IF YOU are still following the daily Covid-19 statistics you’d be forgiven for feeling a sense of alarm as Scotland’s third wave of infection continues to rise. The number of positive cases being recorded now is higher than it has ever been at any point in the pandemic.

Some of the outcomes have been dire, with over 24,000 school pupils self-isolating last week meaning many spent their last days of the 2021 school year at home rather than in the classroom. New findings this month from the REACT study in England also provided updated estimates of the links between infection and long Covid, suggesting around one in five adults who test positive may be left with persistent symptoms and poor health, even among younger age groups.

In the midst of this we’ve seen a shift in strategy from the Scottish Government. Previously, the stated aim was one of maximum suppression – pushing infection levels as low as possible to avoid people becoming unwell and placing unmanageable additional pressure on the NHS.

The strategy now, as set out in Scotland’s strategic framework update from June 2021 is “to suppress the virus to a level consistent with alleviating harms while we recover and rebuild for a better future”. In other words, to live with Covid-19 and try and find ways to mitigate its consequences.

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What does this actually mean in practice? That’s becoming clear in the short term but the longer term picture is still difficult to predict, particularly for the economy and the wider harms the pandemic has caused.

For the public health elements, a continued focus for the next few months will be to keep reducing the health harms from the virus. We can already see this happening. The last time we had case numbers nearing (but still well below) what we’ve seen this week was in early January 2021 when there were also almost 1,500 people in hospital and an average of 50 deaths per day among people who had tested positive for Covid-19.

There are now just over 250 people in hospital and a seven day average of around three deaths per day. This is due to vaccines which, even in the face of a more transmissible variant, reduce the risk of disease by over 80% and admission to hospital by over 90%. The direct harm to health has been substantially reduced but certainly not removed. We hope that it should decline further as more people receive their second dose. Vaccines can also help reduce transmission so we should hopefully see them contributing to driving down case numbers even in younger adults in the coming weeks, although there is no sign of this yet.

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The other changes planned in the short term are to continue to gradually ease restrictions – with all parts of the country moving to Level 0 on 19th July and physical distancing requirements outdoors being removed, with indoors down to 1 metre. With the case numbers we are seeing at the moment and also a rise in the number of people in hospital, this date is not guaranteed. Then from August 9th the hope is that all physical distancing regulations can be lifted. But what about the longer term?

From a public health perspective, there are some things we are living with now that we will need to retain for the foreseeable future. A key component of keeping on top of this virus is actually finding it. So regular testing is something we need to get used to, particularly for certain workplaces and settings. Contact tracing – the Test and Protect system and providing contact details when visiting hospitality or other venues – is unlikely to disappear anytime soon.

Expect an ongoing and, I hope, substantially improved focus on ventilation when we think about how new buildings are designed or how different settings can be safely managed. We may not be required to wear face coverings in indoor public places but I think we will be advised to do so in some circumstances, with tailored advice for more vulnerable groups. Plus we will need to keep coming forward to receive a Coviid-19 vaccine. Interim advice was issued this week that more than 30 million people across the UK should receive a third vaccine dose before the winter. This will sit alongside the flu vaccine and may even be given during the same appointment.

We already have some insight from other countries about which public health measures may be completely removed as part of ‘living normally’ with Covid-19. Singapore has begun to draw up a road map that involves maintaining testing (including using breathalysers and new technologies as an alternative), vaccination, treatments and good hygiene.

But they have said they will stop self-isolation of contacts of a positive case and replace it with daily testing. This is already being discussed here and it seems an almost inevitable next step if the tests used are accurate enough. They are also actively planning to fully reopen international travel once robust certification of vaccination status is possible between countries.

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At the individual level, once Covid-19 is endemic I think behavioural advice to the public will focus on three things. First to understand the risks in any given situation and know what to do, whether that be about avoiding crowded indoor spaces or considering whether travel is essential. Secondly for people and communities to expect living and working environments to take infection prevention seriously – including a culture shift from pressure to turn up for work when we are unwell. Plus a better understanding of how to build an infection control culture into our daily lives. We have a generation of children who know more about hand and respiratory hygiene than those that came before, which might be one small positive among all the negative aspects of the pandemic.

Linda Bauld is Chair of Public Health at the University of Edinburgh.