One year and counting
While Boris Johnson praises ‘capitalism’ and ‘greed’, his plan to end the lockdown risks thousands more deaths, warns James Linney
On February 22 Boris Johnson set out the government’s four-step “road map” for easing the lockdown restrictions in England and, despite the government telling us it will be guided by “data, not dates”, Johnson then went on to set out a series of dates which have no discernible relationship with any data.
Progressing from one step to the next depends on the government being satisfied by the following four tests being met: that the vaccine programme is progressing successfully; that vaccines are sufficiently effective in reducing hospitalisations and deaths; that infection rates do not risk a surge in hospitalisations, which would put unsustainable pressure on the NHS; and that risk is not fundamentally changed by new ‘variants of concern’.
The four steps are each five weeks apart - enough time, we are assured, for the government to evaluate whether it is safe to move onto the next step: “four weeks for the scientific data to reflect the changes in restrictions and to be analysed; followed by one week’s advance notice of the restrictions that will be eased”.1
We will look at some of the finer points of each step shortly, but already alarm bells are ringing. Although the incubation period of Covid-19 is no longer than two weeks, the effects of easing lockdown restrictions on a large population can take much longer to reveal themselves. Let us remember June last year, when the first lockdown was eased, but it was not until the end of September that we saw the number of daily cases start to rise significantly: by the time the second lockdown was introduced on November 5, the UK was recording over 24,000 cases a day. Yet, even if five weeks did provide enough time for assessing increased risk, the proposed four tests represent a pathetically low bar for progressing from one step to the next: presumably, as long as people are being vaccinated and the national health service has not completely collapsed, then it is ‘on with the show’.
The message here is clear: the government is putting all its bets on the vaccine to save them from its disastrous pandemic response and despite the rhetoric it is determined for the end of the lockdown to go ahead on time and be permanent. Hence Boris Johnson described his plan as a “one-way road to freedom”2 and Matt Hancock said: “Our goal is that this release from the lockdown is irreversible”.3
It is true that the vaccine roll-out in the UK has been far more successful than in any other European country. At the time of writing the UK has given first-dose vaccines to about 28 million people (about 50% of the adult population). Compare this to less than six million in France (8.4% of the population), less than seven million in Germany (5.8 %) and 5.5 million in Italy (3.3%). Europe’s failure is partly due to the temporary suspension of the AstraZeneca vaccine - a massively ill-judged decision, based on poor science, which could prove to be very costly, given many European countries are again seeing spiking cases and facing new lockdowns. Of course, the success in the UK has not been down to “capitalism” and “greed”. No, leave aside the army of volunteers, AstraZeneca agreed a cost-not-profit deal with the government and, unlike with lots of other elements of the pandemic response, the vaccine roll-out was not outsourced to private firms. Instead NHS staff were allowed to get on with what they do best. But Johnson is determined to blot out the collective memory of his government’s responsibility for tens of thousands of unnecessary deaths over the past year.
We are currently in the first step of the lockdown easing, which saw all school-aged children and college students return to face-to-face learning on March 8, while from March 29 gatherings of either six people or two households will be allowed outdoors.
The decision for all children to return to school at the same time - instead of staggering their return to give school staff more time to try to make their return as safe as possible - seemed almost like self-sabotage from the start. Of course, everyone wants children back at school; schools provide not just educational benefits, but much needed social contact, and can be a gateway for accessing social and mental-health support. Young people, especially those from poorer households, have suffered horrifically during the pandemic and they will be the ones who suffer most from the dire long-term economic consequences. Even before the pandemic, mental-health problems and self-harm amongst young people were increasing alarmingly. But rushing their return into an environment where neither they nor their teachers feel safe, risking them passing on Covid-19 to their families and eventually risking further lockdowns, is clearly counterproductive.
The narrative from both government and media is that by not immediately returning to face-to-face teaching a generation of young people will be ‘left behind’ and their futures will be irreparably damaged. It is a narrative that not only increases anxiety and stress amongst young people, but it also highlights how inflexible education is under capitalism. It is primarily designed not to help young people to attain knowledge, but to act as a machine for rating young people - an inflexible conveyor belt, transforming pupils into compliant workers.
There are two contested scientific questions that are relevant here, which I will only discuss very briefly, although either question could easily take up an article on its own. Firstly, the question of how big a role schools play in the transmission of Covid-19. The reduced risk of a serious infection or death from infection in younger people is well established, although there is emerging evidence that a significant number of children are at risk of developing Long Covid, a chronic and potentially debilitating illness. Recently published data from the Office for National Statistics suggests that 13% of under-11s and about 15% of 12-16-year-olds reported at least one symptom five weeks after a confirmed Covid-19 infection.
A major Icelandic study4 found that children are nearly 50% less infectious and less likely to transmit Covid-19 overall, although the findings highlighted that the risk of spread increases in older children. Yet schools in England are more crowded and not well ventilated, and the government has done nothing in the past months of lockdown to try to make them any safer. In addition, children are more likely to be asymptomatic, so cases are less likely to have been picked up previously. Recent modelling by the London School of Hygiene and Tropical Medicine suggests that reopening all school years simultaneously will lead to the R number quickly climbing above 1.5
Given that the evidence for safely opening schools fully as a first step is far from clear-cut, surely it is best to proceed with caution. A far more sensible tactic would be opening schools for primary children initially, as older children are more likely to transmit infections and are more able to learn remotely for the time being. However, as we have learnt over the last year, the government does not do ‘sensible’ when it comes to the pandemic.
One reason it feels justified in taking such unnecessary risks - and another contested scientific question - is because of misplaced trust in the use of lateral flow testing (LFT) in schools. Currently secondary school pupils are encouraged to take twice weekly home LFTs, as are staff of both primary and secondary schools. LFTs are a way of testing without the use of a laboratory, so they are cheaper and also provide a result within 30 minutes. The government has been pushing these tests for months, buying more than £1 billion worth from US firm Innova Group, with another £0.9 billion worth of contracts on the way.
The government clearly sees LFTs as yet another opportunity for outsourcing NHS funds, thus they have become a very lucrative business during the Covid-19 pandemic and it is clear from the government’s strategy for ending lockdown that it is going to rely even more heavily on these tests in the future. It hopes that they will not only get students back to school quickly, but also get people back to work, etc.
You would think, where the stakes are so high, that before committing so thoroughly to a test, the government would go to great lengths to first ensure its accuracy. Not even close! It had already ordered 384 million kits before there was any evidence to support their use en masse in asymptomatic people. The relatively limited studies that have now been carried out point towards significant false positive and negative rates, and less sensitivity when carried out by untrained people in the community. As pointed out in a recent BMJ article,
In a pilot study conducted in Liverpool, 60% of infected asymptomatic people went undetected ... Up to January 21 nearly 560,000 lateral flow tests had been done on more than 200,000 Liverpool residents, identifying 4,421 people who may not have otherwise known they were likely to be infectious. Among students undergoing lateral flow tests at the University of Birmingham in December, only 3% of those who would have tested positive on PCR were detected.6
Mass testing may be helpful and necessary in certain circumstances, but the Innova LFT is not fit for this purpose. At best it gives significant numbers of people false positive results, causing a pupil and their fellow students the worry and inconvenience of having to self-isolate. At worst it will not pick up a significant number of cases or give false reassurances of being disease-free in asymptomatic people, allowing the virus more opportunity to spread.
Let us now look briefly at the rest of the government’s plan for lifting lockdown:
- Step 2 (April 12) sees all shops reopening, pubs and restaurant gardens opening, as well as gyms and swimming pools. Self-contained holiday accommodation will also be allowed for a single family.
- Step 3 (May 17) will allow groups of 30 to meet up outdoors and six indoors, whilst seeing the reopening of indoor hospitality, cinemas, theatres, while crowds of up to 10,000 will be able to attend larger sporting stadiums. Hotels and holiday parks are also due to reopen.
- Step 4 (June 21) sees all legal limits on social contact being removed - apparently at this point we will be in the clear.
There is little point in analysing the proposals within each step, because it is the overall method that is problematic. Having said that, it is true that allowing 10,000 people to attend sporting events in less than two months time is mad and clear evidence that the government shows no sign of learning from its past mistakes: the Cheltenham festival and the Liverpool v Atletico Madrid football match in March 2020 were both shown to be major super-spreading events, held just days before the first national lockdown. Equally foolish is the idea that after June 21 nightclubs should reopen: I doubt a laboratory would be able to match such perfect conditions for spreading Covid-19.
More important than all this though is what the government is not focusing on: tracking cases, tracing contacts and facilitating proper isolation. These basic public health principles have never been a priority for the government and were essentially abandoned very early in the pandemic, way back in February 2020. We know now that it had instead decided on a disastrous ‘herd immunity’ policy - a policy so misguided that it is a major contributing factor in the UK currently having the fifth highest number of deaths in the world (over 126,000).
Despite the past 10 years of savage budget cuts, the NHS could have played a major role in limiting the impact of Covid-19. Yet the government instead saw yet another opportunity to divert public funds - this time to over 30 private firms, at the astronomical cost of £37 billion and still rising. The track and trace programme must be one of the worst value-for-money deals ever made and one of the biggest failures of the government over the past year - and there has been some tough competition for that title. Despite parliament’s spending watchdog concluding that there is no evidence the programme contributed to a reduction in coronavirus infection levels,7 it did manage to provide Serco’s two top executives with pay of £7.4m for 2020, including bonuses worth £5.5m.8
A successful tracing and isolating programme is not a very complicated process and can be done without resorting to the mass surveillance tactics of South Korea. By carrying out a comprehensive interview with each person who tests positive, a list of further people identified as at risk of having been infected is drawn up and each of these people contacted and interviewed and so on. Each person identified is tested and advised to self-isolate. People should obviously be provided with the necessary funds - at least enough to cover their weekly bills, extra expenses, etc, as well as providing healthy meals for their time in isolation. People whose accommodation does not allow them to isolate safely should be offered a comfortable, safe and secure alternative.
The government’s ‘road map’ risks failing, because, like last year, it is not interested in improving the track and trace programme. This is partly because it would involve admitting the complete failure of the current one and having to start almost from scratch. But also it is prepared to allow the virus to circulate in the population, hoping that this time those who catch the virus will be young enough to avoid serious illness or because of the vaccine programme many older people will be protected from serious infection. Certainly the vaccine will reduce serious infections, hospitalisations and deaths. But even in the best possible outcome this strategy will see thousands, possibly tens of thousands, of unnecessary deaths.
In creating an environment that facilitates the spreading of more variants, as the government is doing, it is only a matter of time before a vaccine-resistant strain emerges. Although the current vaccines could hopefully be altered relatively quickly to combat this, there would inevitably be more suffering and deaths.
In his 1845 work The condition of the working class in England Friedrich Engels coined the phrase “social murder”, which he described as the process where “the class which at present holds social and political control places hundreds of proletarians in such a position that they inevitably meet a too early and an unnatural death”. This term could equally be applied to the Tory government’s mishandling of the Covid-19 pandemic.