Andrew Watterson: Government needs to be cautious when setting Covid strategy

Yesterday Scotland recorded 11,957 new Covid cases. This week the national seven-day positivity rate reached more than 1,110 cases per 100,000 of the population. All Scottish local authorities exceeded  the 800 mark and 18 were over the 1,000 mark. Omicron has proved less serious than Delta with fewer hospitalisations, ICU admissions and deaths but we do not decide which variants appear and so we need strategies to suppress them all. 

Vaccines have been highly effective in saving lives and reducing hospitalisations. Nevertheless Omicron’s rapid spread across Scotland showed vaccines alone cannot be relied on. Non-pharmaceutical interventions (NPIs) – ventilation, masks, testing and tracing, social distancing, and self-isolation – are also needed to run alongside the vaccines. A Lancet health policy paper this year examined the benefits of a low-incidence Covid-strategy – and Scotland does not yet have low incidence – combining vaccines and treatments with NPIs. It concluded failure to pursue such a strategy harms the most vulnerable especially the economically deprived and socially marginalised; damages the workforce; adversely affects education; threatens health care delivery; increases the likelihood of variants of concern emerging; and paradoxically, also leads to the need for tougher NPIs in the future.

What works: the Scottish Government future pandemic strategy appears carefully considered in parts with strong commitments to surveillance, testing, self-isolation, risk assessments, PPE at work and hybrid working. There is a welcome emphasis on supporting people at the "highest’"risk but not, it should be noted, at elevated risk, and in reducing health inequalities. Vulnerable people will still be in jeopardy when other recent Scottish Government decisions are taken into account. Time will tell if these proposals translate into effective action and can be funded.

What does not work: current changes and the future strategy. The strategy places too much weight on vaccines and treatments and some current changes look premature. There is over-confidence in the uptake of positive behaviours, and voluntary compliance after key protections are removed. Reliance on "encouraging" people to adopt safe practices, masks (albeit not effective PPE) and improving ventilation beyond sawing off door bottoms are reasonable. However, it will still be difficult for the public to identify "sensible’" adaptions and behaviours and select "personally responsible actions" to protect the vulnerable and themselves in many settings.

Major problems emerged last week with what was said and how it was said. The ending of requirements for high school students and staff to wear face coverings in classrooms illustrates why. Scottish Government advisors in a revealing if bizarre choice of words indicated they were "comfortable" with the decision whereas many working in the sector facing the risks expressed unease. Effective masks are a cheap and not too onerous solution to stop Covid transmission. The Education Minister indicated the Scottish Government is guided by "scientific and expert advice" in dropping this mask requirement but even scientists like Sir David Bell agree effective masks do reduce Covid transmission. So when the Education Secretary welcomed an end to requiring masks in the classrooms , she did so with the caveat that Covid-19 hasn’t gone away – “ we all still need to be on our guard and exercise caution. Pupils and staff must still wear face coverings in communal areas and distancing rules still apply”. Such messages are at times contradictory, mixed, muddled and not precautionary as protections have been lifted.

What should we do? The Scottish Government wants "a balance to be struck" in moving away from Covid-19 pandemic controls to "judgments" and advice. These judgments may be finely balanced and based on uncertainty. Transparency in decision-making will therefore be vital. Hence, a much better and earlier flow of evidence to the public than has hitherto been the case is needed to justify any policy changes.

The Government’s current mantra of "personal responsibility" is also one that too easily offloads employer and official responsibilities for precautionary public health measures on to the shoulders of individuals and away from clear protections especially for vulnerable people. Paradoxically too, the Scottish Strategy document refers in places to "adjusting behaviours" when the levers and actions needed to protect those exposed to Covid-19 risks primarily require actions by government and employers to be effective and not public or employee behaviour.

No one wants to see unnecessary pandemic measures continued. The Scottish Government now explicitly stresses its “duty” to remove such measures as soon as possible. However, the same “duty” it has to protect the vulnerable by retaining some protections and remaining precautionary has not been stressed in the same way.

When striking a balance on Covid, the Government should therefore fully commit itself to a low-incidence NPI strategy. In doing so, it should clearly favour precaution and public health to protect society and the economy. It should favour the vulnerable and shielding, and those most exposed to risks in for example education, the hospitality sector and other workplaces. Finally it should favour non-onerous but effective measures like improved ventilation, PPE and testing.

Professor Andrew Watterson is a Public Health Researcher with the Faculty of Health, University of Stirling

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