I am a retired doctor, having worked in the NHS with children and families, and as a researcher in respiratory virus epidemiology. In retirement I’m privileged that people feel free to talk to me about their experiences of illness, this pandemic and the impact it’s having on their lives. I cannot share these stories with you, for ethical reasons. I therefore present five hypothetical scenarios, which are close to the lived experiences of my contacts in relation to isolating, and make some suggestions about how isolation could be better supported through both services and informal neighbourhood organisation.
The parents of a family with a three-year-old and a baby due to arrive have tested positive. They are trying to isolate but no one has given them advice about the best thing to do when the mother goes into labour. They’re worried and tell their grandparents they don’t know what to do. The grandparents, both elderly and one of them with a chronic illness, live 200 miles to the north. After the phone call they get into their car and drive south.
Two things are happening fast at this point in the UK Covid epidemic. The science is becoming clearer every day about what needs to be done so that we can get back to living our lives again, whilst grieving for those who tragically succumbed the virus. At the same time pressure is rapidly mounting on the Westminster Government to take the action that the science requires – pressure from the media, from trade unions, from NHS staff, from workers and from communities. BBC TV even gave peak-viewing time to an extended interview with David King, chair of the Independent Sage.
But the Government remains intransigent, locked down itself by its ideology and business interests. Each day the Government fails to change course towards eliminating the virus, hundreds more people will have their lives taken away from them before their time.
A young woman in a care home who is isolating as a contact and had been complaining of feeling lonely, absconds to go to a party.
At the Independent SAGE weekly public briefing on 6 November, a journalist asked what could be done to get the Government to change course. The Independent SAGE, constrained (though increasingly reluctant) to maintain its political independence, did not come up with an answer to this question, apart from making the general point that the Government needs to be given an incentive.
It’s clear therefore that the emergence of the Zero Covid initiative, which has the potential to develop into a mass movement, is the answer to that question. If enough people demand change, Governments have no choice. Either they listen or they will be replaced. If enough people demand change quickly, Governments quickly listen.
A man returns from visiting his son in Denmark. He’s asked to isolate for two weeks. He can’t afford the cost of a hotel, so he takes the risk and goes home to his wife and daughter.
What clearly needs to be done is described in the Zero Covid statement. But there are things around the edge of this statement which need to be further discussed before they also become clear – for example why (not whether) schools need to close at this point, and how NHS staff can be protected not just from the virus but from going into a repeat of their emotional nightmare in March. But the thing I want to say a bit more about here is Support for people asked to isolate – the S in FTTIS.
Support in this context is widely understood to refer to financial help. Yes, people on low incomes asked to isolate need more than the current £500 payment and yes, people who have a job and have tested positive need full sick pay. But there may be a lot of other kinds of support they need to make it possible for them to comply and to do it willingly as an act of social solidarity. They may need accommodation, someone to do their shopping, hot meals, easily available health advice, someone to share their mental distress with, additional child care, nursing care, help with ways to fill their time, someone to walk the dog, just someone to talk to, and perhaps other things which we haven’t thought about.
A terminally ill man being supported at home by his family and intermittently by a Marie-Curie unit as an outpatient has been asked to isolate as a contact. The whole family has to isolate. They are desperately short of practical support. Close to breaking point, they get the neighbours to look after their children.
Before public services had been hollowed out by privatisation, centralisation and cuts, this sort of support in epidemics was part of ‘shoe-leather epidemiology’. Local public health workers, often known and trusted, walked their patch every day, checking on cases and contacts known to them, picking up new cases, finding out what each case and contact needed to make sure they isolated, and supplying the things they needed either through services or through the informal community network.
What can we do right now to meet these support needs? First, we should call for a whole army of new public health workers, properly trained and paid, funded by repayments from the private companies who were supposed to be looking after our health and have spectacularly failed us. Second, in the face of inadequate community services we can organise collectively in our immediate neighbourhoods to find out what each person asked to isolate needs, and do our best to meet those needs between us. Third, we can organise at a district level to demand that Councillors should not implement any more cuts to services and should demand the Government to provide more money for Councils at this time of unprecedented need.
The current proportion of cases and contacts who actually isolate is a derisory 5-10%. Some of that failure is due to failed contact tracing by the private companies, but a lot of it is because people don’t have enough support to make it possible and worthwhile for them to isolate. If people aren’t given all-round support, even the best Test, Trace and Isolate system will fail, and we’ll be stuck in this epidemic for a long time.
A middle-aged woman who lives on her own tests positive following an outbreak at her workplace. She only has mild symptom, and manages to shop on line for her food. She gets through the fortnight, but says the loneliness was hard to bear. It was a close thing resisting the temptation to go to see her daughter who lives round the corner. She says that just to see and talk to a real person through the window or at her door would make all the difference. Phone calls just aren’t enough.