Coronavirus (COVID-19): framework for decision making

Section 2: Harms from COVID-19

• The pandemic is a health crisis, a social crisis and an economic crisis that is causing harm on an unprecedented scale.
• Difficult decisions are required to balance these various, inter-related harms so as to minimise overall harm.
• The harms caused do not impact everyone equally.
• We will protect those most at risk and protect human rights.

COVID-19 causes harm in at least four ways. First, the virus causes direct and tragic harm to people's health. We have seen this in these first phases of the pandemic in Scotland in the daily growth in number of new cases; number of new hospitalisations; number of people requiring treatment in Intensive Care Units; and, sadly, the number of deaths related to the virus.

Second, the virus has a wider impact on our health and social care services in Scotland; how our people are using those services; and how this impacts on non-COVID health harms. We have mobilised our health and social care services to an unprecedented degree to respond to COVID-19. That has meant the postponement of other types of care and treatment.

Despite the NHS remaining open for those who need it, we have seen significant reductions in people seeking help. This will impact on those most at risk. The health impacts brought about by greater inequalities may themselves be significant over years to come. We must adapt to ensure that our health and social care services can resume this wider care as soon as possible, and this forms part of our planning for the period ahead.

Third, the restrictions which Scotland, together with the other UK nations, has necessarily put in place to slow the spread of the virus can in turn cause harm to our broader way of living and society, including, for example, the negative effects of increased isolation, particularly for those living alone, and the impact on children's well-being from closing schools.

Fourth, along with the wider negative impacts of the global pandemic, the lockdown has had an enormous impact on our economy, with a potential fall of 33% in GDP during the period of lockdown. This is unprecedented and is causing deep uncertainty and hardship for many businesses, individuals and households. The damaging effect on poverty and inequality may be profound.

Closures and job losses have been inevitable, even with the unprecedented support provided by government. And the impacts will intensify the longer the lockdown continues: we will see more businesses unable to recover and we risk the scarring effects of unemployment. The risks of increasing hardship and increasing poverty are real. This in turn risks damage to the health of the population. We must do everything possible to avoid permanent, structural damage to our economy.

All these harms are related; health harms impact on society and the economy, just as the societal and economic effects impact on physical and mental health and wellbeing. Navigating the right course through the crisis will involve taking difficult decisions that seek to balance these various, inter-related harms so as to minimise overall harm.

COVID-19 affects everyone but the harms caused by the pandemic are not felt equally. Our response to this pandemic must recognise these unequal impacts. Just as we have sought to shield those most at risk, we must continue to provide additional support for those who need it and seek to advance equality and protect human rights in everything we do.

The lockdown measures set out in emergency legislation have been carefully considered in light of medical and scientific advice and are necessary to protect public health in Scotland. The measures are proportionate to the nature of the disease and the scale of the crisis. Consideration of the impact on human rights, and the need to protect those rights has been central to that decision-making process.

The pandemic is a health crisis, social crisis, and economic crisis of unprecedented scale with profound and permanent implications for our society. Our collective endeavours, with the people of Scotland, with the other nations across the UK, and with our partners in the European Union and beyond, to respond effectively, will help us to minimise the harms, respond to the pandemic, recover as a people and, however difficult, renew as a society.

In all these efforts – to respond, recover, and renew – Scotland will continue to be guided by evidence and judgement. That evidence will be needed to drive real innovation across every sector of society if we are to adapt to living with the virus.

Scotland is a responsible global citizen – an outward-facing, connected nation which listens to the advice and expertise of the World Health Organization, to the European Union and its Centre for Disease Control, and to our UK and Scottish sources of expertise, evidence and advice. It is by acting and learning with others that the most effective ongoing public health response to COVID-19 for Scotland will be found.