Diagnosing the new normal: interview with the Interim Chief Medical Officer

“I think we have to prepare ourselves for the fact that coronavirus is not going to be going away. When people talk to me about getting back to normal, I often wonder what they mean by that because I don’t think we will get back to how life used to be, I think we will be living with coronavirus for some time yet.”

These days, everyone has an opinion on how long coronavirus will dominate our lives and impede our day-to-day interactions, but coming from Interim Chief Medical Officer Dr Gregor Smith, the statement takes on a somewhat starker meaning.

The ‘new normal’ that Nicola Sturgeon first mooted several months ago is now becoming slightly less alien – a cursory check for a facemask each time you leave the house is standard now – but the thought of having to maintain social distancing restrictions long-term is daunting.

As the wider public has to come to terms with what that means for them, their families, their livelihoods, Smith acknowledges how difficult these past few months have been and admits that he is no different when it comes to those feelings of despair, isolation and loss.

Just because he helps make the rules, it doesn’t mean they have always been easy for him.

“Lockdown was really difficult for everybody and I’m no different to anyone else,” he says. “You miss the things that you took for granted in the past. You miss the ability to be able to get out and about and to do things.

“It’s just the ability to interact with people in a normal way. I love being amongst people and I really missed the contact you have with people on a day to day basis. One of the things that I think all of us have really struggled with from time to time is this new way of communicating across a video screen or on the telephone. It’s not easy. People need interaction, it’s one of the things that we value, we’re a social species.

“As soon as you start to take that away, life changes and certainly becomes more difficult. I wholly understand why some people over the course of lockdown started to feel more anxious and started to experience a difference and change in their mental health because it’s those relationships with other people that actually preserve us and give us the resilience in life, and when they’re not there it becomes really challenging for some people.

“I’m adapting, I’m getting used to a new way of interacting with others, it doesn’t feel the same quite yet but I’m sure over time it’ll change again and we’ll readapt and we’ll be able to come back together again.”

But Smith accepts being able to “come back together again” isn’t going to happen any time soon.

Hand in hand with large parts of society re-opening again comes an inevitable rise in COVID-19 cases. And with the winter months drawing closer and closer and temperatures already dipping, these numbers will continue to get bleaker.

“We’ve seen a rise in the number of positive cases that we’re announcing every day and we’ve been very carefully looking at the origins of the increased numbers that we’re seeing,” explains Smith.

“Most of them relate to recognised outbreaks or clusters of cases. And we’ve been dealing, as you know, with the two particularly significant clusters in relation to Aberdeen city first of all and now in relation to the Tayside and Coupar Angus area in particular.

“One of the things, which seems to be a common feature just now is a particular spread indoors. That fits with all the international evidence base. So, any place where people are coming together, indoors, particularly in crowded areas seems to be an increased risk of the virus spreading from person to person.

“That’s understandable, but what makes me a little bit more uneasy is the number of occasions when these clusters have their origin when people have come together in larger numbers than perhaps we would have expected, where there has maybe been indoor gatherings, particularly in households, and above what the guidance suggests should be allowed and that just makes me a little bit uneasy that perhaps we’re creating opportunities for this virus to re-emerge and come back more than we need to be dealing with.”

by Liam Kirkaldy

Dr Catherine Calderwood resigns as CMO

If Smith, the most senior medical adviser in Scotland, a professional who makes decisions solely based on scientific evidence and data, a man who comes across as level-headed, calm and sincere, is uneasy, then that should act as a warning shot to us all.

And perhaps the rest of the population is already sharing this unease as we attempt to return to as close to normal as possible.

Testing centres have been overwhelmed by the number of people requesting tests, particularly since schools reopened. At the end of August, Nicola Sturgeon revealed nearly 17,500 children had been tested for coronavirus in the week before, but only 49 were positive.

There’s been so many aspects of the response that we’ve had which we’ve found tough

Such was the demand, National Clinical Director Professor Jason Leitch had to step in to issue guidance to parents about when they should and should not get tested.

“I think it’s really difficult for parents just now because as children are returning to school, it’s inevitable they will come into contact with other types of infections as well,” says Smith. “And one of the common ones that we’re seeing just now is a rise in the number of cases of a virus called rhinovirus which is a really common virus that particularly affects children and it causes symptoms like the common cold, but often it’s very difficult to differentiate those type of symptoms from what might be COVID, so I completely understand the dilemma that some parents and people are faced with as they are wondering whether they should go for testing or not.”

Anxieties over what is a common cold and what could be COVID-19 will inevitably get worse as winter takes full effect, but the biggest concern most people have about entering those long, cold, dark months is doing so in lockdown.

What is the likelihood of that happening?

“One of the things which I’ve been impressed with over the course of the last three to four weeks is the response of our test and protect teams and our health protection teams across the country in dealing with some of these outbreaks that we’ve had,” says Smith.

“If you take the Aberdeen city outbreak as an example of that, it was an incredibly complex cluster of cases, which spread the tentacles across the city into a number of different environments and establishments. And there was a point where we had to reapply some local restrictions in Aberdeen and that kind of decision is really not taken lightly because of the impact on local people, and in fact on local business as well.

“What it showed is that by doing that, we were able to avoid the virus really getting a hold of and gaining sustained community transmission in that area as well. I would certainly be optimistic that that experience will feed into how we approach other similar situations over the course of the next few months because I think it is inevitable that we will face similar situations to that in the future.

I remain very optimistic that we will have a vaccine that will give us some sort of protection

“Lockdown and the experience over the months of late March, April and May was an experience that I don’t think any of us would want to re-visit. It was incredibly taxing on the whole population. Decisions like that are incredibly difficult for anybody to be faced with, however we need to make sure that as we approach winter, we are ready to deal with any of the threats that we might face as we track how this virus is reacting within our communities.”

It must feel like a lifetime ago now that Smith was catapulted into the role as Scotland’s most senior medical adviser. But in fact, it was just in April – during the height of lockdown restrictions – when former CMO, Dr Catherine Calderwood, resigned after being caught flouting restrictions by visiting her second home.

As Smith is quick to point out, having been deputy CMO for five years, he wasn’t entering the post cold.

“Certainly, events were unexpected in April when I came into role,” Smith recalls. “It wasn’t that I was completely blind to what was going on though, having been part of the response from the early days and working closely with the previous CMO in relation to that. I didn’t feel as though I was coming to the role cold.”

Smith believes one of his key roles is being someone who the public can trust; a professional, medical adviser to the government who is ultimately working on behalf of the people of Scotland.

“There’s a really important role I think that the CMO has in terms of being able to give trusted clinical advice to people and becoming part of that response with the ministers and with my other clinical colleagues,” he adds.

And was that trust hampered by Calderwood’s decision to travel to her second home 44 miles away, despite telling everyone else in the country to stay at home?

“I don’t think so at all,” says Smith. “Certainly I think people would recognise that I was my own person and as I came in, and as I started to communicate with people and make my presence known, in particular the daily press briefings, certainly the feedback I was getting from people didn’t suggest that that was the case.”

Since he moved into the role, Smith has stood beside Sturgeon during her coronavirus press briefings, as they’ve fielded questions together from the press on every aspect of their decision-making processes.

He points out that he “never sought to become a celebrity from all this”, but in a way – like Jason Leitch – he has earned the somewhat dubious title of being the ‘face’ of the pandemic in Scotland.

While Smith seems to take that in his stride, there have been other elements of the role that he’s found harder to deal with at times.

“There’s been so many aspects of the response that we’ve had which we’ve found tough,” he admits. “Probably the toughest, if we were going to characterise it that way, is just the pace at which everything’s moved and the changing landscape, the changing evidence base continually.

“Like many other people just now, the hours that we’ve been working have been very, very long. It’s tiring.

“I think probably there were times during those points, where the hours became much, much longer than were good for people. That’s just the nature of where we were. I don’t think that I was alone in that by any manner of means. And it was a case of just knuckling down and there was a great camaraderie that was shown across colleagues as we came together to try to pick our way through the really complex landscape we were dealing with.”

Now Smith’s focus is on adapting to a world where we live alongside COVID-19 and doing everything possible to minimise its spread.

“I remain very optimistic that we will have a vaccine that will give us some sort of protection,” he says. “I don’t think that will happen quickly, but I do think that with time, we will have a vaccine we can use, in the same way we have responded to other infectious diseases.”