HAIRDRESSERS "closed for six months", football matches played in empty stadiums and talk of pubs being the "last to open".

The debate about lifting lockdown has focused on how long social distancing will rob us of our social lives.

But those on the Covid frontline are grappling with a much bigger dilemma: how to resume a "new normal" in hospitals and GP surgeries which have put routine care on hold.

One of the reasons why Scotland's NHS has coped so well with coronavirus is because thousands of elective procedures were postponed for three months in March to free up beds and staff. No figures have been published to date on exactly how many patients this has affected.

READ MORE: Third of cancer surgeons stop operating completely over virus fears 

The Herald on Sunday asked all mainland health boards in Scotland for their cancellation numbers, but only four responded.

In NHS Borders, 380 procedures scheduled to take place between March 13 and April 30 were postponed due to Covid, with NHS Forth Valley delaying 396 – including 107 orthopaedics surgeries likely be mainly hip and knee replacements. 

NHS Grampian has gone from performing an average of 717 operations a week to just 90 per week in the last three weeks.

NHS Lanarkshire said it had delayed 969 surgeries and non-surgical treatments to date. This included 214 orthopaedics operations, 25 in cardiology, 114 in gynaecology, 107 each in urology and ENT (ear, nose and throat), 105 cataracts and 13 chronic pain procedures, among others.

Outpatients clinics have been cancelled and even some cancer treatments and surgeries have been delayed due to the risk of potentially exposing extremely vulnerable patients to the virus.

This shutdown cannot continue indefinitely, however, and clinicians say they fear the next phase – of trying to balance virus suppression with increased hospital activity – will be much more challenging.

"China has started to do a bit more routine work now but they're doing it with a lot more constraints around who they're choosing to operate on.

But that's also required everyone to be tested before surgery, which is something we're not doing yet," said Simon Barker, a paediatric orthopaedic surgeon in Aberdeen and former chair of BMA Scoland's consultants' committee.

"The other issue is that because of the PPE requirements in theatre it slows the whole system down massively. We're seeing right across the UK that it takes a whole morning to do a single case because of the requirement to all gown up and have kit outside the theatre instead of inside.

"If that continued it would impact our capacity massively going forward because most operating theatres for elective care would normally do two joint replacements in a morning and two in an afternoon at the very least.

"If we were using PPE going forward we'd be lucky to do two in a day. If testing was ramped up and we were doing it routinely for all cases, maybe we could pull back on the PPE and get more capacity through theatre – but that's all speculation for now. There's a lot of unknowns about how and when we can restore normality to services."

READ MORE: How many deaths are linked of poverty and obesity?

Mr Barker stressed that there would be no "flick of a switch" at the end of the three months, and that – depending on priority – some delayed patients would have to wait until 2021 for surgery.

"The waiting times guarantees just can't be on our horizon any time soon," he said.

"It's very heartening to have people clapping for the NHS on a Thursday but we're going to need those same people to have a measure of understanding when this ends and they want their hip replacement done and unfortunately we do not have the capacity to do everybody within a week. It's going to take months to catch up, there's no doubt about it."

It is a view echoed by Jacqui McMillan, an orthopaedics and trauma surgeon at Crosshouse Hospital in Kilmarnock, Ayrshire.

"We weren't in great shape for waiting times beforehand because we have an ageing population and the demand is high," said Ms McMillan, who is also deputy chair of BMA Scotland's consultants' committee.

"The vast majority of my work is in total knee replacements and I do ligament reconstruction in younger patients, and it's breaking my heart. It's not life-saving surgery but I've got a lot of patients out there in pain and they are worrying.

"But a lot of joint replacement patients are older and we're going to have to balance the risk of getting their joint replaced with the risk of having them outside and not shielded.

"We're going to work our socks off to get their surgeries done as quickly as possible but it has to be done safely. That means keeping social distancing in hospital, which will have an effect on how many patients we can admit at any one time."

READ MORE: 'Covid and non-Covid hospitals needed' so that elective surgery can resume

The president of the Royal College of Surgeons Edinburgh, Professor Mike Griffin, this week called on the Scottish Government to tackle the backlog of elective surgeries by establishing designated Covid and non-Covid hospitals, to limit the risk of infection to cancer and other frail patients.

He also suggested that part of NHS Louisa Jordan could be converted into operating theatres to increase capacity.

There are also increasing concerns that serious health problems being stored up at a community level.

Weekly A&E attendances across Scotland have halved and the number of patients with possible cancer symptoms being referred for tests has slumped 72 per cent.

Both trends have been blamed on people too scared to go to hospital in case they catch coronavirus, or reluctant to bother doctors during the pandemic.

Medics report patients leaving infections so long they need surgery when they could have been treated with antibiotics, or ignoring cardiac symptoms until they suffer a heart attack.

Meanwhile, statistics revealed that there have been nearly 900 "excess deaths" registered in Scotland between March 30 and April 19 from heart disease, strokes, cancer and dementia.

This phenomenon poses a serious dilemma for politicians trying to limit the death toll from coronavirus against the dangers of exacerbating mortality from other causes in the process.

The paradox is most acute in deprived areas where chronic ill health and late-stage cancers are most prevalent, yet the population is also rife with risk factors such as diabetes, smoking and obesity which would make them particularly vulnerable if lockdown was eased too quickly and a second wave of the virus struck.

Dr Carey Lunan, chair of the Royal College of GPs in Scotland and a GP in Craigmillar, one of Edinburgh's most deprived areas, said: "The levels of morbidity, especially multi-morbidity – living with three or more chronic conditions – is more of an issue if you live in a poor area because you develop all those disease at a younger age, on average 15 years earlier than the most affluent areas.

"In addition to that the prevalence of smoking and harmful alcohol use is higher as well, both of which are risk factors for Covid. Smoking especially is a significant risk factor for becoming more unwell if you do catch Covid."

Dr Lunan does not expect GP surgeries to resume normal service any time soon, with video and telephone consultations the norm and limited face-to-face appointments.

She said: "Depending on whether we have to maintain the same stringent infection control measures by wearing PPE and cleaning rooms between patients, we'll be able to see far fewer face to face patients. It just takes so much longer."