THE GREAT COVID DIVIDE
On the anniversary of the first lockdown, the north west has the highest Covid death rate of any region in the UK. In a special report, Jennifer Williams analyses why the pandemic has again highlighted the recurring theme of a north-south divide
SPECIAL REPORT: ON THE ANNIVERSARY OF THE FIRST LOCKDOWN JENNIFER WILLIAMS EXAMINES WHY THE NORTH WEST HAS SUFFERED THE HIGHEST COVID DEATH RATE IN THE UK
THERE was one particularly balmy night in summer 2020 that will probably get fleeting mention in most write-ups of the last year. Yet it was a significant and symptomatic plot point in the pandemic story.
At 9.16pm on July 30, as the sun set over millions of northerners enjoying their fourth week of post-lockdown freedom, health secretary Matt Hancock posted a tweet.
There had been a government meeting, he reported.
“Based on the data, we decided that in Greater Manchester, parts of West Yorkshire and East Lancashire, we need to take immediate action to keep people safe,” he said of our Covid-19 rates.
“The spread is largely due to households meeting and not abiding to social distancing. So from midnight tonight, people from different households will not be allowed to meet each other indoors in these areas.”
Most of us here have been banned from meeting one another either indoors, or in gardens, ever since, meaning Manchester and many other places in the north west have only been free from restrictions for 25 days of the last year. July 30’s Twitter thread would be the start of a long slog that saw ministers battle to dampen down the smouldering embers of the pandemic’s first wave, constantly changing localised measures in response to each spark.
To say July 30’s announcement came as a shock is not an exaggeration. On that mid-summer evening, gloriously sunny parks were packed full of people enjoying new-found freedoms. Muslims were busy preparing food for the next day’s Eid festivities. Pub and restaurant managers had no idea that within hours they would have to navigate another set of rules, yet to be codified by Westminster.
Downing Street’s ‘Independence
Day,’ the moment at which national lockdown had been lifted fully in England, allowing pubs and restaurants to open once again, had been less than a month earlier.
Parliament broke up a fortnight after that, meaning ministers did not have to explain what happened next to the House of Commons.
Instead millions of people were told the lockdown news via a latenight Twitter thread. Many of the accompanying practical details around childcare or business support were missing, including clarity on what would or would not be technically illegal.
The following morning, the health secretary appeared on BBC Breakfast and said we were not allowed to meet one another in beer gardens either. It would take a further nine hours, by which point hundreds of weekend pub and restaurant bookings had been unnecessarily cancelled, before the M.E.N. got clarification from the government that households could meet outside pubs and restaurants after all.
There would be no press conferences and no Parliamentary scrutiny of the move throughout August.
The experience of Covid-19 here does not cancel out that of the rest of the country, by any means. Everyone else hardly had a merry old time while we quietly suffered.
But underpinning the government’s actions that summer evening were two uncomfortable realities. Parts of the region already had rising case numbers, which would rumble on for the rest of the pandemic; and the government’s strategy to deal with them, such as it existed, was questionable.
Eight months on, the persistent rates of new infections that have plagued areas such as Greater Manchester since the end of the first lockdown have morphed into death statistics.
The north west has the highest Covid death rate of any region in the
UK, at 240 per 100,000 people, compared to the English average of 197.
Figures released by Public Health England on Thursday reveal the steepest national decline in life expectancy over the past year since the Second World War, but the biggest drops – of 2.3 years among the poorest men and 1.8 years for the poorest women – were jointly in the north west and the north east.
Internal NHS analysis seen by the M.E.N. shows 50pc or 60pc of admissions to some Greater Manchester hospitals in the first wave were people on the lowest incomes, compared to 26pc nationally. Around a quarter of admissions to Manchester Royal Infirmary and North Manchester General were Black, compared to 9pc nationally.
The disparity is familiar, mirroring Sir Michael Marmot’s brutal ‘10 years on’ report into health inequalities, published just days before the pandemic burst into the public consciousness a year ago. England’s health was ‘faltering,’ he found, after a decade during which public health policy had drifted. Gaps were widening and as a society, we were effectively going backwards. And the North, with its pre-existing high levels of poverty and post-industrial economic weaknesses, had particularly faltered. Life expectancy was already falling backwards in some parts of it, even then.
So when you speak to local public health officials about the last year, the word ‘Marmot’ is on the tip of their tongues. The kinds of overlapping health risk factors he identified in February 2020 – employment, poverty, poor housing, ethnicity – underpin the patterns they watched play out in the months that followed and have since been identified by the government’s Joint Biosecurity Centre as a ‘perfect storm’ of reasons for persistently higher rates in places like this.
The risks to certain areas were arguably hiding in plain sight.
GREATER Manchester has some of the highest concentrations of overcrowded housing in the region, and therefore the country, along with Blackburn, Burnley and Preston, which all also ended up in and out of local lockdowns last year due to persistently high rates.
It also has a large ethnic minority population. In nine out of 10 Greater Manchester boroughs, people from ethnic minority groups are more likely to do high-risk, front-facing jobs in leisure, care or other service jobs than white people, according to Office of National Statistics data, with the pattern particularly marked in Oldham.
Just under half of our neighbourhoods, or ‘lower super output areas’ in policy speak, are in the poorest 30pc of communities nationally.
All that was already causing poor health and shorter lives here before the pandemic, so local health officials have not been surprised.
“It was what I expected,” says Prof Kate Ardern, Wigan’s public health director and a leading figure in the Greater Manchester Covid response over the past year.
“The thing you always have to remember – and these things are particularly true when you’re dealing with an outbreak of a new highly transmissible disease – is where you have embedded structural inequalities, particularly where you have conditions that make it really difficult for people to maintain good infection prevention control, such as in housing of multiple occupation that are not decent homes, all of that means that the virus is going to spread more quickly.”
Ultimately, it’s about people’s ability to control their exposure to health risk, she says – whether for domestic, social or job reasons.
“That’s the nature of viruses. You only need to go back and look at how viruses spread in the 19th Century, where modern public health first started. It was poor areas that had more difficulty in accessing clean water supplies and sanitation. It’s equally difficult today if you don’t have the ability to maintain really good hygiene standards and it’s similar in the workplace as well.
“So all of that, I think, played out in the pandemic. There’s a long history of this. It shouldn’t surprise anyone that this was how Covid-19 played out and why the enduring transmission remained.”
Many here are firmly of the belief that before you even consider any of the government’s other pandemic responses, the timing of the first lockdown release made things significantly harder for the region from July onwards, because rates were still comparatively high at the time.
“The whole thing is about being out of sync,” says one senior Greater Manchester doctor.
“In the north we were out of sync with the national policy. That’s not our fault, that means politicians were not understanding the nuance.
“We were spared at the very start, but then it found its way into poverty. We unlocked while we were still endemic – the fire was still burning when they took the fire blanket off.”
Both Public Health England and Greater Manchester’s system quickly identified this in the summer. Slides presented in private to the Chief Medical Officer, Chris Whitty, in September, identify that Greater Manchester – and Lancashire – had continued to experience a ‘low but persistent level of transmission’ even during the first national lockdown, with reopening then occurring ‘with the virus still in circulation.’
“It was lifted too soon,” Prof Arden says of the first lockdown, “because what was not apparent in terms of the central decision-making was that the very high rates that had been seen in London and the South East after the February half term didn’t translate into the north until three or four weeks later, so we were three or four weeks behind.
“So when the first lockdown was lifted, we were still far too high. And that led to the very persistent rate and got into the working age population.”
Government’s answer, along with a new centralised test and trace system, was local lockdowns.
The so-called ‘whack a mole’ approach had been talked up by ministers since May, but despite repeated questioning, it had never been clear what footprint would be used, what the measures might be, what triggers would be applied or what practical support would be provided to those affected on the ground.
JULY 30 would mark only the start of what many here began to call the ‘hokey cokey.’ As government tried to navigate residual, bubbling virus levels, as well as political pressure from the Tory backbenches and the fragmenting, often rather chaotic views of Greater Manchester’s own leadership, people and businesses here and in other parts of the north found themselves under a kaleidoscope of different rules. Between July 30 and September 2, Wigan – and later Stockport – was taken out of measures; Oldham had them strengthened, narrowly avoiding a full economic lockdown; and in the most bizarre episode of all, Bolton and Trafford were removed from rules before hurriedly being put back in again 10 hours later, due to rising rates.
By mid-September, Greater Manchester’s 10 boroughs were living under four different sets of regulations and guidance – before Bolton suddenly had its bars and restaurants closed on September 8, with immediate effect. In a conurbation that functions as an economic entity, with people moving around across boundaries in the same manner as London, it became impossible to navigate.
Government then introduced the national ‘rule of six,’ which didn’t apply here – except in Wigan and Stockport. Even those of us covering the pandemic locally couldn’t remember what rules applied to where.
The Joint Biosecurity Centre (JBC) - set up by Matt Hancock to monitor virus data - would eventually find that the chaotically communicated changes had been detrimental to the Covid-19 response.
In few places has the persistent presence of the virus proved more turbulent than Oldham. The borough is, not coincidentally, a hotspot for the kind of health risks outlined by Sir Michael Marmot a year ago: among the highest levels of poverty in the country, some of the most overcrowded housing, a large ethnic minority population and an economy particularly dominated by front-facing and often precarious service jobs.
If all of that placed it at higher risk of a particularly bad pandemic, it also meant it could least afford to be locked down.
One in four people in the borough are also Muslim, so when the initial rules on household mixing came in late on July 30, the night before Eidal-Adha, many of those preparing to celebrate the major festival saw it as a deliberate, targeted decision.
“When they made the announcement on the eve of Eid, that was not only demoralising for the community but devastating for the community,” says Basit Shah, spokesman for the Oldham council of mosques.
“We are all human beings. The community understood it as being targeted by the government. Absolutely it was received in that way, of course it was. It’s not me saying that, it’s every person in our community. Even non-Muslims felt that too.”
No nod to the impact on Eid was
made in the government’s July 30 announcement – notable, given the headlines around Christmas later in the year. Policymakers have always denied the timing was due to fears Eid would lead to a further surge in case rates, although privately many in the local system are not convinced.
Local leaders were also jumpy last summer about the ethnic patterns in the way the pandemic was playing out in this part of Greater Manchester; nervous that community tensions of the recent past would be inflamed; not particularly inclined to give out data showing the pattern.
Yet for Gwenetta Curry, lecturer in race, ethnicity and health at Edinburgh’s Usher Institute, the greater risk factors affecting Black, Asian and other ethnic minority communities had simply not been properly factored in at the beginning.
“Very early on I was frustrated initially with the Office for National Statistics releases of data, because it didn’t disaggregate by race and ethnicity,” she says. “And I knew this was going to be an issue.
“When it came out, I expected exactly what I saw. We know Black, Asian and ethnic minority people are over represented in front-facing jobs and were going to be disproportionately hit by Covid-19. And they absolutely are. There definitely needs to be some fundamental changes in the way things are done. I’m very clear that the pandemic did not create the inequalities. It has highlighted the ones that existed. And now we’re wondering why ethnic minorities aren’t lining up to have the vaccine like their white counterparts.”
Oldham is also one of the ‘housing renewal areas’ that saw its planned regeneration scrapped in 2010, as one local official points out, a characteristic the borough shares with other places that have suffered higher rates, such as Bradford, Blackburn and Sandwell in the West Midlands.
Like public health directors, Curry points to the consequent impact on non-white communities. “Overcrowded housing has definitely
There’s a long history of this. It should be a surprise that this is how Covid-19 played out Prof Kate Ardern
been a factor. If you’re working in a front-facing job and going back to a multigenerational home, you’re taking the virus back to your family. If you bring the virus into your home, everyone is bound to get it.
“In New York they get 10 days in a hotel, away from their family, paid. They don’t have that here. Here, you are positive, you need to self isolate. How do you self isolate when you live in a house with three generations and you all care for each other?”
Shah echoes all the same overlapping points.
“Particularly in the Muslim community, we have a huge responsibility – we have to look after our mothers and fathers and grandparents and, on the other side, we have got our children,” he says.
“If you’re a taxi driver, you’re coming across many passengers and that has an impact, because when they come home, it doesn’t impact one person, but eight or ten.
“That’s why the numbers went through the roof. That’s where the impact hit on the BAME community and particularly the Asians and the Muslim community. Large families, small houses.”
He is clear that government communications were a factor in the way the pandemic played out. In the early days, he says, the community wasn’t hearing or understanding the messages.
For his community, the impact of a ‘perfect storm’ later identified by the JBC – high-risk jobs, overcrowded housing, deprivation – have been devastating.
“Muslims, if you go to the cemetery now, in five years we hadn’t had that number of deaths. Now when I go, we are running out of space.”
The M.E.N. found last month that most – 59pc – applications for self isolation support in Greater Manchester had been rejected by the councils tasked with administering it.
One cafe worker told us in February how he had been rejected for selfisolation support because the calculations had been done on his wages for the previous year, before his hours had been cut during the pandemic. Statutory sick pay, at £95.85 a week, was not enough to cover his outgoings.
“The feeling of guilt is high because you don’t know whether you are making people ill and I know they were really worried about that,” he said. “I know people have been going into work sick. People are coming in knowing they are ill but they can’t afford not to work.”
A Greater Manchester Combined Authority survey going before leaders this week found only 13pc of people who needed help to self isolate here had accessed the payment. There had also been an increase in people who felt under pressure to go into workplaces.
WHILE public health directors were arguing for self isolation support and localised contact tracing, the ‘hokey cokey’ was continuing, with news of different local restrictions appearing at different times of the day or week.
One of the most notorious episodes occurred on the evening of October 7.
The following day’s Times splash, when it was tweeted out, featured a government-briefed lead story headlined ‘restaurants and pubs in the north to be closed again.’ It mentioned Merseyside, but otherwise did not specify which areas overall would be affected, or when, or what sort of support would be provided.
Northern leaders and MPs of all political stripes were apoplectic, setting the tone for Greater Manchester’s showdown with government over ‘tier three’ restrictions shortly afterwards.
Away from the political noise, however, business owners were not only furious but heartbroken.
Bolton’s hospitality sector in particular had already been on a rollercoaster: investing to reopen safely on July 4; the Greater Manchester-wide restrictions on July 30; in and out of social mixing restrictions within 10 hours on September 2; then closed entirely on September 8, with immediate effect, only takeouts allowed under a 10pm curfew. It was unclear what new support, if any, would be available.
When the countrywide 10pm pub curfew then began dominating national headlines a few weeks later, pub and restaurant owners in Bolton said they simply felt ‘forgotten.’
Rebecca Brayshaw, owner of Bolton bar Courtyard 36, says this period of the pandemic was a ‘white knuckle ride,’ as she kept her eyes glued on social media for leaked government news.
“I think for myself and a lot of business owners – but hospitality in particular – it became almost 10.30pm at night, looking at my phone,” she says.
“What would be happening to my life tomorrow? It became a news story, and a circus, but it felt to me they forgot that it was actually our lives. We were living through it, literally waking up in the morning worrying what on earth would we be facing today. The rollercoaster of emotion was worse in some ways than the financial burden.”
Rebecca has stripped her bar of stock four times during the pandemic and says she has learnt to be wary of government announcements. She isn’t planning to reopen outside on April 12, in case she makes a huge outlay in outdoor coverings, only to find something changes.
Her business has relied on the government’s ‘bounce back’ loans to get through the pandemic, but she says the repayments are due to begin in July and now hang over her like a ‘big black cloud.’ It is a scenario facing businesses across the country, a point she acknowledges. But the sense of unfairness that persists here is marked.
“Imagine if that was Kensington or Oxford or somewhere and they had literally shut the businesses down and said ‘at some point we will get back to you about how we can help you and there might be a form to fill in but as it stands tomorrow morning, you have no business.’
“How on earth was that allowed to happen? My kids still need school shoes. We have a building that costs thousands just to stand still. Had anyone actually given this a second’s thought? The loss of control was not good for me.”
IT was precisely this kind of rage that played out in the weeks that followed the original briefing about pub closures, when government formally announced its new ‘tiering system.’ The move was essentially an acknowledgement that the ‘hokey cokey’ wasn’t working; the mole was not being whacked. Instead ministers now wanted to introduce measures across larger, more uniform footprints.
But as Greater Manchester’s bubbling rates began translating into serious pressures in the hospital system the resulting row revolved around fairness. After a period that had seen people and businesses repeatedly told different things since the night of July 30, it played into a sense of being ‘set adrift and forgotten,’ in the words of Rebecca Brayshaw, that, bizarrely for a government that won both the Brexit referendum and the 2019 election by tapping into exactly that kind of feeling, appeared to be missed in Number 10. Government allowed an extraordinary situation to develop in which local Tory MPs and Andy Burnham were united against it, despite plenty of chaos within Greater Manchester’s own position at the time.
At the very height of the ‘tier three’ row between Greater Manchester and the government, a frustrated Whitehall official got in touch.
“Burnham [is] claiming we’re sacr ificing northern jobs to save southern – it’s hard to deal with such a crisis when there’s such bad faith,” they complained. Intensive care there is heading for blowup. In the South West it is not. Should we be closing Truro bars because Greater Manchester has this acute problem?”
The question gets to the heart of the geographical and political
dilemma facing the government as it tried to dampen down rates in places that simply would not go away.
Except suspicions also lingered here that the argument simply did not apply in reverse. If London had a problem, then national lockdown would ensue, and not on two thirds of furlough.
“We’ve heard lots of rhetoric about the Northern Powerhouse and leveling up,” says Elaine Wrigley, who runs Manchester city centre’s Atlas bar with her husband Mark, which has lost £100,000 and laid off half its staff during the pandemic.
“Even in the last 12 months, you keep hearing ‘levelling up.’ The moment London went into the tiers, it was like the world ended, when we’d been in restrictions for months.
“Owning a business in the North West – and I’m a southerner – I definitely don’t see much levelling up going on. We’ve still got a major issue in the UK that we are really Londoncentric. And I think the pandemic has underlined that.”
What made the politics of the situation all the more baffling, as Rob
Ford, Professor of political science at Manchester University, said the day after Greater Manchester’s showdown, was that Andy Burnham had simply used the playbook Boris Johnson wrote.
“The thing that I find very puzzling about this is that Boris Johnson is a politician who led up a referendum campaign that was framed around ‘ignored people outside of the metropolitan liberal elites need a voice,’” he said. “He then won a 2019 election on the basis of ‘they have always ignored you in the metropolitan liberal elites and you need a voice.’ And now he seems to be surprised that another politician can steal the same applause lines and use them against him.”
WHEN the schools went back in September, the impact of the swirling levels of virus in the community started to disproportionately hit education in the region. To Glyn Potts, headteacher at Newman RC College in Oldham, that chaos wasn’t sufficiently recognised nationally. “It certainly
felt – and I might be dramatising this – a little bit that we were just having to get on with it,” he reflects.
“It was almost like the north was not given the same consideration or concern as some other areas of the country. The Times Educational Supplement did a piece that showed Covid absence between October 12 and October 23 2020. If you look at the London area, there were 682 student absence days. The north west lost 3,870. That was almost three times more than any other part of the country.”
Oldham has long been highlighted as a social mobility ‘hotspot’ by the government, a place that has particularly struggled since the decline in industry with skills, investment and decent jobs.
But children there lost five more school days in the first winter half term than the national average, in a borough that could ill afford to miss them.
Potts also believes far more thought should have been given to the practical realities of learning from home.
“There are children who were riding the tram to do schoolwork because they had no internet,” says Potts of pupils in his school.
Schools here also came to rely more heavily on supply teaching as permanent staff had to self isolate, with heads all fighting for the same extra temporary teachers, spending vast chunks of their budgets on temporary solutions.
Within two months, one in eight children here had been affected by closures, compared to one in 20 nationally. Or, as Chris Tomlinson, CEO of the Co-Op Academy chain which
includes schools in Manchester, Stoke, Merseyside and West Yorkshire - said at the time: “There is no doubt the challenges that schools are facing currently are far greater in the north, due to the very high infection rates in the communities they serve and work within.”
Potts says social services were ‘stretched to the hilt’ and particularly fears an uptick in online gang grooming and ‘county lines’ activity during the lockdown. He suspects more teenagers have been drawn into violence during the months spent out of sight.
RESEARCH into exactly how the pandemic played out in different places, among different groups of people, is clearly far from done. This is not meant to be a definitive assessment of a pandemic that is yet to conclude.
But as it stands, areas like ours have now been hit by a triple whammy: all the structural problems that appear to have made the region more at risk from Covid in the first place; the higher death rates that came with them; and the economic and educational impact of central government attempts to try and solve it in the heat of the crisis.
On many of the points outlined in this article, local public health directors have been banging the drum throughout, because they know their local populations. Despite that, when the latest local public health grant
was announced last week, it represented a real-terms drop of 24pc since 2015.
Decent public health funding was among many essential next steps outlined by Sir Michael Marmot just over a year ago, before Covid hit.
He didn’t suggest everything in society could or should be perfectly equal, however, but that government could no longer afford to ignore the trends already being seen in English society.
“We neither desire nor can envisage a society without social and economic inequalities,” he wrote.
“But the public thinks that inequalities have gone too far, and evidence from across the world suggests that the level of health inequality we see in England, is unnecessary...if we leave this for another 10 years, we risk losing a generation.”
Debate is now growing around a the need for a new ‘Beveridge report,’ the trigger for the creation of the welfare state post-World War Two. Beveridge’s conclusions, Prof Ardern points out, were hugely popular with the public at the time.
And yet maybe it is time for action, rather than more words.
“It is a new Beveridge sort of discussion,” she says of how to solve all the problems we already knew about.
“But perhaps we don’t necessarily want another report written. Reports get written and they get put on a shelf - and don’t necessarily get done.”