Sottish Parliament: Covid-19 Update - Mar 3

On Sunday, we had confirmation of the first case in Scotland of novel coronavirus covid-19. The patient is from Tayside and has a travel history. Although the patient is clinically well, they are being cared for in hospital in Scotland, as a precautionary measure. I am sure that members will join me in wishing them a full early recovery. I know that colleagues will appreciate that it is important that we respect the patient’s right to confidentiality, and that it is not appropriate for me to comment further on the details of the case. Following confirmation of the diagnosis, contact tracing has been completed by the local health protection team.

covid-19 is a new strain of coronavirus. The virus came to light in December last year. It is thought to have originated in Wuhan city in China and has spread steadily across the world. As of yesterday, there were almost 89,070 cases throughout the world, with the most substantial outbreaks in Europe currently being in northern Italy. The scientific advisory group for emergencies—SAGE—which provides expert advice to the Scottish Government, has updated its reasonable worst-case-scenario planning assumptions for coronavirus. It is important to stress that that does not represent a prediction or a forecast; it is sensible modelling that is based on available data that allows us to plan for the worst case. The current modelling tells us that 80 per cent of the United Kingdom population might become infected, with 4 per cent of that amount requiring hospitalisation, and an estimated 1 per cent fatality rate among those who are infected.

Those are big numbers, so it is important that I put some caveats around them. First, I stress that the modelling will be continually updated as we learn more about the virus and its behaviour from data that will come from other countries, including in Europe, and from our UK cases.

Secondly, the vast majority of people who are infected with the virus will have mild symptoms, will not require hospital treatment and will be able to return to their normal lives after a week to 10 days. However, some people will experience more severe symptoms, and some of them will become very unwell. From our understanding at this point, those of us who are older or have underlying health conditions will be at greater risk of becoming more unwell than others. We also know that, as the number of cases rises, there will be an impact on people in our working population who will unable to work either because they are unwell or because they are caring for family members who are unwell.

covid-19 is a new virus to which we currently have no immunity and for which there is currently no vaccine, which means that it has the potential to spread extensively. The approach that we must take has four elements. The first is the phase in which we contain, which will consist of detecting early cases, following up close contacts and preventing the disease from taking hold for as long as possible.

The second element is delay, the aim of which will be to slow the spread of the disease so that we can lower its peak and thereby enable our national health service to cope with it better. That is critical, but we need to understand that by slowing spread down and flattening out the peak, we will also prolong the length of time for which we will be managing the disease.

Thirdly, the research element will enable us to better understand the virus and the actions that will be needed to lessen its effect, which in turn will lead to responses including diagnostics, effective antiviral treatments and, ultimately, vaccines.

Fourthly, the mitigation element will involve providing the best possible care for those who are ill by maintaining essential healthcare and other services and taking steps to minimise, where we can, the overall impacts on society, public services and the community.

I will touch briefly on two of those elements. Containment, which is where we are right now, requires the steps that I outlined earlier, but it is also the phase in which the public can help us greatly by actively and consciously using good respiratory care and hand hygiene. The “Catch it, bin it, kill it” message is important—people should use tissues to catch sneezes and coughs and then bin them. Good hand hygiene is also important, not only after using the toilet but before preparing food. Hands should be washed regularly throughout the day, especially if people are in physical contact with others or with surfaces that others use. That matters and will help a great deal.

If we see that the disease is taking hold, we will look to slow the spread of the virus as far as we can, and to flatten the peak of its impact. That is when we will look at a full range of measures to help us to delay its spread, including potentially extraordinary social-distancing measures, self-isolation and restrictions on public events. Evidence from elsewhere in the world has shown that such measures can, when they are undertaken in combination, be very effective. It is important to stress that we are not at that stage yet, and that the decisions on when to introduce such measures will be taken on the basis of evidence that tells us about the balance between their effectiveness in slowing the spread and the impact on, for example, the economy.

Members will be aware that today we published the four-nations action plan—“Coronavirus: action plan. A guide to what you can expect across the UK”—which is a product of the joint work that is going on across the UK. In addition to the approach that is set out in the plan, we have been working closely with the UK Government and the other devolved Governments to develop emergency legislation that it is intended will be laid at Westminster this month.

The emergency legislation will contain a number of additional powers that would not be considered if not for the extreme seriousness of the challenge that we now face. The emergency legislation will, for example, allow the temporary lifting of some requirements of registration in order to allow former NHS staff to return to work, should they be needed and should they wish to do so. It will enable enhancement and deployment of staff to health and care settings, and it will enable easing of some legislative and regulatory requirements to allow, for example, ministers to direct school closures, should that be needed.

The bill will also enable us to require mandatory flu vaccinations for health and social care workers if we consider that spread of the virus might continue into next year’s flu season. Given the projections for staff absences and pressure on the NHS, we wish to do all that we can to protect the workforce and patients.

None of those proposals is being made lightly. In taking the new powers, we will carefully consider first whether they need to be used, and then when and how they are to be used. It is important to note that the bill will contain a sunset clause to end the existence of the emergency powers, either after a set period or when the UK’s chief medical officers declare that there is no longer an emergency.

Finally, I will briefly outline some of the important work in the health service that has been under way for some time now. All NHS boards have been asked to review their preparedness planning, using their pandemic flu plans as their bases. From those, they should develop specific covid-19 plans for primary, secondary and social care settings. There is frequent daily engagement between senior health directorate and clinical officials and boards, and their counterparts elsewhere in the UK. 

The Scottish Government resilience room has been activated and its members are meeting regularly to ensure that plans are in place across Government for the areas in which we anticipate that there will be an impact. The First Minister, the chief medical officer and I continue to participate in Cobra meetings to ensure that, as far as is practicable, our responses are aligned across all parts of the UK.

Along with other parts of the UK, Scotland has extensive experience in handling pandemic outbreaks, including the swine flu and severe acute respiratory syndrome—SARS—outbreaks. We have in place established frameworks, and our preparations to date include the establishment of testing laboratories in Glasgow and Edinburgh, and speeding up of identification of confirmed cases, which leads to faster contact tracing and, in turn, limits potential spread of the disease.

As a precautionary measure, general practices have been supplied with face masks to ensure that they have readily available supplies. I have asked NHS National Services Scotland to continue to ensure that the NHS and, where appropriate, social care services continue to receive the supplies that they need.

We have updated the Public Health etc (Scotland) Act 2008 to make the virus a notifiable disease, thereby placing on registered medical practitioners a duty to notify health boards of suspected cases of the disease, and on directors of diagnostic laboratories a duty to notify health boards when cases of the virus are detected.

To support our prevention activity, we have enhanced surveillance through a network of clinicians and laboratories to strengthen early detection of community transmission, which will provide important data on early warning of coronavirus in community and hospital settings, and allow health protection teams to quickly undertake contact tracing in order to limit further the spread of the virus.

Our advice to the public has not changed. However, I re-emphasise the importance of good personal hygiene practices that everyone should use at all times to limit and slow the spread of coronavirus.

It is understandable that people will become more concerned, so we will continue to provide reassuring, consistent and clear advice. Up-to-date and accurate information to inform our work and decisions, and to inform the public, is vital. Our approach is to have the maximum possible accurate information and transparency.

Health Protection Scotland has issued a suite of guidance to health professionals and others on detection and early management of coronavirus cases, which has been communicated to all boards by the chief medical officer. The guidance includes sector-specific guidance to a wide range of bodies, including schools, colleges, universities and the oil and gas sector.

There is understandable concern among people in Scotland about the presence and impact of the virus, but although we rightly operate to worse-case scenarios, there are important points to make to put that in context. We expect more cases, but for the majority of those who are affected, the symptoms and impact will be mild. Our contain, delay, research and mitigate approach is the right one to take. The public have a critical role to play in helping us by following the straightforward personal hygiene messages. If anyone has travelled to affected areas and developed symptoms of coronavirus, they should go home and phone to seek medical advice from their general practitioner or NHS 24’s out-of-hours service. The public should use the website nhsinform.scot for advice and continuously updated guidance, and NHS 24 has set up a free helpline.

This is a serious situation that we are taking very seriously. We are monitoring it very closely here and across the world, alongside the other UK Administrations, the World Health Organization and our international partners. We are using all the expertise that is available to us, and the experience of our NHS in Scotland. We are planning and preparing, letting the science and the clinical advice guide us, and doing all that we can to ensure that our response is proportionate and effective. 

We will continue to keep the public and members of the Scottish Parliament fully informed as the situation develops. 

I thank the cabinet secretary for the advance copy of her statement.

Understandably, many Scots—especially those with respiratory issues and compromised immune systems—are deeply concerned about the potential extreme demands that the coronavirus could place on the NHS and social care services.

Over the past six years, there has been a significant reduction in the number of hospital beds, with the loss of 2,762 acute beds. Given the reasonable worst-case scenario planning that the cabinet secretary and the chief medical officer have outlined, which suggests that a high number of vulnerable patients would require hospitalisation, what planning is taking place for recommissioning NHS beds across the hospital estate in Scotland?

In relation to calling back former NHS staff, what steps are being taken to gather information on where those potential staff members currently reside? Have ministers considered carrying out a publicity campaign to help identify them at an early stage?

Before I answer the member’s questions, I want to highlight the point of the approach to containing and delaying. The point of containing is self-evident; the point of delaying is to spread the peak of the coronavirus.

If we do not delay and things run their normal course, the peak will follow a curve—I cannot find the exact word, but the member can see it from my gesture—which would place significant demand on our health service. If we can delay the process, we will flatten that peak so as to enable the NHS to manage it. That will prolong the time during which we are managing the disease, but it will allow the emergence of additional anti-viral treatments and a potential vaccine further down the line should the scientific research bring one. That is the point of delaying.

As the national clinical director said this morning on the radio, not every case will appear at the one time, nor will they appear in the one place at the one time.

As this scales up, what current business-as-usual NHS work would it be possible to pause in order to create more space? I am meeting COSLA tomorrow, and the chief officers of our integration joint boards are already engaged in this. What more can we do in order to create greater impact on the delays in care for those who are clinically ready to leave hospitals but are not yet leaving? What does that tell us about the additional capacity that we might need. All that work is under way. At this point, it is too early to give any definitive answer, but Miles Briggs has my absolute assurance that, as I have done up until now, I will make sure that he and other party spokespeople on health, and others, are kept fully informed as we undertake our work.

We do not need to call back staff yet. Plans are being worked up for how we might reach out to those members of staff who are retired or have taken a break in their career for personal or family reasons and so on, in order to understand what they would need, if they were willing to come back—such as part-time work, more flexible hours and so on. We also need to build into any return scheme time for people to upskill again, so that they are confident in the clinical environment. All that work is under way to put those plans in place.

I am grateful to the cabinet secretary for advance sight of her statement and I thank her and the chief medical officer for their briefings with Opposition parties to date. Scottish Labour supports the international and UK-wide efforts to contain, delay and mitigate covid-19, and we will continue to work constructively with the Scottish Government to ensure that the public is well-informed and that we are as prepared as we can be for all scenarios. 

I understand that the NHS 24 service has seen a spike in the number of calls. On the basis of modelling and scenario planning, what level of calls does the Scottish Government expect and what resources and contingency measures are in place for that? With regard to the NHS and social care staff, can the cabinet secretary say more about the advice that has been given to staff and about discussions with trade unions? In the event of school closures in parts of the country, or of an impact on social care, what might be in place to advise and support staff who are worried about childcare or other caring responsibilities?

Ms Lennon will know that I have offered a briefing to party spokespeople and party leaders after the statement, should they wish it. Mr Dey’s office has emailed the four nations action plan to all members, so they will all have sight of that. On NHS 24, the most up-to-date figures that I have are for 1 March—I will have yesterday’s figures later. There was an increase of 44 calls to the helpline. There was a significant increase in the number of views of the NHS inform web page. The increase in calls is important, but it is not yet overly significant; however, NHS 24 has a free advice helpline, as well as the 111 number for those who experience symptoms—they would receive a clinical triage through that line.

We have asked NHS 24 to do some scoping work on how it might need to scale up and what would be needed to allow it to do that. That is part of what all our boards are looking at as we speak.

On staff and unions, an initial call was made this morning to all senior figures in Scotland in all unions involved in the NHS. We will undertake conversations with them about what the detail of all the necessary work might mean. NHS Scotland staff policies cover situations where, for example, a member of staff is asked to self-isolate in order to ensure that that does not count for their absence record. There are also NHS policies around carers and caring responsibilities, and so on. We have asked that those policies are double-checked, and we will have a discussion with unions to ensure that they are as good as we need them to be for this particular situation.

I have asked—I hope that it has already happened—that detailed information to all NHS staff be circulated, with a repetition of the guidance and with a commitment that we will continue to keep them informed about what is happening even if they do not work in an area that is actively engaged in the current situation.

On employers in other sectors, I know that, as part of her portfolio responsibilities, my colleague Ms Hyslop is engaging with the business sector and others to ensure that they are planning and thinking about how they will help their employees to help us in the particularly important phases that we need in order to manage the spread of the virus.

I thank the cabinet secretary for advance sight of her statement and for her on-going communication on the issues involved.

The symptoms of covid-19 are similar to those for other respiratory illnesses, which might result in increased contact between patients and GPs in their practices. Can the cabinet secretary confirm how the Scottish Government plans to reassure people who are concerned and ensure that support is available to GPs so that they do not become overloaded? The cabinet secretary has touched on the issue of unpaid carers, but they are very concerned about the impact of their absence, if they have to self-isolate, on the person who they look after. In addition, what consideration has been given to those on zero-hours contracts and in insecure work, who will receive no pay whatsoever if they are absent?

The case definition of the virus is: a cough, fatigue and difficulty in breathing. If people who have those systems have a travel history from the areas currently affected, be that in Europe or elsewhere—again, that information is available on the NHS inform website—using the NHS 111 number will take them through some clinically appropriate questions, then produce bespoke advice about what that individual should do.

As members will know, we have a range of different testing methods across our boards that are designed to prevent the spread of infection, which can be accessed in a designated area in a health board; in the drive-through testing that members might have seen in Lothian, which is also appearing in other parts of the country; or in community testing, whereby the testers will come to an individual.

Those are the symptoms and that is what people with them should do. They are not, strictly speaking, flu symptoms, although they are comparable. The best thing for people to do if they are concerned about their symptoms is to use the NHS inform website or the 111 number to check and get reassurance, or to get advice about additional actions, if they are required.

On the role of GPs, work is under way across the primary care sector with GPs, primary care teams, dentists, community pharmacy and optometry in the community for them to understand and engage in the work that we need them to do in providing advice to individuals, ensuring that they have the supplies that they need for their own staff and others and helping us with the elements, which I described, of containing, delaying and mitigating.

Unpaid carers and those in our community who are more vulnerable, in either health terms or other terms, are a particular concern to us. Where that issue relates to employment, my colleague Ms Hyslop has work under way, as I said. Equally, my colleague Ms Campbell is looking with us at what more we can do for those in our community who are vulnerable, in terms of not only their health but possibly their location.

On the unpaid carers who might be concerned about what happens to the person who they care for if they become unwell, that will be part of the response that I will be discussing in more detail with COSLA tomorrow.

Does the health secretary agree that, if event organisers want to avoid the restriction phase, they must help now with the containment phase? Well over 100,000 people go to the football each week, and stadium toilets often have cold water—or even no water at all—and empty soap dispensers. People go on to shake hands and celebrate with those sitting around them. Does the cabinet secretary agree that, if such events are to continue, as I hope that they can, it is critical that decent washing facilities are in place? Will she contact the Scottish Football Association and Scottish Professional Football League coronavirus response group to ask it to urgently ensure that facilities are up to scratch?

What I agree with Mr Cole-Hamilton on is that everyone—every person in the chamber, every member of our families, every employer organisation and every entertainment venue—has a serious responsibility to help us in the containment phase with the very simple steps that I outlined.

If an entertainment venue, a sports facility or an employer needs to ensure that the facilities are there to allow people to effectively wash their hands, bin tissues and so on, I strongly urge them to do that. I know that our officials from active Scotland are in contact with the various sports bodies. We will take that work forward with them; my colleague Mr FitzPatrick will ensure that that happens, so that we can ensure that people are doing what they need to do right now.

If the disease takes hold in the community and we move into the delay phase, we will be looking at the decisions that Mr Cole-Hamilton hints at, but we will look at them in a proportionate and reasonable way, in order to ensure that we get the balance right between effectively protecting the health of our citizens and minimising, where we can, the impact on society and the wider economy.

I remind the chamber that I am still a registered nurse. [Interruption.] Yes, I am. Can the cabinet secretary again emphasise the impact that members of the public can have on reducing the spread of covid-19 by doing things such as washing their hands frequently, not touching their face and covering their nose and mouth with a tissue when coughing and sneezing? She has already highlighted that, but it is so important.

I think that our marketing campaign has just produced its first result, Mr Briggs. I certainly know where to find Ms Harper.

I simply concur with Ms Harper. We all know that we should do those things, yet every single one of us becomes lazy about it. We might wash our hands—I hope that we do—after we have used the toilet, but we do not always think about doing that before we prepare food and so on. We certainly teach our children to do those things.

We now need to become exemplars of personal respiratory hygiene. The onus is on all of us to do that and to encourage everyone with whom we are in contact, be it family members, friends, colleagues or whomever, to ensure that they all do it. Doing that will not only have a significant impact on the containment of the virus but be an additional boon to public health in general.

I have been contacted by concerned constituents who regularly commute to London by plane or train. What advice is being offered to companies with employees in that situation and to transport operators and transport hubs? How are the Scottish and UK Governments ensuring that that advice is heard?

As I said, we have one case in Scotland and 40 cases in the UK. I should make the point that, of the 40 cases that we have in the UK, 15 patients have now been discharged from treatment. That is an indicator of what I said about how the majority of us will experience mild symptoms. We are in the containment phase at this stage and so it is—by and large—business as usual, while we are taking those important personal precautions in relation to our own respiratory hygiene and health.

Employers will be looking at what plans they need to make should we have to move into the delay phase, which we expect to have to do. As I said in my statement, in the delay phase we will give serious consideration as to whether we need to advise the curtailment of public transport, gatherings and so on. We will balance what the evidence tells us about the positive impact that curtailment will have on the spread of the disease against any impact that it might have on individuals, normal life, the economy and so on. However, we are not yet at that point.

Will the cabinet secretary set out the process of contact tracing for the coronavirus case that was identified in Tayside, which is of great interest across Scotland? Will she also reiterate the very low risk that is posed by the possibility of passing someone who has the virus on the street or in a shop?

I mentioned social distancing in my statement. Generally speaking, the scientific advice is that we are at greater risk of contracting the disease following face-to-face contact within a distance of 2m for up to 15 minutes. The risk comes through the droplets that are expelled if someone sneezes or coughs. As such, it is not particularly circulated in the air around us and we would not contract it if we passed someone in the street or in a shop. We can, however, contract it from surfaces, which is why regular hand washing is important. That is, by and large, what I said earlier about case definition and about how coronavirus is spread. Therefore, as I have said many times already, those simple personal steps are important. 

On contact tracing, an individual who has tested positive is asked to take the local health protection team through everything that they have done. For example, they take the team through their travel history and everything that they have done from the point at which they were in a designated coronavirus area—that is, one of the areas in northern Italy or other places in Europe, or in a country such as Iran, South Korea and, indeed, China. They go through the means by which they travelled and with whom they were in close contact, such as family members or work colleagues—it depends on each individual case. 

All those individuals are then traced, clinically assessed as to their own state of health and—if necessary—tested; close contacts in particular are tested. That is what contact tracing involves and, obviously, the more cases we see, the greater the burden of contact tracing on local health protection teams. As such, that is another area where we are asking people to assess whether additional resource is needed for that work to be undertaken, should the number of cases significantly increase. 

The cabinet secretary will be well aware from World Health Organization statistics that coronavirus is highly infectious and that older people with pre-existing conditions are most at risk. For example, in China, the highest death rates are among those with cardiovascular disease, diabetes and chronic respiratory disease, in that order. How will our most vulnerable citizens be protected?

Vulnerable people will be protected in part by the ways in which we can all protect ourselves, which I have described. Where they have particular concerns because of underlying conditions, their GP or NHS 24 can give them specific additional clinical advice. As we move from the containment phase to the delay phase, depending on the clinical and scientific advice that we receive, we may provide those groups with additional advice and steps that may differ from what is provided to others.

However, we are not at that stage yet, and the evidence that David Stewart has quite rightly referred to—I am not questioning the evidence that is currently guiding us—will be refined as we have more data about how the virus is spreading in other countries and about our UK cases. The modellers will refine that data as they go, and that may point us either to additional conditions that we should pay particular attention to or to a shift in how the virus is impacting as it spreads to other countries.

Further to David Stewart’s question about older people, many of us are essential to the economy, public services, volunteering and caring for others, young and old. Indeed, older people may even be called up as additional resource in the NHS or schools. How will the Scottish Government balance the reasonable message of safety first without scaring older people, who are important both in their own right and because of their significant contribution to society?

I could not agree more that we older people are absolutely vital to our society—in all the ways that Ms Grahame mentioned. In all seriousness, I agree with what she said. It is not our intention to scare anybody. We have been clear about that since we announced the first case and in all the work that has been undertaken by the First Minister, the chief medical officer, the national clinical director and myself. Our job is to be completely honest with people about what we understand to be the position, what the science and the clinical advice lead us to expect as worst-case scenarios, what the caveats are around those and the approach that we are taking and, therefore, what we need the public to do and where they can go for the expert clinical advice that they might seek. That includes older people as well as others. Our intention is absolutely not to scare but to inform and reassure, and to provide people with the information that they need while we get on with planning what we need to do, in the health service and elsewhere, if the disease begins to take hold in Scotland. We are looking to delay it and to manage it against all the factors that I outlined.

Will the cabinet secretary have discussions with health boards about the impending proposal to reduce the number of laundries in hospitals from eight to four? That is obviously of considerable concern, given the coronavirus situation.

Liz Smith has raised a very important point, which is part of what we have asked our health boards to consider. It is not just about the number of beds or staff that they have or board and primary care supply chains, for which we are responsible; it is also about the other facilities, such as estates and laundry. We will pick up that point with the boards, and I will be happy to update her as we make progress on that.

In the light of the announced plans for UK-wide emergency legislation, how is the Scottish Government working with other Administrations to ensure that any such legislation will provide the appropriate and tailored means to tackle coronavirus in every part of the UK, given that there may be different powers in different nations?

Ms Maguire has raised an important question. We are working with the UK Government on the emergency legislation. Its relevant officials are co-operating with ours, and the same is the case for Wales and Northern Ireland. Because it is emergency legislation and because we need to have the option of the additional powers relatively soon, we have taken the view that, even if we might have some of those powers already, we will simply bring the legislative consent motion to this Parliament, in order to take the additional powers.

The key then will be each of the four Governments taking decisions about when and how to use any one of the additional powers. We do not currently have some of the emergency powers although, arguably, we do have some of them. However, emergency powers will ease things for us. The same applies in Northern Ireland, Wales and England.

That is the approach that we are taking. The key issue with the emergency powers is, as much as having them, how and when we take decisions to use them. It will, of course, be for the Parliament to debate and decide on the LCM.

The cabinet secretary mentioned the importance of research and innovation, including diagnostics, antiviral treatments and, ultimately, a vaccine, to reduce the impact of the virus. It is clear that those efforts will all be global ones. Where does Scotland, in particular, have the expertise and the ability to input into finding those outcomes in due course?

Mr Macdonald is absolutely right: they are global efforts, and those efforts are being pursued with urgency, as members might imagine. Scotland is an active player in those global efforts. From memory—I would be happy to provide Mr Macdonald with more detail on this—I know that the University of Edinburgh, for example, is one of the leaders in some of the trials that are under way. Work is going on here to look for what might be the right vaccine, although we are some months away from that and, as people will appreciate, that will not assist us in the current situation. Work is also under way in which existing antiviral medicines and treatments are being looked at to see whether, with any adaptation, they could be effective against coronavirus, although they might have been developed for another particular virus.

As members would expect, given how successful Scotland is in its research work, including clinical work, in all four of our major universities in Aberdeen, Dundee, Edinburgh and Glasgow and in other universities, we are actively engaged in all of that work. Across the UK, an additional £20 million has been contributed to that particular research effort.

How will the Scottish Government ensure that organisers and attendees of large-scale events will be kept informed of any changes to the current coronavirus advice, which might affect such events or lead to their cancellation?

We have stood up SGoRR—the Scottish Government resilience room—and the Scottish Government’s resilience operation, which the First Minister chairs. Obviously, that involves cabinet secretaries across the Government’s portfolios undertaking work in their own areas. My colleague Ms Hyslop is looking at cultural events and organisers, sporting events and other types of events, and she is getting in contact with organisers so that they understand where we currently are on coronavirus. They are picking up some of the points that Mr Cole-Hamilton made about ensuring that there is resourcing for people to wash their hands properly, for example. Contact is being maintained with them so that they are alongside us as we go actively through the containment phase and contribute to that containment, and so that they are among the factors that we would play in when we came to look at whether we wanted to place any restrictions on large-scale events. I stress again that we are not at that stage yet, and we have not made those decisions. A number of factors would need to come into play before we did that.

It is clear that nurseries, schools, colleges and universities are environments of concern in which close contact poses risks of localised outbreaks. What clear advice is the Government giving to parents, teachers and those who are in charge of those environments so that there is absolutely no doubt about what they are able to do freely of their own accord and what they might be required to do if instructed to do so by the Government or authorities?

Health Protection Scotland has issued detailed advice on health measures and steps and the nature of the virus through the relevant networks. Universities Scotland, Colleges Scotland and local authorities are among our key partners in the resilience effort. There is advice for people about much of what we have discussed in the chamber today.

Mr Greene may not yet have had the opportunity to read the four nation action plan, which indicates that the groups that are most at risk, as Ms Grahame said, are elderly people and people with underlying health conditions. However, at this point, it appears that children are not particularly vulnerable, and neither are pregnant woman. 

As I said, all of that is being led by the science, and that advice has gone out. As matters develop, further detailed advice will continue to go out in much the same way, and I will continue to keep members updated on developments.

I would like further detail about what containment means. For example, would the Government not consider being more proactive by recommending against large gatherings before the virus spreads further, instead of waiting until it does and then simply delaying its spread as the cabinet secretary described in her statement?

Should the Scottish rugby fans who were at last week’s six nations rugby match in Rome and who were mixing with Italian fans from northern Italy before the lockdown in that area be afforded a test as a precaution?

Will the Government disaggregate the data on coronavirus by sex, so that we can see whether there is a difference in infection and mortality rates between men and woman and, if there is, what biological and social factors might cause that difference?

I was hoping for a quick question and answer.

The disaggregation of the data would initially be done by us as part of the UK effort. At the moment, the primary focus for the scientists and those who are modelling on the basis of the science is to help us to understand the virus, its nature and its spread as much as we can. We will certainly feed in that ask.

Rugby fans who were at the game in Italy are receiving the same advice as has been given to others. If they feel as though they are experiencing the symptoms that I have described, they should get in touch either with their GP practice or with NHS 24 by telephone.

Elaine Smith asked why we are not advising against large gatherings now as opposed to keeping that proposal under consideration for later. All the evidence tells us that to do that when only one case of the virus has been confirmed in Scotland, and before we reach a point at which we understand that containment is not working and that the disease has taken hold in the community, would make the restriction on large gatherings less effective than if we advised against them in the delay stage.

A lot of what I have set out is not exclusively what I, as the health secretary, think is the right thing to do; it is led by the science and clinical advice. That is why it is a four nation UK plan. The work that I have set out and that the Scottish Government is undertaking, as well as the approach in terms of those four elements, is shared right across the UK and is based on scientific and clinical advice.

The cabinet secretary will know that my region welcomes tourists on cruise ships from across the world. If cases of the virus are reported on board, as they have been in other places, what additional support can be provided to those often small NHS boards? Are there any plans to move any vessels with cases on board to areas where increased medical support can be provided?

On the second question, that will be part of the consideration. My colleague Michael Matheson and others will be looking at that as part of their resilience planning should that happen; obviously, it has not happened yet. The provision of additional support from one health board to another is standard across our NHS, and that practice would simply be part of the existing resilience plans. We would expect health boards to be doing that, and they do. 

There is guidance for ports in respect of our devolved powers, and there is also guidance from the UK Government for all ports, given the reserved powers that it holds.