18th of March there were almost 200 confirmed or suspected cases. From the 27th of march, the figure fully separates suspected and confirmed cases. Over time there is a steady increase in the number of cases. By the 8th of April there are 1400 confirmed cases and around 400 suspected cases of COVID-19 in hospital in Scotland. The graph shows a flattening after this date – the number of confirmed and suspected cases being treated in hospital does not appear to be growing.

We need a better understanding of the transmission of the virus in particular places - especially our hospitals and care homes – and how that may impact community transmission. And – within the overarching constraint of keeping transmission suppressed – understanding the impact of our options on our economy and our society, on our children's ability to learn, and on meeting the needs of those most at risk will be critical.

Our values matter too. We will ask of each option, how does this impact on different groups in society – is it ethical, does it promote solidarity, does it promote equality and does it align with our legal duties to protect human rights? At all times we will ensure that the action being taken is necessary and proportionate. Restrictions should be eased as soon as it is safe to do so, but we should be clear that it may be necessary to re-impose restrictions if the evidence indicates that this is the best way to safeguard public health and the right to life.

In acting in an open and transparent way we will explore new ways to engage with the public as this pandemic progresses. We will also continue to publish on a daily basis the key measures of how the pandemic is progressing, and we will share our thinking at every stage.

Assessment Framework

Determining when and how to ease, maintain or (re)impose physical distancing measures will be some of the most important decisions that we will make in relation to the crisis.

We will need to assess existing measures, and potential new measures, individually and in combination. We will consider how they interact with other factors such as testing and contact tracing, and hopefully, in the longer term, any breakthroughs in treatment or vaccine – though we are not counting on these now.

We will be assessing physical distancing options for their contribution to minimising overall harm to our health, economy and broader society. To do this, we will use the best available evidence and analysis (e.g. modelling of the epidemic and of the economy, and the interaction between the two), supported by external expertise.

Our assessment of the options will be constrained by the need to keep transmission of the virus under control (in technical terms, to keep the R below one). It is likely that we will need small, incremental steps initially in terms of easing the measures.

To make sure this would not lead to an unmanageable acceleration in COVID-19 cases, we will use evidence about the scale of change: how many more people would come into contact with others in each option and what that means for the likely spread of the virus. When we do ease restrictions, we will then continue to monitor new cases daily, as well as regular monitoring of the other health, economic and social harms stemming from COVID-19, to validate our existing assessment and inform future assessments.

We will also assess options against broader considerations including how well any measures can be communicated and understood, how likely they are to be complied with, whether their impact on human rights is proportionate to the current level of risk, and their impact on different equality groups – as we know that both the virus and the physical distancing measures affect different groups in society in different ways.

Within these considerations, we will also assess the merits of tailoring options to, for example, specific geographies and sectors, or parts of the rural economy, or those able to work outdoors – but only if that is consistent with the aim of minimising overall harm and can be implemented effectively. We will also take account of other relevant factors such as how people and goods move around the country. We understand the importance of work to people's health and wellbeing and we want to be able to allow businesses to re-open and people to go back to work just as soon as it is safe to do so.

These assessments will inform the decisions we take about the Health Protection (Coronavirus) (Restrictions) (Scotland) Regulations 2020 that determine the legal aspects of physical distancing, and which must be reviewed at least every three weeks and lifted when there is no longer a need for them.

These assessments will also inform our discussions with the UK Government and other devolved administrations, as part of a process of collective assessment and decision making when appropriate.

This framework for decision-making will, on its own, be insufficient to achieve our aims of controlling transmission of the virus and minimising broader health, economic and societal harm. Achievement of these aims will require unprecedented levels of support and compliance from the whole population. The virus has not been eradicated.

Assessment Framework

1. Options for physical distancing measures – easing, maintaining, (re)introducing – are technically assessed using the best available evidence and analysis of their potential benefits and harms to health, the economy, and broader society so as to minimise overall harm and ensure that transmission of the virus is suppressed.

2. Potential options – individual and combinations of measures – are assessed for their viability, for example taking account of how easy they are to communicate and understand, likelihood of public compliance, the proportionality of any impact on human rights and other legal considerations.

3. Broader considerations also include equality impacts and consideration of tailoring measures, for example to specific geographies and sectors.

4. Assessments will inform the required reviews of the Coronavirus regulations and collective assessment and decision-making with the UK Government and other Devolved Administrations as appropriate.



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