This blog aims to provide new Members with general information on COVID-19. It covers information on key terms and bodies as well as information on testing and vaccination.
SPICe has produced many detailed briefings and blogs on COVID-19 covering subjects such as testing, vaccinations and new variants. You can also listen to our podcast on COVID-19: The Road to Recovery. You can listen to our podcast on COVID-19 recovery and health harms.
Legislation
What legislation is being used to help stop the spread of COVID-19?
The Scottish Government has used emergency powers to put in place measures to help control the spread of COVID-19. The powers come from three main sources:
- The UK Coronavirus Act 2020.
- The two Scottish Coronavirus Acts – the Coronavirus (Scotland) Act and the Coronavirus (Scotland) (No 2) Act.
- A wide range of other Acts, including the Public Health etc (Scotland) Act 2008.
You can read more about these in the blog COVID-19 emergency powers: a short explainer.
When does this legislation expire?
- The UK Coronavirus Act 2020
Section 89 of the UK Act sets up a “sunset provision”, meaning the Act expires two years after the day it was passed, on 25 March 2022, though this is subject to some exceptions which are set out in the legislation.
Both the Scottish Acts were originally due to expire on 30 September 2020 but were extended to 30 September 2021, by regulation. However, under the terms of the two Acts, this was the Scottish Government’s last opportunity to extend the regulations and if the measures in these Acts are still needed, new primary legislation will need to be passed by the Parliament.
Characteristics of the virus
Each of these terms are often used interchangeably but they are actually quite distinct. Coronaviruses are a family of viruses that range from the common cold to MERS (Middle East Respiratory Syndrome) and SARS (Severe Acute Respiratory Syndrome).
SARS-CoV-2 stands for Severe Acute Respiratory Syndrome Coronavirus 2 and is a new type of coronavirus. It is this specific virus which causes COVID-19, the name given to the resulting disease.
How transmissible is SARS-CoV-2?
The transmissibility of a virus is measured by the reproduction number, R. This measures the average number of new infections generated by each infected person. When R is greater than 1, an outbreak is self-sustaining unless control measures are introduced to slow or stop transmission. When R is less than 1, the number of new cases decreases and eventually the outbreak will stop.
Some variants of the virus are more transmissible than others and can influence the R number.
The Scottish Government regularly publishes reports on modelling the COVID-19 epidemic.
What are variants of SARS-CoV-2?
The SARS-CoV-2 virus that causes COVID-19 carries its genetic information (genome) in the form of a single strand of ribonucleic acid (RNA) containing around 30,000 letters of genetic code. The process by which viruses replicate their genetic material is prone to errors, leading to mutations in the genetic code.
Most mutations are harmful to the virus and will not persist in the viral population. However, any mutation that provides a benefit to the virus may allow the new variant to out-compete other forms of the virus.
How are variants being monitored?
The UK has a comprehensive system for monitoring mutations in the virus. This is done through genomic sequencing of a proportion of all positive cases by COVID-19 Genomics UK (COG-UK).
A variant will be classed as a ‘variant under investigation’ (VUI) if it is thought to differ in terms of:
- its transmissibility
- the severity of the disease it causes
- its ability to evade immunity or testing
- its responsiveness to treatment.
If classified as a VUI it will undergo a risk assessment and if it is found to demonstrate any of the above characteristics it will be classed as a ‘variant of concern’ (VOC).
What variants are in circulation in Scotland?
A number of new variants of the virus have been detected in many countries around the world, including the UK, South Africa, Brazil and India. Some of these variants have been found to be more transmissible than earlier forms of the virus.
Public Health England publishes information on current variants of concern and those under investigation. This includes information on the number of confirmed cases, broken down by country.
You can read more in our blog Variants of SARS-CoV-2 and in the Parliamentary Office of Science and Technology (POST) blog SARS-CoV-2 virus variants.
How much COVID-19 is there in Scotland?
Public Health Scotland publishes daily information on the number of reported COVID-19 cases, and rate per 100,000 population, in Scotland and by Health Board area. We also publish a blog on the “latest data” covering the number of COVID-19 positive tests, deaths and hospital admissions.
What is long COVID?
Long COVID is a syndrome associated with COVID-19 infection that can persist for 12 weeks or more. The signs and symptoms of long COVID are variable and wide ranging and can include breathlessness, chest pain, fever, headache, nausea, symptoms of depression and anxiety, dizziness, skin rashes, among other symptoms. You can read more in our blog.
A recent estimate of prevalence by the Office for National Statistics, found 87,000 people in Scotland reporting symptoms of long COVID.
Public Health Scotland and the University of Glasgow are undertaking a study into the long-term health effects of COVID-19 infection. All adults who have had a positive test will be invited to take part in the study over two years. It hopes to gain a better understanding of the scale and nature of long COVID.
Key Organisations and Groups
What is SAGE?
The Scientific Advisory Group for Emergencies (SAGE) provides scientific and technical advice to support government decision makers during emergencies. The UK Government publishes the latest available evidence provided to SAGE. This includes information on current understanding of COVID-19, behavioural and social interventions, behavioural science, self-isolation and household isolation, mass gatherings and modelling on the virus.
What is the Scottish Government’s COVID-19 advisory group?
A COVID-19 Advisory Group has been set up by the Scottish Government to provide scientific analysis of the impact of COVID-19 in Scotland. The Group is chaired by Professor Andrew Morris, Professor of Medicine at the University of Edinburgh and Director of Health Data Research UK.
A number of subgroups have also been established including the Advisory Sub-Group on Public Health Threat Assessment, Advisory Sub-Group on Education and Children’s Issues and the COVID-19 Nosocomial (hospital associated and onset) transmission Review Group.
What is the WHO?
The World Health Organisation (WHO) directs international health and leads global health responses. It has an interactive dashboard which provides information on the global numbers of COVID-19 infection and cases by country on a daily basis.
The WHO has published considerations for implementing public health and social measures in light of COVID-19. Noting that decisions introduce, adapt or lift measures to help stop the spread of COVID-19 should be based primarily on an assessment of the intensity of transmission and the capacity of the health system to respond, but the impact on the general welfare of society and individuals must also be considered.
What is the MHRA?
The Medicines and Healthcare Products Regulatory Agency (MHRA) is the UK’s licensing and regulatory authority for medicines and other health care products. Its functions are reserved to the UK Parliament but it operates on behalf of the four UK countries. The MHRA is primarily concerned with safety and quality assurance and it issues marketing authorisations (also referred to as a ‘licence’) for medicines and medical products, including vaccines.
A marketing authorisation can only be issued following the completion of clinical trials that show:
- the medicine treats the condition it was developed for
- the medicine meets safety and quality standards
- the medicine does not cause unacceptable side effects.
The MHRA is responsible for approving COVID-19 vaccines for use in the UK. Approval for the first COVID-19 vaccination developed by Pfizer/BioNTech was given in December 2020.
What is the JCVI?
Once a vaccine has been authorised for use by the MHRA, it is then considered by the Joint Committee on Vaccinations and Immunisations (JCVI).
The JCVI is a UK advisory committee which makes recommendations to the four UK health departments on the use of vaccines in the NHS. It is an independent Departmental Expert Committee and a statutory body in England and Wales.
Just because a product has a marketing authorisation from the MHRA, does not mean it will automatically be used in the NHS. This is because the MHRA’s role is essentially limited to ensuring a product is safe to use and has the effect the company claims it has.
The wider consideration of the cost-effectiveness of a vaccine and who is likely to benefit from it then falls to the JCVI. As a result, the JCVI is more concerned with determining the broader value and effectiveness of a vaccine and advising on strategies for how it should be deployed. Scottish Ministers are not bound by its advice.
COVID-19 Testing
What types of test are used?
There are two types tests used in Scotland to test if people have COVID-19. These are:
- PCR (Polymerise Chain Reaction) tests. These work by detecting the genetic material of the actual SARS-CoV-2 virus. It usually takes up to 48 hours to get the results. People with COVID-19 symptoms should get a PCR test.
- Lateral flow tests. These are rapid turnaround tests that can be processed without laboratory equipment. They aren’t as accurate as PCR tests and are mainly used in people who don’t have symptoms. People in Scotland can do this type of test twice a week.
More information can be found on the NHS inform website and in the SPICe FAQ blog on COVID-19 testing.
What is antibody testing?
An antibody test looks at whether someone has previously had COVID-19 by detecting a person’s immune response to the SARS-CoV-2 virus. These tests are being used in surveillance and research programmes to find out how many people have had the infection or to study the immune response to infection.
Antibody testing is being used in Scotland for population research and, where appropriate, clinical management of patients. People can request an antibody test but this will be at the discretion of your clinician, and will depend on whether this will affect your treatment or clinical management.
What is Test and Protect?
Test and Protect puts in place the test, trace, isolate, support strategy in Scotland. It aims to prevent the spread of coronavirus by:
- identifying cases of coronavirus through testing
- tracing the people who may have become infected by spending time in close contact with them
- supporting those close contacts to self-isolate, so that if they have the virus they are less likely transmit it to others.
Contact tracing is a process for identifying people who are at risk of coronavirus infection because they‘ve had enough contact with a person who has tested positive. People who have been in close contact with someone who has tested positive for COVID-19 will be asked to self-isolate at home for 10 days.
What is test positivity?
Test positivity is the percentage of COVID-19 PCR tests that are positive. The Scottish Government reports on test positivity including providing information on trends in the data. More information can be found in our blog on the “latest data”.
Test positivity is one of the indicators that the Scottish Government uses to assess which restriction level a local authority is placed in. It is useful because it can provide a more reliable indication of transmission in a community. This is because the number of cases in an area can be very dependent on the level of testing taking place, whereas test positivity gives a more reliable indication of transmission.
Vaccines
What vaccines are licensed for use in the UK?
To date, four vaccines have been approved for use in the UK by the MHRA. These are:
Pfizer/BioNtech were the first to reach the UK market but they were closely followed by Oxford/AstraZeneca and, more recently, Moderna and Janssen. Janssen is the first single dose vaccine to be approved.
How have the vaccines been made available so quickly?
In order to achieve a marketing authorisation (often referred to as a ‘licence’) vaccines must undergo certain processes (see figure below).
Prior to Brexit, the UK usually waited for the authorisation to be granted by the European Medicines Authority but each EU nation also has its own authorising body. In the UK, this is the Medicines and Healthcare Products Regulatory Authority (MHRA).
The authorisation process for COVID-19 vaccines is being fast-tracked globally and many countries have adopted a ‘rolling review’ approach. This means that instead of each part of the process taking place one after the other, the stages are being compressed and overlap, with data being reviewed as it becomes available.
The different stages are shown in the figure below.
The rolling review process has allowed the vaccines to come to market much more quickly than normal, but they have still undergone the usual stages of development.
What vaccines are being used globally?
There are currently 300 vaccines at different stages of development worldwide.
Source: GAVI [accessed 9 June 2021]
The World Health Organisation operates a global vaccine tracker which is updated frequently to reflect progress in the development of each vaccine candidate.
Once a medicine has a marketing authorisation and is being used in patients, it is closely monitored. In the UK, the MHRA is responsible for this monitoring, sometimes referred to as ‘pharmacovigilance’. Ongoing monitoring is important as the marketing authorisation is usually only assessed on the basis of clinical trial data, as opposed to real-world experiences.
UK monitoring happens via the ‘yellow card scheme‘. This scheme allows side effects to be reported to the MHRA and these are considered alongside clinical trial data, data from other international regulators and emerging medical literature.
If a new side effect is identified, the drug is assessed by safety experts and the MHRA can take action such as issuing new guidance for use or, more rarely, withdrawing its marketing authorisation.
Is there a preference for which vaccine(s) should be used?
The JCVI has not recommended a general preference for any particular vaccine. However, each vaccine has different characteristics which may make them more or less suitable for certain people.
For example, the Pfizer/BioNTech vaccine may be given to those at greatest risk of illness and death because of its higher efficacy. However, it is not advised for those with a history of severe allergic reactions.
Similarly, the JCVI has advised that the Oxford/AstraZeneca should not be the first choice in those under 30 due to a slightly higher incidence of rare blood clots in younger adults.
Practical considerations also need to be taken into account. For example, the requirement to store Pfizer/BioNTech at extremely low temperatures can render it an impractical choice for some settings.
How is Scotland obtaining its supply of COVID vaccines?
COVID vaccines are being procured for the four UK nations by the UK Vaccines Taskforce (VTF).
The VTF was set up by the UK Government to drive forward the development and production of a coronavirus vaccine as quickly as possible, bringing together government, academia and industry.
Decisions on all vaccine supply contracts and major investments in manufacturing and clinical opportunities are taken by UK government Ministers. Procurement decisions and contracting are handled by the civil service.
The UK has struck agreements to access eight different vaccines with a total of 457 million doses secured. The number of vaccine doses procured by the UK is shown in figure 3.
Source: https://www.statista.com/statistics/1193154/covid-19-vaccine-doses-ordered-by-the-uk/
The devolved nations’ share is based on population, so for Scotland this equates to approximately 8.2% of the doses secured.
Details of supply are commercially sensitive but once a week the Scottish Government publishes cumulative data on supplies allocated and delivered to Scotland.
Vaccine uptake
At the time of writing, 75.4% of the Scottish adult population had received their first dose of a vaccine, and 50.9% had received both doses.
For up to date data on vaccination roll out then see our blog Vaccinations in Scotland – latest data.
Public Health Scotland also publishes data on the proportion of each key group that has been vaccinated. This is available on its daily dashboard.
Can vaccinated people transmit SARS-CoV-2?
Initial research has found that the vaccine significantly cuts the risk of transmission but may not eliminate it entirely.
This is because the vaccine is not 100% effective and so, for those who subsequently become infected despite being vaccinated, there is still a chance they can infect others. Nevertheless, findings from a Public Health England study, found that those who had been given one dose of the vaccine but went on to be infected, were between 38% and 49% less likely to pass on the virus to others in their household.
Are vaccines effective against the new variants?
How effective vaccines are against new variants is an area under close consideration. Public Health England undertakes analysis of vaccine effectiveness against symptomatic disease using national genomic and immunisation datasets. It has reported that while there is a reduction in vaccine effectiveness against the Delta variant (sometimes known as the “Indian variant” or VOC-21APR-02 (B.1.617.2)) after one dose, any reduction in vaccine effectiveness after two doses of vaccine is likely to be small.
Are there plans for ‘vaccine passports’?
Vaccine passport is a term used to refer to proof of vaccination which may then be required to travel or to access certain services or venues. This has proved to be a contentious topic and the Scottish Government has previously stated that:
“We need to know more about the efficacy of the vaccines, their impact on transmission and the length of immunity before it would be safe to introduce a vaccine certificate.”
However, recently several countries announced their intention to allow travellers with proof of vaccination to enter without the need for a negative PCR test or the need to quarantine.
In response to this, the Scottish Government announced that people will be able to download a ‘vaccination status’ letter from the NHS Inform patient portal. This is intended to ease pressure on GPs having to provide such confirmation. However, the same press release also stated that eventually it will be replaced by ‘digital COVID Status Certificates’.
What is COVAX?
COVAX is an initiative led by Gavi, an organisation which aims to improve access to vaccines in low-income countries. COVAX includes the collaboration of the World Health Organisation and UNICEF and is a financial platform which will enable access to donor-funded doses of COVID-19 vaccines. It is aiming to secure 2 billion doses by the end of 2021.
Protection Levels
In May 2020, the Scottish Government published Coronavirus (COVID-19): framework for decision making – Scotland’s route map through and out of the crisis, which set out a phased approach to lifting COVID-19 restrictions. An updated strategic framework was published in February 2021.
There are five protection levels in Scotland with associated restrictions. The Scottish Government has published guidance on what you can and can’t do at each level and a postcode checker can be used to find out what level an area is in.
We have published a blog on protection levels.
Travel Restrictions and Quarantine
What travel restrictions are in place?
On 11 May 2020, the First Minister announced changes to international travel restrictions. The Scottish Government has published guidance on international travel and managed isolation (quarantine) this explains the traffic light system which is in use.
- Entry from red list countries requires the completion of a passenger location form, a pre arrival COVID-19 test, 10 day isolation in a managed isolation hotel, and two PCR tests taken on day two and day eight.
- Entry from amber list countries requires the completion of a passenger location form, a pre arrival COVID-19 test, self-isolation at home for 10 days and two PCR tests taken on day two and day eight.
- Entry from green list countries require a passenger location form, a pre arrival COVID-19 test and one PCR tests taken within two days of arrival in Scotland.
Public Inquiries
Are there going to be public inquiries into the COVID-19 pandemic?
The UK Government has announced that an independent public inquiry into the handling of the COVID-19 pandemic will be held in Spring 2022.
The SNP manifesto committed to commission a statutory public inquiry into the handling of the COVID-19 pandemic in Scotland.
Lizzy Burgess and Kathleen Robson, Senior Researchers, Health and Social Care