WE were supposed to be "all in it together". That was the appeal as the Covid outbreak took off and the public were urged not to panic buy pasta, stockpile medicines, and avoid crowded places.

Yes, coronavirus can affect anyone. But the reality is it mainly affects the old, and has disproportionately killed the poor. Those living in Scotland's most deprived areas have been twice as likely to die from the virus compared to the most well-off.

Multiple factors will be at play: the poor are more likely to be in worse health already with higher rates of obesity, smoking, cancer, cardiovascular and respiratory diseases; they are more likely to live in crowded accommodation; and their jobs are more likely to be ones that cannot be done from home.

Statistics for Scotland have shown that factory and construction workers, drivers, and social care staff have the highest Covid mortality rates by occupation - substantially higher than those in the NHS frontline.

READ MORE: Cancer waiting times target missed for full seven years 

A fascinating report this week provides a snapshot of the challenges poorer Scots have faced, and the pandemic's potential to widen health inequalities even further.

It is based on the first-hand experiences of 12 'Deep End' GPs in Glasgow and Edinburgh - those whose practices are based in our most deprived communities.

One GP recalls their concern that patients referred to the Covid assessment hubs due to possible symptoms "were expected to arrive in their cars, and those who didn't have them were struggling".

It is a simple point which highlights barriers which poorer Scots were much more likely to face in trying to access care.

The GP adds that the problem was "rapidly resolved" as volunteers came forward or NHS staff were re-deployed to provide free transport to these patients, but questions why a similar system cannot be expanded to GP surgeries.

While primary care has pivoted to providing the bulk of consultations remotely via video or telephone, this brings its own obstacles too.

One GP said: "Many of our patients’ smartphones were not up to date; others had no credit on their phones; and some just don’t have phones."

READ MORE: WHO says minimum alcohol pricing 'reduces health inequalities'

Another said that only 30 per cent of their attempted video calls with patients worked "often due to older smart phones that did not have new technology and thus couldn’t be accessed", while one spoke of "giving up" on trying to hold consultations via videolink where a translator was required.

While remote consulting will continue at some level while the threat from Covid-19 remains, the report stresses that "it is important that the new technologies do not introduce new types of exclusion...a counselling contact phone number or mindfulness App is not adequate for many patients with mental health problems".

GPs also spoke of writing sick lines for stress and anxiety for patients forced to continue working in shops, care homes and NHS wards despite suffering from high blood pressure, diabetes or lung conditions.

One GP said they were "truly shocked to hear of NHS managers who expect patients [the GP's patients, not hospital patients] with co-morbidities and in high risk age group to work in Covid wards. I had patients in their 70s still going to work".

Some patients were faced with impossible dilemmas because they neither fell into the shielding category nor furlough.

READ MORE: From care homes crisis to surgery and scanning backlog, 100 days of lockdown will leave lasting legacy

One GP described the case of a woman who worked in a care home but had a young son at home with a chronic respiratory condition.

"She was constantly fearful of carrying the virus between work and home," said the GP. "In several cases the anxiety levels themselves made these people unfit to work – in which case I could give a certificate – but this didn’t fix the underlying issue."

Doctors said they had received "more frequent letters from A&E about domestic abuse incidents" during lockdown, and also worried about a rise in overdose deaths among their patients.

One GP recalled the case of a single mother with a history of trauma who was "struggling to such an extent that she started drinking heavily and her children moved out to stay with other family".

It is one of the ironies of our NHS that those with the greatest need are usually least likely to seek help, even in the good times, because they lack the confidence, pushiness and health literacy of the 'worried well' middle classes.

As the report tragically observes: "The system depends on patients being satisfied, or resigned, with less...patients who are sometimes described as 'hard to reach' are also 'easy to ignore', and are often ignored."

It also notes that the NHS has been buffered by putting large amounts of work on hold, storing up an "impending tsunami" of problems.

"The economic and mental health effects of the pandemic have hardly begun and are likely to fall especially on previously disadvantaged groups.

"As with an impending tsunami, the tide has gone out, and there is a period of calm while the flood wave is expected."