On the 4th of May 2023, the World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus declared that the Covid-19 pandemic is no longer a public health emergency of international concern. There have been just under 7 million reported deaths worldwide due to Covid-19, models that try to estimate the number of unrecorded deaths put the total death toll somewhere between 20 and 30 million. Many survivors have been left with chronic, debilitating conditions. Over three years on from the emergence of Covid-19, now is a good time to critically examine the narratives that have built up around how we should have responded. How we should have responded to Covid-19 informs how we should respond to future pandemics, which will undoubtedly occur.
Andreas Malm’s book Corona, Climate, Chronic Emergency describes the intrinsic tendencies of capital accumulation that will make zoonotic spillovers, where diseases cross from animal to human hosts, inevitable. Humans are striking out deeper into hitherto undisturbed habitats to satisfy their ever-expanding needs for resource extraction. At the same time these commodities (and pathogens) will travel across global markets that are both faster and more interconnected. The disintegration of the global climate will spread disease vectors, such as mosquitoes carrying malaria and dengue, into new territories. It will also displace entire communities, creating swathes of refugees living in conditions that will be more favourable for disease transmission.
We can’t, therefore, treat the response to Covid-19 as a historical debate over what should have happened, the questions raised will be relevant to future outbreaks. A prominent response to Covid-19 has been to question the need for the blanket “lockdown” policies that most countries around the world chose to respond with. The greatest negative consequences of these lockdown policies fell upon the poorest — nationally and globally. As people dealt with the financial and emotional consequences of restriction policies, the capitalist class made the most of the opportunities that the crisis presented: just under 500 new billionaires were created during the pandemic. Given the severely unequal distribution of the harms that resulted from lockdown, it is fair to question whether such restrictions were necessary.
I spent the Covid-19 pandemic working in a university as an infectious disease modeller. I was part of a Covid-19 working group that used models to estimate how effective lockdowns and tiered restriction policies were at reducing Covid-19 transmission. I also forecasted Covid-19 deaths and hospital admissions and estimated epidemiological indicators such as the reproduction number and the case fatality rate. These estimates and model outputs went to the UK government scientific advisory panels SAGE and SPI-M-O and formed part of the evidence that the government used to justify lockdown. There were many times during our stints as impromptu scientific advisors where I felt conflicted about the policies of a government spurred into action by our work. Covid-19 had developed into a good opportunity for the UK government to harden its borders and suppress political protest under the aegis of science.
In their book The Covid Consensus, the historian Toby Green and journalist Thomas Fazi provide a left critique of lockdown policies and instead advocate for “focused protection”. Focused protection was the approach recommended in “The Great Barrington Declaration”, a statement published by three senior epidemiologists in October 2020 that expressed concern about the impacts of lockdown policies and recommended an alternative framework. The GBD authors claim that they were “coming from both the left and the right”, and that the “most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk”.
There are few concrete examples of what a focused protection policy would involve in the Great Barrington Declaration. However, its authors claim that a “comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented, and is well within the scope and capability of public health professionals”. In a later interview, Sunetra Gupta, one of the authors of the Great Barrington Declaration, explained the lack of concrete ideas: “People criticize us on the finer points; ask why we didn’t lay out exactly how it was to be enacted. But a fundamental point is that people fail to appreciate that it was a strategic statement. The way that it would be implemented in different locations had to be worked out specifically within those settings”.
Green and Fazi list a few examples of concrete policies that could have been implemented in richer countries: developing PPE manufacturing centres, retraining and rehiring retired nurses and doctors to work with Covid-19 patients, and designated exercise and shopping times for vulnerable and older members of society. During spikes of high transmission gatherings would be limited to 50 people and schools would be closed for short periods of time. For poorer countries Green and Fazi explain that “the need for focused protection, and what it would have looked like, again would have been different”, without listing any examples.
This is the crux of the problem with focused protection, it doesn’t seem like the people advocating for it have seriously considered what focused protection policies would have looked like had they been implemented by the governments of the world in 2020 that instead implemented lockdowns. They also implicitly assume that the negative consequences of lockdowns were due to the technical details of the scientific modelling, rather than the manner in which they were implemented. I would argue that a considerable portion of the negative impacts of lockdowns, particularly the financial repercussions of not being able to work, could have been mitigated by a government with different priorities. People who could no longer work due to lockdown did not have to be thrown into poverty – but they were. The interests of the capitalist class intervened in the process of lockdown policy formation to ensure that the negative consequences of the restriction policies fell disproportionately onto the global working class.
Lockdowns in scientific models take the form of reducing “social” contacts between randomly interacting particles that represent humans. Which of your social contacts were restricted or permitted and how brutally this reduction was policed was the domain of those who created the policy. Many modellers may well have acted as handmaidens in defending the punishing lockdowns being pushed by their governments — this is unsurprising: many scientists come from wealthy backgrounds and are privately educated. Furthermore, as a field, infectious disease modelling focuses on technical fixes to specific problems rather than engaging with larger structural problems in society. But neither of these factors make scientific models the ultimate origin of the punishing nature of lockdowns rather than governments across the world.
In the UK the estimates produced by infectious disease modellers were used to justify the policy response. In practice, this meant that their suggestions for imposing restrictions to reduce transmission were gladly seized upon. Meanwhile, suggestions to provide financial support for those being restricted were met with less enthusiastic responses. Surveys consistently found that low adherence with self-isolation was associated with having dependent children, lower socioeconomic status, and financial hardship during the pandemic. The government knew this, since these surveys were reported to the Department of Health and Social Care and the Scientific Advisory Group for Emergencies (SAGE). While the UK government temporarily allowed people to start claiming sick pay immediately, rather than from the fourth day of being sick, statutory sick pay in the UK remains amongst the lowest in Europe.
Eventually the government introduced a “Test and Trace Support payment” that provided low income people with a lump sum of £500 if they were required to isolate themselves. But food bank use increasing over the pandemic shows that this was clearly not enough to slow the rise in poverty that lockdowns caused. What this demonstrates is that the government was selective when it followed the science. Scientific analysis was apparently enough to justify restricting people’s activities to reduce transmission, but other scientific analysis suggesting that poverty made these restriction policies leaky was not enough to justify meaningful action to reduce poverty. Lockdowns in the UK were constructed through the lens of how the Conservatives already liked to treat the poor.
In the UK we could have had a lockdown that aimed to encourage people to comply with social distancing by providing support to make it less painful to do so. Instead, we had a lockdown that focused on punishing offenders that broke the rules. The fact that we had the latter instead of the former doesn’t seem to me to originate from the technical aspects of the modelling used to justify restrictions in general. That lockdown policies did vary by country, and that some countries were more caring than others, says more about in whose interest that state is run than it does about their ability to “follow the science”. There are two consequences of this: that focused protection policies implemented back in 2020 would have shared the punishing nature of the lockdowns of 2020, and that lockdowns could have had some of the caring aspects of imagined focused protection policies.
For an example of a more caring, less punishing lockdown we can turn to the Covid-19 response in Cuba, historian Helena Yaffe reports that: “Business taxes and domestic debts were suspended, those hospitalised had 50% of their salaries guaranteed and low-income households qualified for social assistance and family assistance schemes, with food, medicine and other goods delivered to their homes”. In April 2020 utility bills were suspended, further alleviating the economic consequences of being confined to the home. For children missing school, lessons were broadcast on national television to guarantee the widest possible reach. In Cuba the state placed restrictions on the liberty of its citizens to avoid the worst consequences of widespread Covid-19 transmission while at the same time acting strongly to alleviate (as much as possible) the negative effects that this produced.
In contrast, the government that oversaw lockdown restrictions in the UK was the same government that cut council funding until a child died in a mould-ridden flat and continues to take pleasure in deporting migrants to Rwanda. Is it any wonder that lockdown policies in the UK were not of the caring variety? Green and Fazi pose the question: if the punishing nature of lockdowns stems from the callous nature of national governments, then why did many left-wing governments also pursue punishing lockdowns? The sad answer lies in what counts as a left-wing party in many countries: parties that maintain a fundamental commitment to full-blooded capitalism and the interests of the capitalist class, with perhaps some minor redistribution of wealth.
In the face of implacable worldwide neoliberalism the desire for focused protection is partly a pragmatic one: you can spare many the harms of neoliberal lockdowns by preferring a policy where far fewer people fall under restrictions. However, the aspirations of focused protection advocates go beyond imagining that neoliberal lockdowns happen to fewer people. During a lockdown in the UK two young women in Derbyshire that drove separately into the countryside to go for a walk together were arrested. I don’t think focused advocates would find this a proportionate response, even if the two women had been elderly.
Green and Fazi go to great lengths to list the ways in which people were forced into poverty during lockdown. Under focused protection, would only those people likely to have had severe Covid-19 infections be forced into poverty? It seems to me that the authors envisage an ideal pandemic response that would not have forced anyone into penury. I agree with the authors on wanting a pandemic response that does not force people into poverty, as, I imagine, would most other people.
But neoliberal was the nature of the pandemic response on offer back in 2020. In the UK, if we had drawn the line for being covered by focused protection at 60 years old, which the Great Barrington Declaration describes as “somewhat high risk”, this would have put roughly one in four people under some kind of restrictions. This number would increase when you include those who are clinically vulnerable for reasons other than age. Perhaps testing whether people were vulnerable enough to be eligible for support might have been outsourced to the same callous firms that the Conservatives use to decide if disabled people are fit for work or to run migrant detention centres.
Under neoliberal focused protection people vulnerable to severe infection would have faced the same plunge into poverty that people faced on a much wider scale during lockdown. For the population not under restrictions, a non-lethal infection with Covid-19 would have been most damaging to the poorest. As we saw during the pandemic, the Conservatives saw no reason to increase sick pay simply because people were too poor to comply with restrictions.
How well the most vulnerable are able to isolate themselves is more important during a focused protection policy, since the prevalence of infection in the general population will be higher for certain periods of time. In 2020, Sweden, the poster child of most arguments in favour of focused protection, set up a National Commission to evaluate the effectiveness of their Covid-19 policy. Epidemiologist Jonas Ludvigsson summarised the commission as concluding “that the high number of deaths among older people in Sweden, especially during the first wave, was probably due to high overall viral transmission in society. However, other contributory factors included structural deficiencies in residential care and lack of pandemic support for staff.” Despite the good intentions of focused protection advocates, I doubt the policy that would have emerged from most governments around the world would have been particularly focused or particularly protective.
Much anti-lockdown literature mentions the “laptop class” of affluent workers that worked from home all pandemic or were placed on a comfortable enough furlough — the “winners” of lockdown policies. To me this seems a begrudging acceptance that if these circumstances were the norm, then much of the sting could have been taken out of lockdown. This is not to downplay the toll that was taken on so many people, including myself, through missing their friends and loved ones. However, it does highlight how so much of the damage of lockdowns as they were implemented could have been averted if no-one had to worry about how they were going to feed, heat, and house themselves.
Those who continued to work through lockdown to keep the country running while others sheltered should have been compensated to reflect the risk of harm from infection that they faced while doing so. This is something that Green and Fazi describe as part of focused protection, but it is also something that I think should have happened during lockdown. Hazard pay didn’t happen during neoliberal lockdowns for the same reasons that it wouldn’t have happened during neoliberal focused protection. This is indicative of how the focused protection versus lockdown debate is too narrowly focused on the specific policy response when most of the harms were not caused by the policy in a strict sense but in how it was implemented.
Focused protection would have faced the same neoliberal filtering that shifted the burden of lockdowns and Covid-19 infections onto the poor. The comparison between lockdown and focused protection in the shadow of neoliberalism seems to me far more brutal and less obviously skewed towards focused protection than many claim. The reason why lockdowns caused so much harm to the global working class is the same reason that they lived so precariously before Covid-19 existed. If we really want better outcomes for the global poor in the next pandemic, we don’t need a different policy response, we need a different world.