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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                                                2
1. 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                                                                                                3
1. 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                                                                                               4
1. 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                                                                                             5
2. 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                                                                                              6
1. 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                                                                                         7
Figure 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                                                                                                   8
3. 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                                                                                                 9
1. 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                                                                                         10
1. 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                                                                                         11
1. 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                                                                                          12
1. 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                                                                                           13
1. 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                                                                                              14
1. 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                                                                                             15
How 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                                                                                    16
4. 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                                                                                                       17
1. 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                                                                                           18
1. 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                                                                                           19
1. 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                                                                                           20
1. 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                                                                                              21
1. 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                                                                                         22
Moderate-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                                                                            23
1. 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.

                 COVID-19: Scotland’s Testing Strategy Update                                                                                            24
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