In this first of two extracts from Terina Hine’s new book, A People’s History of Covid, the impact of inequality and neoliberalism in the UK on the spread of Covid is outlined

Rumours of a mysterious virus originating in China were first reported in January 2020. Within a matter of weeks, the virus had spread across the world and soon touched the lives of everyone on the planet. In an interconnected, globalised world, the Covid-19 virus spread at a speed and scale never before encountered. The pandemic has been compared to a world war, and just like a war, the warnings were ignored and much of the devastation avoidable

The biggest lesson to be learned from the pandemic is that we were not all in it together. That our society is structured in such a way as to ensure that when crisis hits, the rich are protected and the poor pay the price. Two years of Covid made this crystal clear: inequality is the greatest threat to health and wealth the best shielding strategy.

In 2020, the UK had the misfortune of being in the hands the worst possible government for a national emergency. Having won power on the back of the Brexit vote, Boris Johnson led a chaotic, indecisive government. It lacked political acumen, intellectual rigour and had no moral principles. A deadly mix in a health crisis. Decision making was slow and policy formed by a handful of libertarian backbenchers with the help of opinion polls, rather than medical or scientific advice. They had no thoughts about how to govern, let alone how to govern in a crisis. Their only thoughts were about how to dismantle the state, making as much money as possible for themselves and their cronies in the process. The focus was on ‘getting Brexit done’ regardless of the global health emergency. All warnings of the looming pandemic were ignored.

We now know that up to 30,000 deaths could have been prevented if the government had put the UK into lockdown just one week earlier, and the lockdown would have been both shorter and less economically damaging.

Preconditions for disaster

Ideologically wedded to a shrinking state, the Cameron/Osbourne duo left office in 2016 with the country’s health system seriously damaged. In 2015, the King’s Fund reported that the NHS had received the smallest increase in spending over the previous five years since the Second World War, and that the ‘ten years up to 2020/21 were likely to see the largest sustained fall in NHS spending as a share of GDP than in any period since 1951.’ As a witness to the Covid Inquiry in June 2023, Cameron’s health secretary, Jeremy Hunt, admitted the country had been left exposed by staff shortages and cuts to social care. His former boss, David Cameron, refused to acknowledge any responsibility for the crisis.

However, it was not just the NHS that suffered from Cameron/Osbourne austerity. Lack of sick pay, low benefit rates, and poor housing all ensured the poor had less resilience. Those without sick pay and in precarious employment were unable to take time off work, less able to shop online, more reliant on public transport, and were in jobs requiring greater social contact. Overcrowded, multi-generational housing provided the perfect incubator for disease. Private gardens and comfortable, warm, spacious homes made life for the rich not just easier during lockdowns, but far, far safer.

During the first harsh lockdown, it was only key workers who were permitted to leave home for work: those working in health, education, transport, utilities, food, key public services, national and local government, and public safety. In total about ten million people, a third of the workforce. Everyone else had to remain at home.

Key workers are disproportionately drawn from more deprived communities, they are more likely to be female or come from an ethnic-minority background, and more than a third work in health and social care. About a third have school-aged children.

Once the stringent ‘stay at home’ rule was relaxed and replaced with advice to work from home ‘where possible’, more and more low-paid workers were forced back to work. By the second lockdown, ONS figures showed that 46% of the working population was travelling to workplaces, while 20% of employees who could have worked at home were prevented from doing so by their employer.

Throughout the pandemic, sick-pay levels were so low that many people had no option but to continue to work even if infected. The UK then, as now, had the lowest rate of sick pay in Europe, compounded by welfare payments being too low to meet basic needs without additional income. Lower-paid key workers were not only more at risk of contracting the virus, but once infected, were less likely to be able to isolate. The vicious cycle of community spread was set, and in this case the community was the working poor.

Over 230,000 died in Britain with Covid-19 named as the cause of death on their death certificate. The toll of Covid was most harshly felt by the poor and disadvantaged. Mortality rates, hospitalisation, long Covid and economic hardship were disproportionately felt by those with the least. Low-paid workers were more likely to lose their jobs, were far less able to work from home and often had no choice but to work while infectious or ill. Greater exposure to risk was compounded by high levels of co-morbidities, inadequate housing, and a lack medical and financial support. The high death rate among the working-aged poor, ethnic minorities and disabled groups shows a catastrophic failure of healthcare, and exposes a society in which social, economic and health inequalities have been accepted as the norm for over a decade.

Official figures show more than 2,000 health workers died from Covid during the pandemic, including porters, nurses, and doctors, with the majority being care-home employees. In July 2021, a report by Amnesty International revealed the UK had the highest health-worker Covid death rate in Europe, the third highest in the world. These appalling figures are an indictment of the government’s lack of planning and failure to provide adequate PPE. These workers went unprotected as they saved lives; the government still failed to take responsibility.

Herd Immunity and the first lockdown

Disturbingly, there is a growing body of evidence that the government’s refusal to act, their repeated delays to lockdown, their ignoring or cherry-picking of the science, was a neither incompetence nor simple indecision, but part of a deliberate herd immunity plan with a smattering of eugenics.

Herd immunity in relation to a deadly pathogen is politically toxic. It means the weakest are left to die – the disabled, the old, the sick. The government denied they followed such a policy. But we know Johnson argued to let the virus rip, that he knew casualties would mount, claimed those dying had reached their time anyway. ‘Let the bodies pile high’ he yelled in an outburst against the third lockdown, and they did.

Boris Johnson and Matt Hancock discussed the plan with their Italian counterparts in telephone conversations later revealed to the media. Italy, already in lockdown, clearly thought the British government was taking a dangerous risk, and tried to stress the need to ban large gatherings. But with a herd immunity approach, keeping things open made sense. The public was not so sure. They had seen tv images from Italy and, along with a number of public institutions, took matters into their own hands. Sporting authorities began to cancel fixtures and people began to avoid large gatherings. A week before lockdown was announced, many began working from home.

On 13 March, Patrick Vallance was more explicit. He explained on Sky News how herd immunity was the only way to beat the virus, how it would require 60% of the population (forty million people) to be infected. Evidently shocked by his candour, the news anchor was quick to point out the implications: ‘an awful lot of people dying’. Vallance reluctantly agreed, adding ‘this is a nasty disease’. At this point, infections were doubling every three days.

The media, the public and the medical establishment were appalled. The plan was not just callous, but deeply flawed. Exponential growth would result in incredible numbers falling ill and requiring hospital care. The heath service would be rapidly overrun, swathes of medical staff would be too sick to work. The NHS would be overwhelmed in a matter of weeks. Plus there was no evidence that immunity would last, and clearly, as more and more people died, the public would take action to reduce the risk to themselves by staying at home, avoiding public spaces, mass gatherings and public transport, and where they could, they would work from home. Any economic benefits of keeping society open would be lost, and at a very high price.

Terina Hine, A People’s History of Covid is available here, from Monday, 8 April