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Covid-19: The Scottish way

Scotland's First Minster Nicola Sturgeon yesterday published the outline of a new public health measure, called 'Test, Trace, Isolate, Support'.

It is billed as one of a range of public health measures to be used to ensure low levels of community transmission of Covid-19.

It is, in essence, the well-tried and tested virus hunting approach, in which public health tracing teams, already existing in local authorities and health districts, would be bulked up with extra staff.

They then set about following the established playbook for contact tracing to find people infected with the virus and others who might have come into contact with them and quarantine them.

The novel twist this time around is that there is now, like so much else, an app for that.

But unlike the UK government, the Scottish government is not selling the technology bit of the approach hard.

The Scottish government document on TTI (as the policy is known - the 's' seems to be silent) states an app can be "an important enhancement to contact tracing, but it is also important not to see it as a substitute for the approach to contact tracing we describe here".

In other words, the app is not going to solve the Covid-19 problem.


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The Scottish government appears to be putting its faith in old fashioned phone bashing, calling contact after contact and having actual human beings ask them questions.

The document admits such work is "resource intensive", and it is mindful of the need to ensure that all areas of Scotland, especially the remote and sparsely populated parts, are able to enhance their contact tracing capacities to deal with the virus.

So they are treating the app, which is being developed by the digital unit of the health service, NHSX, and a web-based tool being developed by the Digital Health and Care Institute (DHI), as extras to help to automate and speed up an established administrative task.

And as usual, using more computers to automate administrative tasks means more administrators have to be hired as well.

In this case, human contract tracers, which the document tells us are "more than simple data gatherers".

The humans perform the difficult-to-programme functions like risk assessment and providing active support for contacts. Better to have a human break the bad news than a machine, especially to vulnerable citizens.

The Scottish government estimates it will have to hire an additional 2,000 contact tracers to augment the existing teams to deliver "a sustainable service across Scotland". 

The service will remain in place as long as it is needed.

Some NHS boards in Scotland are already engaged in contact tracing, and the plans calls for a countrywide enhanced Covid-19 contact tracing system in place by the end of the month.

But what of the other two (or three) letters in the acronym? There is little point in tracking people down unless they can be tested to see if they have the virus.

So, like the rest of the UK, scaling up testing capacity is important.

The documents says "we know that 'test, trace, isolate, support' will have the greatest impact when people are confident in what to do if they have the symptoms, are able to receive the test quickly and get results delivered rapidly".

This will require "an unprecedented scale of testing capacity in Scotland".

So how does Scotland, with its population of 5.4 million compare with Ireland, and its 4.9 million population on the testing front?

Minster for Health Simon Harris said yesterday that Ireland had built a capacity for 12,000 tests a day.

In Scotland, the government document says it now has a capacity for 4,350 samples a day, and intends building that up to 8,000 a day by the middle of the month.

It can also call on a capacity of abut 4,000 a day through "Lighthouse Laboratory" arrangements - the newly built large scale laboratories built specifically for this disease, in Glasgow, Milton Keynes and Alderney Park.

The Glasgow facility is in the University of Glasgow Hospital campus.

But the Scottish government thinks it will need a capacity to test 2% of the population, which it calculates means being able to test (and rapidly process) 15,500 people per day when the system is fully operational.

But the number of tests may need to increase further, depending on the progress of the disease. And it says that "active community surveillance" at local levels will also be key in identifying outbreaks and informing where the testing and tracing regime needs to focus "as the pandemic progresses in Scotland".

Then there is 'I' for Isolation.

Finding and testing people should lead to their isolation in order to break the transmission chains.

That means staying isolated for 14 days - no going out for exercise or even to buy food.

Which brings us to 'S' for Support.

The document recognises that such isolation will be hard, particularly for certain groups, and puts the system on notice for having to make arrangements for people, such as food shopping, financial support or moving them to another location, where they can properly isolate form their existing household (eg people living in crowded conditions).

The TTI regime will, the document stresses, not replace existing hand washing, respiratory hygiene and social distancing measures, merely augment them and help to measure and manage the spread of the virus.

It is essentially a stopgap measure until a vaccine is developed and deployed to allow some easing of lockdown measures.

Yesterday's Covid-19 daily updates for Scotland and Ireland show some similarities for the progress of the virus.

Ireland had 93 people with a positive Covid-19 test in Intensive Care Units, in Scotland the equivalent number was 91.

(As of yesterday) Ireland had 900 coronavirus cases in hospital, while in Scotland the figure was 1,720. The death total in Scotland was 1,576, while in Ireland it was 1,319.

A correspondent writes questioning my figures on death rates in Scotland.

She says that these are not comparable to Irish figures, as they are for deaths where there has been a positive Covid-19 test, not including suspected Covid-19 deaths as is the case in Ireland and directs me to the website of the National Records of Scotland, which is hosting Scottish statistical data, updating the daily government figures with death certificate information (similar to the ONS in England and Wales).

It shows the following information on Covid-19 deaths on 29 April, (with the next update published tomorrow, 6 May).

"As at 26 April, there have been a total of 2,272 deaths registered in Scotland where the novel coronavirus (COVID-19) was mentioned on the death certificate". The figure from the Irish Department of Health for Sunday April 26 was 1,087 deaths.

On the breakdown of where the deaths happened, the Scottish Records Office says: "Over a third (39%) of COVID-19 deaths registered to date related to deaths in care homes.52% of deaths were in hospitals and 9% of deaths were at home or non-institutional settings".

The death tolls and intensive care figures in the original article above come from the Scottish Government website (gov.scot) which publishes a daily information dashboard on the disease. The Irish Department of Health (gov.ie) also publishes a daily dashboard of similar information.