Winter is coming - and Covid is back in the news amid signs that infections are on the rise and uncertainty over the impact of a new, highly-mutated strain. 

Vaccines mean the situation is very different compared to 2020, but with surveillance curtailed it is more difficult to track the pandemic and not everyone will be eligible for boosters. 

So what do we know about the situation in Scotland and the new BA.2.86 variant?

Covid levels are increasing - should we be worried?

Surveillance in Scotland, and the rest of the UK, has been massively scaled back so it is unclear exactly how prevalent Covid now is.

The Office for National Statistics previously sampled tens thousands of UK households every week in order to provide an accurate estimate for Covid levels in the community, but this was mothballed in March.

Some surveillance remains in place, however, including wastewater sampling and hospital testing.

Wastewater testing looks for traces of the virus in sewage in order to track what is happening in the community. This tends to fluctuate week-to-week, but the overall trend suggests that levels were comparatively low from mid-April to mid-July but subsequently increased.

Levels in mid-August were the highest since June last year.

The Herald: Wastewater Covid levels, tracked up to August 25Wastewater Covid levels, tracked up to August 25 (Image: PHS)

The number of Covid positive patients in hospital is also the highest since May 8, when changes in how they are counted were introduced. Over the past two months, the number in hospital with Covid has climbed from 65 on July 10 to 210 on August 10, and 420 on September 10.

While these patients have Covid symptoms, they are not necessarily in hospital because of Covid.

What's happening with vaccines?

Winter vaccinations are now underway in Scotland for both Covid and flu. In Scotland, everyone over 50 is being offered a flu jag on the NHS but Covid boosters are limited to the over-65s.

Health boards are expected to bring forward Covid vaccinations for higher risk groups including over-75s and elderly care home residents due to uncertainty over the impact of the new BA.2.86 variant.

In addition, Covid boosters will be offered to care home staff; pregnant women; frontline health and social care workers; anyone aged 12 and over who lives with someone who has a weakened immune system; carers aged 16 and over; and anyone aged six months or older with a specific health condition considered to put them at higher risk.

The Herald:

What do we know about the new variant?

The BA.2.86 variant was first detected in Denmark in July and designated as a "variant under monitoring" by the World Health Organisation (WHO) on August 17.

It has since been identified in several countries around the globe, including Hong Kong, Thailand, Israel, Germany, South Africa, and the United States, suggesting it has spread widely.

Nicknamed 'Pirola', it has more than 30 new mutations on the spike protein. This has prompted concerns that it may be more immune evasive and transmissible because existing antibody protection - from vaccines or prior infections - would be less effective.

However, there is currently no evidence that it is more virulent and vaccines are still expected to provide good protection against severe disease.

What should I do if I am infected?

Guidance continues to advise the public to stay home and isolate if possible if they think they are infected with Covid. However, most people no longer have access to free lateral flow tests.

The Herald:

Will masks and testing come back?

There have been calls from some scientists and clinicians to reinstate access to free lateral flow tests for Covid as winter approaches.

Campaigners, including some healthcare workers, have also urged the government to bring back masking in hospitals and care homes, including FFP3 masks as a minimum for frontline workers.

They also want to much greater use of ventilation and air filtration technologies to reduce the airborne spread of the virus in healthcare settings.