Section One – Introduction – Why We Test
Scotland's overall pandemic strategy is set out in COVID-19: A Framework for Decision Making, published on 23rd April 2020. That strategy is to suppress the virus – driving the number of cases to the lowest levels – to enable as close to normal life as possible to resume, while remaining vigilant and ready to respond quickly to prevent new cases transmitting onwards.
We know meeting this challenge requires a comprehensive set of public health measures of intelligence, anticipation, prevention, mitigation and response – no one intervention on its own will suffice. Our testing strategy is one key part of this approach.
Our approach to testing has already adapted as the pandemic has progressed in Scotland, and will continue to adapt as we deal with the distinctive challenges of future phases into winter. Our approach to testing will also adapt as the science and evidence base around the behaviour of the virus builds – in particular on transmission – and as innovations come on stream. This ability to adapt to the conditions facing us is a key principle of our approach.
|Testing to support direct patient care at the peak of the pandemic.||Testing to support direct patient care as the NHS remobilises|
|Testing to enable keyworkers to return to work|| Testing to reduce transmission to
the lowest levels possible including protecting vulnerable groups at higher risk by testing health and
|Testing for population surveillance to understand national epidemic progression||Testing for population surveillance to understand national epidemic progression - extended to support early warning and monitor key sectors including schools|
|Antibody testing for direct clinical care and population surveillance||Continued antibody testing for direct clinical care and population surveillance, plus research to establish any immunity link|
|Lockdown reducing opportunities for transmission||Proactive case finding, testing asymptomatic people in high risk contexts, subject to expert advice|
The table above sets out how our approach to testing has already adapted during the course of the pandemic as prevalence of the virus has changed. During lockdown, opportunities for transmission were considerably reduced in the population and the core strategy then was to use testing to save lives; to ensure that critical staff could return to work if it was safe for them to do so, and to monitor the spread and prevalence of the virus.
The 'why' of our testing approach has changed as the pandemic has progressed and as we navigate our way out of lockdown. Testing for COVID-19 in Scotland is currently undertaken for three main reasons:
- to reduce the risk of transmission and continue to drive the number of cases down to the lowest possible levels;
- to support patient care; and
- to enable surveillance of the disease in the population and in particular sectors.
As we move through the weeks and months ahead we will continue to adapt our strategy to address the pandemic conditions we face, and in doing so we will apply the eight key the principles below to guide and shape our strategy.
Testing Strategy – Principles
1. Testing is part of our overall public health approach designed to minimise transmission of the virus, in line with our overall strategy of driving the number of cases of COVID-19 in Scotland to the lowest levels possible and maintaining that level.
2. Our priorities for testing are informed by scientific, clinical and public health advice from our expert advisory structures.
3. Our approach to testing, including prioritisation, is flexible and adaptable to the prevailing conditions of the pandemic at any time, and informed by expert advice.
4. Our approach to testing takes full recognition of the limitations of testing (particularly at low levels of disease prevalence) as well as the opportunities of testing.
5. Our overall priority at this stage of the management of the disease is rapid identification and testing of people with symptoms.
6. Asymptomatic testing will increasingly be used on a risk based approach to both minimise transmission through active case finding and to reduce harm to individuals at high risk.
7. The deliverability of any new testing priorities and pathways will be considered at an early stage to maximise successful implementation.
8. The capacity to accurately and efficiently record, report, interpret and respond to every test in a timely manner is critical.