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Covid-19 Tests

– in the Scottish Parliament on 2nd June 2020.

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Photo of Jackie Baillie Jackie Baillie Labour

1. To ask the Scottish Government what the daily average number of Covid-19 tests carried out last week was. (S5T-02218)

Photo of Jeane Freeman Jeane Freeman Scottish National Party

During the week commencing Monday 25 May, an average of 4,624 tests were carried out on the Scottish population each day. That figure does not include the numbers for home testing.

Photo of Jackie Baillie Jackie Baillie Labour

That figure falls well short of Nicola Sturgeon’s promise that we would have 10,000 tests per day by the end of April, which was subsequently revised to 15,000 tests per day by 26 May. Indeed, yesterday saw the lowest number of tests being carried out—only 2,729—and only 937 new people being tested, which are the lowest figures for months. Further, only 2.1 per cent of the population has actually had a test.

Will the cabinet secretary therefore explain why testing is not being done at even a third of the capacity that is available in Scotland, but at a level that is considerably less than 10 per cent of the number of tests routinely carried out by the national health service in England? Will she also explain why we have one of the worst testing rates in Europe, if not in the world?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I thank Ms Baillie for her supplementary question, but before I respond to it I will correct a couple of points. The First Minister did not say that 10,000 tests per day would be carried out. What we said—and delivered on—was an initial increase in capacity to 8,000 tests and a further such increase last week, to the end of May, of 15,500 tests. Those figures are for capacity and not for the number of tests being carried out per day. In both cases those capacity commitments were delivered on.

Such testing capacity is used in two ways. The first is largely demand led. It is led by key workers, which now includes people across a range of sectors, and anyone over the age of five who has symptoms, going for a test. That is done primarily through the United Kingdom Government’s regional testing centres and the tests are processed by the Lighthouse lab.

The NHS labs are delivering on tests taken for those over the age of 70 who are admitted in hospital settings. At the moment, the number of such cases is reduced, given the pause that we have put on so much of the NHS’s work. It is delivering on tests for patients in intensive care units—whose numbers are, fortunately, reducing, as Ms Baillie will know—and also those in hospital for Covid-19 and those in care homes. Testing in care homes is being rolled out. Many of our board areas have now completed their testing in homes in which there have been cases, and they are working through tests for care workers in homes in which there are currently no active cases.

The capacity that we have created, and we need to go further, is to ensure that we have the capacity in our NHS system to cope with the demands that might come as a consequence of easing lockdown measures and seeing an increase in the transmission of the virus, which we will then deal with through the test and protect system.

Photo of Jackie Baillie Jackie Baillie Labour

I thank the cabinet secretary for her further response. However, I am surprised at her defence, because I am sure that she would agree that there is absolutely no point in having capacity unless we are actually going to use it.

As the cabinet secretary has outlined, she has made a number of announcements about extending testing. She did so twice in March, three times in April and twice in May. That suggests that the eligibility criteria were far too narrow to start with and remain so now.

The World Health Organization told us months ago that asymptomatic people were carriers too, and that the more of them who were tested the better. Given that we are now moving to the test and trace phase, in which testing will be critical to managing a return to work, will the Scottish Government finally follow the advice of experts at the World Health Organization whose mantra is “test, test, test”, or are our clinicians more expert than those world experts?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I will make a number of points. First, what I said in response to both of Ms Baillie’s questions was not a defence but an explanation. Secondly, eligibility for testing was increased as the evidence emerged suggesting that it was possible to do so.

More importantly, let me quote the World Health Organization on the subject of asymptomatic individuals. We have consistently taken a precautionary approach in relation to asymptomatic or pre-symptomatic transmission. On 2 April, the World Health Organization’s statement said:

“there has been no documented asymptomatic transmission”.

As both the First Minister and I have said, in the early days of the pandemic the clear advice that we received from our scientific and clinical experts was that there was no transmission from asymptomatic individuals.

That advice has changed over time. There is still no set view on the part of the scientific or clinical community on that or on the difference between being infected and being infectious in relation to those asymptomatic individuals. Nonetheless, we are taking a precautionary approach; that is why we have introduced testing for care workers in care homes where there is no active case and those care workers have no symptoms. We will continue to consider, as we look to remobilise our health service, in what way further testing can assist us to do that safely.

Photo of Brian Whittle Brian Whittle Conservative

Cabinet secretary, given the need to get the reproduction numbers down, would it not make sense to focus all that spare capacity where the biggest impact from Covid-19 is being felt and where the highest R number now resides—in our care homes?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

That is precisely what we are doing—we are testing in our care homes. In those care homes with an active case, all residents and all care workers are being tested, and we are also testing care workers in care homes where there is no active case. That is precisely our focus, as well as the work that is under way in the hospital setting. As I have said, as we remobilise the health service, which is the subject of the debate that we will have later, there will be further consideration of whether testing can assist us to do that safely for both patients and staff.

However, I remind members that the test tells us only whether someone is symptomatic of Covid-19 on the day on which the swab is taken; it does not tell us whether someone will be symptomatic two days later. It tells us whether they are symptomatic on the day of the test. If someone is asymptomatic and tests negative, the test has to be repeated, and that is precisely what we will do in those care homes that have no active cases. Testing care workers will be an iterative process, repeated every seven days.

Photo of Liam McArthur Liam McArthur Liberal Democrat

As I highlighted to the First Minister last month, giving people access to information on the level of testing that is taking place locally will be key to building public confidence and securing compliance as we move ahead with test and protect.

The First Minister appeared to agree, yet there is still no sign of the data being made available to people in Orkney or across Scotland. When can the public expect to be able to access that data and other relevant information relating to test and protect?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

We will be able to provide information on the tests that are conducted through our NHS-controlled facilities—that includes not just our NHS labs but our partners in three of the major universities and in the Scottish National Blood Transfusion Service—over the coming days, once we are sure that the evidence and the numbers that they are giving us through Public Health Scotland are robust and make sense.

We should bear in mind that a test may sometimes be taken in a particular board area but processed through a lab in another board area, in order to ensure that we meet the timeline that we need to meet, of as close to 24 hours as can possibly be managed.

However, we will not be able to break down the number of tests that go through the Lighthouse lab by area, because we get the figure for Scotland as a whole, not necessarily for different parts of the country. We are working to give as clear and robust data as we possibly can, and, as soon as we are ready to publish that data, I will certainly make sure that Mr McArthur knows that, as well as the frequency with which we will update it.

Photo of David Torrance David Torrance Scottish National Party

The cabinet secretary mentioned the importance of flexibility in scaling up contact tracing, depending on demand. Can she outline how the Scottish Government will assess demand?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

The assessment of the testing capacity that is needed comes from pulling together all the information that we have. For example, we know the number of 70-year-olds who are being admitted to hospital whom we need to test, and we will be able to project that number as we look to restart elective care in our NHS. We know the number of health and social care key workers that will come through, although that number is declining, and we know what care home demand will be as we test care homes with active cases and, increasingly, as we test care workers in care homes that do not have active cases.

We also get information on demand from the modelling estimates that produce the R number and the anticipated number of individuals across Scotland who have the virus. There is also the work on the test and protect approach, through which the message that we are sending to the public is different from before—the message now is that, if people have symptoms, they should please get in touch with NHS Inform or NHS 24 and book a test.

All of that is factored into the modelling that shows how much more than a capacity of 15,500 we need for testing in Scotland.

Photo of Alison Johnstone Alison Johnstone Green

On 18 May, the Scottish Government widened access to testing so that anyone with symptoms could get a test, and it introduced routine testing for 53,000 members of staff in care homes. Before those changes, 5,000 tests were being carried out each day; however, as we have just heard, since then, the number of tests has actually decreased. To test staff in care homes weekly, some 7,000-plus tests would have to be carried out each day. Can the cabinet secretary confirm that it is the Scottish Government’s intention to carry out that testing? If so, when will it start?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

It has started. Before I go into that, I should say that the drive-through test numbers—in other words, the numbers from the regional test centres, which now largely involve that wide eligibility group of anyone who is over the age of five and who has symptoms—have declined in the recent period. To a degree, that is not a surprise, because the R number is reducing and the level of the virus in Scotland at the moment is low, so we can reasonably expect a lower number of individuals to have symptoms and to seek tests.

The work on care homes has begun. All boards have now produced plans that identify the priority with which they are going round care homes in their areas to undertake testing, including those where there are no cases and where they are testing care workers. There have been a number of glitches in that path. Up until a week ago, one of those related to care workers who were reluctant to be tested because their terms and conditions from their employer were such that their weekly income would reduce significantly if they tested positive. The Government has now acted to resolve that impossible dilemma for them.

Of course, individuals have to consent to be tested, and we cannot expect 100 per cent of people to give that consent. In some instances, particularly with care home residents, consent is not possible because of the conditions that they suffer from, and the clinical decision might be made that the particular test involved would cause too much distress to force it on the person—although, of course, we cannot force a test on any individual. However, testing is by no means the only route by which care homes should be preventing the transmission of the virus between one resident and another. Care homes should be following the clear guidance that has been issued and reissued from 13 March onwards.