Protecting those at risk: What some COVID-19 experts think

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Last year SPICe developed a COVID-19 Register of Experts to allow the parliament access to academics who could provide expert insights on the COVID-19 pandemic and its impacts.   Following a request from the COVID-19 Committee, SPICe asked those on our register of experts for their views on three issues: the overall strategy for tackling the pandemic, where there are gaps in data and understanding, and finally who is at most risk and how we can protect them.  Responses were overwhelmingly concerned with protecting those at risk.   

Within that topic, however, we received a broad range of thought-provoking responses.  Some of these identified specific groups of people (such as children and young people, people with dementia and their carers, staff in care homes or early career researchers).  Other submissions identified policy areas (such as physical activity, and the economy).  Others considered approaches – such as the need for effective community engagement or the need for a human rights based approach).

We are very grateful to all those who provided submissions.  Whilst it is not possible to do justice to the detail of each submission, this blog picks up some of the themes, as identified by SPICe.

Children and young people

The Children and Young People’s Centre for Justice (CYPCJ) expressed serious concerns about the risk to children (under 18) who come into contact with the police and the legal system, and those in secure care.  They said that children will fail to adhere to regulations put in place to control COVID-19 and this could result in a criminal justice response with potentially long-lasting implications for them.  CYPCJ also has serious concerns about children in Young Offenders Institutions (and potentially prisons) during a pandemic.

Dr Daniela Mercieca and Dr Duncan Mercieca of the University of Dundee pointed out some of the issues arising for the education of children during lockdown, particularly in more vulnerable families.  For example, based on interviews with practitioners, they highlighted the importance of the physical school building, which normally allows “for equity and equality to be operationalised”, whilst conversely, online learning could lead to a widening of the attainment gap.

Dr Sinead Rhodes (University of Edinburgh) and Dr Carla Schmoll highlighted that children with additional support needs (ASN) are a highly vulnerable group at risk from the other “harms” associated with COVID, including longer assessment times, learning gaps and mental health difficulties.  These children were

especially vulnerable to the impact of missed school attendance on academic learning during the spring lockdown. Lockdown has heightened their vulnerability to the social and psychological effects of school absence.

In particular, it was suggested, the pandemic has had a detrimental impact on the mental health of young people (anxiety, mental health and social function), especially those with additional support needs.  There has also been a significant increase in presentations of depression and a notable increase in anxiety. Many young people are also experiencing marked loneliness as a result of isolation, precipitating low mood, and are struggling with the lack of educational support.

Professor Kay Tisdall, (University of Edinburgh), and Dr Fiona Morrison (University of Stirling) however pointed to gaps in the evidence in this area.  They drew on a detailed children’s human rights analysis (May-June 2020) of legislation and policy resulting from COVID-19, applied to children and young people in Scotland.  They say that

the crisis caused by COVID-19 has amplified the long-standing gaps in available data. Statistics are not routinely available on key children’s rights questions.

Taking a different tack, Professor Jindal-Snape (Dundee University) provided links to some of the comics (developed with the Scottish Centre for Comic Studies at Dundee University), and blogs, created to capture the impact of COVID-19 on transitions of children, professionals and families, for example as children left school during the pandemic, or returned back to school classes (Lost and Found in Transitions: Pandemic Tales/ School Transitions/ University lives in transition)

People with dementia, and their carers

Professor Debbie Tolson: (University of the West of Scotland) flagged up the increasing evidence that people with dementia and their family carers are disproportionately at risk and suggested they warrant protection.  Two approaches were suggested:

  • Sustaining family caring: through the Alzheimer Scotland Centre for Policy and Practice (ASCPP) Carers’ Academy, and by affording family carers key worker status and classifying those caring in family homes as living alone.
  • Preventing deteriorations: including a named professional to provide support, reinstating access, on a priority basis, to selected services, extending access to expert nursing and trauma-informed telephone and remote support.

Staff in care homes

Hockley, Johnston, Watson and Shenkin (of the University of Edinburgh and Edinburgh Napier University) identified the pressures on frontline care workers in care homes. They said that care home residents and their families, and the staff who care for them, are at risk of harm following COVID-19; in particular there is a risk for staff, due to the impact of deaths of care home residents and risk of burnout. The authors suggested there is a need for interventions based on evidence and sustainable, and also that are co-designed with care home staff, clinicians, and academics “to support this vital workforce during COVID-19 and for the long term”. 

Early career researchers

Professor Mandy MacLean, (University of Strathclyde) identified the challenges for medical/scientific careers in the context of reduced medical charity income. In conclusion Professor Maclean said

As COVID has shown, we need our scientists and we cannot afford to lose a generation of our next future leaders and this will happen if some attention is not paid to this now

Economics and jobs

Based on a detailed review of evidence, Dr Daniel Kopasker of the University of Aberdeen, said that some of the most damaging and common risk factors for mental health resulting from the COVID-19 crisis relate to exposure to economic insecurity.  He describes this as:

the anxiety produced by the possible exposure to adverse economic events and by the anticipation of the difficulty to recover from them. 

Dr Kopasker suggested that secure, high quality jobs are crucial and a bold commitment now to what he describes as a “job-quality led route to recovery” would improve health and productivity outcomes for generations. Conversely, a recovery built on low-quality jobs risks exacerbating an emerging mental health crisis, that threatens to harm labour productivity and entrench generations of disadvantage. 

Professor Matthew Smith (University of Strathclyde) set out the case for a Universal Basic Income (UBI) – a payment made to all individuals without conditions or means testing.  He said that those most affected are the most vulnerable in society: on the one hand, people with underlying health conditions, and on the other, people in precarious financial situations (particularly the young).  He suggested that UBI would have been a simpler, fairer and more universal approach than the furlough scheme.  Professor Smith concludes that if we are really serious about protecting those at risk, we need to start considering much more fundamental changes and – regardless of the difficulty in instituting them – taking the steps to implement them, and that UBI should be front and centre in these debates.

Physical activity

Ian Findlay, chair of the Movement for Health pointed out the “compelling evidence that physical activity has huge health benefits for everyone, especially for people with long term conditions”.  However, although there was a focus on daily exercise during the early stages of the pandemic, this messaging has dropped off.  Writing in November, and so coupled with the move into the Winter months, he said there is a risk of a widespread reduction in activity levels, disproportionally affecting those with long term health conditions.  Continued messages advocating physical activity should be prioritised, it was suggested, and overall a well-researched communications strategy will be a key measure.

Professor Nanette Mutrie of the University of Edinburgh (and also chair of the Chief Medical Officer’s expert group on communications on physical activity), had a similar message, and highlighted the evidence suggesting that those who have chronic health conditions, who are overweight or have low levels of activity, are more at risk of covid and covid complications.  Regular activity can protect against those conditions. 

A rights-based approach

Professors Jill Stavert and Colin McKay (Edinburgh Napier University) indicated that people with a mental illness (including dementia), people with a learning disability, and people with a neurodevelopmental condition (such as autism) are all likely to be disproportionately impacted by Covid-19.  As a result they will be significantly more at risk from serious illness or death from this disease and other related “harms” than others. Such “harms” include a failure to provide appropriate support and services (as well as affecting human rights), and a rights-based approach is proposed including:   

  • Non-discrimination in treatment/support and reasonable adjustments for people with disabilities.
  • Recognising rights guaranteed in the European Convention on Human Rights and UN Convention on the Rights of Persons with Disabilities (CRPD) and providing the necessary support, including supported decision-making.
  • Involving people with disabilities and their organisations in developing plans for way forward.

Community engagement

Dr Lucia D’Ambruoso (University of Aberdeen) drew on an extensive range of sourced evidence and identified the need for a community engagement strategy and practice that brings together the authorities and civil society with at-risk groups.  It is suggested it should be one that goes beyond consultation but involves a two-way exchange and builds relationships between communities and institutional partners.

Read the responses, and a more detailed summary by SPICe on the COVID-19 committee web pages

Find out more about how academics can engage with the Scottish Parliament    

Simon Wakefield, and Emma Robinson, SPICe