Health

Covid Scotland: How lockdown gave way to ‘learning to live with’ virus


IF the first half of 2021 was about driving cases down through lockdown and restrictions, the second half was about “learning to live with” much higher levels of infection while relying on vaccines to suppress hospitalisations and deaths.

In Scotland, July began amid rapidly rising Covid infections which peaked around 3,318 cases per day on July 3 – at the time, the highest level for the year so far.

The acceleration in cases was blamed on a perfect storm of the highly-transmissible Delta strain, unvaccinated young people, increasingly relaxed rules on mixing, and the Euros football tournament, which had encouraged Scots to gather together in pubs and homes until the national side crashed out on June 22.

HeraldScotland:

Public Health Scotland (PHS) later reported that four per cent (2,632) of the 63,874 Covid cases reported in Scotland between June 11, when the tournament kicked off, and July 7, were related to Euro 2020.

Overall, 90% of these positive ‘Euros’ cases were in men, and 73% were in those aged 20 to 39.

PHS noted that Scotland’s early exit from the competition “probably contributed” to the fall in infections from early July onwards.

PART ONE: A Year of Vaccines and Variants – Scotland’s Path from Lockdown to ‘New Normal’

By now, the extent of the danger posed by the Delta variant was also becoming clear. It appeared to be twice as transmissible as the original Wuhan Covid and roughly 40-60% more transmissible than the previously dominant Alpha strain.

Without any mitigations, each infected person would be expected to spread the virus to a further six people, and there was mounting evidence that Delta had also eroded the ability of vaccines to prevent infection.

Research published in the prestigious journal, Nature, on July 8 noted that “a single dose of either the Pfizer or the AstraZeneca vaccine induced a barely detectable level of neutralising antibodies against the Delta variant”.

Two doses increased the protection against symptomatic infection to around 60% with AstraZeneca and 88% with Pfizer, though this was also “notably lower” than it had been with Alpha.

A report compiled by the Centres for Disease Control and Prevention in the US summed up the dilemma in a report to officials, stating simply: “the war has changed”.

HeraldScotland: Protesters in Paris campaign against the introduction of the country's Covid 'health pass'. A similar scheme would later be adopted in ScotlandProtesters in Paris campaign against the introduction of the country’s Covid ‘health pass’. A similar scheme would later be adopted in Scotland

Fully vaccinated individuals were now more likely to become infected – and more likely to pass the virus on – than they had been when Alpha was circulating.

The effectiveness of everything from physical distancing to facemasks was also reduced by the sheer infectiousness of Delta.

Addressing the Scottish Parliament on July 13, Nicola Sturgeon described the new variant as “something of a game-changer – even for countries on course to achieving full vaccine protection.”

The goal of herd immunity had been pushed out of reach; even if the entire population were fully vaccinated it appeared that Delta Covid would persist, spreading at a constant low level in the population.

READ MORE: Why the Delta variant has left herd immunity through vaccines alone mathematically impossible

This was reflected by the tone of the public messaging in the run up to England’s ‘Freedom Day’ on July 19, as the UK’s new Health Secretary Sajid Javid repeatedly insisted that the nation would have to “learn to live with” Covid even as cases were, at the time, exceeding 50,000 per day.

Vaccines may be less effective at stopping infections, but they remained robust against serious illness, he said.

“We could see a doubling of case numbers by the time we get to 19 July [but] we are not seeing a corresponding increase in hospitalisations and death numbers,” said Mr Javid.

“And that is because the vaccine is working, that is what the vaccine is for.”

HeraldScotland: Revellers celebrate England's 'Freedom Day' in JulyRevellers celebrate England’s ‘Freedom Day’ in July

As England celebrated its ‘Freedom Day’ by scrapping everything from physical distancing and facemasks, to reopening nightclubs and allowing theatres, football matches and concerts to return to full capacity, Scotland moved – more cautiously – into Level Zero.

The whole country had originally been scheduled to shift to Zero from June 28, but this was delayed by concerns over the Delta variant. Thirteen council areas across the Central Belt – including Glasgow, Edinburgh and Dundee – still remained at Level Two.

This finally changed on July 19, however, as eight people from up to four households were allowed to meet indoors in a private home, rising to 10 from four households in pubs and restaurants.

HeraldScotland:

Outdoors, the rules were more generous: 15 people from up to 15 households could mix in parks, private gardens, or in venues such as beer gardens.

Indoors, physical distancing was cut from two to one metre, and abandoned completely outdoors.

Up to 200 people were now allowed to attend weddings and funerals, and soft play centres – banned in Level Two areas – reopened.

Self-isolation was also scrapped for any travellers coming into the UK from amber list countries, provided they were fully vaccinated and took a PCR test within two days of arrival.

READ MORE: Hospitals ‘jammed’ amid signs that pandemic backlog starting to hit NHS

The move was seen as an important step towards normalising “living with” the virus, while incentivising vaccine uptake.

But 3000 miles away in Israel, warning signs were beginning to emerge about waning immunity from vaccines.

The country – which had used only the Pfizer vaccine – had eased restrictions just as the Delta variant began spreading, and its hospitals were quickly filling up with a combination of unvaccinated young and over-60s fully vaccinated five months earlier whose protection had dwindled.

HeraldScotland:

On July 29, Israel became the first country in the world to launch a Covid booster campaign.

Anyone over 60 who had last been vaccinated five months before was eligible, but the rollout was soon extended to younger age groups and by the end of August boosters were being offered to everyone over 12.

Back in Scotland, August 9 heralded a watershed moment in the pandemic.

For the first time since March 2020, nightclubs reopened, limits on socialising ended, and venues from restaurants to theatres were finally able to operate at full capacity without physical distancing.

Unlike England, face coverings would still be required in shops, schools and public transport and working from home continued to be encouraged, but ‘Beyond Zero’ was the closest thing to normality the nation had experienced in 17 months.

READ MORE: What’s really behind the worst winter crisis facing the NHS?

However, the combination of restrictions ending and schools returning in mid-August saw Covid cases – rising since the beginning of the month – suddenly accelerate.

By September 6, Scotland was averaging more than 6,400 cases a day – higher than at any other point in the pandemic.

A subsequent influx of Covid patients into hospital piled pressure on an NHS that had been increasingly struggling with a backlog of non-Covid illness, emergency admissions, and bed shortages.

Delayed discharges – the number of acute beds occupied by patients well enough to leave but stalled by a lack of social care – had been climbing steadily since May, and would peak at around 1,600 by the end of September.

HeraldScotland:

Ambulances stacked outside A&E departments, unable to offload patients; health board after health board suspended routine operations and declared “code blacks” as hospitals reached capacity; and record numbers of patients spent over 12 hours in A&E – some up to two days – waiting for a bed on a ward, while reports emerged of spiralling ambulance response times.

On September 16, the Herald revealed that an investigation had been launched into the case of Gerard Brown, a 65-year-old father-of-three, who died in his home following a 40-hour wait for an ambulance.

Later than day, Nicola Sturgeon told the Scottish Parliament that the Army would be drafted in to help drive ambulances.

READ MORE: Investigation after father-of-three dies following 40-hour wait for ambulance

On September 20, elderly care home residents became the first in Scotland to receive Covid boosters, while plans were also underway to introduce Covid certification for entry into nightclubs, adult entertainment venues, and larger events such as concerts and football matches.

Similar schemes were already in use internationally, but Scotland stopped short of extending certification to bars and restaurants – as France and Italy had done – while stipulating that only being fully-vaccinated would qualify.

Evidence of prior infection or a negative test was ruled out as the initiative was used to try to drive uptake in the hesitant or procrastinating young while, as Ms Sturgeon put it, “keeping our economy fully open, fully functional and fully trading”.

It was finally enforced from October 18 following concerns over technical glitches.

HeraldScotland:

From October 31 until November 6, Glasgow welcomed around 40,000 delegates – along with climate activists, world leaders, and celebrities such as Leonardo DiCaprio – as the city played host to the much-anticipated COP26 summit.

Despite fears the event would trigger a fresh spike in Covid cases, analysis would show that infection rates actually fell in the two weeks following the end of the summit.

Unfortunately, Scotland – and the rest of the world – was about to face an even bigger challenge.

READ MORE: Omicron – Why the latest Covid variant has scientists worried

On November 11, a new and disturbing Covid variant was identified for the first time in virus samples collected from a patient in Botswana two days earlier.

It had roughly 50 mutations in total, including 30 to the spike protein in areas scientists had previously linked to vaccine escape and high transmissibility.

The war against Covid had shifted yet again.

On November 24, the strain – later named Omicron – was reported to the World Health Organisation and declared a variant of concern on November 26.

Alarmed scientists at the UK’s Health Security Agency described it as the “worst ever” Covid variant and the UK swiftly closed its borders to several southern African nations.

HeraldScotland:

By now, though, Omicron was already in Scotland: the first nine positive cases were detected in guests who had attended a private function in Glasgow on November 20.

As December wore on so did a creeping sense of déjà vu, as the First Minister warned of a looming “tsunami” of Covid cases.

Scots were urged to “defer” work Christmas parties, then to “cut back” on socialising, to meet in groups of no more than three households, and eventually just to “stay at home” as much as possible.

Omicron overtook Delta as the dominant variant on December 17, with hospitality bosses complaining of a “lockdown by stealth” as customers stayed away and cancellations ballooned.

READ MORE: Why the Covid ‘lab leak’ is no longer just a conspiracy theory

In the end, Scots were urged to keep Christmas Day gatherings “as small as family circumstances allow”, and Boxing Day saw the introduction of strict limits on the size of public events.

Football stadiums could accommodate just 500 fans; theatres 200. Pubs and restaurants, meanwhile, were required to reinstate physical distancing and table service, and Edinburgh’s Hogmanay street party was cancelled for the second year in a row .

HeraldScotland: The origins of the SARS-CoV-2 virus which causes Covid remain a mysteryThe origins of the SARS-CoV-2 virus which causes Covid remain a mystery

As 2022 approaches, we are not where we hoped to be – but we are still far better off than we would have been without vaccines and, crucially, boosters.

More than two years since Covid first emerged in China, its exact origins remain a mystery.

In Chinese astrology, 2022 is the year of the Tiger: people who “if they can work hard and keep making progress, will surely realise their wishes”.

Perhaps that is an omen of better times to come.





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