Social inequality — the critical factor that’s missing from the UK Covid response

[NB This article was orignially a twitter thread]

Earlier this year I found myself cooking for a woman I’d never met before who lived on a local estate. She was a single mother, her teenage son had picked up Covid from school, and given it to her. She had a zero hours contract, and had run out of money to feed her family.

They’d been surviving on tinned soup for three days, but that was used up. So she made the unusual step of putting out a call on social media, and I got in touch. I have never heard anyone apologise more; she was utterly humiliated to have to beg for help from strangers. As you would be. It was horrible.

Now, this woman happened to have become very sick with Covid too. And I often wonder — if she’d been one of the many who only had mild or no symptoms, what decision would she have made? Would she have isolated to the point she had to beg from strangers? Admit to people she’d never met — admit to herself — that she was no longer in a position to provide for her family? Or would she have gone to work?

Ask yourself honestly: what would you have done in that situation?

It’d be easy for me as an epidemiologist to bemoan the fact that not enough people are isolating after testing positive or being in contact with a positive. But I have money in the bank, I work from home, I can afford to have online shopping delivered. Stay at home orders mean little to me, other than being a bit of an annoying dampener on my social life. I can stay home, easy.

We know how Covid works by now. We know the epidemic is being driven by close contacts, and we know that those contacts are very often driven by having a lower socio-economic status. People living in crowded households. People with public-facing jobs that can’t safely be done at home. People working all day indoors in warehouses in order to feed our Amazon Prime 24 hour delivery addiction.

We see this being borne out in the data. People of low socio-economic status are more likely to be infected. More likely to be hospitalised. More likely to end up in ICU. Just look at this graph from a recent paper in the Lancet. The relationship between increasing deprivation and increased risk of Covid is as clear as day.

And if that’s not something you find morally wrong — know that it affects you too.

Because it’s these pressures on the health service, this lack of ICU beds, that are affecting YOUR freedoms. Because the current whack-a-mole strategy of business closures, school closures and lockdowns is a blanket response that fails to address the core factors driving Covid.

And yet this point is almost entirely lacking from the national discussion. Difficult to know why — perhaps because control measures that address social inequalities are seen as “too political”? Even scientists don’t seem to be massively pushing this point — with some fab exceptions like Müge Çevik and Jackie Cassell, whose work I’d urge you to follow. We model the effect of school closure, but before we opt to deprive children of their education, should we not first be modelling the potential effect of universal basic income for those on the lowest incomes?

We need to change our approach. We need to be more creative in our thinking. The new variant was shown to spread even during lockdown, because there are still people out there who are forced to mix with each other, and we are not supporting them to cease doing so. It doesn’t make sense to keep doing the same things but harder, when those things are already proving not to work. We need targeted interventions that address the actual challenges at hand. Increased sick pay, supported isolation, a vaccine strategy that takes deprivation into account.

Without this, we are doomed to always be behind the curve, cursed with blunt blanket restrictions that don’t work and leave us all in this mess for longer. And those who had least to start with end up paying the biggest price.

It’s time to start levelling up.

I’m an infectious disease epidemiologist with special interest in zoonoses, new & emerging infectious, One Health, and interdisciplinary public health research