Hello!
Welcome to your weekly pulse of public policy. But before we get into that, some news: I’m very excited to be making the leap to working freelance, starting next week. I’ll be offering policy development, analysis and advice on a consultancy basis: see jmkpolicy.co.uk for full details. So if you know anyone who has a policy project that needs doing, or who needs to add a bit of capacity to their team for a while, I’d be very grateful if you’d consider pointing them my way.
Policy Pulse will be taking a break next week while I get some start-up admin done, but the plan is to be back in your inbox as usual after that. But for now, let’s get to this week’s article…
Functioning with Covid
Chris Mason’s recent appointment as the BBC’s Political Editor reminded me that I’d had a polite argument with him on Twitter last summer about the use of the then-current term “pingdemic”. I felt that it placed emphasis on the working of the NHS Covid-19 App, and deflected attention from the real problem: high levels of Covid infection. Changes to the rules around the app made the term’s use only fleeting, but I can’t help but wonder if that initial period after restrictions were lifted has been influential: Covid cases continued to oscillate around a high level, and appear now to be finding a new, even higher, level since the Omicron variant arrived late last year. Yet of itself, this isn’t apparently a subject of much public concern: if the story had initially been reported in terms of high infection levels, rather than a “pingdemic”, might people now be more questioning of the Government’s policy approach?
Well, maybe. Or maybe that’s a stretch. What we do know is that the issue does periodically creep back into the news in terms of staff absences disrupting public and commercial services. This is effectively the same as the “pingdemic” stories, without the buzzword. And this is what I want to look at briefly this week. While the Government has a strategy for “living with Covid”, it amounts simply to ending any and all measures to address the ongoing public health problem of Covid-19, including both restrictions on liberties (such as enforced mask wearing) and items of public expenditure (such as freely available lateral flow tests). This approach is taken, from the perspective of some on the government benches in the House of Commons, in the name of keeping the economy open.
Except it’s pretty clear that this approach does not achieve its stated aims: it does not keep the economy open, and it does not enable us to live with Covid. It remains to be seen whether we have seen the last major Omicron spike before the autumn: with more interaction moving to outdoors, we might not have to worry about the problems caused by high rates again for a few months. Or then again we might: once Covid cases bounced back up last summer – albeit in a largely vaccinated population, of course – they continued to oscillate around the level of the deadly Alpha variant peak, with the only sustained dip coming when children were out of school. Omicron cases may simply oscillate around an even higher level, so the decrease we’re enjoying at the time of writing might only be a temporary respite. And that of course assumes the absence of an even more transmissible variant.
The scale of the problem is extraordinary: at one point recently, one person in thirteen had Covid; around five million people have been infected in the most recent wave alone, and as I type the number of people infected is still somewhere around three and a half million.
The nature of Covid, even in a vaccinated population, means that these numbers are indeed a problem. While some people are Covid-positive without any symptoms, and some are only mildly unwell, for many people it remains a markedly more serious, unpleasant bout of illness than a dose of the flu: it can comfortably be enough to knock someone out of circulation, and therefore unable to work, for five to ten days. That’s leaving aside people knocked out of the workforce over the long term by Long Covid, and the unpleasant prospect of long-term consequences for millions of people as Covid is associated with cardio-vascular, cognitive and other problems – whether they prove to be evident only among older people, or are lying in wait decades from now for people who had it in their 20s or 30s, remains to be seen.
But here, I want to look at the immediate economic problems. The “Living with Covid” strategy asks the wrong question, catastrophically so for the 250 to 300 people per day currently dying from it, but more generally for the country as a whole. The question is not whether we can live with Covid, but whether we can function with it. We appear to be facing a situation where large spikes in infection levels – possibly regular spikes, as we’ve seen two in just five months – seriously disrupt public services and also many businesses.
We’ve seen this in the NHS, which is of course hit with a double whammy as its staff absences coincide with spikes in patient need. It recently reported the highest staff absence levels since late January, which were in turn similar to those of the Alpha wave of winter 2020-21.
Similar patterns can be found elsewhere, with disruption reported in January, and returning in March and April. On the railways, timetables were reduced at the start of the year due to staff shortages, and cancellations have been a feature of services since late March, including compounding the Easter travel disruption, on top of planned closures.
Likewise in schools: at the start of April, absence levels among teachers were reported at 1 in 12, a similar level to January, when the worst affected schools reported having more than 10% of their teachers absent at the start of term in January. There has not necessarily been any online teaching for children sent home, so bad has the absence problem been.
Not all sectors show such a clear pattern of twin peaks (forgive me): disruption to bin collections was reported far more widely in January than more recently, for instance. And for airlines, the picture is complicated by changing rules on travel restrictions over the winter, although even then there were reports of staff absences driving some cancellations, on top of other reasons for reduced travel. This month however, the situation has been much more clear-cut, with Covid-related absences driving cancellations, on top of staffing problems as the industry gets back up to capacity after the acute phase of the pandemic.
The failure of the Government’s plan for “Living with Covid” is therefore now plain. So much so, in fact, that the NHS Confederation has called for a new plan that will actually work. It’s not surprising that it’s an NHS body that has been first (I think – correct me if not!) out of the blocks in making this call: as noted above, the NHS faces a double challenge when cases rise.
Confed’s recommendations are quite heavily focused on measures that will keep the pressure off NHS hospitals, though the suggestion that messaging around Covid should be revised to emphasise the seriousness of the situation is surely right. There has been some comment to the effect that mask wearing might not be all that effective in the face of a major spike, as there was a point at which cases in Scotland, where it was still compulsory, were rising faster than anywhere else. But since then, it’s become clear that Scotland succeeded to an extent in “flattening the peak”, with cases now well below anywhere else in the UK. This might vindicate their approach: masks and app sign-ins were rigorously enforced throughout Scotland until recently, and free lateral flow tests have remained available: whatever the merits of masks particularly, their retention certainly sent a continued message to the public that the situation should be taken seriously. One way or another, this message surely needs to be got through to the public in England as well.
Perhaps more practically useful would be reinstating the requirement to self-isolate, and financial support (preferably much improved) for those who need to do so. And some access to LFTs could surely be reinstated without restoring the previous free-for-all offer: something along the lines of an entitlement of a pack a month or fortnight, to encourage tests before gatherings or when experiencing symptoms, with more available for anyone logging a positive result, would surely be feasible, and definitely useful. Continued and better promotion of the actual symptoms of Covid, rather than the “classic three” that became outdated once we had a few months’ data on the virus, should also be part of the mix.
None of that would amount to a dramatic escalation of restrictions, but it might just be enough to keep infection levels oscillating around a lower level that does not tend to cause wholesale disruption to businesses and public services. Until, of course, the situation changes again: hopefully that will be through the roll-out of a vaccine that is substantially more effective in preventing illness from Omicron and other variants; but we should brace ourselves for the possibility that it might be an even more infectious variant, or even one that is more effective at causing serious illness even in vaccinated people.
Policy Pulse 22: Functioning with Covid
Excellent discussion as usual John. I would agree that the impact of 'Long Covid' that we are aware of currently, and that is yet to become evident, is seriously underestimated. It affects all areas of society and relatively simple actions, such as mask wearing, should be reconsidered as you suggest.
I wish you well in your new freelance role.
Your best and most succinct analysis yet John (IMHO). You've very neatly expressed many of my concerns about the present policy and I suspect they are shared by a great many others. "Living with COVID" is a gamble, not an informed decision, based on the most cynical of political calculations. The withdrawal of almost all free testing whether PCR of LFD looks especially like willfully blindness. We can only hope the government has called it right, albeit for the wrong reasons, otherwise our PM has thrown a lot of grannies under the bus!