A group of public health doctors and epidemiologists from the Royal College of Physicians of Edinburgh (“the College”) have called for better planning in Scotland to safeguard vulnerable groups - such as those in care homes - ahead of the next pandemic or a second wave of coronavirus.

Their call comes as the Cabinet Secretary for Health and Sport, Jeane Freeman MSP, is set to give evidence during a Health and Sport Committee session on Wednesday (17 June) on how prepared Scotland was for COVID-19.

The College responded recently to a Scottish Parliament consultation on COVID-19 resilience and emergency planning, where we said that previous planning did not adequately prepare the country for the coronavirus pandemic - including inadequate protection of frontline workers, particularly healthcare staff.

While the College acknowledged that there was extensive COVID-19 planning from Scottish Government level down, we understand that there was an overreliance on pandemic flu modelling, and on the idea that the population would gain some immunity and then normal life would move on. 

As a result, the resilience and emergency planning included a heavy emphasis on mortuary capacity and numbers of secondary care beds.

Finally, the College believes that a four nation response to tackling future pandemics or a second wave in infections is important in the UK, but political leaders and public health authorities need to be aware of local variation in areas such as in Inverclyde or London.

We have set out 5 key measures, which can help Scotland (and the whole of the UK) prepare better for the next pandemic or a second wave of coronavirus:

  • Personal protective equipment (PPE): the whole world is looking for the same PPE items during a pandemic. This has been proven by the response to the coronavirus pandemic.  The College recommends putting “sleeping” contracts in place for items which would be required to respond to a pandemic, including PPE, pharmaceuticals and resources such as laboratory space and staff.
  • Treatment and testing: there should be a clear strategy for outbreak response which is multidisciplinary and includes public health communicable disease control experts. There needs to be pre-existing capacity to move to rapid treatment and vaccine trials, and to scale up key resources quickly for activities such as testing of key workers and members of the public.
  • Shielding: action should be taken early on to protect or “shield” vulnerable groups, such as those in care homes, those with weakened immune systems, and those in deprived populations where the average life expectancy is shorter than in the least deprived areas. This should include early interventions and accurate information for targeted, shielded groups.
  • Key workers: the protection of healthcare staff (and others on the frontline) must be a key consideration and scenarios must be planned in advance to “map out” how staff can work safely, including PPE, social distancing rules and testing. The College has called for all healthcare workers to be prioritised for COVID-19 testing.
  • Learning from other countries: It is vital that Scotland/the UK learns from other countries and their response – whether good or bad.  There needs to be rapid work on understanding and learning the immediate lessons from the experiences of other healthcare systems. Moving forward, disease surveillance will be important: “horizon scanning for next big outbreak”. This can be done by population symptom tracking using surveillance tools such as the ZOE app, and through NHS and university research partnerships.

Commenting, Dr Susan Pound, vice-president for Scotland and Northern Ireland (Royal College of Physicians of Edinburgh) said:

While we acknowledge that planning was done from government level down, we think that it would have been helpful to have focused more on wider public health and the health and social care system as a whole, rather than concentrating on secondary care and the NHS.

The heavy focus on secondary care and the NHS was a factor in the inadequate response to protecting care home residents and staff.

We are concerned that the MERS and SARS outbreaks were seen in the UK as being largely confined to countries in Asia, resulting in a view that an epidemic originating in Asia would be highly unlikely to ever cause an outbreak in the UK. 

We have seen evidence that nations such as South Korea, Taiwan and Hong Kong learnt from their response to MERS and mounted an effective response to COVID-19, and it is vital that we are in a position to learn from what has and has not been successful, in order to be better prepared in responding to a second wave of the coronavirus, or a future pandemic.

We must have arrangements in place for provision of PPE, treatment and testing capacity, protecting the most vulnerable and key workers, and surveillance monitoring to stay ahead of the curve should new viruses emerge – or re-emerge.

During pandemics, healthcare workers must be protected with the best available PPE, social distancing for respiratory diseases, and quick and effective antigen testing.