THIS week saw governments either side of the border unveil their visions for what “living with Covid” should look like.
In Scotland, vaccine passports will be dropped from Monday with the wearing of face coverings set to shift from a legal requirement to recommendation from March 21.
In England, masks and passports – briefly mandated during the Omicron wave – were abandoned in January, with attention now pivoting to self-isolation which has transitioned from a legal requirement (enforceable – at least in theory, though very rarely in practice – by fines) to guidance. From April 1 – when free testing is also scrapped for all but the most elderly and vulnerable – it will become a matter of “personal responsibility”.
READ MORE: The truth about claims Covid vaccine ‘driving massive infections’ among vaccinated Scots
It remains unclear what the situation on testing will be in Scotland from April onwards, with Treasury funding cut.
Even more uncertain is whether post-pandemic Britain really will replace a culture of presenteeism with absenteeism if employees are unsure whether their coughs and fevers are caused by Covid or a common cold virus.
Unlike England, self-isolation in Scotland has always been guidance rather than law (albeit the tone of has implied that it is something we “must” do to protect others).
For now, Scotland’s £500 self-isolation grant remains in place for those on low incomes, and hybrid home and office working continues to be encouraged; in England the grants were axed on Thursday, and people “should now talk to their employers to agree arrangements to return to the office” – but “try to stay at home if you’re feeling unwell”.
One thing missing from the UK Government’s living with Covid plan, however, was any change to statutory sick pay (SSP) or employment law that might make that more feasible.
Those in employment which comes with paid sick leave – especially those whose jobs can be done from home – will find it much easier to “do the right thing” compared to people dependent on the UK’s measly £96.35 a week SSP.
READ MORE: ‘It might be fine – but it is a gamble’ – Is it too soon to scrap self-isolation?
Among the advanced nations, only the US and South Korea have traditionally paid less.
In Germany, where citizens are entitled to full pay for the first six weeks of sick leave, data pre-pandemic shows workers took an average of 18 days a year off sick compared to four for British workers.
Yet productivity is still higher: by as much as 24 per cent on average per worker in Germany compared to Britain.
Doing more to look after workers might have a dual benefit of boosting the economy as well as curtailing the spread of respiratory viruses.
Setting these issues aside, however, it is debatable how much of an impact self-isolation, vaccine passports, and facemasks are making at this point in the pandemic.
While it is impossible to link any single measure to infections – there are far too many variables at play – it is worth noting that, right now, the prevalence of Covid in Scotland exceeds England despite our extra protections.
In the week ending February 20, an estimated one in 20 people in Scotland had Covid compared to one in 25 in England.
The question is, will England’s softer messaging on self-isolation translate into a surge in infections in the weeks ahead?
It’s possible – but very uncertain. One clue lies in comparing ONS estimates against confirmed cases.
Take the Scotland data, for example. In the week ending February 20, the ONS estimates that 240,700 people in Scotland were infected with Covid, yet over those same seven days just 43,362 cases were actually confirmed through testing.
That doesn’t necessarily mean there were 197,000 infectious people roaming free who should have been isolating, however.
READ MORE: Watchdog casts doubt on Scotland’s ‘difficult to deliver’ NHS Recovery Plan
The ONS extrapolates its population estimates from a random sample of households based on taking PCR swabs – but since PCRs detect residual, as well as active, virus a substantial portion of those “infected” will be people who have already recovered.
Nonetheless, it correlates with projections that around half (or more) of infectious cases are now going undetected – partly because vaccination means more cases are asymptomatic.
If people do not know they are positive, they are unlikely to be isolating.
In this context, it is possible that ending self-isolation as a legal requirement (or, in Scotland, eventually moving away from strict guidance on quarantining for seven to 10 days dependent on lateral flow results, which becomes less tenable once LFDs are not freely available to all) will not trigger the seismic shift some fear.
As for masks – worn properly, they are effective in curbing transmission. However, Omicron has made cloth masks much less powerful, and only a minority wear the stronger – and more expensive – FFP2 style.
Finally, vaccine passports have applied to such a narrow range of venues in Scotland compared to the continent – where they restricted entry to everything from bars and restaurants to cinemas and some public transport – that lifting them is unlikely to be a game-changer.
The French Covid pass increased vaccine uptake among over-60s by an estimated 9 percentage points, reducing hospitalisations & deaths in Q4 2021.
Brilliant research from @OliuBarton et al, written up by @donatopmancini with charts from @digitalcampbell https://t.co/hYuWQqJ0FP pic.twitter.com/KLmfpZZ8zO
— John Burn-Murdoch (@jburnmurdoch) January 18, 2022
That doesn’t mean they don’t work, however.
In France, Italy, and Germany they are estimated to have boosted vaccine uptake by 13%, 9.7% and 6.2% respectively, according to a paper published in January by Belgian think tank Bruegel and the French Council of Economic Analysis.
In addition, the policy was estimated to have benefitted GDP in all three nations and, in France, to have stemmed Covid deaths and hospitalisations to levels significantly lower than they would have been without the extra vaccine protection.
A potentially bigger risk ahead is a return to pre-pandemic levels of mixing.
Even now, average daily contacts in Scotland are hovering around four and have never rebounded anywhere near the eight to 10 daily average before Covid triggered an exodus from the workplace.
Separately, the more transmissible BA.2 Omicron sub-strain is on the rise and may already account for half of Scotland’s Covid cases.
Real-world data from the UK and Denmark so far indicates that it does not cause more severe disease – but it won’t be the last Covid variant.