Covid: What does Scotland's experience tell us about 'Plan B'?

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Scotland also still has the strictest facemask rules of any of the UK nations: in Wales, they remain compulsory on public transport but not in pubs or restaurants; in Northern Ireland they are required on buses, trains, and all hospitality venues, but not in schools.

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However, Scotland, Wales and Northern Ireland all continue to advise working from home wherever possible, in comparison to a push in England to get more people back into offices.

Covid cases began plateauing in Scotland in early October, around the same time that there was a consistent rise in England

Wales' vaccine passport system came into force on October 11 restricting entry into nightclubs and large events only to those who are fully vaccinated or (unlike in Scotland) have had a negative lateral flow test in the previous 48 hours.

In Northern Ireland, vaccine passports have been ruled out but nightclubs remain closed (they will not reopen until October 31, with social distancing in bars and restaurants also dropped on the same date).

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Against the backdrop of diverging and overlapping Covid measures, it is arguably unfair that some of our European neighbours have been quick to criticise 'UK policy' for rising infections, with Italy's Corriere della Sera asking "how many deaths are the British willing to tolerate not the renounce their liberty" and France's L'Express newspaper denouncing our "dangerous myopia".

Confirmed cases have also been on the rise in Wales and Northern Ireland since the beginning of October, though less steeply than in England

As always, England is conflated with Britain, even though Scotland's policy (with the exception of a vaccine passport scheme that applies to a very limited range of settings) largely matches the continent's.

The more interesting question is to ask whether Scotland's experience actually bolsters, or weakens, the case for Plan B.

Right now, Scotland is averaging just over 2,500 confirmed cases per day. Infection levels, which fell sharply through September, stalled suddenly around October 6 and have plateaued ever since with some areas - Falkirk, East Dunbartonshire, Fife and Clackmannanshire - now seeing fairly rapid increases again.

In the month after moving to Beyond Zero on August 9, Scotland also saw the fastest rise in infections of any part of the UK. This coincided of course with an end to social distancing and the reopening of nightclubs, with revellers allowed to hit the dancefloors mask-free.

READ MORE: The surprising fall in Scotland's Covid cases - but will it last? 

Yet England's July 19 Freedom Day - which also included nightclub reopening, an end to distancing and the scrapping of facemasks - saw no such spike.

What about the return of schools? Between the first pupils returning in Scotland on August 11 and September 6, when infections peaked, average daily cases surged by nearly 400%.

In England, the first three weeks after schools returned saw a 3% drop in cases.

Wales currently has the highest Covid rates per head in the UK, whereas Scotland - which was highest during much of August and September - has seen case rates fall

In both countries, school-age children accounted for a disproportionate majority of infections even though Scotland has the UK's strictest policy on mask wearing for pupils and England does not enforce them at all.

Even the recent testing blunder which saw some 43,000 people in the south of England wrongly given false negatives after September 8 does not shift the overall picture significantly.

England has only really seen a consistent rise in infections since the beginning of October - the same point where Scotland's decline in cases stopped and levelled off. The same is true for Wales and Northern Ireland, whose cases have also been climbing since the beginning of this month.

None of this is to say that mitigations including facemasks, homeworking, and vaccine passports 'don't work'.

Rather it tells us that unpicking the impact of various measures in a real-world setting with so many confounding variables, especially around human behaviour, is extremely difficult.

The reality is that we don't really know why England's epidemic played out so unexpectedly, nor can we know how much worse Scotland's third wave might have been without them.

Scotland has now vaccinated half of 12-15s, compared to around 15% in England. But over 20% of 18-29s and 15% of 30-39s remain unvaccinated. Most other nations are also double vaccinating children over 12

Vaccine passports, of course, have only just come into force. Comparing approaches and outcomes in Scotland and Wales against England and Northern Ireland, and parts of Europe - where they apply to most public spaces - would be illuminating.

It is not a straight comparison though: much of the continent also benefits from lower levels of obesity, higher healthcare spending, and less chronic multi-morbidity, which has also helped to keep their Covid death rates lower relative to the UK.

For now then, Boris Johnson is banking on vaccines and boosters (and boosterism?) to get England through.

In Scotland, nearly 430,000 people have had their Covid booster - enough to cover all care home residents, and around 60% of all frontline NHS, social care workers and over-80s combined.

The 70-79 age group have begun receiving appointment letters.

Nonetheless, organisations including Age Scotland, have expressed concern that the programme is not moving fast enough at a time when over-80s - a group which is entirely fully-vaccinated - are making up 25% of hospital Covid admissions, up from 19% in mid-September.

Over 400,000 have now had boosters and 85.4% of people aged 16-plus are fully vaccinated. However, protection against infection appears to wane around six months

The JCVI is now said to be considering moving boosters to five months, rather than six months, amid concerns about waning immunity, winter pressures on the NHS, and new evidence that they propel protection against symptomatic infection back up to 95%.

If so, 50-59-year-olds who mostly received their second doses from mid-May would suddenly become eligible now, as opposed to mid-November.

Meanwhile, nearly one in 10 eligible Scots - 373,000 people aged 16 and over - are yet to be vaccinated at all.

Anything that can be done to enable or persuade this group to come forward still remains our best remaining weapon against Covid this winter.