Virus simulation exercise exposed 'clear gap' in Scotland's preparedness for outbreak

An exercise simulating a virus outbreak in Scotland exposed a “clear gap” in the country’s preparedness and outlined frontline unease at the lack of clarity on PPE availability, training and testing.

Held in March 2018, the exercise involved an outbreak of the Middle East respiratory syndrome coronavirus (Mers-CoV) – a rare but severe illness first identified in 2012 – to assess NHS Scotland’s readiness to respond to a suspected outbreak.

A 15-page report on “Exercise Iris” was disclosed by the Scottish government earlier this week “given understandable interest in activity around preparedness or panic for infectious disease outbreaks” and following a request under freedom of information laws by the BBC.

It was delivered by the Scottish government and involved NHS Scotland boards, NHS 24, Health Protection Scotland and the Scottish Ambulance Service. The exercise outlined three scenarios of an outbreak, including an initial case of the disease and a final simulation where 40 people had tested positive for the virus, including ten in intensive care.

“The number of suspected and confirmed cases continues to increase,” it said. “But there is no more hospital capacity in your Board area and neighbouring boards are already at or close to capacity due to the ongoing outbreak and wider pressures of flu season.”

During a discussion with those involved in the first scenario, it was noted “issues around PPE are not unique to a MERS-CoV outbreak”, adding: “The profile of PPE within the day’s discussion underlined the need for substantive progress on PPE use within Scotland.”

While the simulation found “no great surprises”, it said: “Amongst frontline staff there is unease at the lack of clarity on PPE availability, training and testing.

“This is a clear gap in Scotland’s preparedness for MERS-CoV and other outbreaks and needs to be addressed as soon as possible”.

The report’s conclusions went on: “The exercise identified 14 actions across a broad range of themes. Despite the breadth of discussion, there were no great surprises in the issues identified as priorities.

“In the event of a large scale crisis, Boards will appreciate strong, national coordination and clear guidance. Scottish government and Health Protection Scotland should endeavour to ensure that relevant guidance is up to date and communicated effectively and that processes are in place for standing up and accessing national coordination structures and that these processes are widely agreed and understood.”

The BBC added the findings were shared with the UK government’s expert committee the New and Emerging Respiratory Virus Threats Advisory Group (Nervtag) in June 2019 – six months before the novel coronavirus was first detected in Wuhan, in China’s Hubei province.

A broader exercise simulating the response to a pandemic carried out by the UK government and Public Health England in 2016 was leaked last month.

Codenamed Exercise Cygnus, it stated: “The UK’s preparedness and response, in terms of its plans, policies and capability, is currently not sufficient to cope with the extreme demands of a severe pandemic that will have a nationwide impact across all sectors."

A Scottish government spokesperson said: “As the first minister said at the briefing today we have been working right from the start of this outbreak to make sure we had PPE for those who need it, and at no point have we run out of any item. Since the start of March, over 158 million items of PPE have been delivered to hospitals in Scotland.

“Since the beginning of the outbreak, the Scottish government has worked closely with NHS Scotland to ensure health service capacity, trebling the number of ICU beds and suspending non-urgent elective operations, while vital services continue.

“On contact tracing, we launched NHS Scotland’s Test and Protect system last week with capacity for 15,500 tests and we want anyone who has symptoms to self-isolate and come forward for testing.”