The COVID-19 pandemic has led to unprecedented calls on the health system, as well as policy and financial decisions that have made fundamental changes to everyday life for people in Scotland. While it has been necessary to take these extraordinary measures to protect public health – indeed, it has been vital, given the Scottish Government's duty to protect the right to life, the proportionality of the measures taken and their differential impacts on the Scottish population have been an intrinsic part of the decision making during this emergency situation.
The Coronavirus (COVID-19): Framework for Decision-Making and Scotland's Route Map through and out of the crisis, along with the updates published on 28 May and 18 June, make clear that COVID-19 is first and foremost a public health crisis and the measures to combat it have been necessary to save lives. The Framework for Decision-Making identified four main categories of harm: direct health impacts, non-COVID-19 health harms, societal impacts and economic impacts. These harms are deeply inter-related: health harms impact on society and the economy, just as the societal and economic effects impact on people's physical and mental health and wellbeing. The Route Map sets out the range and phasing of measures proposed for Scotland as it moves out of lockdown. Like the initial response to the crisis, navigating the right course out of lockdown involves taking difficult decisions that seek to balance these inter-related harms and risks.
Harms may be felt over different time horizons. Some harm may not be fully understood for many months or even years, such as long term impacts on people's physical and mental health and on school attainment. However, even in these initial stages, it is clear that impacts are not being felt equally across the population and that the most negative impacts fall on those least able to withstand them. Consideration of the continued but differential impacts, as lockdown is lifted in careful phases, will continue to be critical to the decision making process.
Scotland's Route Map recognises that estimates of the reproduction number R are uncertain and that room for manoeuvre is limited. The phases, although they seek to restore as much normality as possible when it is safe to do so, are therefore gradual and incremental and will be accompanied by careful monitoring of the virus. Proposed activities are grouped into categories and divided into four key phases (preceded by the Lockdown phase). The Route Map sets out criteria on which progress from one phase to the next is assessed. Decisions on the correct time to progress through the phases are being taken depending on the transmission of the virus in the population, the balance of harms and an informed understanding of the impact of measures across the diverse population, including, the impacts on equality groups, on the realisation of human and children's rights, and on those people who are the most socio-economically disadvantaged in our society.
New evidence is continually being produced and this evidence, alongside the views of partners in the public, private and third sector and the views of Scottish citizens will be important in taking the next steps.