Coronavirus: Scotland's slower lockdown exit has had 'marginal' benefit

The move comes amid a seemingly steady fall in coronavirus rates.

In the week to Friday, there were just two deaths in patients who had tested positive for Covid and 57 new cases detected through hospital labs, drive-thru centres, and - as of July 8 - home-testing kits.

That compares to 134 cases a week as recently as mid-June, when only hospital results were included.

Even the most vulnerable - those who have been shielding - have now been told their risk is low and, if the pattern continues, it should be safe for them to return to work and school in August.

READ MORE: Why scientists think handwashing and physical distancing might be 'insufficient' to protect against coronavirus

Professor Linda Bauld, an expert in public health at Edinburgh University, said elimination - meaning all outbreaks are contained, as opposed to the virus disappearing altogether - is "achievable".

But she cautioned that the increase indoor activity poses a genuine danger. 

"All the international evidence suggests that that is a risk.

"It's not just the things like pubs and restaurants. It's more sharing of indoor space by individuals who don't live together. 

"We're seeing that from other countries in the outbreaks that we've seen recently.

"In South Korea it was linked to bars, restaurants, and casinos; the Melbourne cases were people coming back into the country but not complying with quarantine; in Singapore it was an outbreak in concentrated housing, where you had groups of migrant workers. 

"So it's not just this fear people have of 'we shouldn't be opening the pubs' - it's just more human interaction in general which increases the risk."

Prof Bauld said pockets of Glasgow and Edinburgh with higher rates of deprivation and crowded accommodation were "most likely to be a cause for concern", illustrated by Leicester where the recent spike in cases was traced to an area of the city with tightly-packed terraced housing and multi-generational households. 

Since May, Scotland's lockdown changes have mostly related to an increase activity in lower risk outdoor settings where the virus is dispersed in open air, there are fewer surfaces for droplets to settle on, and ultraviolent light is known to degrade it. 

As a result, we should not be overly reassured that infection levels have continued declining, says Professor Rowland Kao, a mathematical biologist who studies infectious disease dynamics at Edinburgh University.

"The fact that most of the changes have been about outdoor gatherings tells us is that the amount of risk associated with those things is very low," said Prof Kao.

"But of course, if that's true, that will always have been true - and most of the transmission earlier on won't have been because of that. 

"So if you think about the difference in the R number now, which is still under one, and it being probably over three - maybe even four at the peak - that means there's a lot of room for things to get worse as we move indoors.

"We're also going to have increased air travel and traffic between Scotland and England, and all those things will start to bring cases in.

"The key thing, in the absence of a vaccine, is keeping the number of infections low enough so that if you get an outbreak you've got the resources there to get on top of it very quickly. 

"That means having plenty of people to do the contact tracing, more than enough tests available so you can test everybody in a blanket area, and more than enough hospital beds so that the NHS isn't overwhelmed."

READ MORE: Cancer referrals still a third lower than normal in June 

Currently Scotland and Northern Ireland are hovering around one new case per day per million population, compared to 10 in England. 

But Prof Kao is sceptical that Scotland's comparatively slower exit from lockdown is the cause. 

"So much of what would have broken the back of the virus occurred at an early stage, when [the four nations] were doing effectively the same thing," he said.

"The longer term effects of releasing lockdown are going to have relatively marginal effects compared to that. 

"Also, the virus took off in London long before anywhere in Scotland and that's going to make the biggest difference. 

"If lockdown occurs at the same time but you're at an earlier stage in the epidemic, you're definitely going to have an advantage. We can't pat ourselves on the back too much."

Prof Bauld added that population demographics had also helped to stem the epidemic in Scotland. 

"We have Glasgow, Edinburgh and Aberdeen, but they are smaller urban centres than several of the larger English cities, plus we've got much more rural space.

"When you look at the published data on cases per 100,000, there are some regions of England that are very low - it's not like Scotland is the lowest. Northern Ireland is lower than us as well. 

"So we're in a really good position but it's not as if we're top of the rankings so to speak."

READ MORE: Excess deaths paint a grim picture of Scotland's pandemic experience 

Another statistic has appeared to signal the end of the epidemic in recent weeks: the fall in excess deaths. 

From March 9 to June 21, the overall number of deaths in Scotland - from all causes - was 32% higher than the five-year average. An extra 5,135 people lost their lives. 

While many were Covid deaths, 127 were from cancer, 392 from dementia, 173 from heart disease and strokes, and 643 from "other" causes. 

But in the past two weeks - for the first time since March - the number of people dying has dipped back below average, by a total of 60 deaths. 

For 2020 as a whole, Scotland's death toll is running 14% higher than normal and may fall further if a second wave of Covid is avoided and improvements in hygiene - such as increased handwashing - curtail the spread of other potentially fatal respiratory bugs, including influenza.

Australia is already reporting a fraction of the flu cases it normally would in winter. 

The Office for National Statistics - which is reporting similar declines in excess deaths for England and Wales - said last week that coronavirus may also have hastened the deaths of elderly or sick people who, under normal circumstances, would have died later in the year. 

However, public health experts caution that the full impact of the pandemic will probably take years to emerge. 

Professor Allyson Pollock, a Scottish public health doctor and academic based at Newcastle University, said: "I really don't think we're going to have a full picture of the non-Covid deaths for quite some time - maybe even later than the end of the year when you think about delayed diagnoses for cancer. That's going to show up in the coming years with quite a few people.

"There's also a huge backlog in admissions and routine care including physiotherapy and rehabilitation which will be increasing people's disability and affecting quality of life, as well as length of life.

"Then there's the longer term consequences of widening inequality and poverty as a result of the pandemic. 

"So I really don't think we should be painting a picture of 'well, we're evening out' and deaths were just brought forward. 

"If you're in your nineties your last six months of life is very precious."