Analysis: Is Covid over in Scotland? Will we ever be forced into lockdown again?

Is Covid finally over? Or will the threat always be hanging over our heads? The Scotsman’s health correspondent Joseph Anderson investigates...

It has been just a year since the Scottish Government removed the requirement to wear facemasks – the last vestige of the coronavirus-era restrictions – but are we really living in the post-covid era? Is Covid over?

It depends largely on the metric you use to measure the historical impact, and the present day repercussions. Deaths may be far, far lower than they were – thanks to the vaccine – but life has changed dramatically since the start of the pandemic.

A large proportion of people now work from home, the economy is yet to recover, and the NHS is still crippled. The Scottish Parliament estimates that 187,000 Scots have self-reported “long Covid” symptoms, while mental health issues – largely ignored during the pandemic – have grown, and the trauma of fear and lockdown has taken its toll on an ageing population.

NHS pressure

Whether Covid is over or not depends largely on the likelihood of a return to pandemic-style restrictions. That in turn depends on how much pressure a new wave of coronavirus could exert on the NHS.

The main rationale behind lockdown was that the NHS could not keep pace with the number of hospitalisations and deaths which would occur without stopping the spread of coronavirus through social distancing.

If the virus had been allowed to spread through the population unimpeded, then the NHS’ lifesaving capabilities would have collapsed, leaving heart attacks, strokes, falls and traumas untreated, and therefore much, much more deadly.

It is therefore conceivable that a vaccine-resistant variant of coronavirus, or an entirely different virus, could force a government re-enact lockdown restrictions in order to protect the NHS.

So what are the main statistics governments will use to assess the risk? Let’s take a look at some of the key measurements, between then and now.

Terrible statistics

The first Covid-19 death in Scotland was reported by NHS Lothian on 13 March 2020.

Since then, and as of January of this year, 16,465 have died with a Covid-19 infection. This is largely the same as the number of excess deaths recorded in Scotland over the same period, calculated by the National Records of Scotland (NRS) by comparing mortality rates to a five-year average. Because of this, we can be fairly certain Covid-19 was the main cause of these deaths.

Deaths are still occurring, but the rate at which those deaths are occurring has slowed dramatically.

At the peak of the first wave of the coronavirus pandemic, in early 2020, there were over 650 weekly deaths. The highest weekly death rate from coronavirus this year was 102, in January, during NHS Scotland’s winter crisis. The latest figures show a weekly Covid death rate of just 14.

There have been two distinct waves of deaths, from March 2020 to October of that year, then from October until June 2021. Plotted on a graph, they look like two giant spikes – the first wave peaking at above 650 deaths a week, and the second peaking at around 450 deaths a week, before returning to a low base rate for each summer.

From June 2021 onwards, there have been much smaller, rounded waves of Covid deaths, each progressively getting smaller as more and more people achieved full vaccination status.

Infections are hard to ascertain now that mass testing has ended – but the Office for National Statistics (ONS) has been carrying out a Covid infection survey of randomly selected households in Scotland since September 2020, which gives us some indication.

It shows us that infections and deaths are not particularly correlated anymore. For example, during the second wave, infections in Scotland peaked around 50,000, while deaths peaked at around 450. However, when infections hit 500,000 in early 2022, during the “Omicron” wave, weekly deaths didn’t reach 200. The decoupling of infections and deaths, which was so prevalent during the first two waves of the pandemic, has now been severed by the vaccine.

Hospitalisations is the metric likely to be of most concern to decision makers, given the pressures on the NHS over the last winter. Curiously, the number of daily hospitalisation across the first, second and Omicron waves of coronavirus peaked around 150. Although the first wave was far deadlier than the second, and the second far deadlier than the Omicron waves.

Worryingly, the first half of 2022 also saw a similar number of daily hospital admissions due to Covid, despite the highly vaccinated population. So although there isn’t a correlation between hospitalisations and deaths, it does appear that a large number of hospitalisations would be caused by another wave of coronavirus.

New variants

A new coronavirus variant has been found to be spreading in Scotland, leading to winter vaccinations being brought forward.

Public Health Scotland (PHS) said variant BA.2.86, also known as Pirola, was identified on August 16 through a PCR test.

Less than a fortnight later on August 29, it was found in wastewater in another NHS board area.

Pirola has already been found in England, Sweden, Canada and America, and is said to be the “most striking variant since Omicron”.

The new variant has prompted the winter vaccination programme in Scotland to be brought forward to September 4 from mid-October, for care home residents, the over-75s and those who are clinically vulnerable.

A report from PHS said: “Scottish wastewater surveillance data provided by BioSS to PHS have identified the presence of BA.2.86 in a different NHS health board.

“Accuracy of the detection of specific variants varies due to the nature of wastewater sequencing data and caution is required when interpreting genomic wastewater analyses.”

The UK Health Security Agency (UKHSA) has held a technical group meeting to assess BA.2.86 “due to a high number of mutations and the unknown effects this may have on transmissibility and severity”.

Covid-19 hospital admissions in England are running at their highest rate for three months, in the latest sign the virus could be becoming more prevalent – though the figures remain well below levels seen earlier this year.

Admissions stood at 3.4 per 100,000 people in the week to August 27, unchanged from the previous seven days and the highest since mid-May, according to the UKHSA.

Rates are highest among people aged 85 and over, at 34.2 per 100,000, and 75 to 84-year-olds, at 17.7.

Is Covid over?

Deaths and infections appear to no longer be correlated, but what is worrying is that hospitalisations can still reach pandemic levels despite the vast vaccination programme undertaken by the Scottish and UK governments.

This week, top medics warned the NHS Scotland is headed for a worse crisis than last winter – when 50 Scots suffered avoidable deaths every week and waiting times stretched out over days.

The Royal College of Emergency Medicine (RCEM) in Scotland has warned that situations in A&Es this winter could be as bad – or worse – than last year, without “urgent and significant intervention”.

During last winter’s NHS crisis, the college warned there was an excess mortality of 50 deaths in Scotland every week, due to the pressure on emergency departments.

Last winter – “the worst winter ever”, according to Nicola Sturgeon – Scotland’s hospitals reached 95 per cent capacity, waiting times for A&E soared and ambulances queued up outside. The severity of the situation led the then First Minister to host weekly, televised press conferences.

According to the RCEM, recent accident and emergency (A&E) figures show Scotland is “heading towards the colder weather with a poorer baseline than a comparable period in 2022”.

Meanwhile, the Royal College of Nursing (RCN) has said recent A&E figures “paint a worrying winter ahead”, with vacancies and bed blocking contributing to fears over a harsh winter for the NHS.

Add to this the potential for mass hospitalisations caused by coronavirus - as well as flu - and suddenly the Scottish Government may consider implementing pandemic-era measures such as face masks, social distancing and lockdown.

Whether Covid is over or not will depend largely on the NHS’ capability to cope with the increased pressures of Covid, which – similar to flu – is becoming seasonal. It will also depend on the political will to re-implement wildly unpopular pandemic-era measures.