Walking a tightrope: A key moment in the fight against COVID

Delicate, fragile, precarious. 

Those were three words used by the First Minister in parliament last week to describe Scotland’s progress during an unrelenting global pandemic, which has claimed thousands of lives.

‘Transition’ was another, giving form to what had previously been alluded to, in that the Scottish Government’s approach to coronavirus may be on the verge of significant change.

“This is a key and difficult moment,” Nicola Sturgeon said as she spoke of a perilous situation. One that can be viewed with both promise and caution, finely poised between stepping forwards and tumbling backwards. 

The so-called Indian variant, renamed as April-02 by the government to avoid stigmatising one group of people, and then again by the World Health Organization as Delta, is spreading faster than previous strains of the virus and, the government believes, accounts for the majority of new daily cases in Scotland.

It’s a worrying development, a setback in a return to normality craved by so many, and the first major obstacle blocking the country’s route to a less restrictive way of tackling COVID-19 – a strategy which would see the virus become a manageable health issue, where case numbers do not drive ministers’ decisions and people’s lives do not exist in a perennial state of flux. 

Ground has been covered in our capacity to deal with this novel virus in 15 months. It has been a treacherous learning curve for governments, but we now have more than one effective vaccine, a greater understanding of available treatments, and mass testing. 

We don’t have to look far for research which suggests that vaccination is cutting rates of hospitalisation and deaths. A study here in February found that by the fourth week of an initial dose, the Pfizer and AstraZeneca vaccines reduced the risk of hospitalisation by up to 85 and 94 per cent respectively. 

There are promising signs among the elderly also, with the same study finding vaccination among those aged 80 and over was linked with an 81 per cent reduction in hospitalisation risk in the fourth week, when the results for both jabs were combined. A separate study among healthcare workers in Scotland in March showed positive results, suggesting vaccination was reducing transmission.

While less is known about variants, Sturgeon said her government is “increasingly confident” that vaccines are effective, though hospital patients were being closely monitored. “We do now have evidence that the link between cases and serious illness, hospitalisation and deaths does appear to be weakening,” she told parliament on Tuesday. 

Since January, the proportion of new cases which lead to hospital admission has reduced – from 10 per cent to five per cent – and the length of time people spend in hospital has also declined. However, the need to press on towards full vaccination at pace has become vital. “Protection against the Delta variant after one dose is not negligible, but it is not substantial either,” Sturgeon said. “It is after two doses that the protection becomes much stronger.”

Protection against the Delta variant after one dose is not negligible, but it is not substantial either. It is after two doses that the protection becomes much stronger.

The early signs hold promise. Professor Devi Sridhar, chair of global public health at Edinburgh University and a government adviser, said in a recent column in the Guardian that if countries can reach vaccination levels of 80 to 90 per cent of their populations, COVID-19 will become a “manageable health issue”. 

She even suggested that the end of the pandemic is in sight for some. “COVID-19 won’t end with a bang or a parade,” Sridhar wrote. “Throughout history, pandemics have ended when the disease ceases to dominate daily life and retreats into the background like other health challenges. Barring a horrific new variant, rich countries such as Britain and the US may be within months, if not weeks, of what their citizens will see as the end of the pandemic.”

However, arriving at this stage of the pandemic has not been without cost. COVID-19 has been cited on the death certificates of more than 10,000 people in Scotland. 

In the first wave, over 1,300 elderly people were discharged from hospital to care homes before a testing regime was in place. The virus spread through the setting and left a trail of devastation in its wake. 

Businesses have had to adjust to lockdown-release cycles, which have caused disruption and financial uncertainty. Cities and towns have lived under harsh measures intended to contain the spread of the virus – Glasgow an example of one of the worst affected in the UK, enduring nine months of restrictions before returning to a level resembling a form of normality on Saturday.

The calls made by decision makers will be thrust under the microscope when a four-nations independent inquiry into the handling of the pandemic takes place in spring of next year. However, the First Minister has urged the UK Government to move faster, calling for it to start this year. 

The urgency of that inquiry was heightened following Dominic Cummings’ explosive appearance at a joint hearing of the Health and Social Care Committee and Science and Technology Committee at Westminster towards the end of May, where several serious questions were raised about the competence of the UK Government and its ministers. 

The Prime Minister’s former aide said Boris Johnson was “unfit for the job” during a marathon evidence session, painting a picture of chaos in Downing Street in the early stages of the pandemic, and claimed Matt Hancock should have been fired for lying – allegations which have been denied by the UK health secretary.

Cummings’ testimony, which suggested the UK Government was not adequately prepared to lead an effective pandemic response, raised concerns among the public health community. Speaking on BBC Debate Night, Professor Linda Bauld of Edinburgh University said she was “shocked and appalled” by the contents of his evidence. 

She added: “I think governments need to take collective responsibility for decisions that have been made and he was at the heart of government for part of that. I think the thing that really shocked me the most is he was playing back what many people in the public health community had been saying from very early on in the pandemic about how you approach this.

“And it was the exceptionalism that I think came across from a UK perspective and I think affected all parts of the UK – that we didn’t need to learn from south-east Asia, we didn’t need to learn from global health and infectious disease and countries that have dealt with this previously. I think that’s something we’re going to be reflecting on for a long time.”

It’s difficult to fully evaluate the extent of governments’ failures before the completion of an inquiry, but some of the key elements which require further scrutiny have already been identified. The mistakes which led to the virus seeding in care homes, the overexuberance of the Eat Out to Help Out scheme pursued in a nation which had barely exited lockdown, and the delay in introducing border restrictions or mass testing are just some of the areas that should be examined. 

Indeed, at times, some of the solutions seemed to be painstakingly obvious exercises in common sense. This was highlighted by SNP MP Anum Qaisar-Javed in her questioning of Cummings at the committee. The former modern studies teacher had discussed pandemic handling with her students at a secondary school in Edinburgh when the outbreak first took hold in Wuhan in January of last year. She said: “My 13-year-old weans understood the concept of closing the borders or stopping people from entering or leaving the country.”

The comment holds particular relevance given there have been warnings in recent days that we are on the threshold of a third wave, with the latest variant fuelling a further spread in COVID cases.

Professor Ravi Gupta of Cambridge University expressed concern about a “false sense of security” because of the vaccination programme, while Professor Adam Finn of Bristol University, said the UK remained in a vulnerable position as large numbers of people have not yet been immunised. 

If the UK is to avoid losing its footing in the battle against coronavirus, the need to tread with caution is clear. Scotland and its neighbours are at another crossroads in this pandemic, where one wrong step could have far-reaching consequences on their journey back to normality. 

Governments will need to show a willingness to learn from the areas they haven’t got right so far if they are to stay on track in the months ahead.