Government needs to offer clarity on its approach to asymptomatic testing

Scottish Liberal Democrat health spokesperson Alex Cole-Hamilton MSP has today written to the Health Secretary, Jeane Freeman, urging her to publish the scientific advice which informed the government's approach to asymptomatic transmission in care homes and called on her to clarify her comments on the value of testing asymptomatic individuals.

Alex Cole-Hamilton commented: 

"Residents of care homes, and worried family and friends, deserve a clear and comprehensive explanation of the scientific underpinning of the Scottish Government’s decisions on asymptomatic patients being admitted to care homes.

"We knew from the outset of this crisis that older people were extremely vulnerable. Some scientists early in the year were stating that there was asymptomatic transmission.

"It's therefore difficult to understand why we would not have erred on the side of caution and tested everyone to prevent them entering the homes if they were positive.

"Care homes are the epicentre of the virus crisis in Scotland. The public deserves clarity. I urge the Health Secretary to publish the scientific advice on which the assumption that asymptomatic patents would not risk infecting fellow residents was based on." 

The text of the letter to the Health Secretary is as follows:

Dear Jeane

Further to our exchange in Health Committee this morning. I asked you about the international alerts around asymptomatic transmission of Covid-19 which started on the 30th of January in the New England Journal of Medicine. This was around an asymptomatic outbreak in Germany and the reality of asymptomatic transmission was reiterated the next day by Dr Fauci to the White House press corps. There were subsequent, similar alerts throughout February and March.

You suggested there was a dispute in the international community over asymptomatic transmission of Covid-19. I’d be grateful if you could supply me with the scientific publications or studies which suggested that asymptomatic transmission was not possible on which your government based its subsequent policies.

If there were conflicting scientific views, then it is apparent that your advisers latched on to the view that asymptomatic transmission was unlikely, so did not consider it a risk in the context transfer to care homes. I’m nevertheless surprised that your government, which has applied such a precautionary approach to the virus, would pick the far less cautious assumption in a binary scientific debate around asymptomatic transmission.

Secondly, I asked you about your government’s approach to PCR testing of patients who had no symptoms. In those months of high infection- February, March and April, your government policy was to test only those in care homes who exhibited symptoms. I suggested that you had, at the time, justified the position saying it was largely futile to test those who did not seem unwell. You stated in your reply to me in committee and I quote, that:

“In terms of the PCR test for asymptomatic individuals, I don’t believe I have ever said it was of no value.”

Yet on the 26th of May, less than two weeks ago you told MSPs: “During the early part of the pandemic, the advice was that there was no value to testing individuals who do not have symptoms.”

Could you clarify this discrepancy and, if indeed the early advice was that the PCR test had no value in testing asymptomatic patients, could you supply me with the scientific advice, empirical evidence, or publications on which this assumption was based?

You went on to suggest that we now know that while PCR testing was 97% effective in Symptomatic cases, its efficacy is lower in asymptomatic cases- you suggested it was around 80% effective. Can I ask when you learned of this efficacy rate?

There was presumably a great amount of data on test efficacy from the outset of the pandemic and if we knew it was 80% effective- why did we suggest it was of no value in asymptomatic cases? It strikes me that a test that could pick up 80% of asymptomatic cases would have been a vital safeguard in the mass transfer of patients from hospitals to care homes.

Finally can I address a point you made on a number of occasions in committee today. You said that the decision to move patients en-masse to Scottish care homes had cross party support at the time. Can I respectfully remind you that in the foothills of this emergency we bent over backwards to support all government efforts in the crisis, but we were not part of the decision making process. On the transfer of patients from hospital to social care, we were not made aware of: the scale of the transfer; the fact that your advisers had identified a problem with transmission within hospitals that you couldn’t understand; the fact that no asymptomatic patients were being tested prior to arrival in the homes. We were presented with the reality as a fait acompli and without this level of detail (much of which has only come to light in recent days) then there’s no way we could have been expected to challenge it. As such it is unfair to say these actions and decisions had cross party support in the way that you imply.

I’m grateful for your consideration of the questions I’ve raised here and look forward to your reply.

Kind regards


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