Covid 'early warning' system could put a stop to lockdowns

Genetic material from the virus is present in sewage and can help to pinpoint increases in prevalence without relying on people with symptoms seeking tests.

The goal is for proactive and targeted local measures such as door-to-door ‘surge testing’ and intensive contact tracing to bring outbreaks under control quickly, before hospitals come under pressure.

Professor Rowland Kao, chair of veterinary epidemiology and data science at Edinburgh University’s Roslin Institute, said: “A key to this is to understand how the numbers of people being vaccinated may vary geographically, as any local clusters with larger numbers of unprotected individuals could drive local outbreaks.

“In a winter where resources will also be strained by flu and other seasonal infections, controlling those outbreaks, if they occur, could be crucial to avoiding further lockdowns.”

READ MORE: Why UK scientists are worried about the rise of the Indian variant

It comes as Nicola Sturgeon unveiled plans for an accelerated exit from Covid restrictions on Monday that will see many island communities - but not Skye or Arran - fast-tracked into Level One, while larger than expected gatherings will be allowed in private homes for the first time this year.

Instead of a maximum of four people from two households, the First Minister said groups of up to six people from three households could meet in one another’s homes or gardens without physical distancing - meaning that people can once again hug family members and friends.

“I know how desperate we all are for this,” said Ms Sturgeon, adding that she felt “a bit emotional” at the prospect.

Mainland Scotland will move to Level 2 from Monday - with the exception of Moray - while several island communities will move into Level One

Leisure venues such as cinemas, theatres, and bingo halls will also reopen from Monday, with limits on capacity, while hospitality will be allowed to serve alcohol indoors for the first time this year to groups of six people from three households inside, or up to eight from eight households outdoors.

From Monday, Scotland will also adopt the same traffic light approach to overseas travel as England, ranking destinations as green, amber or red.

Ms Sturgeon said the UK Government framework was "appropriately cautious" at this stage, but could not rule out taking a stricter position in future.

Countries on the red list, which currently include Turkey and India among others, will require returning travellers to enter supervised hotel quarantine for 10 days at their own cost, while 10 days of self-isolation at home with two PCR tests will be required for anyone returning from an amber country.

READ MORE: Quarantine-free travel to limited destinations from next week

Only 12 destinations are rated green and many - including Australia, New Zealand and Singapore - have already closed their borders to keep Covid out.

There are just 12 green list destinations but many, such as Australia, are currently closed to tourists anyway

Holidaymakers can fly to Portugal, Gibraltar or Israel without having to quarantine on return as long as they can provide a negative PCR test, but Ms Sturgeon stressed that jetting abroad was not necessarily "desirable" in an ongoing pandemic.

"Everyone should think seriously about whether they need to travel abroad this summer," she said.

"I know that that for many people international travel is about a family connection, but when it comes to holidays abroad my advice continues to be to err on the side of caution and to staycation this summer."

It also remains "highly probable" that Moray will remain under Level Three restrictions from Monday with a travel ban on non-essential movement in and out of the council area in a bid to stop the current outbreak spilling into neighbouring regions.

"There is in the opinion of public health experts widespread community transmission in Moray," said Ms Sturgeon, adding that it would not be "safe or sensible" to ease restrictions there "unless the situation materially improves".

Moray is currently averaging 94 cases per 100,000 people, compared to 23 per 100,000 for Scotland as a whole.

Dr Gregor Smith, Scotland's chief medical officer, said there was no evidence that rarer Covid variants were driving the surge as the relative proportions of cases caused by the dominant B117 'Kent' strain to other variants was "consistent with the rest of Scotland".

He said there are now 18 confirmed and 10 provisional cases in Scotland of the new variant of concern, B1.617.2 - a subset of the 'Indian' variant - but said none of these had been detected in Moray.

Cases of this subtype have been rising rapidly in London and North-West England, with Public Health England warning that it is "at least as transmissible" as the Kent variant - though some experts believe it is outcompeting it and will become the dominant form of Covid by summer.

The proportion of Covid cases caused by the Indian variant 'subtype 2' climbed from 1% to 11% in England in the two weeks to May 1, excluding cases from travellers and surge testing

"It does appear to be transmitting as well as the Kent variant," said Professor Jason Leitch, Scotland's national clinical director.

"What we don't know yet is what it does for disease severity and for vaccines, so that's why we're keeping a very close eye on it."

READ MORE: Warning UK lagging behind EU and G7 countries and will face 'worsening health outcomes' without NHS funding overhaul

As well as uptake, Prof Kao said the early warning system will feed in evidence on how long it takes for vaccine-induced immunity to wane, which he said should be available "fairly soon" for older adults.

A recent Danish study found that natural protection as a result of a prior infection fades to around 50% in over-65s within six months, compared to 87% for younger people.

"Because the rollout started with the elderly people, we won't know about the bulk of the population until later," said Prof Kao. "So we may get a very different picture initially compared to, hopefully, a more positive picture later on.

"We should also get a better idea of, even if people do get infected, do they get severe infection? Because if it's mild, even without an extensive booster campaign, you could still maybe treat it like flu."

Teams from the Universities of Edinburgh and Stirling will also conduct a survey as part of the project to gauge attitudes towards and ease of access to vaccines, and examine how the results relate to the Scottish index of multiple deprivation.

Areas of high deprivation have been disproportionately affected by Covid-19 but previous surveys have indicated that residents are more reluctant to be vaccinated.

The researchers will be able to feed data into so-called ‘vaccination games’ – simulations to see how various scenarios involving differing rates of vaccine uptake in communities play out.

"The thing people have to be aware of is we could have quite a good summer, and still have an issue in the winter that we need to be prepared for," said Prof Kao.

"Hospitals don't care if you're in hospital because of flu or Covid - you're in the hospital and if you're using up beds and ICU space, that's still capacity, so the mix of flu and Covid together - especially when we know very little about what flu is going to do this winter - could potentially cause a problem, and those are the things we want to avoid.

"We want to keep things down to a level where we can just deal with the cases rather than trying to push everyone into something like lockdown."

The project is a partnership between the Universities of Edinburgh, Glasgow and Stirling, Scottish Environment Protection Agency (SEPA), and Scottish Water.

David Pirie, executive director for SEPA said its laboratory at Eurocentral in Lanarkshire is already analysing 200 wastewater samples a week for Covid.

He said: "We’re proud that our science expertise is helping public health partners make key decisions to support community testing.”