WHY don’t we just protect the vulnerable and let the rest of us get on with our lives?
At face value this seems like a logical suggestion given the enormous discrepancy in the risk of death from Covid-19 infection between the healthy young and the frail elderly, obese, or those with underlying conditions.
Right now, thousands of students are effectively locked up in halls of residence, even though there have been no coronavirus deaths in Scotland at all in the 15 to 24 age group.
During the first wave of the pandemic, the rate of Covid hospital admissions among young people aged 15 to 19 in Scotland was just 7.1 per 100,000, compared to 886 per 100,000 for those aged 85 plus.
They are not immune to the virus, but their chance of suffering life-threatening complications is tiny.
READ MORE: How can we persuade young to follow the rules when there risk is so low?
Meanwhile, there are growing fears about the impact of extended restrictions on the economy, with sectors from hospitality to aviation already haemorrhaging jobs even before furlough ends.
Long-term unemployment and loss of income has its own deadly public health consequences.
It is little surprise then, with frustration mounting and a long and increasingly bleak-looking winter ahead of us, that some commentators are floating the idea of a two-tier approach that prioritises those most at risk, while the low-risk majority resume more normality.
On the one hand, it provides a much-needed shot in the arm for an ailing economy, and on the other potentially allows some degree of herd immunity to accrue in the wider population.
The caveat, of course, is that we don’t yet know how long immunity to SARS-CoV-2 lasts and would be gambling on the assumption that even if it wanes, subsequent infections would be less severe.
A second stumbling block is ‘Long Covid’. More evidence is emerging all the time about the long-term consequence of infection.
The first results of Oxford’s COVERSCAN study, reported on Tuesday, provide cause for concern.
Of the 160 ‘recovered’ Covid patients in the trial, half showed evidence of heart, liver, or kidney damage three months on from the infection - even among those never hospitalised.
Many, especially men, showed subnormal heart pumping function and 13 per cent had liver inflammation.
The median age of participants is just 43.
READ MORE: Shielders who received free food parcels 'more likely to go out for groceries'
Another side effect is debilitating fatigue, brain fog, muscle pain, and breathlessness.
An Irish study earlier this month found these problems were equally likely to occur in both hospitalised and non-hospitalised Covid patients, although rates were higher in females and individuals with a pre-exiting diagnosis of depression or anxiety.
Some patients, including a 36-year-old woman who was a fitness fanatic pre-Covid described how she is now a “disabled, housebound, isolated woman” who is usually too exhausted to make breakfast and has left her home just five times in the past seven months.
Allowing the coronavirus to just sweep through the low-risk population might not cause a surge in mortality, or even overwhelm the NHS, but it could store up years of chronic health problems instead in a Scottish population which was already the sick man of Europe even before the pandemic.
And finally, setting aside the ethics of it, the idea that we can segregate whole sections of society at home so that the rest of us can “just get on with it” misses a key problem: it’s not that easy to shield the vulnerable.
A study of 1.3 million people registered with GPs in Greater Glasgow and Clyde, published last week, looked at outcomes in the shielded and non-shielded population, up to the end of May.
READ MORE: New study reveals patients most likely to suffer 'long-haul' Covid symptoms
Professor Jill Pell, a public health expert at Glasgow University and a member of the Scottish Government’s Covid-19 Advisory Group, is among the researchers.
The study concluded that shielding “has not been effective preventing deaths in those with highest risk” (and bear in mind, this was during a period where we were all in lockdown).
Those aged 70 and older were 74 times more likely to die than the low-risk rest of the population.
The authors added that “to be effective as a population strategy, shielding criteria would need to be widely expanded to include other criteria, such as the elderly”.
That would actually mean one in four Scots: those in the original shielding category plus everyone over 70, regardless of their health.
How would that go down? And what about the people they live with?
Shielding, or ‘cocooning’, is a distinctly western response to the pandemic. Asian nations have sought to protect young and old equally and have fared much better, partly due better test and trace systems but also more effectively isolating infectious individuals, for example using quarantine hotels to limit household and community spread.
There are better, fairer, ways out.
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