There’s no need for confusion about when and how to relax social distancing, argues Mike Downham. Guidelines such as those provided by the World Health Organisation and the UK Independent SAGE committee clearly spell out the conditions for a safe exit from the lockdown. But pressure by working class people will be needed to stop the government from deepening the social catastrophe caused by its handling of the Covid-19 pandemic.
This article is adapted from a piece developing a Scottish perspective that will be published in the Scottish Socialist Voice later this week.
Will this go on forever?
The current confusion about when and how to relax lockdown has led to widespread feelings of helplessness and corrosive pessimism. For many people the result has been mental breakdown, especially among those for whom lockdown is most difficult – to cite a few based on cases I know about personally: the single mother living in a tower block with three children; those who have lost jobs which sustained them financially and emotionally; those who have resorted to emergency food relief for the first time; those with chronic health conditions from whom services have been displaced by the epidemic.
The government is indicating that it may back down on its plans to re-open schools on 1 June, in the face of an impressive campaign by parents and teachers, although the battle is not over yet.* Some workers, particularly construction workers, have protested collectively against non-essential building projects, even walking out to force closure. This shows what working class people can do to save lives in the face of the government’s confusing and dangerous approach to this pandemic.
But many children, parents and other workers are seriously struggling under the lockdown. Some have responded to the mixed messages from government and the media by arguing that schools and other workplaces should re-open. Some workers are in such a state of daily crisis that they feel beyond protest: including many staff and residents of care homes; homeless people; asylum seekers; offshore workers in the North Sea; healthworkers exhausted by their workload and its nature, and grieving for the loss of colleagues, and for patients whose lives they were unable to save.
All this confusion, and these lives lost, come down to two questions facing the UK Government: is it prepared to sacrifice lives in the interests of shareholders? And will it be allowed to get away with it?
We can’t bring back the dead. But we can prevent further deaths and further fall-out from the confusion around relaxing lockdown. Because in fact this is simple – there’s no need for confusion.
No need for confusion
Government messaging and media reporting give the impression that the confusion reflects uncertainty about the science. But voices have now emerged that show this is not the case. The best of these are the World Health Organisation (WHO), the new Independent SAGE Committee, and the Professor of Global Public Health at Edinburgh University – Devi Sridhar.
The WHO is a political institution overseen by 194 governments. It has to continually balance its political mission to build global cooperation with its mandate to support science-based health efforts. This is inevitably a fine balance, and the WHO inevitably gets a lot of flack. It can now add to its cap the feather of Trump’s announcement that he is halting US funding to them. At a press conference on 11 May Director-General Tedros Ghebeyesus, an Ethiopian microbiologist and the first African in the Job, released a three-question checklist for relaxing country lockdowns:
- Is the epidemic under control?
- Is the healthcare system able to cope with a resurgence of cases?
- Is the public health surveillance system able to detect and manage the cases and their contacts, and to identify a resurgence of cases?
The answer to question 1 isn’t straightforward. Too much emphasis has been put on the R number. (The R number measures the rate of reproduction of the disease: if R is at 1, it means that for every one person infected, they will on average infect one other person.) Just because R is said to be well below 1.0 in London or Edinburgh hides the fact that it remains more than 1.0 in settings where social distancing isn’t possible – care homes, some hospitals, prisons, hostels, migrant detention centres, mail sorting offices, on-line-order depots, multi-occupancy households, multi-generational households. Rather than attempt to measure R in these settings, the solution is to prioritise them for testing-tracing-isolation resources, and for PPE.
The answer to question 2 is a probable yes in the case of the UK. One of the most remarkable things the pandemic has revealed is the commitment and resilience of health workers across the world – nowhere more than in the UK, which, sit down, now has the highest Covid-19 death rate per million population, not just in Europe, but across all the rich countries in the world. At least some NHS workers have now had a short breathing space, but they are humans as well as heroes, and some remain scarred by their experiences. It’s hard for the rest of us to imagine just what it must be like for a nurse to have to make the choice between using PPE or not using it so that a colleague can be protected. But I’m now hearing stories of further exhaustion from attempting to catch up with the back-log of patients with long-term conditions – physiotherapists, for example, whose whole shifts are taken up on the phone, ploughing through long lists of patients who’ve missed out on important treatment. The exhaustion of this turns on frustrated skills. They signed on to train and work with their hands, not as triage officers.
The big question for the UK at this point is question 3.
A week before the WHO advice was released, a new UK Independent SAGE Committee of twelve scientists and doctors met live on youtube. This is a remarkable initiative, likely to become highly significant both in terms of saving lives and as a challenge to the Government. It moved fast, releasing a report on 12 May, only eight days after its first meeting. In relation to coming out of lockdown the report supports the WHO checklist, and adds: ‘Communities and civil society should have a voice, be informed, engaged and participatory in the exit from lockdown’. It also emphasises the importance of engagement with ‘BAME, marginalised and low-income groups’.
Devi Sridhar has been saying much the same, but with the additional impact of words which are easier to connect with. On 4 May she spelled out in The Guardian an eight-point strategy headed ‘This is what you should be demanding from your government to contain the virus’:
- A test, trace and isolate programme
- Readily available PPE for health and social care workers
- Surveillance to detect hotspots and subpopulations
- 14-day quarantine for international arrivals
- Clear and honest communication with the public
- Continued distancing and facemasks in public
- Lockdown is not a solution in itself it only buys time for governments to build public health infrastructure
- All these are short-term strategies pending more information about the virus and a vaccine
On 12 May she followed up with an article entitled: ‘Unless the government changes tack, the UK’s lockdown will have been for nothing’. She warned: ‘Easing social distancing without a proper programme of testing, contact tracing and isolating will lead to a second wave of coronavirus’.
So where are we?
The devolved governments are all being cautious, having at last split from Westminster policy. The Scottish and Welsh Governments openly acknowledge that their systems for testing-tracing-isolating aren’t ready and they recognise the seriousness of the risk in relaxing before those systems are up and running. The Northern Ireland Executive is less candid but implies the same.
The key pillars of relaxation are returning to non-essential work, opening schools, and opening pubs and restaurants. The Westminster Government jumped the gun by encouraging people to return to non-essential work this week and threatening to open schools on 1 June. As has become alarmingly familiar with this government, it’s hard to be sure how ready their testing-tracing-isolating system truly is. A government which on 30 April posts out 40,000 home-testing kits, many of which were probably not used, and some of which didn’t include return envelopes, for the sole political purpose of hitting their much-vaunted 100,000 tests a day target by the end of April, hardly encourages trust.
The hiring of contact tracers is even more shrouded with confusion and lies. Last week, with an 18,000 recruitment target for mid-May looming, we were fed three different figures by Government spokespeople ranging from 1,500 to 17,000. They can’t all be telling the truth. And at the weekend many of the numberless recruits complained that they weren’t able to access the promised on-line training, and that they still don’t have contracts. Hanging over that is the uncertainty whether 18,000 is the right number. Some scientists have said it should be 100,000!
Contact tracers and the information they gather also need a coordinating and support system. Yesterday (19 May) Greg Fell, Director of Public Health (DPH) in Sheffield, spoke on Radio 4. He knows what needs to be done – DPHs got it done not so long ago for TB and HIV. He specifically pointed to the need to set up local Outbreak Management Committees ready to act so that any new clusters of cases can be responded to quickly to prevent further spread. He’s not on his own – other DPHs are also saying they aren’t ready.
Only one thing is clear. Everything is being done in a last-minute rush. And the government’s rush to open up the economy has trumped the government’s rush to control the virus.
Many people in England don’t want to come out of lockdown yet – they have seen through the Government and don’t trust it. Polls suggest only 11% want pubs and restaurants to open and only 8% want to allow mass gatherings. Johnson’s popularity has plummeted since he changed the message from ‘stay at home’ to ‘stay alert’.
Now there’s a local authority rebellion in the north of England, spreading southwards. Writing in the Observer on Sunday (17 May) the Mayor of Greater Manchester, Andy Burnham, said:
In Greater Manchester, we had no real notice of the measures. On the eve of a new working week, the PM was on TV ‘actively encouraging’ a return to work. Even though that would clearly put more cars on roads and people on trams, no one in government thought it important to tell the cities who’d have to cope with that … Far from a planned, safety-led approach, this looked like another exercise in Cummings’s chaos theory.
The leader of Gateshead council, Martin Gannon, told the Observer on the same day:
There are pockets of deprivation in this area where people are especially vulnerable to Covid-19. Life expectancy here is two years below the national average… We locked down too late; this unlockdown strategy is premature. The testing capacity isn’t robust enough, neither is the tracking and tracing system, the R-rate isn’t low enough. They’re doing this too soon; it means a second wave will happen.
Tedros Ghebeyesus of the WHO had said back on 11 March:
Several countries have demonstrated that this virus can be suppressed and controlled. The challenge for many countries is not whether they can do the same; it’s whether they will. The UK is one of the few countries to stop contact tracing and quarantine. The UK needs to act in concert with the rest of the world to suppress and control this virus, both for ourselves and for other countries, especially those which may have weaker health care systems.
Why has the UK Government made so little progress? Is it just inept? Or is it systematically calculating and manipulating the public on a grand scale? Destroy the economy ahead of Brexit; use Covid-19 as another giant distraction; sell out, privatise, make deals with Trump; pass laws; and further screw all of us who aren’t in the ‘have lots’ club?
We mustn’t at any point in all this underestimate the enormous difficulties lockdown is presenting for millions of people. But we can say three things about it.
First, we should demand the truth about the government’s progress with the testing-tracing-isolating (TTI) system. We should check with our local Directors of Public Health whether or not they have their TTI systems ready, and if not, whether it’s a matter of needing more time, or more resources, or both. Parents, teachers and schoolchildren now have the government on the back foot. This demand can now be the next stage in forcing the government to ensure our safety. With proper public scrutiny, and the right measures in place, it could be safe to relax the lockdown much sooner. It’s not forever.
Second, if we do what the government has encouraged us to do – go back to work immediately, and if we send our children back to school before it is safe, the sacrifices we’ve made over the past eight weeks will have been wasted.
And third, if we get this wrong the combined impacts of further lost lives and further economic and social devastation could amount to meltdown.
*NOTE: An earlier version stated that the government had already backed down. As of 4.30pm on Thursday 21 May, the government has not – yet at least – admitted that their own five tests, let alone those of the National Education Union, can’t be met by 1 June. We need to keep the pressure up to meet the requirements outlined in this article. See the #NotSafeNoSchool campaign website.