- 3 Mar 2020
On Sunday we had the first positive case of novel coronavirus – COVID19, confirmed in Scotland.
The patient is from the Tayside area and had a travel history. While the patient is clinically well, they are being cared for in a hospital in Scotland as a precautionary measure and I’m sure members will join me in wishing them a full and early recovery.
I know that colleagues appreciate that it is important that we respect the patient’s right to confidentiality and that it is not appropriate for me to comment further on the details of this case.
Following confirmation, contact tracing has now been completed by the local health protection team.
COVID-19 is a new strain of coronavirus which came to light in December last year, is thought to have originated from Wuhan City in China and has spread steadily across the world. As of yesterday there were 89,070 cases throughout the world with the most substantial outbreaks in Europe currently being in Northern Italy.
The Scientific Advisory Group for Emergencies (SAGE), who provide expert advice to us has updated their reasonable worst case scenario planning assumptions for coronavirus. It is important to stress that this does not represent a prediction or forecast, but it is sensible modelling based on available data that allows us to plan for the worst case position. This current modelling tells us that 80% of the UK population may become infected, with 4% of that number requiring hospitalisation and an estimated 1% fatality rate in those infected. These are big numbers and it is important that I put some caveats around them. Firstly that this modelling will be continually updated as we learn more about the virus and its behaviour from the data coming from other countries including in Europe and our UK cases and secondly, that the vast majority of those who are infected by the virus will have mild symptoms, will not require hospital treatment and will be able to return to their normal lives in a week to 10 days.
But some will experience more severe symptoms and some will become very unwell. From our understanding at this point, those of us who are older or have underlying health conditions will be at a greater risk of being more unwell than others.
We also know that as the number of cases rise, there will be an impact on those in our working population unable to work either because they are themselves unwell or because they are caring for family members who are.
This is a new virus for which we currently have no immunity and for which there is currently no vaccine. That means COVID-19 has the potential to spread extensively. So the approach we have to take has 4 elements.
- Contain - detecting early cases, following up close contacts and preventing the disease from taking hold for as long as possible
- Delay – slow the spread of the disease, if it does take hold, so we can lower the peak impact enabling our NHS to better cope with the impact. This is critical but we need to understand that in slowing down and flattening out the peak we also prolong the length of time we are managing the disease.
- Research – to better understand the virus and the actions needed to lessen its effect and innovate responses including diagnostics, effective antiviral treatments and ultimately, vaccine
- Mitigate – providing the best possible care for those who are ill, maintaining essential healthcare and other services and taking steps to minimise where we can the overall impact on society, public services and the community.
Let me touch briefly on two of these. On containment, where we are right now requires the steps I outlined earlier. But it is also the phase where the public can help us greatly by actively and consciously using good respiratory and hand hygiene. So the catch it, bin it, kill it message is important – using tissues to catch sneezes and coughs and then binning them. And good hand hygiene, not only after using the toilet but also before preparing food and regularly throughout the day especially if you are in contact with others or surfaces that others use too. This matters and will help a great deal.
When we see that the disease is taking hold and we are looking to slow the spread of the virus as far as we can and flatten the peak of impact. That is when we will be looking at a full range of measures to help us delay the spread, including potentially extraordinary ‘social distancing’ measures, self-isolation and restrictions on public events. Evidence from elsewhere in the world has shown that when undertaken in combination these measures can be very effective. It’s important to stress that we are not there yet and the decisions on when to introduce these will be taken on the basis of evidence that tells us about the balance between effectiveness in slowing the spread and impact on, for example the economy.
Members will be aware that today we publish the 4 Nation Action Plan. This is a product of the joint work going on across the UK. In addition to the approach set out in the Plan, we have been working closely with the UK Government and the other devolved governments to develop emergency legislation which is intended to be laid at Westminster this month.
This emergency legislation will contain a number of additional powers that would not be considered if it was not for the extreme seriousness of the challenge we now face. The emergency legislation will, for example, allow temporary lifting of some requirements of registration to allow former NHS staff to return to work should they be needed and should they wish; the ability to enhance and deploy staff to health and care settings and the easing of some legislative and regulatory requirements to for example, allow Ministers to direct school closures should that be needed.
The Bill will also enable us to require the mandatory vaccinations for health and social care workers, the flu vaccine, if we consider that the spread of the virus may continue into next year’s flu season. Given the projections of staff absences and the pressure on the NHS, we may wish to do all we can to protect both the workforce and patients.
None of these proposals are being made lightly. In taking these new powers we will very carefully consider first if they need to be used, when and how they are used. Importantly, the Bill will contain a sunset clause to end the existence of these emergency powers after a set period, or when the UK Chief Medical Officers declare there is no longer an emergency.
Presiding Officer, let me finally briefly outline some of the important work that is underway and in health, has been for some time now.
All NHS Boards have been asked to review their preparedness planning using their pandemic flu plans as a basis, but from that developing specific COVID-19 plans for primary, secondary and social care settings and there is frequent daily engagement between senior health directorate and clinical officials and Boards and their counter parts in the UK.
The Scottish Government Resilience Room has been activated and is meeting regularly to ensure plans are in place across government for areas where we anticipate impact. The First Minister, CMO and I continue to patriciate in COBR meetings to ensure as far as practicable that our responses across all parts of the UK are aligned.
Along with other parts of the UK, Scotland has extensive experience in handling pandemic outbreaks such as the Swine Flu and SARs. We have established frameworks in place and our preparations to date include the establishment of testing laboratories in Glasgow, and Edinburgh, speeding up the identification of confirmed cases and therefore faster contact tracing which, in turn, limits the potential spread of the disease.
As a precautionary measure, GP practices have been supplied with face masks to ensure that they have readily available supplies. I have asked National Services Scotland to continue to ensure Scotland’s NHS and where appropriate social care, continue to receive the supplies they need.
We have updated the Public Health (Scotland) Act 2008 to make the virus a notifiable disease, placing a duty on registered medical practitioners to notify health boards of any suspected case of the disease, and on directors of diagnostic laboratories to notify health boards of any case of the virus being detected.
To support our prevention activity, we have enhanced surveillance through a network of clinicians and laboratories to strengthen the early detection of any community transmission, providing important data on early warning of coronavirus in the community and hospital settings and allowing health protection teams to quickly undertake contact tracing to further limit spread.
Our advice to the public has not changed, however I would like to re-emphasise the importance of good personal hygiene practices that everyone should use at all times to limit and slow the spread of the coronavirus.
It is understandable that people will become more concerned and we will continue to provide reassuring, consistent and clear advice.
Presiding Officer, up-to-date, accurate information to inform our work and decision-making and to inform the public is vital. Our approach is maximum possible accurate information and transparency.
Health Protection Scotland has issued a suite of guidance to health professionals and others for the detection and early management and these have been communicated to all Boards by the Chief Medical Officer. This has included sector specific guidance to a wide range of bodies including schools, colleges, universities and the oil and gas sector.
There is understandable concern amongst people in Scotland about the presence and impact of this virus. But while we rightly operate to worse case scenarios there are some important points to make to put that in context.
We do expect more cases. But for the majority of those affected the symptoms and impact will be mild.
Our contain, delay and mitigate approach is the right one to take. And the public have a critical role to help us by following those straightforward personal hygiene messages.
If you have travelled to the affected areas and develop symptoms of coronavirus, you should go home and phone to seek medical advice from your GP or NHS 24 out of hours.
Use the NHS Inform website for advice and continuously updated guidance and NHS 24 have also set up a free helpline.
This is a serious situation that we are taking very seriously. We are monitoring it very closely here and across the world, alongside the other UK administrations, the WHO and our international partners. We are using all the expertise available to us and the experience of our NHS in Scotland, we are planning and preparing letting the science and the clinical advice guide us and doing all we can to ensure our response is proportionate and effective.
We will continue to keep the public and members in this Parliament fully informed as the situation develops.