Covid-19 reader: 17 December

Asymptomatic testing in Scotland – how well did it do?

Scottish government, evaluation report

Scotland’s asymptomatic testing pathways performed well over eight months from November 2020, identifying more than 7,000 cases that might not otherwise have been detected or would have been detected later after more social interactions had taken place.

A Scottish government evaluation looked at the country’s nine asymptomatic testing routes, which include workplace testing, school testing and home testing, all of which predominantly use lateral flow device (LFD) tests to provide quick results direct to the test user. In total, between 19 November 2020 and 27 June 2021, 6.7 million test results were recorded. Just over 14,700 of these were positive cases, with 72% going on to take a confirmatory laboratory-processed polymerase chain reaction (PCR) test. Four out of five of these were found to be positive.

The study said that this equated to 7,271 positive cases identified by LFD and confirmed by PCR.

As well as detecting these asymptomatic cases, the study reported a number of other positives. People felt reassured by being able to access testing and employers were positive about testing as a means to keep staff and clients safe.

However, a number of barriers limited the programme from having its maximum impact. Individuals don’t always understand the benefits of regular asymptomatic testing and there are ongoing concerns about the accuracy of tests. There is also a tendency only to report positive tests.

There was some confusion about the range of delivery models for asymptomatic testing. The study suggests that ‘the opening up of the universal offer has blurred the boundaries between pathways’, with people using tests from the universal offer but recording them as workplace results on the online portal, making the process seem ‘opaque and confusing’. ‘Simplifying the testing landscape may increase uptake,’ it said.

Better communication was also needed about appropriate use of tests, with some evidence of individuals using LFD tests when they should be accessing PCR tests, such as symptomatic individuals.

Health secretary Humza Yousaf (pictured) said Scotland’s testing strategy was a key part of its approach to controlling the Covid-19 pandemic and minimising transmission. ‘This report shows the importance of regular asymptomatic testing in capturing cases of Covid-19 often before symptoms emerge,’ he said. ‘These would otherwise go undetected or be found much later in the virus progression, once symptoms had developed.’

He added that frequent testing with lateral flow devices was essential and encouraged people to make sure they report the results – whether positive, negative or void. ‘Everyone should do a lateral flow test before mixing with people from other households. That means before going to a pub, to a restaurant, visiting someone’s house, or even going shopping,’ he said.

Immigration and social care workforce shortages?

The Migration Advisory Committee has called for social care workers to be placed on the shortage occupation list to make it easier for employers to recruit from Europe to address increasing vacancies in the sector.

The list was introduced after free movement of people between the UK and the European Union ended in January and includes occupations where employers face shortages of suitable labour. The listed occupations are given some special dispensations when employers are using the new skilled workers immigration route.

For occupations on the list, 20 points are allocated in the points-based eligibility system. Combined with the mandatory criteria of having an acceptable standard of English, an offer from a licensed sponsor and the required skill level, this will deliver the required 70 points needed in total. But the key impact is that inclusion on the list lowers the minimum salary that must be paid by 20% from the £25,600 rate for skilled workers to £20,480.

The social care sector has faced significant workforce shortages. According to the committee’s annual report, the ‘underlying cause of these workforce difficulties is due to the underfunding of the adult social care sector’. These difficulties have been heightened by Brexit and the end of free movement. However, the Covid-19 pandemic is continuing to exacerbate shortages. ‘The gap between the supply and demand for care workers may well worsen in the short-term as a result of burnout from the increased workloads that occurred during the pandemic and the vaccine mandate, both of which may lead to further difficulties in retention,’ the report said.

The committee is clear. Immigration policy will not solve social care workforce problems. But the ending of freedom of movement has had a direct and indirect effect on the sector. The direct effect is the inability to recruit care workers as they are not covered by the skilled worker route. But indirectly, increased competition from other sectors has also seen reduced access to European workers.

It has recommended care workers and home carers are made ‘immediately eligible’ for the health and care worker visa and the occupation is placed on the shortage occupation list. However, this is no panacea – with the cost of immigration route too high for some small- and medium-sized enterprises. Also, the £10.10 per hour for a full-time worker implied by the £20,480 minimum salary rate is significantly higher than the rate at which many care workers are paid.

However, the committee noted that the £10.10 rate is equivalent to the 48^th percentile for the occupation, according to the latest data, and the Scottish government has introduced a minimum rate of £10.02 per hour from this month.

The committee is currently undertaking a full review of the impact of ending freedom of movement on the adult social care sector and is due to report in April. It has made this early recommendation because it believes the current problems need to be addressed urgently.

Martin Green, chief executive of social care providers’ representative body Care England welcomed the committee’s recommendation. ‘There is an acute workforce shortage in adult social care now so this recommendation cannot be enacted fast enough,’ he said.

Could booster programmes exacerbate vaccine inequity?

World Health Organization, speech

The World Health Organization has called for a focus on primary vaccination doses as many countries across the globe ramp up efforts to deliver boosters to their whole adult populations.

The rapid spread of the Omicron variant of the Covid-19 virus has led to lots of countries, including the UK, accelerating their booster programmes. From this week in the UK, adults under 30 have also been able to book a booster dose, with the aim of offering all adults a booster jab by the end of the year.

At a media briefing this week, WHO director-general Tedros Adhanom Ghebreyesus (pictured) reported that 77 countries had reported cases of Omicron, although the reality is that the variant is now in most countries. However, he said the roll-out of all adult booster programmes was being taken forward ‘even while we lack evidence for the effectiveness of boosters against this variant’. He fears these programmes could lead to further vaccine hoarding and exacerbate inequity.

‘WHO is not against boosters,’ he said, pointing out that they could play an important role in the fight against Covid, especially for those at highest risk of severe disease. ‘We’re against inequity. Our main concern is to save lives, everywhere. It is a question of prioritisation. Who gets what vaccines in what order?’

The order is important, he insisted. ‘Giving boosters to groups at low risk of severe disease or death simply endangers the lives of those at high risk who are still waiting for their primary doses because of supply constraints,’ he said. ‘On the other hand, giving additional doses to people at high risk can save more lives than giving primary doses to those at low risk.’

More lives would be saved overall by making sure health workers, older people and other at-risk groups receive their primary doses. And in most countries, it was still the unvaccinated that are being hospitalised and dying. ‘So, the priority must be to vaccinate the unvaccinated, even in countries with most access to vaccines,’ he said. ‘It is really quite simple, the priority in every country, and globally, must be to protect the least protected, not the most protected.

He highlighted dramatic gaps in the rates of vaccination between countries. ‘Forty-one countries have still not been able to vaccinate 10% of their populations, and 98 countries have not reached 40%,’ he said. And there are also significant inequities between population groups in the same country.

‘If we end inequity, we end the pandemic,’ he said. ‘If we allow inequity to continue, we allow the pandemic to continue.’