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 6: Controlling the Pandemic – Respond and Recover

  • We will use surveillance to identify and track the spread of the virus.
  • We will develop and deploy the public health services we need to tackle outbreaks.
  • We will work with all sectors of society including schools and businesses to develop policies and practices that contain transmission.

All our consideration of options for physical distancing measures will be constrained by the need to minimise the transmission of the disease, so that we do not re-enter a new phase of sustained community transmission.

Figure 3 – Breaking the chain of transmission
the figure shows how breaking chains of transmission can reduce the exponential growth of cases. If there are no measures in place to slow transmission, and one person spreads the virus to three others, then the number of cases grows very quickly. If one person spreads the virus three, and those three to another 3 and so on, there are 243 cases of covid-19 after only 5 generations. However, if these chains are broken – for example one person at the start of the chain doesn’t visit their mum, then this greatly reduces the spread. This shows how the social distancing actions help to contain covid-19.

Efforts to prevent the spread of the virus will need to be sustained, and, in advance of effective treatments or a vaccine becoming available, we will all need to keep up the strong hygiene practices and elements of physical distancing that are beginning to impact on the spread of the virus.

Our plans to respond and recover must take account of the possibility of a cycle of lifting and re-imposing restrictions. The steps we take to rebuild our economy or restore some degree of normality in society must recognise the possibility of restrictions being re-imposed quickly. That will require fundamental change to how all sectors of society organise themselves.

Unprecedented efforts to understand this virus, its potential treatments and to produce a vaccine are underway across the world. But we must be clear that there can be no guarantee of quick success nor of permanent success. Other viruses – like influenza - require seasonal vaccination.

We will be led by the science and focused on reducing the harms to human wellbeing caused by the virus and the unintended impacts of the measures in place to control it.

We will do this by drawing on WHO, European, UK, Scottish and wider international expertise to understand the virus and our responses to it. The best scientific advice suggests that it will in due course be possible to relax lockdown, but that strong measures to sustain low levels of transmission will be required until either a vaccine or cure is developed.

Some of the range of lockdown relaxation options described above are beginning to be put in place in different countries. We will learn from the international community, in particular those further ahead than Scotland in their pandemic curves. At this time, it seems likely that the most promising approaches for Scotland are likely to involve some combination of the following key measures:

  • Innovative approaches to maintain and enhance physical distancing
  • Continued focus on strong hygiene practices
  • High public community awareness of symptoms and prompt action in response
  • Active surveillance
  • Case finding, contact tracing and quarantining
  • Shielding of clinically at risk groups

If we see evidence of outbreaks of the disease we will need to be ready to act decisively to suppress them and so prevent wider transmission. This will require both a very high degree of virus-aware public behaviour along with enhanced public health services. These services would come in five stages. Work on all of these is underway in Scotland and we will set out further detail shortly.

1. Effective disease surveillance. We need to understand where the virus is and how prevalent it is.

2. Early identification and isolation of possible cases. High population awareness of symptoms, clear action on what to do if you have them, high propensity to act.

3. Early and rapid testing to confirm cases.

4. Early and effective tracing of everyone a confirmed case has been in contact with over a certain period. This will need to involve digital tools and require active support from the public, as well as support from contact tracing teams.

5. Early and sustained isolation of contacts. Chains of transmission can only be broken if those who could transmit the disease to others are isolated so they cannot do so, and get the support they need to maintain that isolation.

Continuing to increase our testing capacity is a critical part of this challenge. Our ability to ease restrictions will be related to our testing and tracing capacity and, ultimately, to issues like the public uptake and acceptance of (possibly repeated) testing of individuals.

In tandem, we will redouble our efforts to prevent transmission in particular settings, including hospitals and care homes. Throughout the world, hospital acquired infection and virus spread in care homes has been a great challenge. We need to understand more about how this virus spreads through institutions and adapt our buildings and practices to limit its potential to do so. Ensuring sufficient supply of Personal Protective Equipment (PPE) is a crucial part of this.

The safety of our essential frontline workforce is an absolute priority, and we will continuously monitor and improve the supply and distribution of PPE. We recognise that workers need absolute clarity on what type of PPE they should wear in which setting or scenario and we will work continuously to ensure our guidance is in line with the science as our understanding develops.

Working together under the 4 Nations PPE Plan, we will continue to ensure we benefit from mutual co-operation on the procurement and distribution of PPE where appropriate.

The Scottish Government will continue to develop our own supply, procurement and logistics arrangements, working with manufacturers in Scotland and globally to ensure we have adequate supplies.

We will also, with the other nations across the UK, need to carefully consider 'port health' – the impact of international travel on transmission of the virus. It is unlikely that we will be able to contain the virus domestically, without some form of surveillance of those coming into the country from elsewhere. We will urge the UK Government to have this as a part of their approach.

We need better data to identify areas of spread and the rate of exposure and immunity in the population, locally, regionally and nationally so that we can monitor the impact of any changes and make decisions in as close to real time as possible.

Stopping a resurgence of the pandemic – another peak – will allow us to work with our partners in business, trade unions, local government, the voluntary sector and in broader society to redesign workplaces, education settings and other premises so they are places where spread is minimised - allowing people to get back to work, children to return to school, and our young people to continue their education through our colleges or universities, when it is safe to do so.

We will support businesses and other organisations in this redesign so they can be places where physical distancing can operate. Our health and safety professional communities will play a critical role.

We will need to consider compliance with physical distancing advice in the workplace and in other settings. We have already begun the conversation on how to respond, re-set, restart and recover with our business community and our trade unions. Businesses are already learning about safe working with physical distancing in place, showing how effectively they can adapt and change their business models.

Partnership must be at all levels to be effective – national, local, and community. And this partnership requires support – for individuals, families, communities, organisations and businesses.

Our support for business, for example, is now around £2.3 billion and complements UK Government schemes. This support will need to continue for as long as necessary and we will work with the UK Government to secure this. Business support must be responsive to the business needs of each nation, and informed by evidence and expert advice.

To date, we have rightly focused the majority of our efforts on protecting as many businesses and jobs as possible through either financial support or to help them repurpose. We are developing guidance for businesses to safely return to operation when the scientific and health advice supports this.

This epidemic is evolving rapidly, and our understanding of best responses will evolve as well. Additional evidence, context, and insights about the epidemic become available every day and we will continually adapt our response in the light of greater understanding.



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