Covid Scotland: Omicron is fading - but what's the future for the NHS?

Depending on how you count them, cases are in fact either plateauing or increasing.

According to the latest surveillance by the Office for National Statistics one in 25 people in Scotland were infected in the week ending February 5 - up from one in 30 the week before.

This is considered the gold standard estimate for virus prevalence since it is based on PCR testing and regular random sampling of thousands of households UK-wide.

One in 25 people "infected" is not the same as one in 25 "infectious", however: PCR kits are known to pick up traces of dormant virus weeks after a person has recovered.

Cases are plateauing around 6000-8000 per day, compared to 2000-3000 when Delta was dominant in November

Nonetheless, daily confirmed cases based symptomatic people seeking a PCR or self-reporting a positive lateral flow (designed to detect active infections) have been hovering stubbornly around 6000 to 8000 since mid-January - two to three times higher than the pre-Omicron plateau back in November.

Around 33 per cent of lateral flow results are going unreported in Scotland, according to the latest Modelling the Epidemic report, but the vast majority of these are negative, suggesting that the 6000-8000 figure is probably fairly accurate.

The cause for optimism then is really nothing to do with infection levels and much more about the reduced impact in terms of severe disease.

Source: Scottish Government

The number of people in intensive care with Covid is the lowest since early July, and weekly Covid deaths are a third of what they were this time last year despite cases being eight times higher.

Boosters have provided strong protection, aided by the reduced virulence of the Omicron strain.

The pandemic itself is far from over - 38% of the world's population is yet to be vaccinated at all, and there is no guarantee that future variants will be less dangerous - but for now the threat from Covid has receded, and the feared resurgence of influenza has also failed to materialise.

READ MORE: Should Scotland follow England and scrap self-isolation? 

In theory, the NHS should be well-placed now to focus on recovery.

Weekly A&E attendances in Scotland are running around 12% below pre-pandemic averages and the number of patients being admitted to hospital for emergency treatment has fallen back to around 10,000 to 11,000 per week, having spent more of last year from April to November in the 11,000 to 12,000 bracket.

Yet the total number of hospital admissions - including elective - is still around 16% below pre-pandemic levels, and the mood among those on the frontline is anything but optimistic.

Dr Phil Hammond, a GP and clinician specialising in post-viral illness who doubles up as Private Eye's 'MD '- writing for decades about the NHS - summed things up in a tweet this week: "When I qualified in 1987, NHS waiting times were often over two years.

"Peoples’ lives would be ruined while waiting and some would even die ‘on the list’; 35 years later and we’re back where we started…"

Dr Hammond was reacting to the delayed publication of England's NHS recovery plan, due to set out how it intended to tackle the backlog of its six million patients on waiting lists.

Clinicians and members of the public responding to the tweet recalled cases of patients and loved ones in the 1980s and 1990s suffering fatal perforated ulcers brought on by taking painkillers as they awaited a hip replacement; of 'routine' operations cancelled and rescheduled every six months for years due to bed shortages; of people dying before they could get long-awaited cardiothoracic surgery.

READ MORE: NHS recovery will fail without serious investment in staffing

Professor Allyson Pollock, a Scottish public health expert now based at Newcastle University responded that the situation facing the NHS now is "much worse than in 1987", adding: "We now half the number of acute and general beds, mental health beds largely privatised and inaccessible, community services and public health decimated - rehab and physio too - care of elderly siphoned off into private nursing homes."

This sense of doom is echoed by clinicians in Scotland who struggle to see how our current number of acute beds, staffing levels, and struggling social care resources can possibly cope with the scale of the treatment backlog: over 106,000 people - and climbing - were on waiting lists for an inpatient or day case procedure by the end of September last year, of whom one in five had already been waiting over a year.

READ MORE: 240,000 fewer operations on NHS Scotland since pandemic began

In Scotland, a recovery plan for the NHS has already been published setting out a vision for a dedicated network of elective centres, but the challenge will be finding the staff to run them.

Meanwhile, there is still little detail on how the NHS can even return to its pre-Covid bed capacity: physical distancing rules remain in place and even if self-isolation is dropped at some point for the general population, stricter rules will almost certainly have to apply to frontline NHS staff.

Total hospital admissions, combining emergency and elective patients, are still running well below the pre-pandemic average

Many - if not most - medics anticipate an inevitable fracturing of what NHS care means as limited capacity is increasingly dedicated in the years ahead to the most urgent procedures and a growing share of elective surgery outsourced to the private sector.

That was not necessarily unusual pre-pandemic - many health boards managed waiting times by paying independent hospitals to carry our hip and knee replacements, for example.

During Covid, however, thousands of Scots have undergone cancer surgery in private hospitals.

What has clinicians most apprehensive though is delays for non-cancer elective surgery becoming so lengthy - as Dr Hammond describes - that wealthier patients will simply pay for their own operations, while the poorer die waiting.

There is also the issue of the wider impact of Covid.

Beyond the waiting backlogs and the acute disease, research published in the BMJ this week found that nearly one in three adults over 65 were going on to develop at least one other new and persistent condition - including respiratory failure, kidney injury, and high blood pressure - following a Covid infection.

The NHS will feel the impact of the pandemic long after Omicron has faded.