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How Scotland became the Covid capital of Europe

A new piece of street art by The Rebel Bear has appeared on a wall in Cannongate, Edinburgh - Andrew Milligan/PA
A new piece of street art by The Rebel Bear has appeared on a wall in Cannongate, Edinburgh - Andrew Milligan/PA

Scotland’s First Minister Nicola Sturgeon talks a good game, but Covid cases have surged over the last week to make Scotland the coronavirus capital of Europe.

Last week Ms Sturgeon’s health minister suggested the Euros - something outside of her control - were partly to blame, but experts say the real problem may be closer to home.

They say a combination of a slower rollout of second vaccine doses, lower levels of antibodies in the population and a failure to contain the initial outbreak of the new Delta variant in Glasgow better explain why new daily Covid cases north of the border have climbed almost vertically to exceed their January peak.

“If you had your time again or a crystal ball, you would not have planned mass events,” says Professor Linda Bauld, a public health professor at the University of Edinburgh, referring to the Euros. “But although football has contributed, it is not the cause of the rise in cases in Scotland. It’s not to blame.”

Scotland is now the worst-hit region in the UK, with 317 infections per 100,000 people - more than double the English rate of 149 per 100,000 people.

On Friday, it reported more than 4,000 new infections - the highest number so far in the pandemic, although hospitalisations and deaths remain mercifully low.

The First Minister herself admitted that football fans only tell part of the story. There were 1,991 cases linked to people watching the championships, according to Public Health Scotland, two-thirds of which were among people who came to London for the June 18 England-Scotland clash at Wembley.

But in the same period, June 11-28, there were 32,500 Covid infections in total in Scotland, dwarfing those related to football.

According to data from the Zoe app, the two worst-hit regions in the UK are Dundee and Aberdeen - with 2,873 and 2,045 infections per 100,000 people respectively.

They are followed by Liverpool and Oldham in north-west England, with 2,035 and 1,486 cases per 100,00. So what is going on?

A victim of its success

Prof Bauld says there were a number of factors. Serology data from the Office of National Statistics shows Scotland has fewer people with antibodies against Covid-19 than England: 79 per cent compared with England’s 87 per cent.

“In some ways, Scotland is a victim of its success - fewer people had the virus in the first and second waves so it has more opportunities to jump now,” says Prof Devi Sridhar, an advisor to the Scottish government. “Now we have got to get vaccinating as quickly as we can.”

But while vaccinations are moving at a similar pace across the UK, the averages disguise important gaps.

And these are gaps which the highly transmissible delta variant will exploit, says epidemiologist Prof Mark Woolhouse. “A more transmissible variant is just better at finding the vulnerable people - looking in the corners,” he explained.

Prof Bauld points out that in the group representing around 70 per cent of all Covid-19 infections in Scotland - those aged 45 and under - only four in 10 have had both vaccine doses.

That’s important because one dose is only around 33 per cent protective against symptomatic infection with the delta variant.

In England, 47.7 per cent of 40-45 year olds have had two doses, and ministers have pledged that all over-40s, as well as the clinically vulnerable, will be double-jabbed by July 19.

Ms Sturgeon, who recently sought to stop travel to Scotland from the north of England, says the precipitous jump in cases is also down to happenstance. “The delta variant seeded into Bolton initially and Bolton is quite small, whereas in Scotland the delta variant seeded in Glasgow, which is our biggest city,” she told reporters last week.

Experts point out there are other factors at play in these areas, too. Across the UK, vaccination rates are lower in the big cities.

“This is all about inequality,” said Prof Bauld, pointing out that infectious diseases “really like” densely populated inner-city areas.

Prof Sridhar said deprivation remained a risk factor, with other issues including the Scottish population’s high level of poor general health also contributing.

Hold your breath

Cases are one thing, hospitalisations are another, and Scotland with its sky-high caseload could provide an early indicator of what happens across the UK over the next month.

“We are all holding our breath to see if vaccines and mass testing will be enough to make sure hospitals are not overwhelmed,” said Prof Sridhar.

So far, in both England and Scotland, hospitalisations are creeping up but not rocketing in line with cases.

There are 1,500 people in hospital with Covid-19 in England, and 202 in Scotland, with 264 and 20 on ventilators respectively. There were 3 deaths in Scotland and 11 in England on 30 June.

Scientists are cautious about further unlocking but agree a move back into full lockdowns is hard to imagine. A big enough rise in cases could still spell disaster for the NHS, though.

“There’s no good option - that’s true for every country,” said Prof Sridhar. “But I don’t like the idea of ‘Freedom Day’. Pandemics don’t end with a parade.”