Coronavirus (COVID-19): framework for decision making - assessing the four harms

Sets out the four harms process for assessment used to establish when coronavirus restrictions could be safely lifted after lockdown and the scientific evidence underpinning the decisions.


Although many challenges presented by COVID-19 are shared across Scotland, some communities will face particular disadvantages linked to place. People living in rural and island communities, for example, are generally less at risk of community transmission as they will come into regular contact with a more limited number of people. However, this needs to be balanced against an ageing population and more limited access to public and health services including urgent healthcare provision. Issues such as a higher cost of living, fuel poverty, part-time work or 'portfolio careers' and more complex and expensive transport links may make it difficult for individuals in rural areas to manage financially through this period of economic stress. The high reliance on tourism will also be problematic with the need for tourists to keep the economy moving balanced against the increased community risks of virus transmission.

People living in areas of multiple-deprivation are more likely to have higher rates of virus transmission, serious illness or death caused by COVID-19 than those in the least deprived areas[15]. Those in more deprived quintiles have experienced more cases (25% of the total) compared to those in the least deprived (18%).[16] They also have a higher risk of poverty, fewer opportunities for social mobility and, in places, poor transport links. People living in some densely populated urban areas may have limited local high quality greenspaces for exercise.

Figure 7 Positive cases by deprivation category (SIMD) (28 February to 29 November 2020) [17]

Craph showing positive cases by deprivation category (SIMD), 28 February to 29 November 2020



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