Risk your livelihood or your life: The new choice for UK’s covid vulnerable

In early February this year we heard of a new virus stalking the globe. First China, then Iran, then Tenerife, then Italy. As it loomed on the horizon, like an oncoming tsunami, the shape and size of the swell became clearer: a respiratory virus, with particularly deadly consequences for the elderly and those with certain high-risk conditions.

As a doctor on safari around some of London’s busiest hospitals at the time, I was deeply concerned for the safety of the most vulnerable patients, calling for early measures to protect them. And now, as the UK faces stricter measures to protect lives, the NHS and the economy, it is those who are physically and financially most vulnerable who will suffer again.

On a personal level I wanted to reduce the spread of the virus as much as possible back in March and protect my own family. My dad is on that list of people at risk. So is my brother-in-law. Eventually, “shielding” guidance and crucial financial and practical support came in for the extremely vulnerable. It lasted until cases had fallen to around six to seven hundred a day on August 1st. 

The transition out of shielding wasn’t easy for many. In my capacity as chairman of healthcare workers’ charity HEROES we heard first-hand the difficulties for key workers on that list, particularly in getting back to work safely. 

Cases are now six times higher than August 1, reaching a peak of 4,200 in terms of the official case numbers. However, with the collapse of test and trace, we can’t know the numbers in the community, and the King’s College symptom tracker estimates it to be many times higher than that.

The lack of guidance for these most vulnerable members of our society at this time is shameful

Given the nature of the virus, with a lag-period of two weeks before any intervention has a meaningful effect, the time for action to curb the rise was, ideally, two weeks ago, when the number of new daily cases returned to the same levels the country saw in May.

On Tuesday Boris Johnson announced new national measures in the wake of rising COVID cases, “acting on the principle that a stitch in time saves nine” as hospital admissions rise significantly once more. The measures keep schools, colleges and universities open, but renege on the previous “get back to work” campaign which, only a month ago, asked office workers to return. 

Table-service will be required in pubs and diners from Thursday, and they must now close strictly at 10pm. Mask-wearing is compulsory for hospitality staff, shop workers and for customers in eateries except when physically seated. These will be legally enforced, fining businesses that break the rules. Mass gatherings like sporting events are on hiatus now, and weddings will have to halve their guest lists to 15 for the foreseeable future.

These are welcome measures, especially the legal enforcement, although there are doubts about how practical this may be. As I told The Big Issue on Monday, early and short is still the best strategy for protective measures, but their effectiveness becomes less likely by the day. 

Just re-upping this.

Short and sharp now means far less time to reduce cases again. Prolonged and delayed will become a total mess. https://t.co/VIyxKt0fps

— Dr Dominic Pimenta MD (@DrDomPimenta) September 23, 2020

Those who were previously shielding, however, have been advised they do not need to shield except in local lockdown areas. Local lockdowns currently affect 13 million people, and the government guidance is unclear about what services will be provided to those shielding in those areas. Instead, they are advised to contact their local authority for further guidance.

While some services continue nationally, particularly the NHS volunteer responders and priority delivery at supermarkets, there is deep uncertainty, particularly for those attending workplaces, at what point they will be asked to shield again and, crucially, what support they will receive to do so.

The lack of guidance for these most vulnerable members of our society at this time is shameful. Already clinically vulnerable, those who can afford to shield voluntarily will more than likely do so. But without a network of support it will be those in difficult financial circumstances and most at risk that have to make a choice between risking their life and their livelihoods, a choice which can change at a moments’ notice, at the whim of the government and its fondness for announcing local lockdowns without warning.

The basics remain the same as they ever have. Stay safe, stay informed and be kind. It’s only together we get through this

Whatever the national support strategy will turn out to be, it is an immutable fact that cases will continue to rise for at least another fortnight after these measures come in, increasing the risk in the community, particularly for those who cannot afford to protect themselves. Far better to err on the side of safety, and end the confusion now nationally, so both employers and those on the shielding list can plan for what is going to be a difficult winter for us all. This meaningless delay in guidance serves only to disproportionately affect those who are both physically and economically the most vulnerable in our society, a dire injustice.

In the meantime we can all do our bit to protect each other as best we can, avoid unnecessary travel, work from home, make space, wear a mask and wash your hands. The basics remain the same as they ever have. Stay safe, stay informed and be kind. It’s only together we get through this.

Dr Pimenta’s new book, Duty of Care, is a gripping account of the first wave of the pandemic from the frontline and is in shops now, published by Welbeck. All royalties from the book will go to the HEROES charity. Dr Pimenta tweets at @juniordrblog.

Image: Number 10/Flickr