There is now a real opportunity for elimination of Covid-19 in Scotland, but the Scottish government cannot be relied upon to ensure that it happens. rs21 members in Scotland discuss how to seize the moment and fight for a just and sustainable recovery.
On this website, we have published two pieces (here and here) discussing the recent Independent SAGE report entitled Zero Covid-19 : Why is England not pursuing an elimination strategy? This report described the death toll over the coming months, implicitly accepted by current UK government strategy, as ‘not only preventable’ but ‘absolutely unacceptable’. It outlined ‘a new overarching strategic objective of achieving a Zero COVID UK, i.e. the elimination of the virus from the UK’. Importantly, it also argued that this ‘should be informed by science and debated in public’.
By ‘elimination’ they mean ‘reduction to zero new infections spread among people living in a country and the presence of the measures necessary to prevent or deal with imported cases and associated spread from new arrivals’.
What about Scotland?
Independent SAGE says: ‘The Republic of Ireland, Scotland and Northern Ireland already have very few deaths and very small numbers of new positive cases. They have the virus under control and are well placed to achieve elimination of the virus.’ By ‘control’ they mean: ‘Reduction of the number of people currently infected with the disease to a low level and the capacity to maintain that control indefinitely).’ For UK countries they define that number as ‘…a seven-day rolling average of one new case per million population per day.’
The report continues:
In Scotland and Northern Ireland (and also in the Republic of Ireland), both the numbers of deaths and the numbers of newly positive cases are very low. Both Scotland and Northern Ireland should continue to increase their efforts until control is assured and there is, in effect, a Zero COVID Scotland and a Zero COVID island of Ireland… It seems sensible that travel restrictions should … be instituted on public health grounds between England (and Wales) and Ireland and Scotland.
How do these recommendations fit with the current strategy of the Scottish Government?
Two days after Independent SAGE published their report, the First Minister announced further relaxations of lockdown measures, to start either immediately or soon. This is ‘Phase 3’, which she said was the most risky step the government had taken. She introduced the changes by saying the government considered that Scotland met all six of the World Health Organisation (WHO) conditions for relaxation of lockdown measures. In the next breath, hedging her political bets, she told us that the fifth condition – a country must be able to manage imported cases – had given the government ‘pause for thought’ about its ability to manage the risk of cases being imported both from overseas and from other parts of the UK.
This all sounds good – the Scottish Government is notoriously successful at sounding good. And one thing they introduced last week – the mandatory wearing of masks in shops, at last, is as good as it sounds. But four important things were missing from the substance of the announcement.
First, the Scottish Government is continuing to be silent about the capacity of its public health system to identify and react to outbreaks of infection quickly enough to deal with them before they spiral. It’s all very well to have stamped out a small outbreak in Annan and Gretna, but what if there were bigger outbreaks, and simultaneous ones in say Ayr, Glasgow and Aberdeen? Could the co-ordination and staffing of the system cope? The First Minister said herself that we should expect other outbreaks. We have seen how it took weeks for the heavily centralised system in England to get the evidence of an outbreak in Leicester to its Director of Public Health, resulting in another lockdown and the likelihood of further unnecessary deaths over the next week or two. Of the system in England, Independent SAGE says that elimination of the virus ‘will require the government in Whitehall to replace their failing NHS Test and Trace System with a fully-fledged and locally controlled system of Find, Test, Trace, Isolate, Support (FTTIS).’
In that context, people in Scotland need and deserve categorical evidence that they can put trust in the Scottish system. At least we know the system hasn’t been outsourced, in contrast to the English system. We have also been informed that nurses, either redeployed or from the bank, are doing the testing and tracing locally. But we should be told about the numbers of these nurses, and about what training they have received for a difficult job. Most critically, we need to know how quickly and frequently local Directors of Public Health are getting information about new cases in their area. The Director of Public Health in Blackburn, interviewed on Radio 4 on 15 July, described in detail how once he had received the postcodes of 114 new cases over the past two weeks in Blackburn, he was able to identify that 97 of them were people of South Asian origin living in multiple-occupancy terrace housing. He then swiftly set up a discussion with the South Asian community and introduced five measures specially tailored for that community. He said, however, that he only started to get weekly data from the centralised system in London two weeks ago, and that daily rather than weekly data was necessary to fight local outbreaks effectively.
Second, it’s nothing but a sound-bite to say that the Scottish Government was given ‘pause for thought’ by WHO condition 5 (which states that before relaxation a country must have in place the capacity to prevent or deal with imported cases), unless it puts travel restrictions in place alongside the relaxation measures. This is clearly a critical problem for Scotland, given its land border and supply connections with England, where current policy makes it highly likely that there will be a second epidemic wave this autumn or winter. So specific travel restrictions have to be put in place, now not later. Independent SAGE advises: ‘Restrict incoming or outgoing personal travel internationally and within Britain and Ireland to the extent necessary to maintain control of the epidemic and, in particular to ensure effective isolation of incoming passengers.’
Third, this should have been the moment to announce measures to address the impact on the rest of the health service of redeploying large parts of the system to focus exclusively on Covid-19. As a result, people with potentially life threatening conditions have been left in limbo, and others with chronic conditions untreated. The scale of this impact is likely to be huge. A study by University College London and DATA-CAN predicted in April that as many as 18,000 people could die over the next year across the UK as a result of delays in diagnosis and treatment of cancer, particularly the surgical removal of tumours. Despite the decline in infection rates, turning this round has been very slow. This is against a background where Scotland’s cancer waiting time targets have been missed for seven years in a row. A strategy for putting public health first has to be comprehensive – not simply an extended crisis response but one that is resourced to meet health needs across the board.
Fourth, there was no reference to the particular difficulties faced by refugees in Scotland. Given recent events in Glasgow, this was a serious omission. The Home Office, not the Scottish Government, is largely to blame for the disgraceful treatment of many refugees in the epidemic, but judging by the rally outside the Scottish Parliament on Sunday (12 July) , there is a strong feeling that more can and must be done by the Scottish Government to support these highly vulnerable people.
The Scottish Government apparently didn’t even pause for thought about WHO condition 6: that ‘Communities are fully educated, engaged and empowered to adjust to the new norm.’ This isn’t just a democratic principle, it’s an essential part of any successful public health strategy. Independent SAGE puts it like this: ‘The government [whether Westminster or Holyrood] must share [its] strategy with the public to seek their support and assistance in seeing it implemented.’
What can we do?
Here are six things we can do, in whatever small or larger ways we are able to:
- Challenge the Scottish Government, through our MSPs, to follow through with the opportunity we have given them and increase their efforts to eliminate the virus in Scotland, in line with WHO and Independent SAGE advice. Specifically, we ask the Government to:
a) give us comprehensive information about its public health capacity to deal with outbreaks,
b) put in place travel restrictions necessary to prevent or deal with imported cases,
c) do more to support refugees,
d)meet the wages of anyone who has to isolate as a contact for as long as they are away from work – after all it’s an action of social solidarity they are being asked to undertake. (You could choose to use this wording in a letter to your MSP.)
- Begin to discuss, in our communities and workplaces, how ‘lockdowns’ can be better targeted on specific high-risk settings and workplaces known to your community, rather than as a blanket, top-down instruction. The word ‘lockdown’ itself has repressive implications, originating from the prison practice of locking prisoners in their cells. We could replace it with ‘safety measures’. Also discuss who are the people in your community for whom sticking to safety measures is most difficult, particularly if they are isolating as a contact, so that community support can be more accurately targeted on the people who most need it. Note above that Independent SAGE includes support for isolating contacts in its recommendations – Find, Trace, Test, Isolate, Support (FTTIS). Effective support can only be organised locally.
- Organise collectively in our workplaces and communities to keep ourselves safeat home, at work and on the way to work (in relation to safe public transport). Join a union if you’re not already in one and elect your own Health & Safety reps who will have legal rights to training and monitoring of health and safety at work. and monitoring of health and safety at work. Ensure that there is adequate and appropriate PPE, distancing and cleaning in your workplace and that no one is forced to work in ways or in places where they are unsafe. Build collective organisation and confidence to save lives, save jobs, save the planet (see point 5).
- Express our solidarity with working class people in England. Infection rates in England are a huge risk for us, but we mustn’t let that be a reason for us to turn against people living there. Their lives are being put at risk by a government whose strategy has now been exposed to be nothing less than class cleansing.
- Argue strongly for a Just Green Recovery for Scotland, to be merged with its strategy for elimination of the virus. Not one after the other, but simultaneously, the two strategies vitally reinforcing each other. The focus of the Just Green Recovery strategy has to be jobs – both new jobs in carbon-saving and carbon neutral sectors (which includes higher education, schools, the NHS, care services, nature conservation, local food production – not only the energy sector), and fighting every single threatened redundancy in these sectors. If we don’t stand up and check the way things are going, it’s estimated that one third of young Scots will be unemployed by Christmas.
- Support the realisation that Our Safety is in Our Hands. We live in the country (the UK) where more people have died so far from Covid-19 per head of population than in any other country in the world. We are best placed to recognise that we can’t put our lives into the hands of neoliberal governments, however they spin themselves as having our interests at heart. They have made it clear that if we are Black, or poor, or old, or disabled, or have underlying health conditions, then they believe we can be sacrificed. We cannot and will not let them.