WHEN Covid first swept through Scotland in 2020, the total number of excess deaths recorded - 6,324 - was the highest in peacetime since the Russian flu outbreak of 1891.

Compared to the previous five years, total mortality was 11 per cent higher.

A tragedy undoubtedly, but one that could be partly blamed on a new and deadly disease against which there were no vaccines, no antivirals, and initially, no medicines.

And, partly, on failures to adequately contain it, of course.

READ MORE: Non-Covid illnesses overtake Covid to cause more than half of Scotland's excess deaths 

Yet two and a half years on, excess mortality has barely changed: the total number of excess deaths from February 28 to August 28 - 2,708 - is still 10% above average for the same six month period in 2016-19 plus 2021 (2020 is excluded as an anomaly).

What has changed is the main cause, and it is no longer Covid.

On the downside, the diminishing lethality of Covid has been offset by much higher rates of the virus, which continues to translate into a significant number of deaths.

HeraldScotland:

HeraldScotland: Covid rates have been much higher over the past year, but the case to fatality ratio is much lower (Source: Public Health Scotland)Covid rates have been much higher over the past year, but the case to fatality ratio is much lower (Source: Public Health Scotland)

All things being equal, however, the excess death toll should still have shrunk.

Instead, we now find other, non-Covid, causes increasingly making up the difference.

It is not impossible that the coming winter could even see excess deaths overshoot the 11% rate seen in year one of the pandemic.

Covid is no longer top of the agenda in public attitudes: polling shows most Scots are primarily worried about rising fuel and grocery bills, with spiralling NHS treatment backlogs and delays to operations close behind.

Nearly 60 per cent surveyed in August said catching Covid now would be "an inconvenience rather than a real concern".

READ MORE: Appointments cancelled as health board says only most 'time-critical' treatments will go ahead on day of Queen's funeral 

Meanwhile, the legacy of Covid is probably only just beginning to bite.

The number of people dying from cancer in 2022, for example, remains below pre-pandemic levels - yet we know that diagnoses fell during lockdown as screening was paused, and that patients currently being referred with symptoms are facing much longer waits for tests.

Not everything is down to Covid, however.

HeraldScotland: The number of hospital beds lost to 'delayed discharge' - patients well enough to leave hospital but unable to - reached a record high in July, the same month that the number of people spending over 12 hours in A&E also reached an all-time highThe number of hospital beds lost to 'delayed discharge' - patients well enough to leave hospital but unable to - reached a record high in July, the same month that the number of people spending over 12 hours in A&E also reached an all-time high

For many, these excess deaths are the chickens coming home to roost after more than a decade of bed cuts carried out without corresponding investment in social care at a time when the size of the population of over-70s with multiple chronic illnesses - exactly those most in need of social care - has soared.

The result? Roughly three in 20 hospital beds lost to patients well enough for discharge, while others languish for for hours - or days - in overcrowded and understaffed A&E's.