Scotland's Testing Strategy Update - COVID-19 This publication will be available in accessible HTML on the gov.scot website - The Scottish Government
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This publication will be available in accessible HTML on the gov.scot website COVID-19 Scotland’s Testing Strategy Update March 2021
Contents
1. Strategic context
■ Testing Strategy – Principles
2. Why we test
■ Testing Strategic Intent
■ Rationales for Testing
3. How we test
■ Context – A Range of Technologies for a Range of Purposes
■ Capacity
■ Access
■ Improving Access to Symptomatic Testing
■ Targeted Community Testing
■ Surveillance Testing
■ Wastewater Testing
■ Whole Genome Sequencing
4. Who we test
■ Test to Diagnose
■ Test to Care
■ Test to Protect
■ Test to Find
■ Test to Support
■ Test to Monitor
■ Three Phases of Strategic Framework
5. Conclusion
COVID-19: Scotland’s Testing Strategy Update 21. Strategic context
1. Strategic context Scotland’s overall current pandemic strategy is set their optimal potential; and second; that testing for
■ Testing Strategy – Principles out in Coronavirus (COVID-19) Scotland’s Strategic COVID-19 is likely to become a permanent feature
Framework Updated, published on 23 February in our lives – though one whose form will continue
2. Why we test 2021. That strategy remains to suppress the to change and adapt as the pandemic, and the
■ Testing Strategic Intent virus – driving the number of cases to the lowest virus itself, does.
■ Rationales for Testing possible level – to support the resumption of life
as close to normal as possible. In addition, given the strategic intent is to support
3. How we test the resumption of life as close to normal as
■ ontext – A Range of
C Scotland’s COVID-19 Testing Strategy contributes to possible, testing will increasingly play a role in
Technologies for a Range of this overall pandemic strategic intent. It is one of supporting wider social and economic goals, by
Purposes
six main tools described in the Strategic Framework further reducing transmission risks through active
■ Capacity alongside: vaccination; protective measures case finding as we return to variable levels of
■ Access including non-pharmaceutical interventions like restrictions across Scotland.
■ Improving Access to physical distancing and face coverings; border
Symptomatic Testing control measures (which also include testing); It remains critical to repeat the emphasis of the
■ Targeted Community Testing adherence support measures (including support original Testing Strategy that testing, on its own,
for self-isolation); and wider care and support to does not stop the virus spreading; it only provides
■ Surveillance Testing
mitigate the harms caused by the pandemic. information that can support us to take action to
■ Wastewater Testing
stop transmission. It is one of many interventions
■ Whole Genome Sequencing The Strategic Framework stresses two key points: that will continue to be necessary in various
4. Who we test that the overall goal remains suppressing the forms for a considerable period of time. Ensuring
virus to as close to elimination as possible, as that there is sufficient support for isolation – and that
■ Test to Diagnose
remains the best way to minimise all the harms those who require this support know it is there
■ Test to Care caused; and that, given the nature of the virus, we and can easily access it – is critical in creating the
■ Test to Protect are likely to ultimately have to live with COVID as conditions that actually stop the onward spread of
■ Test to Find a permanent feature of our lives. the virus.
■ Test to Support
The implications of this for testing are twofold: And, as has been the case since the beginning of
■ Test to Monitor
first; that as we work to suppress the virus to as the pandemic, our overall testing strategy will
■ hree Phases of Strategic
T close to elimination as possible, and keep it there, continue to adapt to both the pandemic conditions
Framework
we will actively seek out every possible case using facing us, and the technology and capability at our
5. Conclusion all of our now advanced testing capabilities to disposal.
COVID-19: Scotland’s Testing Strategy Update 31. Strategic context It remains critical that people and communities Testing Strategy – Principles
■ Testing Strategy – Principles continue to engage with testing as welcome 1. Testing is part of our overall public health
progress is made in the vaccination programme. approach designed to minimise transmission of the
2. Why we test Isolating and booking a test as soon as symptoms virus, in line with our overall strategy of driving
■ Testing Strategic Intent develop, or engaging with routine testing the number of cases of COVID-19 in Scotland to
■ Rationales for Testing programmes where they are established, or the lowest levels possible and maintaining that
engaging in targeted community testing and level.
3. How we test isolating if positive, will all continue to play
■ ontext – A Range of
C a critical role in supporting our overall aim of 2. Our priorities for testing are informed by
Technologies for a Range of suppressing the virus to the lowest levels possible.
Purposes
scientific, clinical and public health advice from
our expert advisory structures. All people moving
■ Capacity We will also deliberately build on the significant to care homes from hospital or the community are
■ Access diagnostics infrastructure now developed in also tested prior to admission.
■ Improving Access to Scotland and invest further in specific testing
Symptomatic Testing capabilities – for instance, whole genome 3. Our approach to testing, including prioritisation,
■ Targeted Community Testing sequencing – in order to intentionally build is flexible and adaptable to the prevailing
■ Surveillance Testing a legacy from this experience that will leave conditions of the pandemic at any time, and
Scotland in a better position to deal with a range informed by expert advice.
■ Wastewater Testing
of other infectious disease challenges and future
■ Whole Genome Sequencing
health threats, including future pandemics. 4. Our approach to testing takes full recognition of
4. Who we test the limitations of testing (particularly at low levels
Scotland’s Testing Strategy as published on 17 of disease prevalence) as well as the opportunities
■ Test to Diagnose
August 2020 set out a group of principles that of testing.
■ Test to Care continue to guide our approach to testing. They
■ Test to Protect are set out again below. 5. Our overall priority at this stage of the
■ Test to Find management of the disease is rapid identification
■ Test to Support and testing of people with symptoms.
■ Test to Monitor
6. Asymptomatic testing will increasingly be
■ hree Phases of Strategic
T used on a risk-based approach to both minimise
Framework
transmission through active case finding and to
5. Conclusion reduce harm to individuals at high risk.
COVID-19: Scotland’s Testing Strategy Update 41. Strategic context 7. The deliverability of any new testing priorities The rest of this update is structured to mirror the
■ Testing Strategy – Principles and pathways will be considered at an early stage original strategy. Section 2 updates why we test –
to maximise successful implementation. outlining six purposes for testing at an individual,
2. Why we test community and population level. Section 3
■ Testing Strategic Intent 8. The capacity to accurately and efficiently updates how we test – including new capacity that
■ Rationales for Testing record, report, interpret and respond to every test enables more widespread rapid testing and crucial
in a timely manner is critical. new technology in surveillance that the Scottish
3. How we test Government is investing in to ensure we are in the
■ ontext – A Range of
C 9. Our approach to testing will aim to continually best position possible for the critical next phase
Technologies for a Range of improve access to testing – both the ease with of the pandemic where the risk is of new variants
Purposes which people can access a test (or routine testing undermining progress. Section 4 updates who we
■ Capacity if appropriate), and the speed with which they test – outlining the significant expansion in routine
■ Access obtain results. testing since the October review of the strategy,
■ Improving Access to and looking ahead to the next phases as Scotland
Symptomatic Testing These principles were reviewed as part of exits lockdown.
■ Targeted Community Testing the Clinical and Scientific Review of the Testing
Strategy, published on 23 October 2020. The
■ Surveillance Testing
importance of access to testing was stressed in
■ Wastewater Testing that review, with the ninth principle added to
■ Whole Genome Sequencing reflect this.
4. Who we test
■ Test to Diagnose
■ Test to Care
■ Test to Protect
■ Test to Find
■ Test to Support
■ Test to Monitor
■ hree Phases of Strategic
T
Framework
5. Conclusion
COVID-19: Scotland’s Testing Strategy Update 52. Why we test: six purposes
1. Strategic context Testing Strategic Intent The clinical and scientific review published in
■ Testing Strategy – Principles Given the current state of the epidemic in Scotland, October set out the consensus view of our senior
our overall strategic intent in the updated Strategic advisers that testing anyone with symptoms
2. Why we test and testing for clinical care are the overarching
Framework, and the technology and capacity now
■ Testing Strategic Intent available, our overall strategic purpose for testing priorities for the Testing Programme. Testing
■ Rationales for Testing is to: for these purposes – and testing for ongoing
surveillance – will likely remain core elements
3. How we test make optimal use of Scotland’s testing capacity of Scotland’s continuing COVID-19 testing
■ ontext – A Range of
C to suppress the virus to the lowest possible level infrastructure on a permanent basis as COVID-19
Technologies for a Range of and keep it there, while supporting the return to moves from a pandemic phase to endemic.
Purposes as normal a life as possible, mitigating the four
■ Capacity harms caused by the crisis, and building a legacy In addition, the most recent expansion of routine
■ Access of improved resilience and preparedness for testing announced on 2 February extends testing
■ Improving Access to current and future health threats. for a sixth purpose: to support the maintenance
Symptomatic Testing of essential services and mitigate wider social and
Within this overall strategic purpose, there are six economic harms. Testing to support our strategic
■ Targeted Community Testing
rationales for testing at an individual, community intent to support the resumption of life as close to
■ Surveillance Testing
and population level, set out below. normal as possible is likely to grow in significance
■ Wastewater Testing
as we move through the phases outlined in the
■ Whole Genome Sequencing
Rationales for Testing updated Strategic Framework.
4. Who we test The original Testing Strategy set out five reasons
■ Test to Diagnose for our priorities for testing for COVID-19
in Scotland: testing to diagnose anyone with
■ Test to Care
symptoms of COVID-19; testing for clinical care of
■ Test to Protect
patients; testing to protect those vulnerable to the
■ Test to Find most harm from COVID-19; testing to proactively
■ Test to Support case find among people without symptoms, and
■ Test to Monitor testing for surveillance to monitor prevalence and
■ hree Phases of Strategic
T understand disease transmission.
Framework
5. Conclusion
COVID-19: Scotland’s Testing Strategy Update 61. Strategic context These six rationales for testing can therefore be 4. Test to Find and interrupt chains of transmission
■ Testing Strategy – Principles summarised as: through Targeted Community Testing and testing
all close contacts of positive cases.
2. Why we test 1. Test to Diagnose all those with symptoms of
■ Testing Strategic Intent COVID-19 to enable rapid isolation of confirmed 5. Test to Support the resilience of essential
■ Rationales for Testing positive cases and contact tracing of their close services and mitigate the wider social and
contacts who may be potentially infectious, to economic harms caused by the pandemic. This
3. How we test advise them to isolate, thereby stopping onward includes routine testing to support the safe
■ ontext – A Range of
C spread of the virus infecting other people. return to school, in higher and further education
Technologies for a Range of environments, and extending an offer of routine
Purposes 2. Test to Care for those receiving clinical care testing to businesses in food production and
■ Capacity in hospital and those admitted to hospital on distribution.
■ Access a planned or emergency basis to both support
■ Improving Access to optimal patient care and the selection of 6. Test to Monitor the prevalence of the disease
Symptomatic Testing appropriate care pathways, and to reduce the risk at a population level, detect early signals of new
■ Targeted Community Testing of hospital-based outbreaks. All people moving to incidence, detect new variants of concern, and
care homes from hospital or the community are understand transmission dynamics (including the
■ Surveillance Testing
also tested prior to admission. impact of vaccination on transmission) in key
■ Wastewater Testing
sectors.
■ Whole Genome Sequencing 3. Test to Protect those most vulnerable to severe
harm through routine testing, for example, staff
4. Who we test
in healthcare and social care settings including
■ Test to Diagnose
hospitals, primary care workplaces, and adult care
■ Test to Care homes, so that those who test positive can isolate
■ Test to Protect and avoid risking transmitting to those most
■ Test to Find vulnerable.
■ Test to Support
■ Test to Monitor
■ hree Phases of Strategic
T
Framework
5. Conclusion
COVID-19: Scotland’s Testing Strategy Update 7Figure 1 below illustrates these six purposes of testing and their relative contribution to mitigating the four harms caused by the virus.
The six purposes of testing are not mutually exclusive, and where there are instances where testing a particular group on a regular basis
contributes to multiple purposes, then the overall case for prioritisation of that particular testing may be strengthened.
Testing strategy – Mitigating four harms
HARM 1: HARM 2: HARM 3: HARM 4:
Suppress the virus, Support broader health, Mitigate social harms, Support the economy,
protecting against the protecting our health protecting against protecting against the
direct and tragic harm to and social care services, broader harms to your devastating impact for
your health. and your health and way of life. business.
wellbeing.
TEST TO DIAGNOSE TEST TO PROTECT TEST TO FIND TEST TO SUPPORT
TEST TO CARE TEST TO FIND TEST TO SUPPORT TEST TO MONITOR
The testing of people with Routine testing in certain Testing supports active case finding Routine testing to support the
symptoms supports rapid isolation workforces and settings (including where there has been known maintenance of essential services
of those diagnosed with COVID-19 healthcare and social care settings) exposure or increased risk (e.g. includes private sector workplace
and contact tracing to limit further identifies cases that would not close contacts). 1 in 3 people who testing in certain sectors where
spread. otherwise be found, enabling are infected do not show symptoms. outbreaks are common and where
people to isolate and avoid Targeted community testing can disruption has severe economic
Testing to support clinical care in
transmitting the virus to those support active case finding and and social impacts.
healthcare settings supports early
most vulnerable to severe harm. reduce community transmission.
diagnosis and appropriate care Surveillance testing informs
pathways. This routine testing supports the Routine testing can add an decisions on opening up the
reduction of outbreaks which additional layer of risk reduction economy.
mitigates risk of spillover to and confidence in workforces &
community transmission. communities – e.g. in schools,
mitigating harm from disruption of
education.
COVID-19: Scotland’s Testing Strategy Update 83. How we test
1. Strategic context Context – A Range of Rechnologies for a Range • the test’s ability to detect new variants of
■ Testing Strategy – Principles of Purposes COVID-19, including those which may be
Scotland’s testing strategy has deliberately problematic at this stage of the pandemic due
2. Why we test to selective advantages such as increased
developed and used a range of testing
■ Testing Strategic Intent technologies in complementary ways to meet transmissibility, increased severity, or reduction
■ Rationales for Testing the overall strategic purpose for testing of of pre-existing immune response and/or vaccine
contributing to suppressing the virus to the lowest effectiveness.
3. How we test
possible levels, while mitigating wider harms.
■ ontext – A Range of
C Each of these technologies has inherent attributes; The range of technologies available has increased
Technologies for a Range of since the last review of the strategy in October,
Purposes advantages and disadvantages which inform
the most appropriate deployment under the with rapid antigen tests (Lateral Flow Devices or
■ Capacity LFD) now enabling larger-scale routine testing,
overarching strategy.
■ Access and targeted community testing, including the
■ Improving Access to These varying attributes include: provision of asymptomatic testing at community
Symptomatic Testing level.
■ Targeted Community Testing
• how sensitive the test is – the proportion of true
positive cases identified; PCR (Polymerase Chain Reaction) testing remains
■ Surveillance Testing
■ Wastewater Testing • how specific the test is – the proportion of true the core technology for symptomatic testing. Since
negative cases identified; the October review, there have been three main
■ Whole Genome Sequencing focuses of development for PCR testing: increasing
• the speed of result; laboratory capacity; improving turnaround times;
4. Who we test
■ Test to Diagnose
• logistics required, including laboratory and increasing population access to sampling
infrastructure and workforce; provision.
■ Test to Care
■ Test to Protect
• whether the test is designed to diagnose active Also core has been balancing the relative
infection or evidence of prior infection; contribution of the UK Government Testing
■ Test to Find
■ Test to Support • the test’s suitability for whole population Programme and NHS Scotland laboratories to PCR
surveillance and monitoring; processing capacity. The remainder of this section
■ Test to Monitor
sets out developments in capacity; access; and
■ hree Phases of Strategic
T investments to secure a lasting legacy of improved
Framework
preparedness for future health threats.
5. Conclusion
COVID-19: Scotland’s Testing Strategy Update 91. Strategic context Capacity Figures published by Public Health Scotland show
■ Testing Strategy – Principles The October review of the Testing Strategy set out the overall Test and Protect system performs
the Scottish Government aim to increase overall well in terms of timeliness of intervention to
2. Why we test support the public health intention of isolating
PCR processing capacity to 65,000 tests per day
■ Testing Strategic Intent by winter 2020. This was achieved through a potentially infectious contacts to prevent further
■ Rationales for Testing combination of increased capacity via the UK transmission. The WHO criteria for effective
Government Lighthouse network, and the building performance of a contact tracing system for
3. How we test COVID-19 is that at least 80% of new cases have
of three new NHS Scotland Regional Laboratories,
■ ontext – A Range of
C with a combined capacity of 22,000 tests per day. their close contacts traced and in quarantine
Technologies for a Range of within 72 hours of case confirmation.
Purposes
This has meant that testing capacity has been
■ Capacity sufficient to meet symptomatic demand over The closest proxy to this in Scotland measures
■ Access the whole of autumn and winter in Scotland. the time between a confirmed positive case
■ Improving Access to Turnaround times have also improved across being entered into the Test and Protect Contact
Symptomatic Testing all testing routes. In the most recent weeks, Management System and the completion of
■ Targeted Community Testing turnaround times have remained consistently the final close contact interview, advising the
■ Surveillance Testing below 24 hours across all regional test sites, contact to self-isolate. In the reporting week 01
Local Test Sites (walk-through sites) and Mobile to 07 March 2021, statistics show that 98.3%
■ Wastewater Testing
Test Units. Turnaround times for NHS Scotland of the contact tracing for all positive cases was
■ Whole Genome Sequencing
laboratories and Regional Hubs are also within completed within 72 hours and 93.9% completed
4. Who we test 24 hours for the vast majority of cases. within 48 hours. Since its launch the Test and
Protect system has consistently performed
■ Test to Diagnose Over the next period, our aim is to maintain this strongly in terms of timeliness, including during
■ Test to Care performance in turnaround times by ensuring the sustained increase in cases during autumn and
■ Test to Protect capacity across the network can remain within a winter 2020.
■ Test to Find daily operational maximum limit of approximately
70%. This is to ensure our symptomatic PCR testing
■ Test to Support
has the maximum possible public health impact
■ Test to Monitor
in terms of rapidly isolating positive cases, and
■ hree Phases of Strategic
T ensuring their contacts can be traced as quickly
Framework
as possible to enable them to isolate and prevent
5. Conclusion onward transmission.
COVID-19: Scotland’s Testing Strategy Update 101. Strategic context Point-of-Care testing capacity has also increased Access
■ Testing Strategy – Principles over this period, through deployment of Lumira Daily case numbers through the testing system are
DX and other point-of-care testing in hospital published each day on the Scottish Government
2. Why we test settings. NHS Scotland now has capacity of 3,000 website and form a key ongoing indicator of
■ Testing Strategic Intent point-of-care tests per day, which are supporting national and local incidence of COVID-19. We
■ Rationales for Testing the testing of patients on admission to hospital. know, though, that not everyone with COVID-19
The faster turnaround times of point-of-care displays symptoms, and not all who have
3. How we test tests compared to PCR has supported better symptoms are tested. So the daily case numbers
■ ontext – A Range of
C patient flow in emergency departments over the consistently represent a significant underestimate
Technologies for a Range of particularly pressured winter months.
Purposes of the actual number of daily new infections in
Scotland.
■ Capacity The most significant change to capacity of new
■ Access technology available has been the increase Given our overall strategic intent of suppressing
■ Improving Access to across the UK in LFD capacity since the end of the virus to as close to elimination as possible,
Symptomatic Testing 2020. Significant volumes of LFD devices have our aim in our testing strategy is make sure
■ Targeted Community Testing been procured under the UK National Testing population access to symptomatic PCR testing is
■ Surveillance Testing Programme, with all four nations now having as comprehensive and accessible as possible (an
LFD capacity sufficient to expand routine updated Equalities Impact Assessment on Test
■ Wastewater Testing
asymptomatic and targeted community testing. and Protect is published alongside this Strategy
■ Whole Genome Sequencing
Update).
4. Who we test Finally, Scotland has invested in newer
technologies to support surveillance testing, In addition to national accessible provision of PCR
■ Test to Diagnose
including wastewater testing and surveillance testing for symptomatic people, we have further
■ Test to Care of variants of concern through whole genome developed a comprehensive programme of local
■ Test to Protect sequencing. These developments are set out in the targeted community testing – both symptomatic
■ Test to Find legacy section below. and asymptomatic – where prevalence is
■ Test to Support stubbornly high, or where communities have
■ Test to Monitor specific transmission risks they wish to address.
■ hree Phases of Strategic
T
Framework
5. Conclusion
COVID-19: Scotland’s Testing Strategy Update 111. Strategic context Improving Access to Symptomatic Testing Targeted Community Testing
■ Testing Strategy – Principles Our approach to improving access to symptomatic In addition to addressing key barriers to accessing
testing is to consider the full range of sampling testing through our expansion of symptomatic test
2. Why we test
routes available, engage with local partners to sites, we have continued to develop a national
■ Testing Strategic Intent deploy all sampling channels holistically and Targeted Community Testing programme which
■ Rationales for Testing flexibly to best reflect population need, and supports both symptomatic and asymptomatic
innovate where necessary; for example, to testing. We have piloted innovative ways to
3. How we test
extend accessibility in more remote communities engage with local communities and groups such as
■ ontext – A Range of
C through small-scale test sites in rural areas of NHS the set-up of testing sites in local community halls
Technologies for a Range of
Purposes Highland in partnership with the Scottish Fire and and places of worship.
Rescue Service.
■ Capacity
Scotland piloted Community Testing in December
■ Access Our symptomatic testing expansion will increase 2020. This included both the deployment
■ Improving Access to the proportion of the population within a thirty- of mobile units to boost symptomatic and
Symptomatic Testing minute drive of testing to beyond 95% of the asymptomatic whole community testing at early
■ Targeted Community Testing population. We are also supporting access to testing signs of rising prevalence, and the operation of
■ Surveillance Testing for those without cars and in areas of higher fully Asymptomatic Test Sites using LFDs.
deprivation, and we will double the proportion
■ Wastewater Testing
of the population within walking distance of During the pilot, 22,133 tests were carried out
■ Whole Genome Sequencing
walk-through local test sites to 36% – meaning with 850 positive cases found.
4. Who we test an increase from 1 million people within walking
distance of a Local Test Site to 2 million people. Since these pilots, we have worked closely
■ Test to Diagnose
with local partners and now have developed a
■ Test to Care Scotland currently has 34 walk-through local test comprehensive programme of locally led targeted
■ Test to Protect sites, 8 drive-through regional test sites, 21 small- community testing, with wrap-around support for
■ Test to Find scale or pick-up test sites in NHS Highland, and isolation built in; supported by regular ongoing
42 mobile testing units, roughly half of which are intelligence and data from a variety of sources.
■ Test to Support
deployed to do symptomatic testing. We have also
■ Test to Monitor
worked with the UK Government and the Royal
■ hree Phases of Strategic
T Mail to expand home test kit coverage to all of
Framework
mainland Scotland.
5. Conclusion
COVID-19: Scotland’s Testing Strategy Update 121. Strategic context This has involved the allocation of over £5 million The ability to identify and effectively respond
■ Testing Strategy – Principles in additional funding this financial year to NHS to community transmission will become even
Ayrshire & Arran, Borders, Dumfries & Galloway, more important as we start to relax restrictions.
2. Why we test Fife, Greater Glasgow & Clyde, Grampian, Therefore, we intend to write to all territorial
■ Testing Strategic Intent Lanarkshire and Forth Valley, and the 20 local health boards and local authorities shortly with a
■ Rationales for Testing authority areas they cover. Discussions are view to agreeing the additional funding needed to
underway with the remaining health board areas continue this programme into 2021-22.
3. How we test and their local authorities with the aim of agreeing
■ ontext – A Range of
C community testing proposals in the coming weeks. Surveillance Testing – adapting to the next phase
Technologies for a Range of This includes discussions with island authorities
Purposes and building a world-class public health legacy
where there may be specific transmission risks
■ Capacity Scotland already has comprehensive surveillance
that island communities would wish to address
■ Access testing in place both at a population level through
using targeted community testing.
the Office for National Statistics (ONS) Coronavirus
■ Improving Access to
(COVID-19) Infection Survey, and in key sectors
Symptomatic Testing Targeted Community Testing is being delivered
through an expanded Mobile Testing Unit fleet such as schools in partnership with Public Health
■ Targeted Community Testing
and the deployment of community Asymptomatic Scotland, and healthcare settings in partnership
■ Surveillance Testing
with NHS Boards.
Testing Sites. As of 15 March, 27 sites were
■ Wastewater Testing
operating across Scotland.
■ Whole Genome Sequencing This surveillance testing uses PCR testing to
Working in partnership with territorial health identify current infection and antibody testing to
4. Who we test detect evidence of prior infection, and provide
boards and local authorities to target testing
■ Test to Diagnose
through this programme has, up to 15 March, estimates of the proportion of the population,
■ Test to Care identified over 1,700 positive cases that may or certain workforces, who may have developed
■ Test to Protect otherwise have been missed, breaking chains of some degree of natural immunity.
■ Test to Find transmission in those communities. 351 of these
The ONS COVID-19 Infection Survey uses PCR
■ Test to Support came from asymptomatic individuals who might
testing to estimate the number and proportion of
otherwise have risked transmitting to transmit
■ Test to Monitor people in Scotland that would have tested positive
COVID-19 to their family, friends or colleagues.
■ hree Phases of Strategic
T for the COVID-19 in the community, regardless of
Framework whether they report symptoms. The study also
estimates the number and proportion of people
5. Conclusion
COVID-19: Scotland’s Testing Strategy Update 131. Strategic context aged 16 and over who would have tested positive Further to Scottish Government funding of
■ Testing Strategy – Principles for COVID-19 antibodies from a blood sample, £1.1 million in December 2020, SEPA has
suggesting they had the infection in the past or significantly expanded its lab capacity to support
2. Why we test have been vaccinated. the programme with capacity now for 200 samples
■ Testing Strategic Intent per week. This has allowed for the continuation
■ Rationales for Testing The study will play a key role in monitoring of national monitoring at wastewater treatment
antibodies in the community population in works, and has also enabled wastewater sampling
3. How we test Scotland which will help to indicate the extent to begin at local sites within the Scottish Water
■ ontext – A Range of
C to which the vaccination programme is building network. This data is contributing to our knowledge
Technologies for a Range of resistance to COVID-19 as its roll-out continues. of prevalence across Scotland, thereby aiding the
Purposes
ONS is currently considering plans for widening direction of Community Testing resources, with
■ Capacity antibody testing to monitor vaccine effectiveness, national mobile resources able to be deployed
■ Access and it is likely that testing to monitor will grow in where there is evidence that prevalence is rising.
■ Improving Access to importance as we move to future phases where
Symptomatic Testing more of the population are vaccinated. The wastewater monitoring approach is a reliable
■ Targeted Community Testing indicator of low viral prevalence and a good early
■ Surveillance Testing Wastewater Testing or lead indicator or signal of virus detection. It
provides a complementary, unbiased data stream
■ Wastewater Testing Wastewater testing offers the potential to monitor
to prevalence detected from human testing, and is
■ Whole Genome Sequencing prevalence and detect outbreaks of SARS-CoV-2.
flexible in scale, with it possible, for example, to
The Scottish Environment Protection Agency
4. Who we test sample an entire city or just one building.
(SEPA), working in conjunction with Scottish
■ Test to Diagnose Water and Public Health Scotland, has formed Importantly for the challenges likely to be posed
■ Test to Care a monitoring network across Scotland for the in the next phases of the pandemic in Scotland,
■ Test to Protect purpose of analysing wastewater samples to it is also possible to detect viral mutations by
determine the level of COVID-19 infection markers sequencing wastewater samples.
■ Test to Find
present. As of 2 February 2021, the monitoring
■ Test to Support
network encompasses 70 sites covering 3.5 million Wastewater testing can also be used to monitor
■ Test to Monitor people. Samples from these locations are tested at other viruses and markers of public health, and
■ hree Phases of Strategic
T least weekly, which can be increased when local so represents a significant post-COVID legacy
Framework outbreaks are apparent. benefit. These broader and longer-term use cases
5. Conclusion could include the monitoring of other viruses, such
COVID-19: Scotland’s Testing Strategy Update 141. Strategic context as influenza, rotavirus, norovirus, enterovirus, which will facilitate early public health assessment
■ Testing Strategy – Principles and the monitoring of antibiotic-resistance in and more rapid interventions to minimise spread
bacterial pathogens. To this end, we are investing in the community. Optimal service delivery
2. Why we test £2.3 million in the further development of options are currently being evaluated.
■ Testing Strategic Intent Scotland’s wastewater testing capability in 2021‑22.
■ Rationales for Testing While this allele-specific PCR testing is suitable
for rapid follow-up PCR testing for known variants
Whole Genome Sequencing
3. How we test of concern (once developed), it is not capable
The next phases of the pandemic in Scotland will of detecting yet to be identified mutations
■ ontext – A Range of
C
Technologies for a Range of have two critical challenges – effectively and or new variants of concern VOCs. Therefore
Purposes promptly stopping outbreaks before they build to for comprehensive surveillance to detect the
■ Capacity sustained community transmission, and managing emergence of VOC, both allele-specific PCR testing
■ Access the risk of new strains of the virus emerging and Whole Genome Sequencing will be required.
either from imports of from mutations occurring
■ Improving Access to
within Scotland. These risk our considerable
Symptomatic Testing Building on the experience and expertise of our
progress in reducing prevalence levels. world-class scientists, we expect to invest a
■ Targeted Community Testing
further £13 million in 2021-22 to build a Whole
■ Surveillance Testing Whole genome sequencing is critical to all of these
Genome Sequencing Service for Scotland. This
■ Wastewater Testing challenges. In outbreak management, sequencing
will both support our ability to maintain progress
■ Whole Genome Sequencing can support analysis of whether an outbreak has
in the coming months – by better managing
its roots in single or multiple introductions. In
outbreaks and detecting imported variants of
4. Who we test managing import risk, sequencing of all positive
concern – and build a legacy of a genuine world-
■ Test to Diagnose cases found in our quarantine testing is supporting
class public health system, better prepared in the
■ Test to Care the detection of new variants of concern. Similarly,
event of any future pandemic. It will be capable
moving towards sequencing all identified positive
■ Test to Protect
cases within Scotland will allow detection of
of sequencing up to a thousand cases per day
■ Test to Find when fully built, and support not just protecting
‘home-grown’ mutations.
■ Test to Support our progress against COVID, but our resilience to
The increase in sequencing capacity will a range of threats, including antibiotic resistance.
■ Test to Monitor
be complemented by the development of Our ambition is to be able to sequence all positive
■ hree Phases of Strategic
T
allele‑specific PCR tests. These are high throughput cases found in Scotland; and to build a legacy that
Framework
tests which can be used for rapid screening of can contribute globally as well as in Scotland.
5. Conclusion known mutations within a variant of concern,
COVID-19: Scotland’s Testing Strategy Update 15How we test – Technology informed by testing strategy
Test for Clinical
Test to Diagnose Test to Protect Test to Find Test to Support Test to Monitor
Care
Symptomatic and
Symptomatic Asymptomatic Asymptomatic Asymptomatic Surveillance
Asymptomatic
qRT-PCR PCR LFD LFD LFD PCR
ePCR ePCR PCR PCR Antibody
Point-of-Care – Sequencing Wastewater
Lumira DX
Wastewater Sequencing
Allele-Specific
PCR
KEY:
• PCR – Polymerase Chain Reaction Testing
• LFD – Lateral Flow Device
• ePCR – endpoint PCR testing
• Point-of-Care testing – near-patient test
• Allele-Specific PCR – amplifies specific genetic variants – can be used to detect VoC
COVID-19: Scotland’s Testing Strategy Update 164. Who we test
Test and Protect pathways for each Testing Strategic Priority
Symptomatic Patient Care Protect Find Support Monitor
Existing areas of testing
Whole Population Universities: Student
Elective Surgery Care Homes ONS Infection Study
(Symptomatic) Term-End Travel Testing
Community Testing
Rural Testing Medical Admissions Care at Home Siren
Pilot
Walk-Through
Emergency Admissions Care Home Visitors CASS
Test Centres
Visiting Professionals
Satellite Testing
to Care Settings
Patient-Facing Health
Care Workers
Testing expansion February 2021 onwards
Healthcare Workers: Close Contacts Schools (senior phase
Small-Scale Test Sites Schools Infection Study
Primary Care (of Index Cases) and S1-S3 pupils)
Other Social Care Higher and Further Whole Genome
Expansion of all Schools and ELC staff
Settings (Staff) Education Sequencing: Expansion
Sampling Routes:
Local, Mobile, Regional Hospices (Staff) Prison Service ELC (Non-School Based) Wastewater Testing
Food Processing
Community Testing
and Distribution
Emergency Service
Control Rooms
COVID-19: Scotland’s Testing Strategy Update 171. Strategic context Test to Diagnose Test to Protect
■ Testing Strategy – Principles Under Test to Diagnose, anyone with one or more Under Test to Protect, all patient-facing healthcare
of the three core symptoms in the case definition workers, alongside Scottish Ambulance Service
2. Why we test
– fever, new persistent cough, and loss of taste and NHS24 call handlers, test twice weekly using
■ Testing Strategic Intent or smell – is encouraged to self-isolate to book a LFDs. Since roll-out commenced in November
■ Rationales for Testing test as quickly as possible. We recognise a wide 2020, Public Health Scotland has reported that
range of other symptoms has been identified as over 778,000 tests have been self-reported by
3. How we test
potentially indicative of COVID-19. From end of in-scope healthcare workers (cumulative as at
■ ontext – A Range of
C March, where GPs have a clinical concern that a 15 March 2021). Of those reported, there have
Technologies for a Range of
Purposes patient without any of the three core symptoms been over a thousand asymptomatic positive test
may have COVID-19, they can advise that patient results identified.
■ Capacity
to book a PCR test through the usual booking
■ Access
portal. As we continue to expand our testing capacity,
■ Improving Access to we are finding more asymptomatic cases amongst
Symptomatic Testing
healthcare workers resulting in an increase
Test to Care
■ Targeted Community Testing in positive cases. However, by identifying
Under Test to Care, anyone in hospital who asymptomatic but positive members of staff
■ Surveillance Testing
develops symptoms of COVID–19 is tested as early as possible enables them to leave the
■ Wastewater Testing
promptly to ensure both optimal clinical care for workplace and self-isolate immediately, in line
■ Whole Genome Sequencing them, and appropriate cohorting to minimise risk with national guidance, thereby breaking chains of
4. Who we test of in-hospital transmission either to staff or other transmission.
patients. In addition, all emergency admissions are
■ Test to Diagnose
tested. All people undergoing planned admission Alongside robust infection prevention and control
■ Test to Care to hospital are given a PCR test 72 hours before (IPC) measures in hospital and other care settings
■ Test to Protect admission via NHS Scotland testing routes, and (including the appropriate use of PPE, extended
■ Test to Find are only subsequently admitted when a negative use of face masks and coverings, physical
■ Test to Support test result has been confirmed. All new care distancing and outbreak management), the
home residents, whether from the community addition of asymptomatic staff testing has helped
■ Test to Monitor
or hospital, are tested prior to admission. COVID support a reduction in hospital-onset COVID-19
■ hree Phases of Strategic
T
recovered patients in hospital require two
Framework cases since January 2021.
negative tests prior to discharge to a care home.
5. Conclusion
COVID-19: Scotland’s Testing Strategy Update 181. Strategic context Roll-out of twice-weekly lateral flow testing Expanded testing for social care staff groups
■ Testing Strategy – Principles to all patient-facing primary care healthcare began on 8 March (for children’s and young
workers started on 15 February 2021, meaning people’s personal assistants and care inspectors
2. Why we test approximately 58,000 staff across patient-facing visiting children and young people services).
■ Testing Strategic Intent teams in general practice, dentistry, optometry Further testing for staff will be phased from March
■ Rationales for Testing and pharmacy, across communities, have access to for the following people working in care roles:
twice-weekly lateral flow testing. All hospice staff children’s care homes, children and young people
3. How we test are also eligible for twice-weekly testing. community services, addiction, homelessness,
■ ontext – A Range of
C mental health, learning disability, women’s aid
Technologies for a Range of In adult social care, all care home staff receive shelters and social workers not yet covered by
Purposes
twice weekly testing; all visiting professionals to testing. Work will also commence to examine
■ Capacity care homes receive routine testing; and family and non-registered services that provide support to
■ Access friend visitors to care home residents are tested vulnerable groups.
■ Improving Access to on the day of the visit as an additional layer of
Symptomatic Testing protection.
Test to Find
■ Targeted Community Testing
Care at home staff began routine testing for adult Since 18 February, all close contacts of index cases
■ Surveillance Testing
have been advised to book a PCR test between
services from the 18 January (adult day centres/
■ Wastewater Testing
day services, care at home, personal assistants, day 3-5 from exposure to a confirmed positive
■ Whole Genome Sequencing and sheltered housing/housing with multiple case. Testing is not an alternative to isolation and
occupancy). This was implemented by the end of individuals who test negative are still required
4. Who we test
February – one month ahead of the planned full to complete the 10-day self-isolation period.
■ Test to Diagnose
roll out date. Testing close contacts will allow cases that might
■ Test to Care otherwise have gone undetected to be identified
■ Test to Protect Across all these social care groups – visiting and further chains of transmission to be broken
■ Test to Find professionals, care at home staff, family and by identifying and isolating potentially infected
friend visitors, and care home staff – Public Health contacts. It will also provide further intelligence to
■ Test to Support
public health teams about secondary attack rates
Scotland figures to date have reported over 500
■ Test to Monitor
asymptomatic positive results. (the probability of infection occurring among close
■ hree Phases of Strategic
T contacts of confirmed cases) and high-risk settings,
Framework
by highlighting where there may be a higher risk
5. Conclusion of transmission to contacts.
COVID-19: Scotland’s Testing Strategy Update 191. Strategic context At a community level, Test to Find is a core part Quarantine testing was introduced with the new
■ Testing Strategy – Principles of the rationale for Targeted Community Testing, Managed Isolation policy for international arrivals
with proposals developed with local partners to to Scotland from outside the Common Travel Area
2. Why we test address problems of stubbornly high transmission, from 15 February. All arrivals are tested twice
■ Testing Strategic Intent or rapidly rising transmission, or specific during their quarantine period – on day two and
■ Rationales for Testing transmission risks in local communities. Proposals day eight of the ten-day quarantine. All day two
for Targeted Community Testing have now been positive test results are sent for sequencing in
3. How we test agreed with 25 local authorities across 10 Health order to detect any possible variants of concern.
■ ontext – A Range of
C Board areas.
Technologies for a Range of Test to Find has also been a core part of outbreak
Purposes
We will introduce testing of staff working in management since the beginning of the pandemic,
■ Capacity prisons to reduce the risk of asymptomatic with mobile units deployed on the request
■ Access prison staff importing COVID-19 into the prison of outbreak Incident Management Teams or
■ Improving Access to environment. We will start with three prisons Directors of Public Health to enable the testing
Symptomatic Testing to assess the operational feasibility and public of whole workplaces, or communities, or other
■ Targeted Community Testing health impact of this type of testing. Subject to a locations of outbreaks. This testing continues on
■ Surveillance Testing successful initial phase, we will expand testing to a case-by-case basis. Through our Community
further prisons in due course. Testing programme, we have worked with the
■ Wastewater Testing
Scottish Ambulance Service, which operates the
■ Whole Genome Sequencing We will also build on our existing programme Mobile Testing Fleet in Scotland, to expand the
4. Who we test of offering testing to students at times of large potential of the current mobile fleet (42 vehicles)
population movement (before and after the through a flexible staffing model that enables
■ Test to Diagnose
end of the first semester), to include extending up to 84 communities to be served by the fleet,
■ Test to Care access to PCR testing to students close to their for sustained targeted community testing or for
■ Test to Protect non‑term‑time address prior to travelling to outbreaks.
■ Test to Find accommodation at university or college. Plans
■ Test to Support are also being developed to roll out regular
(twice‑weekly) testing for university and college
■ Test to Monitor
students and staff.
■ hree Phases of Strategic
T
Framework
5. Conclusion
COVID-19: Scotland’s Testing Strategy Update 201. Strategic context Test to Support The goal of this testing is to identify staff or
■ Testing Strategy – Principles Regular asymptomatic testing is now also available young people who have the virus but do not
at certain food production and food distribution have symptoms and require them to self-isolate,
2. Why we test thus breaking potential chains of transmission
businesses, including places like dairies, abattoirs
■ Testing Strategic Intent and meat and seafood processing plants. early and minimising the risks of outbreaks in
■ Rationales for Testing These are settings that present a higher risk of schools. Test kits are being supplied to all schools
transmission due to factors like low temperatures, in Scotland for onwards distribution to those who
3. How we test wish to take part in the programme. Participants
high humidity and limited ventilation. Under the
■ ontext – A Range of
C scheme, which is voluntary for businesses and will then test at home and record results using
Technologies for a Range of a digital portal (or by telephone if they prefer).
Purposes staff, eligible businesses are provided with free
LFDs. Any positive tests are then confirmed by Anyone testing positive should self-isolate
■ Capacity
according to guidelines, and ensure they take a
a PCR test. By taking part in this scheme, food
■ Access
businesses are helping to support their workers confirmatory PCR test to minimise the risks of
■ Improving Access to and to prevent outbreaks and minimise the risk false positives.
Symptomatic Testing
of closure. They are also helping to minimise the
■ Targeted Community Testing risk of any cases or outbreaks in their premises Phase two of the Schools/ELC Asymptomatic
■ Surveillance Testing spreading into the wider community. Businesses Testing Programme will see all standalone day care
that are interested in participating are invited to of children settings, providing early learning and
■ Wastewater Testing
contact FoodSupplyInformation@gov.scot. school age childcare services, receive the same
■ Whole Genome Sequencing
offer of twice-weekly lateral flow testing at home
4. Who we test Under the Schools/ELC Asymptomatic Testing to break potential chains of transmission early
Programme, twice-weekly at-home testing using and minimise the risks of outbreaks in settings.
■ Test to Diagnose
LFDs is being made available to all staff in primary, Preparation for this expansion is underway and test
■ Test to Care
secondary and special schools, and all secondary kits are expected to be available for staff through
■ Test to Protect school pupils (with the S1-S3 cohort due to be settings by the end of March.
■ Test to Find included in the testing offer as part of an expected
■ Test to Support fuller return after the Easter break, which will be To support the safe running of essential services,
subject to continued progress in suppressing the routine asymptomatic testing has commenced in
■ Test to Monitor
virus). Staff in school-based early learning and the control rooms of Scottish Ambulance Service,
■ hree Phases of Strategic
T
school-age childcare settings will also receive Police Scotland and Scottish Fire and Rescue
Framework
testing as part of this phase of the programme. Service as well as NHS24 call centres.
5. Conclusion
COVID-19: Scotland’s Testing Strategy Update 211. Strategic context Previous iterations of the testing strategy have Three Phases of Strategic Framework
■ Testing Strategy – Principles made it clear that we are taking a risk-based The updated Strategic Framework presents three
approach to testing in workplaces. We believe that phases as we exit lockdown, linked to levels of
2. Why we test this is the most effective use of testing capacity prevalence and progress with the vaccination
■ Testing Strategic Intent and will ultimately allow us to open the economy programme:
■ Rationales for Testing in a more sustained way. We will continue
to identify sectors which would benefit from 1. Moderate-low level of prevalence nationally.
3. How we test asymptomatic testing based on the intelligence on Early vaccine roll-out.
■ ontext – A Range of
C risk and challenges around other mitigations. 2. Very low level of prevalence nationally.
Technologies for a Range of
Purposes
Widespread vaccination (Joint Committee on
Alongside this we will ensure that our community- Vaccination and Immunisation Group 1-9).
■ Capacity based testing is engaging effectively with local
■ Access businesses and workplaces. We will work with 3. COVID no longer a significant threat to public
local heath partners to ensure that appropriate health. Maximum vaccine roll-out.
■ Improving Access to
Symptomatic Testing local businesses within high prevalence areas are
The role of testing and the relative importance of
■ Targeted Community Testing fully included in community testing programmes,
the six purposes for testing will adapt as we go
■ Surveillance Testing providing a coherent and targeted approach where
through these phases.
prevalence of the virus is high. We will continue
■ Wastewater Testing
to engage with business organisations and sector
■ Whole Genome Sequencing
bodies on our testing regime.
4. Who we test
■ Test to Diagnose Test to Monitor
■ Test to Care Scotland continues to invest in surveillance
■ Test to Protect testing to monitor prevalence of the virus at
a whole population level and in particular
■ Test to Find
workforces including health and education. Our
■ Test to Support
approach to Test to Monitor – using population
■ Test to Monitor studies, wastewater testing and whole genome
■ hree Phases of Strategic
T sequencing – is set out in Section 3: How we test.
Framework
5. Conclusion
COVID-19: Scotland’s Testing Strategy Update 22Moderate-low level of Very low level of prevalence COVID-19 no longer a significant
prevalence nationally. nationally. Widespread vaccination threat to public health.
Early vaccine roll-out. (at least JCVI Groups 1-9). Maximum vaccine roll-out.
Gradual easing of some Return to varying levels of COVID-19 ceases to be a serious
restrictions within Level 4, restrictions enables ongoing threat to public health but some
including ongoing reopening of suppression of the virus. ongoing public health measures
schools for in-person learning. likely to remain in place.
Vaccines protect health and reduce transmission
Effective use of Test and Protect to suppress the virus and protect public health
Proportionate protective measures suppress the transmission of the virus
Reduced importation of the virus through effective border measures
Support provided to people, businesses, and organisations to adhere to protective measures
Provide care and support to mitigate the wider harms of the crisis
COVID-19: Scotland’s Testing Strategy Update 231. Strategic context Phase 1 – Moderate prevalence nationally Another key role for testing in this first phase is
■ Testing Strategy – Principles In the first phase, gradual easings of restrictions in mitigating the risk of import. Imperative in this
within Level 4 are taking place, when data first phase to enable progress to the next phase of
2. Why we test a return to a levels approach, is maintaining and
indicates it is safe to proceed. These gradual
■ Testing Strategic Intent changes are conditional on meeting the WHO six building on the continuing progress we are making
■ Rationales for Testing conditions for easing restrictions. The earliest in reducing prevalence and harm, through our
changes began on 22 February, and included vaccinations programme and through our range
3. How we test of protective measures including testing, contact
the opening of early learning and childcare and
■ ontext – A Range of
C schools for years Primary 1 to Primary 3, and tracing and supporting isolation. To do this, we
Technologies for a Range of will maintain our vigilance to reduce the risk of
Purposes a very limited number of senior phase pupils
attending secondary schools; and the opening importation of the virus, and identify and isolate
■ Capacity
any new variants of concern imported.
of care homes to visitors to enable meaningful
■ Access
contact between residents and family and friends.
■ Improving Access to Since 18 January 2021, passengers have been
Symptomatic Testing
Further gradual easings are proposed, subject under a legal obligation to get a COVID-19 test
■ Targeted Community Testing to continued evidence of sustained progress in before they travel. We will continue to make it a
■ Surveillance Testing reducing transmission, including the return of requirement for passengers travelling to Scotland
more children and young people to schools and from outside the Common Travel Area to be able
■ Wastewater Testing
the phased return of a small number of university to certify they have a valid negative test result
■ Whole Genome Sequencing
from the three-day period before travel.
students for in-person learning.
4. Who we test
The role of testing in this phase is to support these We will continue to make it a requirement for
■ Test to Diagnose
all direct international arrivals to Scotland from
individual settings as they return, in particular in
■ Test to Care
education, to find cases and mitigate the potential outside the CTA, or those arriving from Ireland if
■ Test to Protect for this return to increase transmission (Rt). The they have passed through a red list country in the
■ Test to Find schools testing programme and the extension of last ten days, to quarantine in managed isolation
■ Test to Support higher and further education testing to enable facilities and be tested on day two and day eight
routine testing for on campus students and staff, of their quarantine. In addition, those arriving
■ Test to Monitor
and the testing of family and friend visitors to from within the CTA who have travelled through
■ hree Phases of Strategic
T
a non-acute risk country in the ten days before
Framework care home residents, are all testing that is in place
to support this return. arrival in Scotland must take tests on day two and
5. Conclusion day eight of their self-isolation-at-home period.
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