Meeting of the Parliament 03 March 2020
On Sunday, we had confirmation of the first case in Scotland of novel coronavirus Covid-19. The patient is from Tayside and has a travel history. Although the patient is clinically well, they are being cared for in hospital in Scotland, as a precautionary measure. I am sure that members will join me in wishing them a full early recovery. I know that colleagues will appreciate that it is important that we respect the patient’s right to confidentiality, and that it is not appropriate for me to comment further on the details of the case. Following confirmation of the diagnosis, contact tracing has been completed by the local health protection team.
Covid-19 is a new strain of coronavirus. The virus came to light in December last year. It is thought to have originated in Wuhan city in China and has spread steadily across the world. As of yesterday, there were almost 89,070 cases throughout the world, with the most substantial outbreaks in Europe currently being in northern Italy. The scientific advisory group for emergencies—SAGE—which provides expert advice to the Scottish Government, has updated its reasonable worst-case-scenario planning assumptions for coronavirus. It is important to stress that that does not represent a prediction or a forecast; it is sensible modelling that is based on available data that allows us to plan for the worst case. The current modelling tells us that 80 per cent of the United Kingdom population might become infected, with 4 per cent of that amount requiring hospitalisation, and an estimated 1 per cent fatality rate among those who are infected.
Those are big numbers, so it is important that I put some caveats around them. First, I stress that the modelling will be continually updated as we learn more about the virus and its behaviour from data that will come from other countries, including in Europe, and from our UK cases.
Secondly, the vast majority of people who are infected with the virus will have mild symptoms, will not require hospital treatment and will be able to return to their normal lives after a week to 10 days. However, some people will experience more severe symptoms, and some of them will become very unwell. From our understanding at this point, those of us who are older or have underlying health conditions will be at greater risk of becoming more unwell than others. We also know that, as the number of cases rises, there will be an impact on people in our working population who will unable to work either because they are unwell or because they are caring for family members who are unwell.
Covid-19 is a new virus to which we currently have no immunity and for which there is currently no vaccine, which means that it has the potential to spread extensively. The approach that we must take has four elements. The first is the phase in which we contain, which will consist of detecting early cases, following up close contacts and preventing the disease from taking hold for as long as possible.
The second element is delay, the aim of which will be to slow the spread of the disease so that we can lower its peak and thereby enable our national health service to cope with it better. That is critical, but we need to understand that by slowing spread down and flattening out the peak, we will also prolong the length of time for which we will be managing the disease.
Thirdly, the research element will enable us to better understand the virus and the actions that will be needed to lessen its effect, which in turn will lead to responses including diagnostics, effective antiviral treatments and, ultimately, vaccines.
Fourthly, the mitigation element will involve providing the best possible care for those who are ill by maintaining essential healthcare and other services and taking steps to minimise, where we can, the overall impacts on society, public services and the community.
I will touch briefly on two of those elements. Containment, which is where we are right now, requires the steps that I outlined earlier, but it is also the phase in which the public can help us greatly by actively and consciously using good respiratory care and hand hygiene. The “Catch it, bin it, kill it” message is important—people should use tissues to catch sneezes and coughs and then bin them. Good hand hygiene is also important, not only after using the toilet but before preparing food. Hands should be washed regularly throughout the day, especially if people are in physical contact with others or with surfaces that others use. That matters and will help a great deal.
If we see that the disease is taking hold, we will look to slow the spread of the virus as far as we can, and to flatten the peak of its impact. That is when we will look at a full range of measures to help us to delay its spread, including potentially extraordinary social-distancing measures, self-isolation and restrictions on public events. Evidence from elsewhere in the world has shown that such measures can, when they are undertaken in combination, be very effective. It is important to stress that we are not at that stage yet, and that the decisions on when to introduce such measures will be taken on the basis of evidence that tells us about the balance between their effectiveness in slowing the spread and the impact on, for example, the economy.
Members will be aware that today we published the four-nations action plan—“Coronavirus: action plan. A guide to what you can expect across the UK”—which is a product of the joint work that is going on across the UK. In addition to the approach that is set out in the plan, we have been working closely with the UK Government and the other devolved Governments to develop emergency legislation that it is intended will be laid at Westminster this month.
The emergency legislation will contain a number of additional powers that would not be considered if not for the extreme seriousness of the challenge that we now face. The emergency legislation will, for example, allow the temporary lifting of some requirements of registration in order to allow former NHS staff to return to work, should they be needed and should they wish to do so. It will enable enhancement and deployment of staff to health and care settings, and it will enable easing of some legislative and regulatory requirements to allow, for example, ministers to direct school closures, should that be needed.
The bill will also enable us to require mandatory flu vaccinations for health and social care workers if we consider that spread of the virus might continue into next year’s flu season. Given the projections for staff absences and pressure on the NHS, we wish to do all that we can to protect the workforce and patients.
None of those proposals is being made lightly. In taking the new powers, we will carefully consider first whether they need to be used, and then when and how they are to be used. It is important to note that the bill will contain a sunset clause to end the existence of the emergency powers, either after a set period or when the UK’s chief medical officers declare that there is no longer an emergency.
Finally, I will briefly outline some of the important work in the health service that has been under way for some time now. All NHS boards have been asked to review their preparedness planning, using their pandemic flu plans as their bases. From those, they should develop specific Covid-19 plans for primary, secondary and social care settings. There is frequent daily engagement between senior health directorate and clinical officials and boards, and their counterparts elsewhere in the UK.
The Scottish Government resilience room has been activated and its members are meeting regularly to ensure that plans are in place across Government for the areas in which we anticipate that there will be an impact. The First Minister, the chief medical officer and I continue to participate in Cobra meetings to ensure that, as far as is practicable, our responses are aligned across all parts of the UK.
Along with other parts of the UK, Scotland has extensive experience in handling pandemic outbreaks, including the swine flu and severe acute respiratory syndrome—SARS—outbreaks. We have in place established frameworks, and our preparations to date include the establishment of testing laboratories in Glasgow and Edinburgh, and speeding up of identification of confirmed cases, which leads to faster contact tracing and, in turn, limits potential spread of the disease.
As a precautionary measure, general practices have been supplied with face masks to ensure that they have readily available supplies. I have asked NHS National Services Scotland to continue to ensure that the NHS and, where appropriate, social care services continue to receive the supplies that they need.
We have updated the Public Health etc (Scotland) Act 2008 to make the virus a notifiable disease, thereby placing on registered medical practitioners a duty to notify health boards of suspected cases of the disease, and on directors of diagnostic laboratories a duty to notify health boards when cases of the virus are detected.
To support our prevention activity, we have enhanced surveillance through a network of clinicians and laboratories to strengthen early detection of community transmission, which will provide important data on early warning of coronavirus in community and hospital settings, and allow health protection teams to quickly undertake contact tracing in order to limit further the spread of the virus.
Our advice to the public has not changed. However, I re-emphasise the importance of good personal hygiene practices that everyone should use at all times to limit and slow the spread of coronavirus.
It is understandable that people will become more concerned, so we will continue to provide reassuring, consistent and clear advice. Up-to-date and accurate information to inform our work and decisions, and to inform the public, is vital. Our approach is to have the maximum possible accurate information and transparency.
Health Protection Scotland has issued a suite of guidance to health professionals and others on detection and early management of coronavirus cases, which has been communicated to all boards by the chief medical officer. The guidance includes sector-specific guidance to a wide range of bodies, including schools, colleges, universities and the oil and gas sector.
There is understandable concern among people in Scotland about the presence and impact of the virus, but although we rightly operate to worse-case scenarios, there are important points to make to put that in context. We expect more cases, but for the majority of those who are affected, the symptoms and impact will be mild. Our contain, delay, research and mitigate approach is the right one to take. The public have a critical role to play in helping us by following the straightforward personal hygiene messages. If anyone has travelled to affected areas and developed symptoms of coronavirus, they should go home and phone to seek medical advice from their general practitioner or NHS 24’s out-of-hours service. The public should use the website nhsinform.scot for advice and continuously updated guidance, and NHS 24 has set up a free helpline.
This is a serious situation that we are taking very seriously. We are monitoring it very closely here and across the world, alongside the other UK Administrations, the World Health Organization and our international partners. We are using all the expertise that is available to us, and the experience of our NHS in Scotland. We are planning and preparing, letting the science and the clinical advice guide us, and doing all that we can to ensure that our response is proportionate and effective.
We will continue to keep the public and members of the Scottish Parliament fully informed as the situation develops.