LOckdowns only work if they reduce transmission. And transmission is only reduced if patients isolate themselves. But what if that costs too high? The millions of people who cannot afford to isolate themselves face a choice between financial devastation and compliance. By not providing adequate support, the government is forcing people to decide between their families and their communities. This choice is cruel. And it is avoidable.
The evidence is clear that Covid-19 disparities are due to differences in exposure both at home and at work. Those with a lower socioeconomic status are the most affected by both the virus and the collateral damage of the restrictions. In the confinement, almost all the risk is transferred to the 10 million key workers who I can’t work from homeas well as those living in disadvantaged areas and overcrowded houses, two groups that often overlap.
Since the new variant of Covid-19 is significantly more infectious, it will increase transmission within homes and among key workers, who spend a lot of time around others. As is always the case with deprivation, one problem amplifies another: being an essential worker and living in dense multi-generational housing isn’t just associated with Covid-19 risk – it’s the mechanism that creates risk.
Like blockades, testing and tracing will only reduce transmission if infectious cases can be effectively isolated. However, possibly less than 20% of those who should isolate do it completely. The data shows that while most people intend to follow government advice, only 12% get tested, 18% self-isolate, and 11% of contacts properly self-isolate. Fundamentally, the self-reported capacity for self-isolation is three times lower in those who earn less than £ 20,000 per year or have less than £ 100 saved.
A review of the OECD demonstrated that by allowing workers to self-isolate, paid sick leave can contain and mitigate the spread of the virus. Therefore, it plays an important role in protecting workers and their communities during a pandemic. However the UK has one of the lowest proportions of income covered by legal sick pay in Europe, and millions don’t even qualify. The government calls it a war against Covid, but they have left a key weapon at home.
This inability to provide adequate support for self-isolation has meant that the country is divided in two: those who have the means to stay home and protect the NHS, and those who cannot, no matter how much they want. Wealthy communities with adequate housing and sick pay are given socioeconomic immunity, while the burden shifts to the networks of the working class. It is protection for some and pandemic for others.
Nowhere has this been more obvious than in Leicester. Most of the country at least had some kind of break with Covid-19 over the summer, but Leicester has been at the highest level of restrictions since June due to a spike in cases in the city. Evidence from Public Health England showed that workers in the city’s garment factories and food processing plants were a major driver of transmission. Many of these workers felt that they could not stay to isolate themselves when they were sick. The transmission was probably further amplified by poor working conditions and networks of people living in overcrowded multigenerational housing. These outbreaks later spread to the community, contributing to an increase in cases and the application of restrictions.
This is the untold story of the pandemic. The focus on personal compliance has diverted attention from the structural inequalities that impede compliance and lead to transmission. risks in communities.
And yet, with all this evidence, with school, university and business closures, local economies in freefall, and the NHS near breaking point, the government has yet to implement the most basic public health principles. By not allowing economically vulnerable people to isolate themselves, we have repeatedly exacerbated social inequalities and the disasters of the pandemic.
Now we desperately need government action. Key workers must be guaranteed income and social protection. Additional support must be provided to ensure that low-wage, non-salaried, zero-hour workers can afford to follow isolation rules. In addition to job protection, Sage states that in order for people to be able to properly isolate themselves, support must include a text message or a daily phone call and supply of food and basic goods. Sage also emphasizes the need for solidarity and togetherness rather than divisive messages. Workplaces can also be made safer by re-establishing the 2 meter rule, providing PPE and disinfectant, and most importantly ensuring ventilation whenever possible. As in New Zealand, South Korea and NY, the government should use the thousands of empty hotel rooms to provide accommodation, so that people, particularly those living in crowded and multi-generational households, can be adequately isolated.
By directly addressing the barriers faced by socioeconomically vulnerable populations, support for self-isolation of patients and their homes can also increase uptake test and the number of contacts given. In Liverpool, a mass test pilot was implemented with hundreds of thousands of rapid tests and a large number of army personnel to implement it, but the government ignored requests from local public health leaders for additional funds to support the isolation. the pilot report found that the impact of mass testing was reduced due to the low acceptance of testing in disadvantaged communities. The most frequently given reason? Fear of not having adequate support to isolate themselves. It is one of countless examples of the government targeting the moon without worrying about rocket fuel.
Isolation of infectious individuals is the most important measure in terms of control of transmission. If we don’t pull on these basic public health brake levers to slow the spread, the virus will simply continue to spread among key workers and their families. Therefore, the effect of the lock will be limited. Given the emergence of the new variant, providing income protection and support for self-isolation may be the deciding factor in reducing R below 1.
The disproportionate impact of Covid-19 on households living in poverty emphasizes the need to urgently update our definition of “vulnerable” populations and address these inequities. Many (rightly) disagree with Great Barrington’s statement and its focused protection policy. But this current blanket lockdown approach does not address what is really driving the pandemic and is simply the targeted protection of the middle classes. Even the strongest will cannot overcome harsh economic realities. We need specific and sustainable solutions, based on basic public health principles and evidence. To make this blockade a smart blockade, the government must support key workers and self-isolation. This tale of two pandemics has gone on for too long.
George is Digismak’s reported cum editor with 13 years of experience in Journalism