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Your Priorities Platform - Responses to questions submitted by members of the public

Letter from Deputy First Minister and Cabinet Secretary for COVID Recovery, Scottish Government to the Convener on 16 March 2022

Schools and Colleges

1. Has transmission in Scottish schools been underestimated?

In their work relating to education surveillance, Public Health Scotland have been clear that routinely collected data from COVID-19 testing and contact tracing are unable to establish whether COVID-19 transmission has occurred in school settings. This is because these systems were set up to identify cases and trace contacts rather than establishing transmission between contacts and cases at a particular setting. Establishing transmission requires one to first establish an index case and then to establish direct transmission between the index case and contact in a particular setting. The latter is especially challenging in an open system such as a school versus community setting.

Nevertheless, throughout the pandemic, Public Health Scotland relied on routine health data, intelligence from local and national Incident Management Teams, intelligence from education colleagues and national and international evidence for understanding the risk of COVID-19 in schools. For example, the Child Health Systems Programme-School (CHSP-S) database is used to estimate COVID-19 cases in primary and secondary school pupils. These analyses are published routinely on the Education Surveillance Dashboard; however, they are subject to important caveats. Firstly, the CHSP-S dataset is known to underestimate P1 and S1 pupils who may not yet have been added to the system, while overestimating S5 and S6 pupils who may have left school early. Therefore, the number of schools with identified COVID-19 pupil cases should be interpreted with caution. Secondly, these data cannot be used to infer whether transmission took place in schools, as the data cannot tell whether pupils were physically present in schools when testing positive for COVID-19 or during their infectious period.

Despite the above limitations of CHSP-S data, a September 2021 PHS report used these data to estimate the proportion of school pupils who test positive for COVID-19 within 1 to 14 days of being identified as a contact of a fellow pupil case in the same school and school year throughout the 2020-21 school year. To increase the chance that contact tracing took place within a school setting, analysis was limited to index pupils for whom there were more than ten or more school-year pupil contacts recorded in the Contact Management System. Findings of this report showed that in the 2020-21 school year, a small proportion (around 5%) of school-year pupil contacts subsequently tested positive for COVID-19 within 1 to 14 days after exposure to the index case. It is important to note that the data in this report are not able to:

• provide information on infections in school staff as it was not possible to identify school staff in the data
• determine where, for how long, and how close the index case and pupil contacts were in contact
• establish whether transmission took place in school settings or between the index cases and contacts. It is possible that the contacts may have been contacts of other COVID-19 cases not captured in the data. It is also possible that ‘contact’ may have taken place outside school settings, for example at social events such as play dates and after-school clubs.

Although data on transmissions within school settings are not available, throughout the pandemic, in Scotland and elsewhere in the UK, case rates in schools broadly followed that in the community. Although much of the existing evidence pre-date more transmissible variants such as Delta and Omicron as well as availability of COVID-19 vaccination, review-level evidence suggests that, within school associated clusters and outbreaks, adult-to-adult transmission appear to be more common than child-to-adult or adult-to-child.[1] Further, a recent updated international systematic review and meta-analysis, concluded that transmission was markedly more common in household settings (pooled secondary attack rate, 7.6%, 95% CI 3.6 to 15.9) than in school settings (pooled secondary attack rate, 0.7%, 95% CI 0.2 to 2.7).[2] The most recent UKHSA briefing on SARS-CoV-2 variants of concern also suggests that secondary attack rates are higher in household contacts compared with non-household contacts for both the newer Omicron and BA.2 variants (11.4% vs 4.6% respectively for household and non-household contacts of cases with confirmed sequenced Omicron variant, and 14.3% vs 6.1% respectively for household and non-household contacts of cases with confirmed sequenced BA.2 variant).[3]

Public Health Scotland continues to review COVID-19 risk in schools. Some of the newer strains of SARS-CoV-2, for example Omicron and BA.2, have had demonstrable increased risk of transmission but with lower risk of severe illness compared with the wild type. It is important to keep this area of work under continual review.

2. Will the Scottish Government be increasing the level of in-school mitigations to prevent schools further amplifying the spread of COVID-19, including increasing ventilation and using HEPA air filters?

Our current guidance for schools, published on 17 February, already reflects the society-wide process of easing measures within schools.  As part of our next actions to manage COVID-19 and its associated harms effectively, we are currently preparing guidance for more long term routine protection measures. In schools this includes reviewing all mitigations, including face coverings, distancing, ventilation and CO₂ monitoring, to ensure they are proportionate and as effective as possible in schools and other education settings. As has been the case throughout the pandemic, all changes to protection measures will be based upon the advice of the Advisory Sub-Group on Education and Children’s Issues and developed with the COVID-19 Education Recovery Group.

Expert advice from groups including SAGE and the Health and Safety Executive indicates that air cleaning/filtration devices should never be used as a substitute for efforts to improve ventilation. To quote guidance from the Health and Safety Executive on air cleaning/filtration devices: “These units are not a substitute for ventilation. You should prioritise any areas identified as poorly ventilated for improvement in other ways before you think about using an air cleaning device”. Our updated guidance for schools does, however, make clear that air cleaning/filtration devices may be used as a temporary mitigation in exceptional circumstances, while working to achieve a more sustainable solution.

3. How are the Scottish Government spending funds to ensure all schools can improve air circulation to stop the spread of the virus? Improvements don’t appear to be happening quickly enough.

The First Minister announced on 11 January that additional capital funding of up-to-£5 million would be made available to local authorities to support any further urgent remedial work that is needed to ensure good ventilation in schools and ELC settings. This £5 million funding is on top of £10 million of funding for ventilation and CO₂ monitoring in schools and ELC settings, and a previous £90 million for Covid logistics that could be used for purposes including ventilation.

All local authorities have been informed of their potential allocations from the up-to-£5 million fund. Our funding letter makes clear that remedial action should be undertaken in line with guidance on ventilation, with problematic spaces prioritised for action. The Scottish Government has agreed formal reporting requirements regarding the number of remaining problematic spaces with local authorities.  We will provide an update to the Education, Children and Young People Committee in due course, subject to receipt of local authority returns.

4. What lessons have been learned in relation to COVID-19 and buildings in Scotland and does the Scottish Government believe we are doing enough to address the problem of infected air indoors?

The nature of COVID-19 means we all need to consider, on an ongoing basis, how we: use our buildings and spaces indoors, make more use of outdoor spaces, avoid crowding, and manage flows of people. Good ventilation helps reduce the risk of transmission indoors and even simple actions such as opening windows can be effective.

We have strengthened our main Ventilation Guidance in relation to carbon dioxide (CO₂) monitors, air cleaning/purifying devices and the use of poorly ventilated spaces. We have invested £15 million to support this activity in our education settings and schools. Guidance for schools has also been updated including strengthening of the required approach to ventilation and CO₂ monitoring. Updated guidance for further and higher education includes identification of the provision of ventilation in all spaces.

Following our COVID Ventilation Short Life Working Group’s initial recommendations, funding of up to £25 million was identified to help small and medium sized enterprises (SMEs) in the highest‑risk settings make adjustments to ventilation, including the installation of CO₂ monitors and adaptive devices, improvements to natural ventilation and small repairs. The fund went live on 23 November 2021 and pre‑work approvals have been given for CO₂ monitors, air filter/purifiers, small mechanical ventilation and window repairs.

We need to consider how we use protective measures in our buildings and spaces that are designed to keep new infections out and control those already present by limiting transmission. Building infection‑resilience to keep us safe has never been more important. We will use learning from the pandemic to set out how buildings and settings should operate in ways that keep us healthy and safe, and provide us with good air quality and other protections.

5. A number of people have been in touch with the committee about mask wearing in schools and colleges, some are concerned about what may be viewed as an inconsistent approach to mask wearing in education settings, with pupils in a college in Western Isles concerned that in some classes only the teacher wears a mask. Others are questioning why pupils are being told to wear a mask, while some in the adult population are not adhering to rules and guidance on face coverings? Can the government clarify their policy on mask wearing in education settings?

In line with the First Minister’s announcements on 10 and 22 February, guidance for schools, published on 17 February, reflects the society-wide process of easing measures. This means that from 28 February face coverings were no longer required to be worn in classrooms, though individuals should be supported to continue wearing them if they wish.

This guidance reflects the advice of the Advisory Sub-group on Education and Children’s Issues. The Advisory Sub-Group continues to keep all the remaining mitigations under close review to ensure they remain appropriate, proportionate and in line with wider society wherever possible.

Impact on Health and Social Care

6. When will my daughter will be able to get her assessed 5 days a week support at her Resource Centre? (Adult Disability Day Resource Centres were still working at level 3, when the whole of Scotland was at level 0 in October 2021, while ASN schools are open, festivals etc.).

The Scottish Government has overall responsibility for health and social care policy in Scotland and works with the local statutory agencies responsible for commissioning appropriate services to meet local needs. Decisions regarding the re-opening of services must be made at a local level. Services should undertake a risk assessment, bringing in the local authority, Health Protection team and the Care Inspectorate, as required.

Guidance on adult day services remains that services can reopen. This guidance is continually reviewed and updated in line with other regulatory guidance and clinical advice. Supported people attending a building-based day service no longer need to physically distance from each other, though they should continue to follow national guidanceand legal requirements for face coverings as applicable.

If the day service someone would normally attend is not able to offer a suitable option, they may be able to access other forms of support in the interim. For those eligible for social care support, this would include flexible use of your support plan to meet agreed outcomes, moving to a different Self-directed Support Option, accessing care at home services or employing a personal assistant.

Unpaid carers can also contact their local carer centre to find out about local and national short break opportunities.

7. When will acute mental health wards review restrictions? (Meetings with relatives have ceased which has meant key people are removed from discussions, information and planning for discharge; patients are not encouraged to cook or wash their own clothes, these skills and confidence are then impacted upon discharge; the requirements to isolate are beyond measures in other settings and this is causing distress and loneliness.)

Scottish Winter (21/22), Respiratory Infections in Health and Care Settings Infection Prevention and Control (IPC) Addendum was updated on 23 February 2022.

Section 5.12.2 Management of contacts of COVID-19 cases was updated to state that: Self isolation of contacts in the community is dependent on symptomology, vaccine status and LFD testing. Management of contacts in health and care settings generally takes a more cautious approach to account for the volume and type of vulnerable individuals within these settings. Some long term care and mental health facilities where service users are considered physically less vulnerable may undertake an individual risk assessment alongside their local infection prevention and control team (IPCT) or health protection team (HPT) to consider whether 10 days isolation within a single room/ COVID-19 cohort is necessary or whether it is possible to align more closely with management of contacts within the community, e.g. it may be possible for contacts to continue with visits outside of the facility. The risk assessment should take account of the vulnerabilities of other patients in the facility, vaccination status, daily COVID-19 testing, symptom onset vigilance and ability for the individual to adhere with advise provided.

Sight loss and accessibility of COVID-19 measures

8. How is the Scottish Government ensuring the vaccination certificate/passport is accessible for those with sight loss?

NHS Inform provides information on what details are included in your COVID-19 Status Certificate (which you can access through the NHS Scotland Covid Status app or paper certificate). This information can be made available on request in Braille and in other accessible formats, such as audio format, Easy Read, BSL and other languages. An audio file is also available on the Privacy Notice. These products can be found on NHS Inform.

It’s also worth noting that the app has been developed in accordance with accessibility guidelines and is compatible with accessible phone features that assist partially sighted or blind users, including screen readers. These products are currently being updated to reflect the lifting of domestic Covid Status Certification from mandatory to voluntary use, as of 28 February 2022. Updated formats shall be available soon. The available formats continue to provide information on how to obtain your COVID-19 vaccine status or test results.

Equalities Impact Assessments for domestic Covid Status Certification and ongoing stakeholder engagement have identified some accessibility issues in registering for the NHS Covid Status app, solutions to these issues are currently being explored and the paper Certificate is available to all as an alternative.

9. What assessment has been made on the impact of public health measures, such as social distancing and lockdown restrictions, on those with sight loss?

Human rights, children’s rights and equality are embedded in everything we do. To ensure these considerations are central to our response to COVID-19 we carry out a suite of Impact Assessment including an Equality impact Assessment (EQIA). The EQIA is used to analyse the potential impacts for each protected characteristics under the Equality Act 2010 both positive and negative and is key to policy development. Impact assessments are published on the Scottish Government website.

Booster and Flu Jag rollout: impact on people with long term health conditions

10. Why did the Scottish Government and NHS Scotland choose to vaccinate the over 50s with the winter flu jab in 2021 before the under 50s who have a serious underlying health complaint? What is the rationale for a healthy over 50-year-old receiving their flu vaccination before a 22-year-old who suffers with severe asthma and an autoimmune condition? Normally, the latter would have been vaccinated early in to October, nearly November and still no appointment.

Vaccination has always been offered on the basis of clinical priority, with flu and COVID-19 boosters being co-administered where possible in Autumn 2021 to ensure maximum protection was offered to those who needed it most. People aged 70+ were invited for vaccination first, with adults aged 60-69 and those aged 16+ with underlying health conditions receiving vaccination appointment letters from later October 2021. All adults aged 50-59, adult carers, young and unpaid carers and adult household contacts of immunosuppressed individuals were able to book booster appointments online from November 2021.

Flu vaccinations were paused for some groups in December 2021 to allow the NHS to address the immediate challenge of the Omicron variant of COVID-19. Local Health Boards reinstated flu vaccinations to eligible people, including those aged 65+ and those with eligible health conditions, from the end of January 2022. As at week ending 27 February, 2,711,228 people received their flu vaccine as reported to PHS, which is higher than the total number of flu vaccinations delivered in the whole of the 2020 winter season.

11. A number of people have asked why the vaccination programme is not mandatory/compulsory?

Vaccination remains critical in the fight against COVID-19 and while the Scottish Government strongly recommends that people get vaccinated, it is not mandatory and remains a personal choice. Thanks to the dedication of vaccinators and frontline staff in Health Boards across the country, everyone eligible has been offered an appointment and 86.2% of eligible adults have now received a booster.

The Scottish Government does not think mandating vaccination is necessary at this time given the large uptake we’ve seen in Scotland. We will continue to work together and engage with Health Boards across Scotland to further encourage acceptance of the vaccination offer. All our decision making in responding to COVID-19 is guided by the latest scientific evidence from the Scientific Advisory Group for Emergencies (SAGE), advice from Health Protection Scotland and our Chief Medical Officer.

Each employer will need to consider their own specific circumstances and make sure their approach is consistent with their own existing obligations and relevant legislation. Employers can encourage vaccine uptake by supporting dissemination of national campaign information to their employees, individuals retain the right to choose whether to take the vaccine and employers must be mindful of this. Our advice is that employers maintain a voluntary approach and encourage vaccination. Employment law is a reserved matter and the Scottish Government has no direct power to intervene in contractual issues between companies and their employees.

12. Why is it so difficult to obtain a medical exemption to vaccination due to concerns about allergies or family history of clotting?

Billions of vaccinations have been provided globally and there is a great deal of evidence showing that Covid vaccinations are safe. At all times, JCVI advice is followed when administering vaccines and considering exemptions. There are a very small number of people in Scotland who, for medical reasons, are unable to be vaccinated or take a test. Local vaccination centres or the COVID Status Helpline (0808 196 8565) can help to answer questions and advise on what arrangements may be put in place so they can be vaccinated or tested safely. If it is considered that vaccination cannot be administered. The vaccination centre will refer to an immunisation specialist who will assess each case and if appropriate provide an exemption. Further information is available on the NHS Inform website.

13. Is fertility impacted by having the Covid jab(s)?

COVID-19 vaccines available in the UK have been shown to be effective and safe and there icurrently no evidence to suggest that COVID-19 vaccines could affect male or female fertility. Vaccination is the best way to protect against the known risks of COVID-19 in pregnancy for both women and babies, including admission of the woman to intensive care and premature birth of the baby and is strongly recommended.

This approach is strongly supported by the JCVI, Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives. It is best to get both doses, and booster, before the third trimester to ensure maximum protection – the vaccine can be given at any stage during pregnancy. Health Boards and Maternity Services will provide pregnant women and those planning to become pregnant in the future with latest evidence-based advice and guidance, and promote the positive benefits of the vaccine to encourage women to get vaccinated against COVID-19.

Decreasing Restriction Levels and achieving herd immunity

14. A member of the public has asked about removing the need for restrictions and vaccine passports and instead achieve herd immunity? Why is the government not pursuing that strategy instead?

Scottish Government has always and continues to make decisions based on the available scientific and clinical evidence. The policy on restrictions is informed by a wide range of sources including the World Health Organisation (WHO) and Scientific Advisory Group for Emergencies (SAGE), as well as clinical advice and evidence from Public Health Scotland and the Scottish Government COVID-19 Advisory Group.

Herd immunity is the “point at which enough people are immune to infection that transmission begins to slow down.” it depends on how transmissible the virus is and how susceptible the population is to infection. For the Omicron variant, where vaccines and previous infection do not fully protect against infections, and immunity decreases over time, it is unlikely that we will ever reach and maintain the herd immunity threshold for Omicron. In a statement to parliament on 22 February 2022 the First Minister explained that the aim in this phase of the pandemic is now to “to manage COVID-19 effectively, primarily through adaptations and health measures that strengthen our resilience and recovery, as we rebuild for a better future.” This is possible because widespread vaccination coverage and better treatments have reduced the direct harms of the virus. As a result, using restrictions to suppress infection is no longer as necessary as it once was. The First Minister also set out an indicative timescale for remaining legal protections to be lifted (see Living safely with Covid - gov.scot (www.gov.scot)):

• ·vaccine certification will no longer be legally required from Monday 28 February, although the app will remain available to any business that wishes to continue certification on a voluntary basis to reassure customers.
• current legal requirements on the use of face coverings, the collection of customer details for contact tracing purposes, and other requirements for businesses, service providers and places of worship are expected to be lifted on Monday 21 March, subject to the state of the pandemic.

The most likely future scenario for the virus and its associated disease, COVID-19, is one of transition to become endemic, rather than achieving regional elimination. This means that the virus is not expected to disappear but will be always present in a population within a geographic area. Once endemic, it is likely that SARS-CoV-2 will have winter peaks of varying size and circulate alongside influenza and other respiratory viruses. However, it is not known how long the transition to a relatively stable endemic state will take, and how this transition will be in terms of incidence and disease severity.

In the short to medium term, it is likely that the highly transmissible Omicron variant will increase natural immunity in the population that may protect us to a degree and offer a period of relative stability, particularly as we approach spring and summer 2022. However, in the longer term, population immunity will wane and new variants may additionally become more immune evading. It is possible that we will see further waves of infection and some may be severe, especially after population immunity has decreased. Emergence of another variant with the ability to escape immunity is almost certain to trigger a large wave of infection and this may not be seasonal. More information and evidence on the current Scottish government strategy are provided in the following links: Coronavirus ( COVID-19): Scotland's Strategic Framework update - February 2022 - gov.scot (www.gov.scot), Coronavirus ( COVID-19) Scotland's Strategic Framework update – February 2022: evidence paper - gov.scot (www.gov.scot)