Covid Scotland: Nicola Sturgeon announces self-isolation and test rule changes

It comes as surveillance by the Office for National Statistics revealed that an estimated one in 20 people in Scotland were infected in the week to December 31 - the highest prevalence at any point in the pandemic, and up from one in 40 the previous week.

In England, around one in 15 people were believed to be infected.

READ MORE: Housebound mother with terminal organ disease still waiting for booster

Data also shows that the Omicron variant is now making up around 91 per cent of cases in Scotland, based on the prevalence of swabs featuring the S-gene dropout - a genomic marker common to Omicron.

In her first update to MSPs on the Covid situation since the new year, Ms Sturgeon said she expect to see "continued growth in the level of infection" as people return to work and school after he festive break, with "extremely serious implications for the NHS and social care". 

However, she conceded that the current requirements for 10-day self-isolation in Scotland - compared to seven days for the rest of the UK - was compounding pressures on the economy and critical services, which are struggling with increasing rates of staff absence. 

She said: "While the initial advice when someone tests positive will still be to self-isolate for 10 days, there will now be an option to end isolation after seven days as long as you, firstly, have no fever and, secondly, you record two negative lateral flow tests, one no earlier than day six after testing positive and another at least 24 hours later.

"The second change applies to close contacts of positive cases - including household contacts - who are either under the age of 18 years, four months, or who are older than that and fully vaccinated.

"By fully vaccinated, we mean first, second and booster or third doses.

"For close contacts in these categories the requirement to self-isolate will end and be replaced by a requirement to take a lateral flow test every day for seven days. Obviously, if one of these tests is positive, self- isolation will then be required."

Ms Sturgeon said the changes were "significant and not completely without risk", but that measures had to "strike an appropriate balance between the continued  importance of self-isolation in breaking chains of transmission, and reducing the disruption self isolation causes in the economy and critical services".

READ MORE: Omicron 'tsunami' is here - but what is the picture like in hospitals?

The First Minister also confirmed that, from tomorrow, anyone testing positive for Covid on an LFD test will no longer have to book a confirmatory PCR test if they are asymptomatic - but they must self-isolate and report their result online to enable Test and Protect to carry out contact tracing.

Anyone with symptoms of infection should continue to book a PCR. 

"At times of very high levels of infection the risk of a false positive lateral flow result is very low indeed - around just three in 10,000," said Ms Sturgeon.

"So the safest thing to do at this stage is treat a positive lateral flow test as confirmation of COVID.

"This allows us to maximise testing capacity and ensure a speedier start to the process of contact tracing and advice."

Scotland was averaging more than 16,000 cases a day by January 2

It comes amid spiralling case rates which have put pressure on the availability of PCR testing for the general population.

Jillian Evans, head of health intelligence at NHS Grampian, said the rapid spread of the virus meant testing infrastucture is "really, really under pressure", with laboratories struggling with backlogs which are slowing the turnaround times for results.

She said: "I think it probably is a pragmatic decision to start thinking about using lateral flow in perference to PCR and perhaps targeting PCR to where it's most needed - particularly symptomatic cases and people who are working in critical services."

Scottish Labour leader, Anas Sarwar, welcomed the cut to self-isolation, but said key workers were "still reporting waiting days for results despite a pre-existing pledge to prioritise frontline workers". 

He added: "We need urgent clarification on what these proposed changes will mean for those NHS, social care and frontline workers who need access to that testing to relieve pressure on vital frontline public services."

Lateral flows - the rapid home testing kits which detect the presence of the virus from nasal swabs - are highly accurate in detecting whether a person is currently infectious, a period which tends to last around five days on average.

In comparison, PCR tests - where samples are sent off for laboratory analysis - can detect the virus over a longer period of time, including during the incubation period of the virus and for a week or more after a person has recovered.

However, PCR tests are also required to carry out genotyping - a process used to distinguish different strains of the virus.

This has led to concerns that a reduction in PCR testing could lead to new variants being detected early.

Dr Mike Tildesley: "If you get a positive on a lateral flow, it is very very likely that you are positive.

"There is more of an uncertainty around negatives on lateral flow testing. Of course, with PCR tests what happens is that a number of those can get sent away for sequencing and then you get more information regarding the virus itself.

"So that sort of information may potentially be lost. But only a subset of those PCR tests are sent away for sequencing anyway, so hopefully we won't be losing the levels of information we already have in this country that enables us to identify variants as we have been doing throughout the pandemic."

READ MORE: A Year of Vaccines and Variants - How lockdown gave way to 'living with' the virus

The latest data for Scotland shows that more than 113,500 cases have been reported in the past week and there are now 1,223 people in hospital with Covid - up from 679 a week ago.

Data on what proportion of patients are in hospital because of Covid - and how many are 'incidental' Covid patients who tested positive on admission - will be published on Friday, along with information on average inpatient stay. 

It comes amid evidence that while Omicron is more transmissible and more likely to cause reinfections or evade vaccine-induced immunity, fewer patients are becoming seriously ill in the current wave. 

"The evidence that Omicron causes less severe illness than previous variants - at least amongst under 60s, where the virus is most prevalent at the moment - does appear to be strengthening," said Ms Sturgeon.

"Indeed, the fact that the numbers in ICU are so far remaining stable while the numbers in hospital generally rises quite sharply, may be indicative of this."

ICU admissions have doubled from an average of three per day as of December 19 to 6.3 per day by January 4, but remain well below levels seen during earlier waves

There are currently 42 Covid patients in ICU, a figure that has been broadly similar for the past month. 

At the peak of the Delta wave, when there were 1,088 people in hospital with Covid, 82 of them were in ICU.

A study by researchers at Edinburgh and Strathclyde University in December found that hospital admissions for patients with Omicron were 70% lower than what they would expect if it caused equally severe disease as Delta. 

However, cases did not begin rising in Scotland among the over-60s - the group most likely to be hospitalised - until around December 6. 

It is also unclear to what extent Omicron is itself less virulent and how much of this reflects the impact of immunity from prior infection and boosters - which appear to cut the risk of hospitalisation by around 88%. 

Furthermore, given that Omicron is more likely than previous Covid strains to cause reinfections in the previously recovered and to infect the fully vaccinated, this can have the effect of making it appear to cause milder disease - since people with pre-existing immunity are less likely to become seriously ill even if they do become infected. 

Nonetheless, Ms Sturgeon stressed that the sheer scale of infections and hospital admissions is putting the NHS under strain. 

She said: "The NHS is now facing increasing pressure on three fronts.

"First, from dealing with non-Covid backlogs built up over the course of the pandemic.

"Second, many NHS staff are absent and self-isolating because they have COVID, or are close contacts of people with it.

"This means the increasing pressure on the NHS is being managed by a depleted and ever more exhausted workforce.

"And third, as we keep saying, even with a lower rate of hospitalisation, the sheer volume of cases caused by the much greater transmissibility of Omicron will lead to more patients with Covid ending up in hospital.

"And, remember, even if Covid is not the primary reason for someone’s admission to hospital, the fact they have it means enhanced infection control measures are required, which further constrains NHS capacity."

Work is underway to identify earlier those Covid patients likely to benefit from antiviral drugs which, if taken soon after a positive test, can prevent a person's condition from deteriorating so that they can avoid a hospital admission and recover at home instead.

Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said current pressures are "deeply concerning". 

The latest data shows that 5,500 NHS staff were absent with Covid in the week to January 4 - including nearly one in 20 nurses and midwives, the highest figure since May 2020.

He said: “The reality on the ground is that many boards are under enormous strain, as there has been a significant increase in staff absences due to the surge in covid. Staff are isolating with a positive test or due to a contact with someone with a positive test.

“Emergency Departments were overstretched prior to the new variant. But current winter pressures met with widespread staff absences mean staff are put under more and more strain on each shift which affects the quality of care provided and both the patient and staff experience alike.

"For many staff, there hasn’t been a Festive break, and they have had no rest or respite but continue to work tirelessly in Emergency Departments."