Why Scotland isn't faring much better than England despite Nicola Sturgeon's 'zero-Covid' approach

Scotland's "zero Covid" strategy appears to be slipping away as new infections continue to grow - driven by the return of students in the cities.

First Minister Nicola Sturgeon is said to be considering more lockdown restrictions as new cases continue to rise, risking her strategy to eliminate the virus entirely.

While England's situation is worse, with high-risk areas seeing rates double after 15,000 new cases were dumped on Sunday - missed from the system after an Excel spreadsheet error - there are now very real warning signs in Scotland.

And though Scots endured a much stricter lockdown through the summer, as the country begins to open up the rate of infections is now gathering pace, matching England's.

Before Public Health England (PHE) added 15,000 unreported cases last Sunday, it appeared Scotland's infection rate had overtaken England, when adjusting for population.

Scotland was seeing 72 weekly cases per 100,000 residents by the end of last week - the rate having doubled over the previous ten days. England at the time was recording 62 cases per 100,000 - a doubling time of 20 days.

But when the more accurate picture was revealed, England remains the worst affected country, with 101 weekly cases per 100,000 up to October 2, compared to 80 in Scotland, and daily cases are doubling in both nations every nine to ten days. 

Experts have said Scotland may now be suffering as the country experienced relatively low cases numbers throughout the summer, and with university students descending on the major towns and cities several weeks ahead of their English counterparts, it is at a "tipping point".

Linda Bauld, professor of public health at Edinburgh University, says: “Students in Scotland went back earlier than those in England and they have skewed the numbers. If you look at where cases are distributed they are highly concentrated in Glasgow and Edinburgh where there are lots of students."

The infection rate in Glasgow it is 191 per 100,000 of the population, in Edinburgh it is 119 and Dundee it is around 101 - three big student cities. 

Devi Sridhar, professor of global public health at Edinburgh University and an adviser to the Scottish government, agrees that universities are skewing the figures. 

She adds: “If you take away these clusters the community transmission is very low. But I'm very concerned we're at this tipping point - can we hold it in clusters or is it going to tip over into the community?"

The only divergence between England and Scotland on a national footing relates to household mixing, which remains banned in Scotland but has been relaxed in England - only to be tightened again when the "rule of six" was introduced last month. 

A stricter lockdown

Scotland has had tougher lockdown restrictions than England since measures were first relaxed at the beginning of summer, according to a team of researchers at Oxford University tracking government responses to coronavirus. 

Hundreds of laws are now  guiding behaviour in each of the UK nations - banning household mixing and large gatherings or enforcing public health guidelines.

As a devolved issue, public health is a matter for devolved governments and this has led to a confusing and piecemeal set of regulations for the United Kingdom as a whole and a four-nation approach to the virus.

Scotland's own lockdown stringency score - a single measure derived by the researchers from the entirety of a country's restrictions, from the closure of schools to stricter border controls - has been higher than England’s ever since in May.

On May 10 the UK Government updated its coronavirus messaging from “stay at home, protect the NHS, save lives” to “stay alert, control the virus, save lives” - but the Scottish Government announced they would keep the original slogan, ending the initial period of uniformity between restrictions in both nations. 

Though the country’s lockdown stringency scores may now be similar overall, key differences in approaches to combating Covid-19 remain either side of the border.

Scotland has pursued a “zero Covid” strategy, similar to that of New Zealand, with the aim of reducing “unacceptable incidence of the disease”, says Prof Sridhar. 

And in the summer that goal did look tantalisingly within reach - in early July daily numbers were down to single digits. 

“We didn’t eliminate the virus but we got to a better place than England,” says Prof Bauld. “We then got to a position when shops and businesses opened as much as England and cases started to rise again,” she adds.

Testing the union

To some degree the disparity in case rates between England and Scotland could be driven by testing - a nation testing more is bound to discover more cases - but the picture is mixed, with both nations alternating between who is ahead. 

Swab tests carried out in labs, hospitals and care homes  - Pillar 1 and Pillar 2 of the Government's testing regime - had initially been growing at the same rate in Scotland and England from August onwards, with daily new tests in both nations increasing from around an average of 190 per 100,000 people at the start of the month to roughly 250 by August 23.

Then through to the beginning of September, testing in Scotland ramped up amid new local lockdowns in Scottish regions such as Glasgow, Renfrewshire and East Dunbartonshire.

This led testing to overtake the situation England, with the daily rate peaking  in Scotland at around 420 per 100,000 people on September 2.

"Over recent days Scotland has proportionately been doing more tests than other parts of the UK," Sturgeon said at the time.

"We are testing proportionally way above our population share or have been on certain days above our population share in a UK sense.”

Now, however, Scotland has fallen behind and England has pulled ahead proportionally. As of October 1, 350 tests were being conducted each day per 100,000 people in England, versus 282 per 100,000 in Scotland. 

Local lockdowns

A chaotic system of local lockdowns peaked lat week when the Mayor of Middlesbrough spoke out against the UK Government, claiming their restrictions were based on "factual inaccuracies and a monstrous and frightening lack of communication, and ignorance".

Currently close to 16.8m people in Great Britain are living under some form of local Covid-19 restrictions, after a swathe of north Wales and parts of the north-west of England were handed their own fresh guidance.

A legal ban on different households meeting each other was imposed in the Liverpool city region, Warrington, Hartlepool and Middlesbrough on Saturday.

And despite localised restrictions being used in England, Scotland and Wales - some for as long as three months - there is little evidence they are having the desired effect.

Across England and Scotland only two local authorities have had local restrictions lifted and not reimposed - Luton and Aberdeen.

It is despite the UK Government - responsible for measures in England - attempting to lift restrictions only to tighten them once more.

When measures in Wigan were relaxed, the average daily infection rate climbed from two per 100,000 to 20, forcing action to be taken once more.

And after measures were lifted in specific areas of Bradford, the infection rate doubled from 10 cases per 100,000 to 20.

In many of the areas where restrictions were relaxed it appeared rates were coming under control, only to revive again after the measures were loosened. Infections in Calderdale were halved before some of its wards were taken out of measures, only to rise from 4.6 to 12.7 per 100,000 people in the  20 days before the whole local authority was put back into local lockdown.

In Scotland there have not been similar attempts to lift measures prematurely. Only in Aberdeen have restrictions been lifted, and for 25 days the infection rate remained static.

In recent days it has begun to climb once more, from two cases per 100,000 to seven in the last 12 days.

What are the national measures?

England

In England gatherings of more than six people have been banned since September 14, under the "rule of six".

There are some notable exemptions to the English “rule of six”, including for people who live in the same household "bubble" or for specific "reasonable necessary" gatherings.

Currently 12.7m people in England (23 per cent) are living under some form of additional Covid-19 restrictions, concentrated in the north of England, West Midlands and West Yorkshire.

In England, only Bolton currently has strict business closure rules in place. Restaurants, cafes and pubs can only open to provide takeaway or delivery services. A broader range of businesses, including casinos, indoor play areas and bowling alleys must close entirely. 

Scotland

In Scotland outdoor and public gatherings involving more than six people aged twelve and over, from more than two extended households are banned.

There are some exemptions to this rule, including for work purposes, childcare, worship or moving home. Gatherings inside private dwellings are subject to a household mixing rule.

1.8m people in Scotland (32 per cent) are now living under localised restrictions, including Glasgow, Renfrewshire, Lanarkshire and Dunbartonshire.

Wales

In Wales indoor gatherings involving more than six people aged 11 and over, from more than one extended household are banned, as are outdoor gatherings of more then 30 people. 

Welsh Ministers have powers to authorise outdoor gatherings involving up to 100 people organised by businesses, charitable and public bodies, clubs, political parties and sports bodies who have carried out a risk assessment.

2.4m in people in Wales (74 per cent) are living under local lockdowns, with Conwy, Denbighshire, Flintshire and Wrexham joining the list this week.

Trust in leaders

One big difference between Scotland and England has been in public perceptions of and trust in its leaders. 

Ms Sturgeon has continued her daily briefings throughout the pandemic and has not hesitated to discipline those close to her who broke the rules.

She sacked her chief medical officer for breaking lockdown restrictions in April and urged SNP MP Margaret Ferrier to resign after it emerged she had visited the Houses of Parliament and taken a train despite testing positive for Covid-19. 

The Covid-19 Social Study, an ongoing research project tracking attitudes to the pandemic by academics at University College, London found both greater understanding of the rules among people in Scotland and more satisfaction with the performance of its leaders.

“I have worked on Ebola outbreaks and wherever you are in the world it’s about bringing the public with you and it requires everyone to buy into the collective interest. That has happened in Scotland,” says Prof Sridhar. 

The more positive attitude towards Ms Sturgeon is interesting when, overall, Scotland has not fared that much better than England. 

Care homes were hit equally hard in Scotland and England. And on excess mortality - seen as a fairer way of comparing death rates than just looking at Covid-19 fatalities - England had the highest rate in Europe among the under 64s between January and June, and Scotland had the second highest, according to Office for National Statistics data. 

Some say it is unfair to compare overcrowded England, which has a population of 60 million, and Scotland‘s five million. England also has the highly connected London. 

But Prof Sridhar adds: “Scotland’s central belt is crowded and the population in parts of Glasgow is unhealthy with higher rates of obesity, heart disease and non-communicable disease.” These are all risk factors for Covid-19. 

But while Prof Bauld agrees that Ms Sturgeon has done better in terms of messaging and communicating to the public than her English counterparts, the outcome has not been that different.

“Overall I don’t think Scotland has done that much better than England. The differences have been minimal."