Covid Scotland: The challenge of finally ending self-isolation

Over the past two years the requirement to quarantine has been gradually rolled back, from 14 days for close contacts to being avoided altogether as long as they are triple-vaccinated and test negative every day using a lateral flow device (LFD).

For those infected, self-isolation has see-sawed from seven days at the start to 10 days in July 2020 amid evidence of what Scotland's chief medical officer Dr Gregor Smith described as the "low but real possibility of infectiousness between seven and nine days after illness onset".

More recently, the Covid positive have been able to cut short their isolation as long as they test negative using the home antigen test on days six and seven and do not have a high temperature.

READ MORE: Did Christmas curbs really make 'no meaningful difference' to Covid rates?

Similar trends are emerging around the world.

Italy - the epicentre of Europe's Covid outbreak back in early 2020 - scrapped isolation in December for close contacts of a positive case, as long as they are boosted, recently double-vaccinated, or have recovered from an infection within the previous four months. However, they are expected to wear higher grade FFP2 masks in public for a full 10 days.

The US, meanwhile, has adopted a 'five-and-five' approach - five days of self-isolation for infected individuals followed by five days of strict facemask use if they have no symptoms, with advice to avoid vulnerable people, crowded areas, and to take an LFD "if they can" (most Americans have to buy them).

New York City provided residents with free dog walking services and hotel rooms if they were required to self-isolate

The US Centres for Disease Control says the change is "motivated by science" that "transmission occurs in the one-to-two days prior to onset of symptoms and the two-to-three days after".

Cynics might note that "the science" dovetails rather usefully with pressure to safeguard the economy from an Omicron-related surge in workplace absences but, nevertheless, even in the US Covid rates are now falling.

What has yet to be done anywhere in the world, however, is the abandonment of self-isolation altogether, which is why the Prime Minister's pledge this week that it could be dropped in England by the end of March was picked up by news outlets around the globe.

READ MORE: Covid death rate 25 times higher in double-jabbed than boosted amid waning immunity in elderly

The regulations are up for review on March 24 - two years almost to the day since the UK's first national lockdown - and Boris Johnson "very much [expects] not to renew them".

He added: "We don't place legal obligations on people to isolate if they have flu. As Covid becomes endemic, we will need to replace legal requirements with advice and guidance, urging people with the virus to be careful and considerate of others."

Setting aside how much of this was opportunistically timed to appease a Tory backlash over partygate, it is obviously true that self-isolation will not be mandated forever. Whether March will be a safe time to lift it is another matter, however.

Covid rates are declining in South Africa, the UK, and the United States

South Africa briefly pulled the plug on quarantine - announcing on December 23 that it was no longer required for close contacts of a positive case or the infected but asymptomatic.

Instead they were asked to avoid crowds, socially distance, mask, and self-observe for symptoms, with a memo from the Ministerial Advisory Committee (MAC) on Covid-19 stating that it "serves little overall public health purpose" to force isolation on the asymptomatic.

READ MORE: Fewer than one in five applicants in some areas paid self-isolation support grants 

In a surprise U-turn on December 29, however, self-isolation was reinstated for all positive cases, regardless of symptoms, with close contacts also expected to get tested.

However, Sandile Buthelezi, the director-general of South Africa's national department of health, said the policy changes were "on hold", so perhaps South Africa will yet pave the way and give us something of a preview into its consequences.

The Scottish Government, which sets the self-isolation rules here, seems likely to watch and wait and let England go first either way.

The Omicron wave has certainly made self-isolation more disruptive than ever before in terms of staff absences, but compliance has also been patchy throughout the pandemic.

The ability to work from home is directly related to deprivation status, with those from the most affluent areas most likely to be able to continue working while in self-isolation

Numerous leading scientists in Scotland including Muge Cevik, Stephen Reicher and Devi Sridhar repeatedly criticised the UK and Scottish Governments for failing to do enough to make home quarantine practical and affordable for those on low incomes or in crowded accommodation, given the UK's meagre statutory sick pay.

In New York, anyone who tested positive was automatically offered free hotel accommodation and a dog walking service if required; in Norway self-isolaters were compensated with 80 per cent of their salary; in Taiwan, compliance was monitored remotely using mobile phone trackers and enforced with hefty fines, but citizens in isolation were automatically paid a stipend worth around £25 a day, with regular telephone wellbeing check-ups and home deliveries of groceries and pharmaceuticals.

In comparison, Scotland and England offered £500 support grants to those on low incomes - and £750 in Wales - but rejection rates were high and the application process was branded “too patchy, too strict, and riddled with problems” by the TUC.

Overall mortality, from all causes, had returned to pre-pandemic levels at the end of 2021

Exactly how much difference eventually ending self-isolation will make to virus rates in the UK depends on how much it is still curbing them, which is difficult to quantify.

The percentage of infected individuals and close contacts self-reporting total compliance with self-isolation has ranged between 18% and 89% in various UK surveys during the pandemic.

Which is as good as saying we have no idea how many really stuck to it. 

England's 'Freedom Day' - when everything from masks to social distancing ended and nightclubs reopened in July 2021 amid a wave of Delta cases - was dubbed "epidemiological stupidity" and a "dangerous experiment" by scientists who warned it would trigger a surge in hospitalisations.

Yet the surge never came. It was a gamble; but it paid off. Perhaps they will be just as lucky with self-isolation - but maybe they won't. 

Many who can - home workers for instance - may still opt to self-isolate with Covid.

But if free lateral flows are axed then our ability to catch asymptomatic cases will vanish.

That matters less for the general population, but for the immunosuppressed, those in care homes, hospitals or reliant on home carers, contact with Covid positive individuals - with or without symptoms - must continue to be minimised with targeted use of free LFDs.

We should not forget that the 'return to normal' is not equal.