Analysis: What will Scotland's Covid strategy look like in future?

The Scottish Government has signalled a shift in its strategy to deal with the Covid-19 pandemic, moving away from trying to eliminate case numbers and towards accepting some cases in the hope they will not overwhelm the health service or lead to high rates of hospitalisation and death.

The change is hinged on the vaccination programme, and gives a new insight into what Scotland can expect in the months to come.

One of the biggest questions around Covid strategy is whether or not to push for eradication, or “Zero Covid”.

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Countries including New Zealand have had success with this. Much was made of Scotland’s approach over the summer, with very few cases in the lull between the first and second waves.

Queues outside the vaccination centre at Glasgow's Hydro. Picture: John Devlin

However, there are problems with Zero Covid, and it’s very difficult to achieve.

The alternative is learning to cope with the virus, as with other illnesses. This has not been possible in Scotland before as high case numbers threatened to completely overwhelm the health service, as happened in India.

But if vaccines can reduce hospitalisations and deaths – which evidence now suggests they do – then the disease becomes much more manageable.

Professor James Chalmers, an expert in respiratory research at Dundee University, has noticed a “definite change in language” from the Scottish Government recently.

“It seems to be a move by the Scottish Government more in line with the views that have been quite consistent from the UK Government, from Chris Whitty and Patrick Vallance, about learning to live with the virus in a post-vaccine situation,” he said.

Prof Chalmers points to Israel as an example for Scotland.

With the world’s fastest vaccination programme per population, Israel is “about two and a half months” ahead of Scotland. It has managed to suppress Covid cases with vaccination, but preventative measures, like face coverings, are still in place.

“They have gone really, really cautiously, relaxing restrictions very carefully as the data allows, and that's what I would suggest that the [Scottish] government does from here,” said Prof Chalmers.

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“That means a regional approach, and it means driving the decisions based on the data rather than a really strict roadmap.”

In a few months’ time most adults will have had two doses, and Prof Chalmers believes more restrictions can be eased then. Until then he would advocate continued restrictions, as were announced this week.

Dr David McAllister, a senior lecturer in Public Health at Glasgow University, hopes the Scottish Government will take a more “balanced” approach in future, weighing up the benefits of specific restrictions, including lockdowns or measures like face masks in schools, against the harms they cause.

He added that the summer is a good time to relax restrictions, as Covid is a seasonal virus.

Since March 2020 it has been routinely compared to flu – in some cases by those wishing to downplay its seriousness.

“Covid is like nothing we've seen before, and it doesn't really compare to anything that we’ve seen before,” said Prof Chalmers.

While it is a “good frame of reference”, as a respiratory virus for which people may need vaccines every year, it is “much more serious” than flu in terms of deaths, hospitalisations and long-term effects.

The only possible route forward for Scotland is to consider Covid on a similar basis to other respiratory viruses, said Dr McAllister, as eradication is not realistic, and people cannot live under restrictions forever.

People are right to be optimistic about Scotland’s future in the pandemic, he said, so long as they do not expect Covid to disappear.

“It's not optimism that Covid can be eradicated or eliminated, it’s optimism that it can become just like other serious respiratory infections that can make people very ill - and when it when it does so it’s a tragedy, but that it's no longer a state of crisis,” he said.

“All the time societies and governments are weighing up the dangers of particular diseases, against measures that you take in society to try and prevent those - when you use seatbelts, when you tax cigarettes for example, you’re weighing that up.”

“That's not really been the case for Covid, it’s been a case of stopping it at any cost. And what vaccines do is they move it towards joining the long list of other threats to people's health which need to be managed in any kind of free society.”

Scotland is not yet out of the woods. Prof Chalmers pointed to SAGE modelling showing that in the worst case scenario up to 100,000 people in the UK could be hospitalised in the next year if all restrictions were relaxed immediately.

“There's quite there's still quite a bit of uncertainty in the science about how much you can allow transmission to happen before you see at least a small third wave, with an increase in hospitalisation and death,” he added.

“Whatever the government does at this stage is going to be a calculated risk.”

Cases have risen in Scotland in recent days, with the highest daily total since March reported on Wednesday, at 677.

In the mindset of a shift away from case numbers, the key measure will be whether these translate into increased hospitalisations and deaths in the coming weeks.

The vaccination programme has not progressed enough enough to allow a full change in decision making, with less than half of adults given two doses. This means Scotland is likely to see continued restrictions for some weeks to come, but there appears to be hope that after that, harsh lockdowns may be gone forever.

The next challenge will be vaccines for the rest of the world. Vaccine inequality is becoming increasingly stark, and until coverage is worldwide, the risk of new variants developing, and spreading to Scotland without harsh travel restrictions, will remain.

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