Covid is changing. We – people and politicians – must change with it, says Andy Maciver

A COUPLE of Saturdays ago, during my usual ‘Dad’s Taxi’ service, I was listening to Off The Ball on BBC Radio Scotland. Until a couple of years ago, listening to the show was merely weekend escapism, however the now-regular appearances by Scotland’s National Clinical Director, Professor Jason Leitch, has led to a degree of assimilation with my day job.

Professor Leitch has proven himself to be a gifted communicator during the Covid pandemic. He benefits hugely from not being a politician; it affords him the ability to answer straight questions with straight answers, without the need for caveat or concern over how his comments might be interpreted, or misinterpreted, by opposition politicians or by the media.

Sometimes, though, his straightness, his frankness, can raise more questions than it answers. That Saturday on Off The Ball, Professor Leitch made a remark, buried in an answer about the early South African evidence that the Omicron variant spread far more rapidly than Delta but led to far fewer per capita hospitalisations.

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He said, and I hope I am accurately reproducing it here, that the variant we are waiting for is the one which effectively infects everyone but only gives them a cold, before clarifying that he does not consider Omicron to be that variant. The remark went almost unnoticed, but it immediately registered with me as a concept which will inevitably have to change the nature of the way we think, talk and act about Covid throughout 2022 and beyond.

If, and when, we experience that variant (for the sake of this column let’s call it Pi since that it the next letter in the Greek alphabet, after Omicron), it is surely unthinkable that we would retain the current set of rules around self-isolation of close contacts, and indeed around self-isolation of the infected people themselves.

For if we enforce the current rules when the Pi variant hits us, infecting almost everybody but harming almost nobody, then we would find ourselves, in effect, in a complete lockdown, more all-encompassing than any we have experienced before.

As we transition towards Pi, and the other variants which might present themselves on the journey, we are inevitably going to have to change not only the rules but the national psyche around Covid. This must be led from the top.

The signs from the handling of Omicron are not entirely positive in this respect. All evidence, both from South Africa and now from here, is that Omicron is significantly less serious than Delta.

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Chris Hopson, of NHS Providers in England, has explained the current situation very well. Hospitalisations are currently at only 25% of their January 2021 peak. Furthermore, his trusts are reporting that the majority of positive cases are so-called ‘incidental Covid’, by which he means asymptomatic positive cases in patients who have been admitted to hospital for other reasons.

The critical issue for us to consider, with the Pi variant in mind, is that the most significant problem being reported by these trusts is not Omicron-related illness, but Omicron-related staff absence. Despite its continuously record-breaking funding, the NHS remains a scantily staffed service compared to other OECD services. Doctors’ and nurses’ rotas cannot cope with multiple staff absence – there simply aren’t enough of them. Entire teams can be shut down by one or two absences.

The correct conclusion to draw from all of this is that our currently tightening set of restrictions are in place not primarily to protect the population from illness, but to protect the NHS from collapse as a result of staff absence.

Think about this in relation to the variant Professor Leitch discussed, which I am calling Pi. If we apply Omicron’s rules to Pi, we will shut the country down (again), torpedo the economy (again), and plunge ourselves into a mental health crisis (again), all in the name of a variant which is harmful to very few people.

We will be protecting not the people, but the system, from collapse induced by staff isolation.

This would be a grave mistake, and we must change our thinking now, to include a reduction in self-isolation, and eventually an end to self-isolation as the variants become less and less harmful to human health.

During Omicron, Prime Minister Boris Johnson, on behalf of England, has taken a less restrictive approach than the devolved nations. I have, on these pages, often praised the Covid handling of First Minister Nicola Sturgeon. This time, though, I think Mr Johnson has struck the right balance. There is simply not, yet, sufficient evidence to prove that the harm caused by Omicron outweighs the harm caused by restrictions.

Caution is defined by the definer. And I would suggest, given the impact on the economy (which we should remember pays for the NHS) and on mental health, that Mr Johnson could legitimately describe his approach to Omicron as cautious.

More broadly, the switch from Alpha, to Delta, to Omicron, from less transmissible to more transmissible, from more harmful to less harmful, from no vaccination to full vaccination, should encourage us all as individuals to check ourselves.

We have a role to play in protecting ourselves, and protecting the NHS. Of course, there are anomalies and outliers. Of course, there are instances of vaccinated, young, healthy people who need medical intervention when they catch Covid. But facts speak for themselves. Even before the creation of the vaccine, a working-age person without an underlying health condition could consider themselves unfortunate to be hospitalised by Covid.

Now, in the world of Omicron, there will be hospitals across the country which may never see a working age person who has been fully vaccinated, who does not smoke, and who is not obese. They are exponentially more likely to be either completely asymptomatic, or to have a case mild enough to be comfortably managed at home.

We can also protect the health service by becoming more discerning about our use of accident and emergency departments. A&E is under pressure, and as many doctors will tell you privately, many of its visitors need a paracetamol and a cup of tea, not a trip to a hospital.

Covid is changing. We – people and politicians – must change with it.

• Andy Maciver is Director of Message Matters

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