Coronavirus (COVID-19): framework for decision making - supporting evidence

1. Introduction

This paper provides an analytical overview of key analysis and evidence in support of COVID-19: Framework for Decision Making - Further Information, published on 5 May 2020. We are making this information available as part of our commitment to bring transparency to our work and decisions on the crisis and to support understanding and public engagement with some of the very difficult issues that we face.

We have drawn together data and evidence on the various harms and wider impacts – health, societal and economic – caused by the crisis. Much of this evidence is still emerging, and the scale and nature of the impacts will change over time. Our evidence comes from a range of sources, and is brought together with experience and insights from other countries and our own stakeholders.

This document presents data as at 6 May 2020.

We have focussed here on what we know about the impacts being seen in Scotland. We are clear that our primary objective at this point in time is to ensure that the reproduction rate of the virus (the R number) remains less than 1 and that cases remain within NHS capacity. High levels of compliance with the core measures of physical distancing, good hygiene, and shielding of those most vulnerable to the harmful effects of the virus, need to be sustained.

We recognise that public tolerance of the distancing measures is hard to sustain, and that these measures in turn have wider impacts on society and the economy. Central to our considerations is a recognition that the crisis is impacting differentially on subgroups of the population and different parts of the country. A concern with issues of equality will be at the heart of our decision-making and analysis going forward.

In this paper we recognise four areas of impact:

First, the virus causes direct and tragic harm to people's health. Key indicators include the numbers of Covid-positive cases, hospitalisations and deaths.

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. In this paper we focus on excess deaths, use of NHS services, and wellbeing.

Third, the restrictions which Scotland, together with the other UK nations, has necessarily put in place to slow the spread of the virus affect 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. We have identified six dimensions of societal impact and present headline figures for each.

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. 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. We must do everything possible to avoid permanent, structural damage to our economy.

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.

Analysis of the kind set out in this paper feeds into our assessment framework as set out in the Framework for Decision Making and summarised below.

Assessment Framework

1. Options for physical distancing measures – easing, maintaining, (re)introducing – are technically assessed using the best available evidence and analysis of their potential benefits and harms to health, the economy, and broader society so as to minimise overall harm and ensure that transmission of the virus is suppressed.

2. Potential options – individual and combinations of measures – are assessed for their viability, for example taking account of how easy they are to communicate and understand, likelihood of public compliance, the proportionality of any impact on human rights and other legal considerations.

3. Broader considerations also include equality impacts and consideration of tailoring measures, for example to specific geographies and sectors.

4. Assessments will inform the required reviews of the Coronavirus regulations and collective assessment and decision-making with the UK Government and other Devolved Administrations as appropriate.