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When I got polio on a farm in the middle of the Irish countryside in 1956, an Irish Health Ministry official visited our nearest neighbour, a farmer called Dick Cunningham, the next day. He told him what had happened and advised him to keep his children at home. Other farmers in the area, none of whom had a phone, received similar visits and advice.
All epidemics are by their nature local events. A certain person at a certain address catches polio, TB or coronavirus. Such diseases can only be contained locally by well-organised and well-informed people able to respond at speed to identify, isolate and trace the contacts of the infected person.
Those going into voluntary self-isolation will have their lives severely disrupted so they should be told to do so by somebody with real authority and credibility and not by a voice from a call centre.
The latest lockdown restrictions imposed on four million people in the north of England is a measure of the government’s failure to set up an effective track-and-trace operation half a year into the pandemic. The centralised body charged with doing so, headed by Baroness Dido Harding of Winscombe, works less well than the ill-resourced health officials in impoverished rural Ireland more than half a century ago.
Yet finding, testing, isolating and immediately tracing the contacts of anybody who has Covid-19 should be at the heart of any campaign to combat the pandemic. Anger at the amateurism and inadequacy of Baroness Harding’s NHS Test and Trace organisation is boiling over as local councils are forced to launch their own test and trace operations. One of those to do so is Sandwell, in the West Midlands, which says that the central government service only reaches 60 per cent of cases in its area. Local officials are chary of condemning its failures because they must look to government for money and resources, but their frustration is evident.
Lisa McNally, the director of public health in Sandwell, is quoted as saying that “as soon as a new case comes in now, we’re not waiting for [Harding’s] test and trace to fail to reach them, we’re phoning the same day”. In Bradford, one of the places subject to the new lockdown restrictions, the city council says it would like to do the same as Sandwell but lacks funding. Sir Richard Leese, who heads regional health in Greater Manchester, says that local tracing is necessary to cope with cases that cannot be dealt with by a phone bank.
The calamitous consequence of this failure to establish comprehensive testing and tracing in England cannot be overstressed. In Scotland, Wales and Northern Ireland a more localised approach has had a better outcome in terms of deaths and infections. In England, however, the government has managed to get the worst of all possible worlds by combining over-centralisation with fragmented decision-making at the top. Unsurprising, it is Ceredigion, a rural county council in the west of Wales, that set up its own tracing system in March, that has had one of the lowest infection and fatality rates in the UK.
Baroness Harding, a Conservative peer and businesswoman, appears oblivious to the complaints by local councils or the reasons why the system is not working. But the results of her failure to pursue the virus with enough success and aggression to prevent its recurrence has earth-shaking consequences for British society and the economy.
The problem is that “the new normal” is too abnormal to be sustainable, except in the very short term, without devastating damage to all aspects of life in Britain. Social distancing and other regulations mean that schools and universities cannot teach and shops, pubs, restaurants will not get enough customers to survive. Anybody in the travel business, from taxis to giant airlines, faces extinction. Six million small businesses employing 16 million people are at risk.
There are three approaches to coping with the pandemic: letting it run through the population, controlling it sufficiently to let the economy restore itself, and eliminate coronavirus entirely by speedily finding and isolating whoever has it with a fine mesh test and trace system. Britain briefly tried the first option in March, until discovering that this risked massive loss of life. Since the initial lockdown it has, as have other European states, tried to reduce the number of infections to a level low enough for economic life to resume.
The upsurges in infections in the north of England, Catalonia and elsewhere show that attempting to live with the virus is not working as a strategy. This leaves the elimination of the virus by denying it hosts, the strategy pursued in east Asia through aggressive testing and tracing on a street-by-street basis, as the only feasible long-term strategy.
Such a campaign involving millions of people may ultimately prove to be the least bad option. Launching it would have been much easier six months ago before the government’s credibility was shredded by repeated unforced errors over care homes, PPE, face masks, tracing apps, quarantining. It turns out that the government did not even know by a factor of two how many of its citizens were dying from coronavirus every day. In the single week up to 17 July, the Office of National Statistics says the number of fatalities was 284 and Public Health England says it was 574. The reason for the disparity is that PHE counts anybody who tested positive and later dies from any cause as a victim of Covd-19.
The PHE approach is so contrary to common sense as to be funny, but, less comically, means that the government has been basing policies on grossly inaccurate statistics. The old jibe of some politician or pundit that the British government keeps three sets of statistics – “one to deceive the public, one to deceive parliament and one to deceive itself” – turns out to be all too true.
What is truly dangerous is not just that the Johnson government makes mistakes, but that they are very simple ones. It should not have required much thinking about by a sensible person to foreseen that frail, sick elderly people in care homes would be vulnerable; that a speedily developed tracing app might not work; that masks were obviously beneficial. Johnson keeps bleating that he and his ministers were only following the scientific evidence, but in an unprecedented catastrophe evidence will inevitably be scanty and will trail long behind events.
The allegation that Boris Johnson is a bombastic blowhard and careerist who is out of his depth in a real crisis has been confirmed all too frequently by events. There is no need to demonise him and his ministers as actively malign, like Donald Trump and his lieutenants, but their inability to get a grip on the pandemic has had a similarly disastrous outcome in both cases.