A top-down, over-centralised government Track and Trace system is failing poorer communities, reports Puru Miah
“It is BAME communities who have been at the forefront of the struggle against coronavirus – whether in healthcare or transport or social care or any of the other essential services that have kept our country going. And it is BAME communities, tragically, that have paid a disproportionate price.”Boris Johnson
On the 2nd of June 2020, Public Health England (PHE) published their report on the high number of Covid-19 deaths in our Black, Asian and Minority Ethnic (BAME) communities. After accounting for the effect of sex, age, deprivation and region, it found that people of Bangladeshi ethnicity were at most risk, with around twice the risk of death than people of white British ethnicity. Other BAME communities had a 10%-50% increased risk of death from Covid-19, compared to white British. The report was followed by the usual declarations by members of our political class of never again, and something should be and will be done. Now at the cusp of a second wave, have the lessons been learnt or is it a case of business as usual?
Putting these percentages into numbers, in the months of March, April and May this year over 10,000 more Londoners than usual died. At the height of this fatal wave in April nearly 200 people a day were dying in London. At least 1,100 of these deaths (or over 10%) occurred amongst Tower Hamlets residents, in a borough which has one of the highest child poverty rates in the country. In the latest statistics on levels of deprivation, published in 2019 by the Ministry of Housing, Communities and Local Government, Tower Hamlets remains the local authority with the highest levels of income deprivation in the over-60s. This is a combination of factors that has contributed to the particularly large number of fatalities from Covid-19.
Age-standardised Covid-19 mortality rates in the most deprived areas in England – areas like Tower Hamlets – were 128.3 deaths per 100,000, compared to 58.8 deaths per 100,000 in the least deprived areas. As Sarah Caul, Head of Mortality Analysis at the Office for National Statistics (ONS), noted, that means that people living in poorer parts of the country “have continued to experience Covid-19 mortality rates more than double those living in less deprived areas”.
Instead of mitigating inequalities in more deprived areas, the current passive Government strategy of track and trace is replicating them. The current government strategy mainly relies upon individuals seeking out a test for Covid-19 infection on their own initiative, and at their own expense in terms of income and time. PHE’s Screening inequalities strategy clearly highlights how screening processes can reinforce existing structural or systemic inequalities. So those most at risk are often least likely to be screened in self-selecting programmes.
It seems none of the lessons are being learnt from the first wave. In its Infection Survey pilot, the ONS found that in one week in September over 59,000 people had coronavirus in the community in England – the equivalent of 6,000 new cases a day. This study predicts 48 new cases of Covid-19 in Tower Hamlets per day. However, we have only detected 37 new cases per day in Tower Hamlets, according to PHE’s Covid-19 dashboard. Thus, we are missing a significant number of new daily cases in Tower Hamlets, under the current strategy of devolving the responsibility for arranging testing onto the public. If we assume, as per government guidance, that the Reproduction number of Covid-19 is 1.6 today, this would mean that, after 10 serial transmissions, the cases that we have missed would lead to over 1,000 new Covid-19 cases. This failure of a passive test and trace system is further reinforced by the recent BBC Panorama programme exposing chaos, technical problems, confusion and wasted resources inside the Government’s test and trace system.
A physical manifestation of the government’s passive approach and lack of engagement with inequalities on the ground, and the BAME population in Tower Hamlets, is the new Covid-19 test centre in Shadwell, placed adjacent to the busy Watney Market and sheltered housing. Shadwell is a densely populated ward and has among the highest levels of deprivation and overcrowding, with one of the largest concentrations of the Bangladeshi community. No engagement or consultation with the local community was sought, just an announcement. This has left many BAME residents angry and scared. Speaking to members of the local Labour Party BAME forum, many point out the inherent discrimination of being treated as passive observers to decisions that affect their lives. Local councillors report a third of the residents are being turned away from the test centre as they were not aware that they need to pre-book appointments for testing. So angry are local residents that there are talks of planned protests to force decision-makers and the test centre to engage with them.
Outside of London, the second-largest concentration of the Bangladeshi community is in Oldham. There, a different approach has been adopted, involving active engagement with the BAME community and other vulnerable groups. This is a case-finding programme and process of engagement, known as the Oldham model. While Covid-19 has become endemic in parts of Greater Manchester, Oldham has been able to provide a model of how to interrupt transmission of the virus.
Like Tower Hamlets, Oldham has some of the highest levels of deprivation in England and also a diverse multi-ethnic population. The recent surge of infections in Manchester has predominantly affected densely populated, multi-generational households, where the residents are in jobs where they cannot work from home. In response to this, from mid-August, Oldham has pioneered an active case-finding programme, with a team of 80 volunteers visiting 5,500 homes. This door-to-door approach has increased community trust and engagement and provided an opportunity to more effectively educate the public on protecting themselves from coronavirus. Significantly, these teams are also able to swab residents, markedly reducing the barriers to testing and contributing to a reduction in the rate of infection from 108 per 100,000 on 11th August, to 73 per 100,000 on 7th September. Despite the later failure of the pillar 2 testing programme, Oldham continues to have lower rates of infection than similar urban centres like Bolton.
As I write this piece, residents in Shadwell – mainly working class and from the BAME community – are planning a series of protests and a campaign against the Serco test centre being located in the heart of their community without any consultation. The anger is more directed to the fact that despite all the suffering and platitudes, nothing has changed. The government views the community as a passive participant with no agency, at the mercy of the whims of those further up the socio-economic ladder. It seems that Black lives still don’t matter. But things have changed in a community which has seen many of its members fall victim to the pandemic in the face of what many see as indifference by the powers that be. This time at the cusp of the second Covid-19 wave, residents and community groups seem determined to change that.