Tested positive?  Stay at home.  Can’t afford to take time off work? The Scottish Government has an answer. From 16 February more people on low pay can apply for a £500 grant to self-isolate.  But is that enough?  Will it help to stop the spread of infection and reduce deaths from Covid?

Such questions – and the time-consuming bureaucracy attached to the £500 grant – reveal the gap between the harsh realities of daily life for low paid workers, and the ‘FACTS’ of government rules and regulations.

A strongly worded report published in the BMJ at the end of January urges the UK Government to make support for self-isolation a top priority.  

The lead author, Dr Muge Cevik, an expert in infectious diseases and medical virology at St Andrews University, has described self-isolation as our “weakest link” in the battle against the coronavirus.

The charge applies across the UK.  In Scotland, as elsewhere, many people in low paid jobs – staff in care homes for example – cannot afford to take time off work.

“The next phase of the public health response must align testing strategies with people’s lived realities,” say Dr Cevik and her colleagues, Stefan Baral, Alex Crozier and Jackie Cassell. “Ultimately, people need to be able to isolate without fear of a substantial damage to their work, income, family, or caring responsibilities.”

Why so slow to act?

Covid has exposed the link between poverty, inequality, ill health and infection. As long ago as last May, National Records of Scotland showed that people in Scotland’s most deprived areas were twice as likely to die of Covid19 as those in the least deprived areas.

Yet, in January this year, well into Scotland’s second lockdown, Richard Leonard, former Scottish Labour leader, was still pressing the First Minister on the need to improve support for low paid workers.  Fewer than a third of applications for emergency welfare payment were approved, he said: “Will the First Minister agree today to further widen the Government’s criteria so that, at last, the money reaches those people who are in greatest need?”  

Nicola Sturgeon promised to ‘look at it’. Less than a month later, on 2 February, Social Security Secretary Shirley-Anne Somerville confirmed the £500 self-isolation grant would now be available to everyone in Scotland earning less than the Real Living Wage (£9.50 an hour), eligible for Council Tax relief and in receipt of various benefits – increasing the reach by perhaps 200,000 people.  However, as Mark Griffin MSP pointed out during the Scottish Parliament debate, people still have to provide documents to prove they receive benefits, can’t work from home and will lose income if they self-isolate. “It is a devastating irony that those who are most at risk have to do the most to get help.”  

It simply doesn’t take account of real life, as Dr Cevik told The Herald: “You can’t just expect people to sit at home with no money, no income, and then get £500 two weeks later, or four months later.”

A post-industrial disease

Scotland is not alone. The impact of post-industrial decline is revealed in bleak statistics across the UK  – this week, Public Health Wales reported some of the UK’s highest Covid death rates in old mining communities where home-working  is simply not possible.   In the UK’s former industrial areas, the Covid death rate is 30% higher than the national average and 50% higher than London, according to a study by Sheffield Hallam University published in January, reported The Guardian.

Stark disparities are evident within and between Scottish cities too. Why is Glasgow harder hit by Covid than Edinburgh? BBC Scotland’s Andrew Picken gave some answers:  Glasgow is more densely populated, has a higher concentration of people in poverty living closely together in flats and – significantly – more people employed in manufacturing and lower skilled services, often travelling to work by public transport.  According to the Centre for Cities “an estimated 31% of jobs in Glasgow can be done from home, while in Edinburgh that figure is 43%”.

Yet Scotland’s capital also has troubling pockets of deprivation as revealed in the work of Edinburgh Poverty Commission (End Poverty Edinburgh is currently developing a plan approved by City of Edinburgh Council in collaboration with local communities).

Longer-term solutions will require a radical shift in government economic policy, transferring both power and money from the centre to local councils and local communities.   

Right now, Dr Cevik says, “The focus should be on those working in high exposure occupations living in overcrowded housing, or without a home, and should include free and safe accommodation alongside adequate income support, job protection, and help with caring responsibilities”.

Protecting high-risk communities

Other countries show what can be done, according to the BMJ report, and it reveals the value of local action. In the US imaginative schemes have helped to reduce community transmission. New York City contact tracers automatically offer free hotel rooms to anyone testing positive. Vermont designed a response with the needs of high-risk groups in mind. Its community and public health led scheme includes protection from eviction, state supported housing for homeless people, hazard pay, meal deliveries, and free pop-up testing.

The result, says the BMJ report, is “high rates of test uptake, number of contacts identified, and adherence to self-isolation, contributing to reducing total household and community transmission.”

“No-one is safe until everyone is safe,” says Dr Tedros Ghebreyesus, director general of the World Health Organisation. He has been calling for international collaboration to share humanity’s skills and resources in research, medicine and vaccines. But in a tightly interconnected world, collaboration is also urgently needed within and between the four nations of Great Britain.  

By mid-February the UK’s (so far) remarkably successful vaccination programme is likely to have given a first dose to the most vulnerable members of society. Yet vaccination – which must also respond to the challenge of new Covid variants – is not a cure-all. In a time of alarming headlines, the authors of the BMJ report provide a sense of balance.

“As vaccines are rolled out”, they conclude, “even small improvements in people’s ability to quarantine and isolate can have an important effect on slowing transmission, hospital admission, and death, especially among those most at risk of covid-19.

“We can’t wait for vaccine mediated decreases in morbidity and mortality to manifest. Too many lives have been lost or destroyed. Integrating equitable support services for those most at risk for covid-19 is a national emergency and governments should act accordingly.”

Featured image: First Minister Nicola Sturgeon presenting Covid-19 press  briefing May 2020. Creative Commons CC By 2.0 

Further reading: MPs urge Boris Johnson to extend benefit increases worth £20 a week.BBC website