The Covid Pandemic: Could Do Better...? This pandemic has been awful on many levels, and we have looked on in horror as Covid-19 has spread through the population domestically and globally. While a handful of countries in the spotlight have seen very high infection numbers and rates (eg, the USA, Brazil, Russia, the UK), there are others where infection numbers and rates have remained very low (eg, New Zealand, Australia, Taiwan). Throughout, it has felt difficult to separate fact from politics, and there has been an awkward balance between an appropriate clinical response (partly guided by governments trying not to exceed healthcare capacity), and the huge economic, educational and mental health impacts. More than normal, a resolution lies in following scientific advice, quick clear action, a robust healthcare system, and a good deal of trust and buy-in from the general public. Good clinical advice has been available throughout, but government advice has been inconsistent and sometimes incoherent. The UK healthcare system is wonderful, if sometimes overly bureaucratic, but austerity has left it weakened, and this pandemic has exposed that more than ever. The economy too has fractured, growing only in pockets, and revealing deep inequalities in income and opportunity, resulting in massive government borrowing, the channelling of which hasn’t always felt transparent. And a lack of clarity and transparency has further strained our trust in politicians and institutions, already in decline due to political divisions and disputes. With so many different factors in play (geographical, political, economic, social, environmental, etc) there is a wealth of data to inform future academic analysis of countries’ differing experiences of the pandemic. But some clear patterns have already emerged, and perhaps we can learn lessons from them. The USA probably received the most headlines for mishandling the crisis. It was excruciating to watch as, led by President Trump’s divisive example, they struggled to limit the spread of both the virus and misinformation. With only c4% of the world population, the States now accounts for more than a quarter of all cases and a fifth of all deaths. Of course, the USA wasn’t alone in some people refusing to wear masks and believing the whole thing was a conspiracy. But the USA’s failure to cap the spread has been received with a good deal of astonishment. It has undoubtedly affected its credibility and status globally. Will this mark a moment when other countries begin to look elsewhere for global leadership? New Zealand, for instance, found itself thrust upon the world stage in contrast. According to The Lancet, “the lockdown implemented in New Zealand was remarkable for its stringency and its brevity,” with almost no further importations reported within two weeks of their travel ban. With a similar population to Scotland, its response was swift and definitive; immediately clamping down on flights, and testing and quarantining tourists. And as their current Prime Minister is widely respected and trusted, New Zealanders have seemed more willing to follow the clear advice given. With a population of c26 million, Australia attributed its success to following expert advice, closing borders, strict quarantines, broad public compliance, and a switch to telephone health services. Taiwan, with a population of c24 million, gained from experience learned from the 2003 SARS outbreak, and from widespread early adoption of face masks, strict and monitored quarantine, good compliance (a result of trust in government and community culture), financial incentives for quarantining and fines for non-compliance, and a programme of countering misinformation through clear communication and online videos using humour to quash rumour. At the time of writing (February 2021), Scotland has tragically seen over 6,000 deaths and 180,000 infections. The UK as a whole has seen over 106,000 deaths and 3.85 million infections in a population of c68 million. Along with the USA, only India, Brazil and Russia have more cases, but each have far higher populations, so our per capita death rate is far worse. Scotland appears to have a lower infection rate and a lower death rate than the UK as a whole, and although the numbers are changing all the time, it would be helpful to understand what factors have brought about that variation. The next few months are going to be difficult. Our patience with lockdowns is stretching thin, but our anxieties remain heightened, and as we grow more used to distance, we risk losing some of our social skills and empathy. The vaccine will undoubtedly help relieve some of the pressure, but it is not a panacea; there are likely to be some restrictions for much of 2021 and possibly beyond. Will the coming months see clearer advice from governments, and will we have the patience to follow it? Is the NHS exhausted, and what will be the impact of knock-on delays to other treatment, on patients and a very stressed workforce? Will our teachers be given more priority for vaccinations as pressure builds for schools to return? And what can our political leaders do to earn enough trust and sustain the buy-in from the general public? It has been more than a year since this coronavirus appeared on the scene. We have not coped well. We need to take stock and start to learn from those who have coped so much better.