Publication - Strategy/plan

Coronavirus (COVID-19): Strategic Framework update - February 2021

Published: 23 Feb 2021
Last updated: 23 Mar 2021 - see all updates

Sets out how we plan to restore, in a phased way, greater normality to our everyday lives.

Coronavirus (COVID-19): Strategic Framework update - February 2021
Protective measures and our levels approach

Protective measures and our levels approach

Protective measures, or non-pharmaceutical interventions (NPIs) are a critical tool in the management of the epidemic, both in Scotland and abroad. Throughout the pandemic, we have reinforced the importance of individuals, businesses and organisations continuing to follow the FACTS measures for a safer Scotland.

Further NPIs have taken the form of restrictions on activities or settings. A strategic approach to outbreak management based on five graduated levels of restrictions was introduced in Scotland on 2 November. Each of the five levels comprises packages of restrictions to suppress the virus to low levels and keep R below 1, according to different epidemiological conditions in the areas in which they are applied. At present mainland Scotland and some island communities are  in an enhanced Level 4 (the highest level); other island communities are in Level 3.

The levels were designed to be applied locally, regionally or nationally, depending on the course of the pandemic. This flexibility has rapidly targeted interventions to stop the spread of the virus, whilst allowing more scope for people and businesses to resume activities in a safe way, consistent with our strategic aim to suppress the virus while we strive to return to greater normality.

In essence, the Levels work by limiting members of different households from interacting in different settings and activities, where those settings and activities pose different risk factors for transmission of the virus. Decisions must be made about which activities and settings to restrict in order to achieve the required suppression of the virus. When different restrictions would have similar effects on transmission, difficult decisions must be made about which restrictions to apply. To help make those difficult decisions we seek to consider the impacts of the different options on the four harms as well as impacts on particular groups in society, including those with protected characteristics. This is consistent with the principles and approach set out in our Framework for Decision Making in April 2020.

We recognise that living with restrictions is tough for everyone in Scotland, with children and young people, vulnerable groups and businesses being particularly hard-hit. Whilst these measures remain necessary, within the limited resources and devolved powers that we have available, we will continue to provide support for those who need it in these difficult times. The section: providing care and support to mitigate the harms of the crisis sets out how we are working to do this.

We are committed to keeping the Levels approach under review and are grateful for the feedback we have received to date from individuals, businesses and stakeholders on how it has worked for them in practice. Below we set out how we are building on feedback and our own experience of using the Levels to ensure that our approach remains necessary, proportionate and effective in suppressing the virus.

Strengthening the levels approach in response to the new variant

As set out above, the emergence of the Variant of Concern (VOC) B.1.1.7 has increased the transmissibility of the virus and is now the dominant strain in Scotland. This means that it is now more challenging to effectively suppress the spread of the virus.

The chart below shows the changing trends of positive cases over the last couple of months from mid-November 2020. It shows that since January the B.1.1.7 ‘UK’ variant (depicted by the green line) has become the dominant strain and also that it has been declining at a slower rate under the new variant than the previous strains of the virus (red line), reflecting its increased transmissibility. 

As Figure 6 below illustrates, a given level of restrictions (for example, strengthened Level 4) suppresses the new variant at a slower rate than the old variants, as shown by the different gradients of the green and red lines respectively. (There may also be a composition effect). This means that we can be confident that each of the levels will have less effect in suppressing the virus now that the new variant is dominant than they were in suppressing previous variants. Consequently, we have had to adapt our approach, firstly by strengthening Level 4 and secondly by reconsidering the stringency of the Levels system more generally.

Figure 6: COVID cases per 100,000

Positive cases per day: this chart shows the number of positive cases per day over the last few months since mid-November. It shows cases split into ones that were detected by PCR as S gene positive (consistent with previous circulating lineages), true S gene drop out (consistent with the new ‘UK variant’ – B.1.1.7) and weak positive. The chart shows that until the middle of December cases were nearly all positive S gene cases (previously circulating variants) and dropped from the middle of November from around 800 cases per day to the beginning of December where they remained steady at around 550 cases per day until the middle of December. The S gene positive cases then increased from around 550 cases per day to around 800 cases per day peaking at the beginning of January. In the middle of December, true S gene dropout cases (consistent with the new ‘UK’ variant) sharply increased from a baseline just above zero to a peak of around 1000 cases per day in early January. A few days earlier at the end of December, the number True S gene dropout cases overtook the number of positive S gene cases where both were around 800 cases per day. Following the peak in January the rate of decline in the S gene positive cases is far more pronounced than for the S gene dropout cases which by mid-February still accounted for around 500 cases per day.

Covid cases per 100,000,  S-gene drop out positivity: Public Health Scotland

At present, most of Scotland is being protected at Level 4 (with some island communities in Level 3). The Level 4 measures have been adjusted since Boxing Day to address the risk and uncertainty posed in particular by the new variant. For example, fewer shops are permitted to open than before and – since 5 January – people are required to remain in their homes unless they have a reasonable excuse for leaving, while inter-household socialising outside the home is limited to two people (not counting under-12s). A key additional measure across the whole of Scotland has been to close schools and early learning and childcare services to most children and young people, a necessary measure that we have only just begun to ease.

As a result of these measures, reinforced by the positive impact of the vaccine programme and the hard work and sacrifice of people across Scotland, the epidemiological position is now an improving one, with falling incidence and prevalence and pressures on the NHS at last beginning to abate, though remaining at a high level. While every death is tragic, we are also seeing the numbers of deaths and admissions to ICU decrease and this should continue as more people are vaccinated. These positive developments have provided us some very limited scope for easing in the short term. Reducing COVID ICU and bed pressures will also allow the NHS to restart and deal with other health issues, which will yield significant economic and societal benefits.

Easing restrictions within Level 4

We know that the tight restrictions currently in place cause significant harm to individuals, communities and businesses and we do not want to keep them in place any longer than is necessary. We need to ease the current restrictions in a gradual way which stops the virus taking hold once more, limits opportunities for new variants and allows time for the vaccination programme to roll out. In particular, we must ensure that R remains under 1 to continue to suppress the virus: if the R number goes back above one then the virus will grow exponentially again. The current published estimate for the R number is in a range between 0.7 and 0.9, implying that there may be very little scope for significant changes to restrictions in the immediate future.

Given this very limited room for manoeuvre, we have to make difficult choices concerning the prioritisation for easing restrictions within the current, strengthened Level 4. We have already decided to prioritise schools and early learning and childcare. Below we outline this and a number of other priorities for easing within Level 4. These easings will gradually reduce restrictions within Level 4 for mainland Scotland and some island communities. However, we expect to retain some of the additional protections added to Level 4 in response to the new variant. Our plan is therefore to progress through these easings for Level 4, at a pace that the data indicate is safe, and from there to allocate protection levels again in accordance with geographical epidemiological data. This approach is consistent with the advice received from our expert COVID-19 Advisory Group, which underlined the importance of suppressing the virus, including to protect the NHS, and then gradually easing with a priority on schooling.

We will use six conditions recommended by the World Health Organisation in assessing whether it is safe to proceed with each new set of easings. These criteria are outlined below. Consistent with our commitment to transparency in decision making, we intend to publish these assessments to explain our decisions. The first two criteria are more amenable to quantitative assessment based on a number of indicators. The other conditions will be subject to more qualitative assessment in reaching a judgement about whether they are met sufficiently to proceed.

World Health Organisation criteria for easing restrictions

  1. Evidence shows that COVID-19 transmission is controlled
  2. Sufficient public health and health system capacities are in place to identify, isolate, test and treat all cases, and to trace and quarantine contacts
  3. Outbreak risks are minimized in high vulnerability settings, such as long-term care facilities (i.e. nursing homes, rehabilitative and mental health centres) and congregate settings
  4. Preventive measures are established in workplaces, with physical distancing, handwashing facilities and respiratory etiquette in place, and potentially thermal monitoring
  5. Manage the risk of exporting and importing cases from communities with high-risks of transmission
  6. Communities have a voice, are informed, engaged and participatory in the transition

Figure 2 below sets out the likely phasing of the easing of restrictions within Level 4, though we will keep this phasing under regular review. This shows in more detail how we expect the phasing to proceed before we return to more geographically variable levels at a point in time when the epidemic is much more suppressed.

Given the uncertainties inherent in this pandemic, we will continue to follow a data-led approach to decision making, with progress based on meeting conditions rather than following a schedule of dates announced a considerable period in advance.

Consistent with this approach, we would expect there to be at least three weeks between each of the sets of easings shown in the diagram. It is important to underline that if the data do not allow an overall judgement to be reached that the six conditions have been met, further easing would need to be delayed until the data indicated that our progress was back on track.

Although the decisions on if, when, and how to ease restrictions must be made by government, they cannot be made in isolation. We recognise that transparency and engagement is fundamental and that we must listen to and support the people of Scotland as we take our next steps.

In taking decisions, 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 evolving scientific evidence in the context of Scotland. 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 we judge this is necessary based on the evidence. 

Figure 2

Protecting our children’s wellbeing and future

We know that the education and social development that in-person schooling provides is vital to ensure that all our children are able to reach their full potential, and it is also essential that children with particular needs are supported and protected. Moreover, educational attainment is one of the key determinants of inequalities in outcomes, and we are committed to reducing the attainment gap. That is why we have been clear that returning children to school is a priority. Throughout the pandemic we have kept schools open for the most vulnerable children as well as children of key workers. We have already started the return from 22 February of early learning and childcare and primary schools children in P1 to P3, plus a limited number of senior phase pupils, part time from the same date, alongside small increases in existing provision for children and young people with additional support needs where there is a demonstrable and immediate need. We will set out further details on the next phase of school re-opening at the review point on 2 March 2021.

The mental, physical and social benefits of exercise for young people are well documented. Due to the increased transmissibility of the new variant in younger people, in addition to the existing restrictions on contact sports, we have restricted non-contact outdoor sports in Level 4 areas to children under 12. When it is safe to do so we hope to remove this restriction and allow non-contact outdoor sports to be allowed again for 12 to 17-year-olds in line with previous guidance.

In addition to the phased return to schools, there are a number of other areas where we are keen to ease restrictions when it is judged safe to do so.

Meeting up with loved ones

We know how important it is to be able to connect with loved ones and the damage that can be done when meaningful contact is restricted.

The protective measures, while necessary, have increased social isolation for many, which can often have a detrimental impact on well-being and physical and mental health.

That is why we are also prioritising easing of some measures that would allow people to potentially see a little more of their close family and friends – recognising that this will necessarily continue to be constrained by the need to limit opportunities for transmission. 

In particular, we have worked with relatives, care home providers and wider social care partners to support a return to meaningful contact between care home residents and their close family and friends, enabled by having both staff and visitor testing in place and the very high uptake of the vaccination in care homes. We are publishing safe visiting guidance on 24 February which recommends that indoor visiting resume from early March.

We are also working with partners so child contact centres can open to support essential contact between children and families.

Once the virus has been suppressed sufficiently, we hope to increase the number of adults and children aged 12 to 17 from two households who can meet outside the home from the limit of two people that has applied since 5 January, up to four people from two households.

Higher and further education

Our colleges and universities have key roles in supporting the growth and personal development of young people, and in developing the talent that will drive our economic recovery. They also act as anchor institutions in our communities, providing stability and driving economic growth.

In January, universities began a staggered return of undergraduate students, with a small number of students returning to critical in-person learning. Colleges have been following the guidance in place for their local authority area’s protection level.

The safety of staff and students is paramount and while we are making progress, both in suppressing the virus and in getting people vaccinated, continued caution in our fight against COVID is necessary. As such, the return of students to in-person learning will continue to be limited.

In addition to the students allowed to return for critical in-person learning under current arrangements, when conditions allow we will look to progressively broaden the scope of those allowed to return with priority continuing to be given to work placements to maintain workforce pipelines in critical sectors, such as health and social care, and early learning and childcare; and students whose attendance is time-sensitive and critical to the successful conclusion of their studies and cannot be delivered remotely or postponed.

Places of worship

Places of worship play an important role in supporting communities, and people of faith. We recognise the importance of individual and group worship to many people’s spiritual health and general wellbeing and have been pleased to see the many different ways that individual prayer and group worship have continued to be delivered by many faith and belief communities. When it is safe to do so, we will work with the faith community to re-open places of worship in Level 4 areas on the restricted-numbers basis that was allowed before 8 January.

Reopening the economy

The pandemic had an unprecedented impact on the global economy in 2020 with necessary restrictions on economic activity required to counter the spread of the virus and support public health. We recognise these impacts explicitly in our approach to managing the epidemic in Scotland: the impact on the economy is ‘Harm 4’ in our approach and we monitor and report economic impacts on a monthly basis. Significant fiscal and monetary measures have been introduced to support the economy, businesses and labour market during this period. Nevertheless, the UK economy contracted by 9.9 per cent in 2020, the largest fall in recent times and the outlook for recovery remains protracted given the current restrictions affecting the economy. Scottish output broadly tracked the UK position as outlined in the box below.

As we move through the easings within Level 4, the most significant change will be the reopening of schools. This reflects the priority we have placed on the education and wellbeing of our children and young people, which will of course also benefit the future of our economy beyond this crisis. Reflecting the difficult choices we must make, prioritising education will likely use up much of the limited room for manoeuvre for easings over the next few weeks, if we are to avoid the epidemic resurging once more.

Beyond opening schools and the limited return to broader education, one of the changes that we are keen to make in support of the economy is to ease some of the additional restrictions we placed on non-essential retail as part of the strengthened Level 4 that has been successful in suppressing the second wave of the virus. We have identified this change as a priority for consideration in the third group of easings within Level 4, prior to the return to geographically variable levels.

More generally, it is the return to geographically variable levels that we consider to be the best means for easing restrictions on the economy and the other aspects of society. We think this approach will be better than a nationwide route map when we reach this stage of managing the epidemic because it should allow areas with lower prevalence to see the easing of restrictions on business and other activities more quickly than if we were waiting for those same restrictions to be lifted on a nationwide basis. This is consistent with our commitment to keep restrictions in place for only as long as they are necessary and proportionate.

This is different from our nationwide approach to easing over May-August 2020 and reflects several key differences in our understanding and ability to manage the epidemic between now and then. For example, on the negative side, we have a much more transmissible virus to contend with, but on the plus side, we now have better local data on the status of the epidemic in different parts of the country;  we have a ready-made and well understood levels system that can be deployed and adjusted rapidly; we have a much more established and expanded Test and Protect system; we have more effective border measures and, of course, we have a highly successful vaccination programme.

The return to geographically variable levels should enable the opening up of the economy at a pace that is right for the state of the epidemic in the areas concerned. As we move down through the levels, retail reopens, the restrictions on hospitality are increasingly eased, the entertainment sector reopens in stages and domestic tourism opens up – particularly when domestic travel restrictions are able to be relaxed (below Level 3 currently).

We are deeply conscious that this easing process will take time and the pressures on business mount daily. However, easing too quickly, and unsustainably, risks inflicting greater economic damage in the longer term. Therefore our approach is to reopen the economy in a safe, sustainable way. Crucially, we recognise the need to support affected sectors financially, within the constraints of our limited resources and devolved powers, and we will continue to press the UK Government to use all of its reserved powers to make sufficient funding available to support businesses and people through this crisis. In particular, we will continue to make the case for the continuation of the ‘furlough’ scheme, which has provided a vital lifeline to both employers and workers who have been affected by this crisis through no fault of their own.

We are conscious that, even within the easings afforded by the Levels process, some important sectors of the economy will be constrained from operating anything close to normally for a considerable period ahead. In particular, we  recognise the particular needs of the events sector, for which long planning periods are often required. Clinicians and policy officials will therefore work with stakeholders, in particular the Events Industry Advisory Group, to agree a route map for eventual reopening.

We set out the various elements that comprise our unprecedented package of support to business during this crisis in the section: providing care and support to mitigate the harms of the crisis.

Scottish economic output

Following the introduction of national lockdown restrictions in March, Scotland’s GDP fell 24% over March and April, broadly in line with the UK.

Economic output had partially recovered as national lockdown restrictions were eased and economic activity resumed with growth from May to October 2020.  However, demand in the economy has remained subdued and the subsequent increase in the coronavirus infections rate and the introduction of necessary local level restrictions in autumn and the strengthened Level 4 in 2021 has led to contractions in output and less economic activity taking place. 

The most recent output data for Scotland show that output fell in Scotland by 1.4% in November, reflecting the increased tightening of restrictions during the month (UK:-2.3%). Scotland’s GDP in November 2020 was 7.1% lower than its pre-pandemic level in February (UK: ‑7.4%) . The pace of recovery has varied by sector, reflecting the impact of restrictions during 2020. As at end November, accommodation and food services was 59% below its level of output in February, while manufacturing was 5% above its level in February.

However, with the move into strengthened Level 4 for most of Scotland, output is again in decline with the number of business closed rising and increased workers requiring furlough and self-employment income support.

Reflecting these immediate challenges, the Scottish Fiscal Commission (SFC) has forecast Scotland’s GDP to fall 5.2% in the first quarter of 2021 and for unemployment to rise to 7.6% in the second quarter of this year. The scale of the contraction forecast in quarter 1 is significantly less than the first national lock down (around one quarter) reflecting the fact that more business activity has remained open and that business have innovated to remain trading by switching activity to online.

Labour market

Despite the scale of the economic shock, Scotland’s labour market has been protected significantly by the Coronavirus Job Retention Scheme (CJRS), which has supported jobs and incomes since restrictions on activity started in March 2020.

However, even during periods of recovery in 2020, HMRC data shows that the CJRS was supporting nearly around 9 per cent of workers (216,500) across Scotland at the end of September. The most recent data reports nearly 11 per cent of workers (282,800) on furlough at the end the December 2020, with the sectors most impacted by restrictions with significantly higher rates (accommodation and food services), with 30% of workers under CJRS at the end of December 2020.

Returning to the variable levels system in mainland Scotland

As vaccination continues to roll out, and as incidence and prevalence continue to fall, we will gradually remove some of the additional restrictions we introduced in December and early January.

While we are easing restrictions within Level 4, as set out above, our understanding will develop in two key areas:

  • the effectiveness of the vaccine, particularly in terms of reducing transmission
  • how the R number, particularly of the new variant, responds to changes in protective measures

This intelligence will inform our next steps.

Faced as we were, following the arrival of the much more transmissible B.1.1.7 variant, with a rapid increase in incidence and prevalence, the Levels approach, as intended, provided us with the means to rapidly reapply restrictions nationwide to suppress the virus. As a consequence, mainland Scotland and some islands have been moved into a strengthened Level 4, while other island communities have been moved into Level 3, and schools were closed to most children as a necessary additional measure across the country.

Consistent with our strategic intent, we believe that - once we are confident that we have the regained control of this second wave of the epidemic, taking account of the increased transmissibility of the virus - it will be right to apply restrictions that are proportionate to the epidemiological conditions in different parts of the country.

We will always take epidemiological conditions into account, but we believe at present that the  decision to move from the enhanced Level 4 to geographically varied levels, will – with the exception of certain island communities – likely be a nationwide decision.

As the return to more geographically variable levels should lead, in due course, to a significant easing of restrictions, it is critically important that we do this only when it is safe. Although important uncertainties remain, our current expectation is that the roll-out of the vaccination programme will help to provide the necessary reduction in transmission over time to enable safe easing consistent with the return to geographically variable levels. Other factors are also important, such as the ongoing adherence both to restrictions and to the requirements of Test and Protect by everyone across Scotland, even when many of us have been vaccinated.

Given the importance of vaccine roll-out to the safe return to geographically variable levels, we are therefore setting an important further condition that must be met in addition to the six WHO conditions for easing outlined above. This condition is that at least all of the JCVI groups 1-9 must have been offered a vaccination prior to the return to geographically varied levels. We will however continue to review the appropriateness of this condition, as we are learning more all the time about the impact of the vaccine in reducing transmission. For example, if our improving scientific understanding of the impact of vaccines on transmission indicates that a greater proportion of the population needs to be vaccinated before it is safe to return to geographically varied levels then we would need to reflect that. In combination we are calling this vaccine coverage restriction alongside the six WHO conditions our ‘gateway condition’ for returning to geographically variable levels.

Therefore, as we continue with our easing of restrictions within Level 4, we will continue to assess whether the WHO six conditions have been met and the appropriateness of ‘JCVI 1-9’ as the necessary vaccine coverage condition. This would then pave the way for easings suited to the epidemiological conditions in different parts of the country, with decisions taken around that time on the appropriate pace of such easings (e.g. what levels areas should move down to initially from Level 4).

The need for a more stringent approach to the levels

Our experience over the last few months and the changed landscape brought about by the new, more transmissible variant in particular has shown that we cannot assume that the protective measures applied within the original levels approach will have the same effectiveness as when first implemented. However, it is also likely that the roll-out of the vaccine programme will reduce the transmissibility of the virus for any given level of restriction.

To address this issue, we have decided to adjust our levels approach primarily by rebasing the indicators that we use to guide judgements about levels allocations decision on those recommended by the WHO in their most up-to-date interim guidance on considerations for implementing and adjusting public health and social measures in the context of COVID-19 (November 2020). We will also continue to keep the contents of the restrictions within each of the levels under review for continued effectiveness and plan to publish updated tables with any changes to the contents of the levels in mid-March, some time ahead of the likely return to variable geographical levels across Scotland.

Indicators

The key means by which we intend to respond to the increased transmissibility of the new B.1.1.7 variant is through tightening the indicators that inform the allocation of areas to levels. These revised indicators, as set out below, have been informed by the World Health Organisation interim guidance. Although there are some differences, this aligns broadly with our Levels approach and indicates that we should lower or tighten some of the thresholds associated with each of our five levels. This will have the effect of keeping some areas in higher levels than they would previously have been for the same level of incidence, which we see as a necessary response to increased transmission of the new variant. While we will continue to give careful consideration to WHO advice as it continues to develop, we will seek to tailor such advice to Scotland’s particular circumstances where appropriate.

Key elements of WHO interim guidance

The World Health Organisation (WHO) published interim guidance on considerations for implementing and adjusting public health and social measures in the context of COVID-19 (November 2020). We have carefully considered this advice in reviewing our approach within the Strategic Framework.

The WHO advises that it is necessary to understand the available health system response capacity depending on whether there is adequate, moderate, or limited capacity. The same level of transmission can result in a very different situation and require a different degree of Public Health and Social Measures (PHSM) implementation. Applying this analysis, PHSM should be tailored to the lowest administrative level for which situational assessment is possible and, for which, measures can be enacted practically.

A Situational Level should be assigned to a geographic area that will inform whether and how to adjust PHSM. The indicators should be monitored regularly (e.g. biweekly) and the Situational Level assessed accordingly to inform the appropriateness and impact of the PHSM measures taken and to anticipate future changes. 

The WHO recommend 5 levels (0-4):

  • WHO Situational Level 0: corresponds to a situation with no known transmission of SARS-CoV-2 in the preceding 28 days
  • WHO Situational Level 1: is a situation where basic measures are in place to prevent transmission; or if cases are already present, the epidemic is being controlled through effective measures
  • WHO Situational Level 2: represents a situation with low community incidence or a risk of community transmission beyond clusters
  • WHO Situational Level 3: is a situation of community transmission with limited additional capacity to respond and a risk of health services becoming overwhelmed
  • WHO Situational Level 4: corresponds to an uncontrolled epidemic with limited or no additional health system response capacity available, thus requiring extensive measures to avoid overwhelming of health services and substantial excess morbidity and mortality

The WHO also advises on the use of indicators in allocating areas to levels, and we have carefully considered this advice, as set out in this section.

The World Health Organisation (WHO) published their ‘Considerations for implementing and adjusting public health and social measures (PHSM) in the context of COVID-19 interim’ guidance on 4 November 2020. 

We will publish a separate analytical paper about indicators and data, and how we propose to make use of them ahead of the point at which we believe it is appropriate to begin varying levels geographically again in mainland Scotland.

For the purposes of comparison, Table 1 below shows the WHO’s suggested ranges in relation to prevalence and test positivity alongside the indicative ranges associated with our levels approach to date. As can be seen, the WHO ranges (thresholds) are generally set at a lower (tighter) level.

Table 1: WHO advised indicators compared to current Levels indicators

 

 

Level 0

Level 1

Level 2

Level 3

Level 4

Weekly cases/100k

Current range

< 20

20-75

75-150

150-300

300+

WHO range

Close to 0

<20

20-50

50-150

150+

Test positivity

Current range

<1.5%

1.5-3%

3-5%

5-10%

10%+

WHO range

Close to 0

<2%

2-5%

5-20%

20%+

In summary, our current intention in relation to the use of indicators to inform judgements about levels allocations is as follows:

  • we will continue to use cases per 100,000 people and percentage of positive tests as core indicators of our progress towards suppressing the virus: along with forecasts of case numbers
  • we will present more trend data in our analysis of indicators at local level
  • we will pay close attention to different patterns of infection for older people
  • we will continue to look at forecasts of hospital admissions and ICU occupancy, incorporating in our modelling what we know about increased transmissibility of the new variant and changing patterns of hospital and ICU stays it causes: but we will also incorporate in our forecasts data on wider non-COVID pressures on hospital and ICU numbers, to take better account of the overall pressures the NHS is facing
  • we will also consider the ability of the NHS to begin to resume services that are currently paused and where waiting lists are lengthening with many patients waiting well over a year to be seen and then treated. The ability to resume services needs to also take into account that many patients are not presenting or are presenting later - these patients are now beginning to appear in the primary care and hospital system with additional complex treatment requirements. This underlines the urgent need to reduce substantially the numbers of patients hospitalised or in ICU by continuing to suppress the virus.
  • we will align the ranges for the cases and test positivity associated with each protection level with the ranges proposed in the WHO guidance. The ranges for case rates are lower than the ranges we published in the original Strategic Framework, and allow us to take into account the increased transmissibility of the new variant. This means that areas will stay at higher levels until case numbers have fallen further than would have been the case under the approach we took between October and December, when the new variant emerged

As noted we will set out clear data and indicators in a supporting indicators paper ahead of reapplying geographically variable levels. 

Governance

We will continue to publish regular updates of the indicators to accompany our decisions, and to outline our reasons. But it is important to emphasise that those decisions will continue to be informed not only by the indicators, but also by detailed intelligence from Directors of Public Health about the situation at a local level and by evolving epidemiological evidence. They will draw in consideration of local, regional and national non-COVID health, economic and societal factors. Decisions on the allocation of areas to levels will ultimately continue to be a matter of judgement, taking various relevant factors into account. We will continue to take decisions informed by:

  • the key indicators, by local intelligence and evolving epidemiology
  • the public health advice of Directors of Public Health and the National Incident Management Team chaired by Public Health Scotland
  • assessment of that advice and the recommendations of our senior advisors and policy officials, considering the wider health, social and economic harms alongside the harm caused directly by the virus

Our local authority partners will continue to have an important part to play in our decision-making, through their involvement as observers in the National Incident Management Team and the ‘Four Harms’ consideration by advisors and officials; and we will continue to engage with local authorities both in our plans to implement our updated Strategic Framework and, once we move back to a more geographically variable Levels approach. 

In the light of our experience of using the levels approach, of the effect of the protective measures and of the evolution of the new variant, we intend to monitor the data carefully after every change to assure ourselves that the virus is on course to be suppressed. This means we will conduct formal reviews of the levels every three weeks, rather than weekly – although we will continue to be prepared to take action swiftly to escalate an area if a rapid and dramatic increase in cases should justify our doing so. And to give people, businesses, local authorities and delivery partners greater clarity and certainty to plan, we intend that areas should remain in a level for at least three weeks, and show a sustained declining trend in cases, before moving down a level.

To support business planning, we will aim to give five days’ notice of any reduction in levels. However, particularly given the increased transmissibility of the virus, it will not always be possible to provide advance notice if an area needs to move up a level.

The approach set out here assumes that there will be a need for protective measures for some months ahead. This approach can be revisited as our understanding of the impact of the vaccination programme increases and in response to wider epidemiological developments. We will, however, keep the position in all areas of the country under close review on an ongoing basis, mindful of the need to ensure that protective measures should remain in place for only as long as they remain proportionate, necessary and justifiable in suppressing the virus and protecting public health.  

See the current Levels table. We will publish updated Levels tables in March 2021, well in advance of the return to geographically differentiated levels. This will enable us to ensure that we are using up-to-date evidence on the impact of the vaccine programme in determining any required changes to the contents of the levels.

Impact assessments

The necessity and proportionality of protective measures will continue to be kept under close review.  As we take decisions under this Framework, the impacts of changes to these measures – particularly as they relate to business, equality, children and young people’s rights and island communities - will also continue to be closely monitored and assessed.


Contact

Email: CEU@gov.scot

First published: 23 Feb 2021 Last updated: 23 Mar 2021 -