THE announcement on July 13 of relaxations of Covid controls with minor modifications in Scotland may prove “unlucky”, not just for the few but the many. The Scottish Government is undoubtedly taking a more cautious and gradual approach than England but that may not be sufficient. It is too reliant on the reduction in Covid hospital admissions as the main trigger for moving to level 0. The Scottish Government policies have clearly shifted away from suppressing the virus to the lowest levels possible before loosening controls as the best way of protecting public health and the conomy.

In the context of Scotland’s poorer Covid performance when measured against a number of countries of similar or larger size, much still remains to be done on basic things such as vaccination rates, test and trace, ventilation, long Covid prevention, securing borders and self-isolation.

The Scottish Government’s Covid policies now look neither cautious enough nor gradual enough when set against a whole series of benchmarks and unanswered questions. Here’s why we still have problems.

The Big Picture

AS of July 13, Scotland had just under two-thirds of the population over 18 double vaccinated. So more than three in 10 have not got that protection. Vaccinations not only protect those vaccinated but also help to ensure new variants of Covid do not emerge. We have therefore not yet suppressed the virus sufficiently in Scotland by vaccination. Scotland’s seven-day positivity rate yesterday was just under 10% – that is double the figure recommended by WHO for getting back to normal. The seven-day positive Covid case rate is 343 per 100,00 and several parts of Scotland have rates over 400 per 100,000 including Angus, East Lothian, East Renfrewshire, Inverclyde and Glasgow. It is worth noting that in much of February 2021, Scotland had a positivity rate of just over 5% and a case rate of just over 100 per 100,000 and there was no suggestion then that we should move to level 0.

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Three out of 10 double vaccinated adults may still get Covid and just under one in 10 double vaccinated adults may get seriously ill. So vaccination gives a great deal of protection but other public health measures are needed to control the virus and should not be watered down at this time.

In addition, vaccination of under 18s looks neglected and delayed in Scotland. In the US in May 2021, Government advisers considered Covid vaccination for over 12s to be safe, as did Pfizer. In Scotland, the Government waits for the UK Joint Committee on Vaccinations and Immunisation to decide what to do although it is not legally required to do so. This means that for older teenagers under 18 who will be out in workplaces and socialising, there is no vaccine protection. The Scottish Government seems to consider that if over 40s are vaccinated by August, then everything will be all right. Evidence indicates otherwise.

Additional assessments this week have indicated that between 10% to 20% of asymptomatic as well as mild and severe cases of Covid will result in long Covid. So when we look at the currently high numbers of positivity cases across Scotland, a significant number of cases of long Covid are emerging and will continue to do so.

This will stretch NHS medical, nursing and rehabilitation services in the middle and long term but long Covid remains a relatively neglected Scottish priority.

Acute hospital admissions are of course an important factor to consider but they are just one element in risk calculations. Scotland neglected Covid in care homes early in the pandemic and there is a danger we may now do the same with long Covid.

Level 0 changes are confused and confusing

MANY people will be confused today and believe level 0 is the point where we have suppressed the virus but we have not. The First Minister acknowledges cases are still high, and much higher than in February 2021 which indicates dates not data have driven the latest Scottish Government decisions. So there’s mixed messaging at the outset of information.

The modification of closing hospitality at midnight looks a marginal measure and is highly unlikely to increase public health protection. Aerosol risks look to being downplayed with various and confusing reductions indoors and outdoors to the two-metre rule to add to other confusing numbers. “Asking” employers to let employees work at home if possible again does not indicate clear guidance. Nor have the details of risk assessment and risk management plans emerged for employees working in places where controls have been relaxed.

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What “advising” against non-essential overseas travel means in practice and how it will work has yet to be established and the elephant in the room remains with regard to the effect of the UK Government’s “let rip” policy on Covid outbreaks in Scotland through travel.

Issues around self-isolation do not appear to have been thought through or at least communicated effectively and the position of those shielding looks to have been diminished significantly by the premature move to level 0.

What should we be doing?

WITH the abandonment of several parts of the Covid suppression policy, the Scottish Government measures look risky. We need to continue to rely on high vaccination rates, effective test and trace, control of variants, improving ventilation and workplace controls and risk management, supporting vulnerable populations including workers and those shielding. Controlling movements between those countries and places, international and national, with high Covid rates, as well as masks and social distancing will be critical. These approaches have been consistently provided by zero-Covid-tolerance, Zero-Covid-Scotland policies. The Scottish Government should re-adopt them to get back to public health and economic ‘normality’ successfully.

Professor Andrew Watterson is part of the Occupational and Environmental Health Research Group, Public Health and Population Health Research Group at the University of Stirling