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Coronavirus: How will Scotland's testing and tracing system work? Coronavirus: How will Scotland's testing and tracing system work?
(25 days later)
The Scottish government has set out its plans for a "test, trace, isolate, support" system to keep coronavirus in check. How is this going to work - and will its introduction signal the end of lockdown? Nicola Sturgeon has announced the next phase in the coronavirus response.
How will it work? The focus is moving to the strategy of "test, trace, isolate, support" which in Scotland will now be known as "test and protect".
Under the proposed system, when someone starts to feel symptoms consistent with Covid-19 they will be asked to go into self-isolation and it will be arranged for them to be tested. The Scottish government has published details of the plan which will become ever more important as lockdown restrictions start to ease.
If they test negative, they can be released from self-isolation. But if they test positive, they must stay there for seven days - and the contact-tracing system kicks in to identify anyone they have been close to. This is how it will affect us as the easing of lockdown restrictions begin.
This includes anyone who has been within two metres of an infected person for a period of 15 minutes or longer. What is Test and Protect?
These people will be asked to go into isolation for 14 days. A support system will be put in place to help those who might struggle to do so. Test and Protect is Scotland's plan for activating the new phase of the Covid-19 response, which is the "test, trace, isolate, support" strategy.
It is important to stress that this "test, trace, isolate" (TTI) strategy will not be the only restriction in place post-lockdown - the government says it will only work alongside other measures such as physical distancing, hand-washing and use of face coverings. Its job is to break the chains of transmission of the virus within the community.
What kind of support could be on offer? So far, lockdown - staying at home - has managed to help massively with that but as we restore some normality to life and get people back to work and school, it will become more important to contain any outbreaks as quickly as possible to stop the virus in its tracks.
People who are asked to self-isolate for 14 days will be urged to "remain at home completely during this time", keeping away from other members of their household if possible. How does it work?
Ministers recognise that this may be difficult for some, and are drawing up plans to help them based on how the existing "shielding" group is supported. Test and Protect will identify cases of Covid-19 through rapid testing, and as soon as a positive test is registered, all the people who have been in contact with that person for long enough to be exposed to the virus will be traced and asked to self-isolate
Some people may need to be provided with somewhere to isolate away from the rest of their household, or have deliveries of food or medicine arranged. Mental health and wellbeing support may also be needed. If they have picked up the disease, it is hoped this will stop them passing it on to others.
The Scottish government is also talking to the UK government about employment rights and benefits, and how people can access financial support if they are sent into isolation due to contact tracing. A contact is anyone who has been within two metres of an infected person for a period of 15 minutes or longer.
Is there capacity do this? Has the advice changed?
Not yet. A lot of things have to be built up before a nation-wide TTI system will be fully up and running. The basic advice remains the same. If you have any of the symptoms: a fever, a new persistent cough or a loss of smell or taste, you must self-isolate for seven days. The people you live with must self-isolate for 14 days. That means not leaving the house at all, even to exercise or to get food and medicine.
To start with, "extensive" testing will be needed. The government estimates that tests for up to 2% of the population will be required, and that 15,500 per day may need to be carried out under an "enhanced" TTI system. As soon as possible, when you have any symptoms, you should book a test. You can do that online here or by calling 0800 028 2816.
This is significantly more than can currently be done, so further work on expanding capacity is needed. What has changed is that now, if someone has been found to have been in contact with someone who has symptoms, they will be asked by the NHS to self-isolate too, even if they have no symptoms.
Extra staff will also need to be taken on to run the contact tracing side of the operation, which is far from a simple data-gathering task. In total, up to 2,000 additional specialist workers could be taken on. How will people know they have been in contact with someone who has tested positive?
These are the staff who will do the groundwork of contact tracing - phoning up people who are undergoing testing and finding out where they have been over the last 48 hours and who they have been in contact with. As soon as someone gets a positive test for Covid-19, the contact tracing system will be triggered.
Digital infrastructure is also to be expanded to make sure as much of the process as possible can be automated. Some contact tracing systems already exist within the NHS and Public Health Scotland, but new tools are being developed. The patient will be put in touch with the local contact tracing team to talk through and identify close contacts.
This will include a "secure web-based tool for the NHS in Scotland", which will allow ordinary users to input details of people they have been close to so that they can be forwarded to contact tracing teams. At present, most of this will be conducted by telephone calls. Phone apps are in development but Nicola Sturgeon has said that "old-fashioned contact tracing" will be at the heart of the system.
Could a smartphone app help? Close contacts, as well as household contacts, will be asked to self-isolate for 14 days.
In the first instance, contact tracing is chiefly done by straightforward telephone calls as outlined above. However, the UK government is also leading the development of a proximity-tracing app which people could download to their smartphones, with trials to begin soon. The risk of the virus being transmitted is higher the closer the contact, the greater the exposure to respiratory droplets (for example from coughing), and the longer they have been in contact.
This would use Bluetooth technology to identify other users close by, and could be useful in flagging up when someone has come into contact with an infectious stranger - for example on public transport. The self-isolation period is 14 days because if you have the virus, it may take that long for it to develop into an illness.
However, Nicola Sturgeon has warned that a large proportion of people might need to have the app in order for it to be effective, underlining the importance of people having trust in the security of the system and the use of their data. Do the family and friends of a close contact have to self-isolate too?
She said that while an app could eventually be an "important enhancement" to the system, "old-fashioned contact tracing" was still going to be key. No. Not at this stage. The close contact should stay at home for the full 14 days. But family or people in the same household can continue to leave house on essential outings, but only if they are not showing any symptoms.
When is it going to start? If anyone needs self-isolating advice or practical help, the Ready Scotland website has some helpful numbers.
As with a lot of other responses to the virus, mass contact tracing isn't going to be turned on like a light switch one day. Is there enough testing available for this?
The introduction will be phased as capacity is increased, starting with the priority groups of people currently undergoing testing. Ms Sturgeon said Scotland now had the capacity to do 15,000 tests for Covid-19 every day.
Some health boards are already in a position to do some tracing work, and the Scottish government has targeted having all of them in a position to run an "enhanced" system by the end of May. She said about 700 contact tracers would be needed in the first phase of project - although a pool of 2,000 will be in place by the end of the month.
Different systems will need to be tailored to local areas - Ms Sturgeon noted that the challenges in central Edinburgh are different to those in more rural areas like the Borders. How will this affect my work? Can my employer refuse to let me stay at home?
Will this mean the end of lockdown? Announcing the Test and Protect service, Nicola Sturgeon said on Tuesday that the guidance would urge employers to "protect the income" of their staff who were self-isolating.
Not necessarily. Ms Sturgeon has warned that TTI is not a "quick fix" or a "magic" answer to the virus, and even when up and running it will only work alongside a series of other measures. She said: "But there is also a role here for statutory benefits including statutory sick pay - we are not entirely in control of that and this applies to self-employed people and the benefits system as well.
It also cannot be taken for granted that once the system is ready, Scotland will immediately emerge from lockdown. "These are issues we are in discussion with the UK government about because it is really important that people have the support they need to isolate for periods that, I have candidly said before, may be multiple.
Ms Sturgeon has said there will be "an element of trying to balance things as we go", as the country adjusts to a "new normal". "We hope that is not the case, that the virus will continue to decline in the community and this will not happen to lots of people and certainly not happen on multiple occasions, but it is possible that it will."
The harsher restrictions of lockdown will be replaced with other measures, like TTI, that can help keep the virus suppressed overall - but this will be a gradual, careful process. Employers are being asked to make sure employees are aware of and able to follow the public health advice to self-isolate when asked to do so by the NHS. And they should make sure that staff do not have to, or feel that they have to, come in to work.
Ultimately, everything hinges on the virus and how quickly it spreads. If the infection rate - the much talked about "R number" - starts to rise again, severe restrictions could be imposed again with little warning. If you are able to and you are not unwell, your employer can ask you to work from home while you are self-isolating.
What happens at the end of self-isolation?
At the end of your 14 days, you can return to usual activities, practicing social distancing and other lockdown measures. If you had symptoms you will have spent the full seven days in self-isolation. For some people, a cough and loss of taste or smell may last longer even though the virus has cleared.
If you develop new coronavirus symptoms, you must go back to stage one of test, trace, isolate support and book a test. And you may be identified by another person as being a close contact and be asked to self-isolate again.
Who will have my information?
The contact tracing team will be operated as part of the NHS. This means your personal information will remain confidential. Nicola Sturgeon said even the Scottish government will not have access to your personal data.