Freedom for Whom?

Landmark days are often false dawns. Think of George Bush standing on the USS Abraham Lincoln under a sign announcing ‘Mission Accomplished’. The irresistible political pull leading a politician to make this kind of announcement is the knowledge that it’s what most people want to hear. Even as George Bush spoke, plenty of commentators baulked at the implication of the banner’s message. It is increasingly likely that ‘Freedom Day’ in England will be yet another fictional waymarker, an illusion of normality which will run up against the reality of a strained health service and exponentially rising infection.

Promised, delayed and now hedged about with caution, the date when all legal restrictions in England are lifted comes at a moment when the virus seems to be everywhere. Data, modelling and research are telling us that a swift abandoning of restrictions will fuel a fire-storm of transmission leading to rising deaths and more people experiencing long-COVID. The Government expects the success of the vaccination campaign to blunt the cases, deaths and debilitation, but they will still come. It appears that we have decided to accept the cost of 200 daily COVID deaths in order to open the economy and allow life to return to normal. In all likelihood these will be deaths amongst the unvaccinated; people from minority-ethnic communities; the poor and those with underlying health conditions.

Before the final restrictions are lifted, crowded streets in York’s Medieval centre

There must be people in other parts of the world (and the UK) looking on in disbelief. Much of the argument seems to run economy/wellbeing against restrictions/safety. Yet if the cost of delayed freedom is high so too will be the long term price of COVID organ damage; psychological harm; and the risk of rapid transmission producing new variants against which vaccines are less effective. I appreciate that the UK Government, like all governments, is making hard choices on limited data. However, ‘learning to live with COVID’ could mean accepting some permanent changes in society rather than simply giving up on attempts to contain levels of transmission and the associated risks. It appears that our accommodation with COVID will suit the hale and hearty, while shifting the emotional, physical and psychological cost to those individuals and communities already disadvantaged in our society.

“as we are aware, the impact of these government policies will disproportionately affect already disadvantaged groups. Michael Marmot’s recent report shows us that the fall in life expectancy due to covid has been much greater in some regions, leading to even greater health inequalities. The social determinants of health inequalities have become wider during the pandemic, and any further mass infections and lockdown will simply make matters worse”.

“Freedom Day” is on the horizon, and brings with it the risk of mass covid-19 infection, 16 July 2021 BMJ Opinion by J S Bamrah, Chairman, BAPIO and Kailash Chand, former deputy chair, BMA

At the start of the Government’s roadmap to unlocking our arrival at a day without restrictions seemed reasonable. Yet on this narrow path of balanced risks we are straying ever closer to a reckless blow-out with consequences which, if the NHS is overwhelmed in summer, will cause major damage in delayed treatment for non-COVID patients (not to mention staff burnout). It is a missed opportunity that the interruption of routine living has not led to a deeper reflection on what a new normal might look like. There is every indication that many individuals have done that reflection, opting for altered lifestyles and early retirement (where possible), but the idea that we might live differently has bypassed political analysis. Even the modest change to greater working from home has been met with political statements about the need to return to the office.

We cannot live in lockdown indefinitely and few are suggesting that we should. However, with rocketing infection rates the wisdom of removing all legal restrictions in England feel like an irresponsible act. Having observed behaviours in a city during the last few months, let alone watched the antics of crowds at Euro 2020, the idea that most people will choose to observe the use of face covering etc., is ludicrous. An age-divide may well emerge in the way precautions are taken, which is ironic given the fact that younger populations have a lower level of vaccination. What was a disease of the elderly may end up taking a toll on the lives of countless younger people, whether in preventable loss of life or an enduring legacy of damaged organs and tissues.

More than anything else COVID-19 has posed a fundamental question about how we live. How the freedoms some of us assumed and took for granted enabled the rapid spread of a new disease around the world. As people took their holidays, or jetted across the globe for meetings and conferences, the virus went with them. While the lockdowns curtailed some of the human impact on the environment, with fewer journeys, this hasn’t stopped the effects that have burned the west of the USA and Canada, or led to the devastating deluge in Germany. On two life-defining issues, unqualified access to a seemingly infinite range of choices is likely to lead to calamity.

To reach the point of ‘freedom’ it feels like we have othered the virus. With the sustained campaign of vaccination the illness now belongs to those who have failed to understand its importance and declined the jab. Today it is a disease for the poor around the world, the people with no access to immunity or healthcare. At worst it is a minor inconvenience for the wealthy and well-resourced. Something to deny us our well deserved holiday abroad. Maybe all this will be true – but this is a disease about which we know very little. Long-COVID is only just being investigated and understood. No one knows what variant will emerge triumphant from the unimpeded production of virus copies being knocked out every day in the UK. Hundreds of thousands of transmissions every week. The angst being felt by the growing number of people ‘pinged’ by the COVID app should not be seen as a needless disruption to life. The Guardian cartoonist Martin Rowson got it right yesterday. As a motley group of silhouetted figures dance down a hill towards a town the caption reads: ‘Never send to know for whom the app pings”. As the Health Secretary and PM discovered today (eventually), it pings for thee.

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