Dear Mr Javid,
Congratulations on your appointment as secretary of state for health and social care. As you said in your acceptance tweet, this is a critical time for the health of the nation. The fight against coronavirus is far from over. Around 128,000 people in the UK have already died; many hundreds fall sick daily. But there are some grounds for optimism.
Almost half the adult population is fully vaccinated – a measure that has proved highly effective in preventing death, serious illness and onward transmission of the virus. And daily deaths have fallen to a handful. We should note, however, that these encouraging figures reflect the public health measures currently in place and that the new delta variant appears to have triggered a worrying third wave in the UK.
You recently said that having initially “put public health first”, Britain must now “turn its attention to the economy” to help the country recover from what could prove to be the deepest recession in 300 years. You have warned about the dangers of lockdown, including delayed economic recovery with long-term job losses as well as threats to children’s education and an increased risk of child abuse as tempers fray within the home.
I share your concerns about these serious matters. I too want the economy to recover quickly and fully. I too want people of working age to return to their jobs and contribute creatively to building back better. I too want children to be safe, learning and thriving. I too believe the situation is urgent.
You have previously suggested that one way of getting the country “back to normal” might be for the vulnerable to accept continuing restrictions to their freedoms while the young and fit return promptly to their pre-pandemic lives. This is a position with which I strongly disagree, for three reasons.
First, the population cannot be cleanly divided into the “young and fit” and the “vulnerable”. Most people, whether vaccinated or not, lie somewhere in between: they are neither young nor old; while not sick, they have long-term conditions or risk factors that increase their relative vulnerability (for example, the Office for National Statistics estimates that 5% of the adult population are cancer survivors, 7% have diabetes, 12% have asthma and 26% have high blood pressure). The contribution of all these people to a fast and full economic recovery is crucial.
Second, the “vulnerable” cannot be hermetically sealed off from the rest of society. In multi-generational households, for example, such individuals may become infected by a grandchild who catches COVID-19 at school or a family member who commutes to work on public transport. And third, a policy of “living with COVID”, in which a substantial proportion of the population is expected to self-isolate from mainstream society for the foreseeable future, is surely a gross breach of human rights.
Fortunately, there are now evidence-based measures that will allow us to open up society without introducing a divisive form of health apartheid. As economist Andrew Sentance and I argued over a year ago in the Guardian, the best way to protect and rebuild the economy is to align the two goals of economic recovery and public health, not view these goals in zero-sum terms (that is, take the view that in order to immediately open up the economy, we should immediately roll back all public health measures).
It is more than a year since indoor mask mandates were shown to have both health benefits and economic benefits, not least because sick workers are unproductive, costly for employers and contagious. It is a shame that despite a call for precautionary use of public masking in early April 2020, it was not until July 24 2020 that masks were required in public places in the UK. The evidence for the efficacy and safety of masking has continued to accumulate. There are strong economic arguments to persist with this measure until the pandemic has abated, given that most jobs can be done, journeys taken and school lessons learned while wearing a mask (but quarantining severely disrupts all these).
In August 2020, my team summarised the evidence that physical distancing is effective in reducing transmission since most cases are caught from close contact; we also flagged the risk of long-range transmission of airborne viral particles in indoor spaces. There is now strong and consistent evidence that the SARS-CoV-2 virus is airborne. Indeed, the World Health Organization, which initially emphasised droplet and surface transmission, has recently affirmed the message that the virus is spread through shared air. Acknowledging this is crucial for protecting the economy, because it means that poorly ventilated spaces such as offices, factories, health and care facilities, school classrooms and public transport are potentially high-risk environments – especially when people are unmasked and together for long periods.
The government’s own Scientific Advisory Group on Emergencies (Sage) and the Health and Safety Executive have recommended – as a priority – effective ventilation of public buildings, along with monitoring occupancy and CO₂ levels (a measure of stale air) and air filtration where necessary. The US Centers for Disease Control and Prevention have published detailed advice for employers seeking to protect their staff in office buildings and for specific industries. As many of the healthcare workers’ unions have argued, staff looking after potentially infected patients or clients need high-grade personal protective equipment.
Measures like these do not just make workers safer, they also make them more productive. In the longer term, we need a paradigm shift to ensure that schools, workplaces and hospitals are designed, built and maintained to maximise ventilation, thereby minimising contagion. Such infrastructural changes will require short-term investment but will bring longer-term efficiency gains.
Mr Javid, you bring important knowledge and experience of economics to your new brief. If you can move beyond a zero-sum view of risks and benefits, you could use your knowledge to ensure that the nation’s economic recovery and the health of its people progress in step.
Professor Trish Greenhalgh
Trish Greenhalgh receives funding from National Institute for Health Research, Economic and Social Research Council, Health Data Research UK, Health Foundation and Wellcome Trust.