England’s Covid-19 strategy is all about London. Sorry, northerners

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Steve Rotheram is worried about exit strategies. The metro mayor for the Liverpool City Region told the BBC that a newly announced ban on households mixing in Merseyside could be “a bit like the Hotel California: you can check out but you can never leave”. His reason for concern? While areas like Bolton in Greater Manchester were left to deal with takeaway-only restrictions on pubs and restaurants throughout September, even as its case count dipped below many other parts of the country, Labour leader Keir Starmer pointed out at last week’s prime minister’s questions that Luton is the only place to come out of local measures to date.
The same day, as prime minister Boris Johnson explained to Starmer that the people of Luton had simply “pulled together” to manage the virus, Rotheram and Greater Manchester metro mayor Andy Burnham held a joint virtual press conference. All summer, the two mayors have argued that a pro-London bias has affected coronavirus decision-making, with Rotheram remarking in early June, “Not everything that’s in the best interests of London is in the best interests of elsewhere.” This time, Burnham added that “nowhere south of Solihull is subject to restrictions”.


The most compelling evidence of a London-centric approach so far is Public Health England statistics that show that 24 per cent of Covid-19 deaths in Greater Manchester this year occurred after the May 15th easing of the national lockdown, versus just 9 per cent in London – “a legacy of lockdown measures being lifted too early” in the north of England, says Burnham. The mayor isn’t alone in thinking that, either. In an ITV News/Savanta ComRes survey of 2,000 people published in September, 58 per cent of respondents in northern England said the lockdown was lifted too early; 13 per cent thought it too late.
“Places like the north west, Greater Manchester and Leicester still had levels of Covid that were higher and an R value closer to or above one [when lockdown ended],” says Richard Gold, a Labour councillor for Bury Council. “Therefore we had spikes quite soon after. The evidence seems to show that the national release of restrictions was done on London’s trajectory and not the entire country.”
It has also been argued that prioritising the announcement of advice such as the return of the “work from home if you can” message, delivered by Michael Gove on September 22, over alternative national measures is seen best through a London-centric lens. In The Guardian, Bristol University professor of quantitative social geography Richard Harris and UCL professor of geographic information James Cheshire recently made the case that London has almost double the financial, insurance and ICT jobs than England as a whole, and both the north west and Yorkshire and the Humber regions have many more manufacturing jobs than the capital.
“Our belief is that one of the reasons London is doing relatively well is because much of its population is able to better self-isolate by working from home. Not everyone, but enough to reduce the infection rates,” they wrote. In mid-September, Morgan Stanley research found that 63 per cent of London-based office workers were still working three to five days at home.


More casual commentary on Twitter and Reddit around, for instance, the timing of Johnson’s third address to the nation on September 22 coinciding with a rise in London cases is probably unfair, says Linda Bauld, the Bruce and John Usher chair of public health at the University of Edinburgh. In fact, the TV address came a day after Chris Whitty and Patrick Vallance outlined how cases were rising across the whole of the UK. That said, Bauld, who is a behavioural psychologist, offers up a curious theory, suggesting that some choices could be a “function of where government is”.
“One of the things I’ve been talking about a lot is that one of the differences between the area I normally work in, which is cancer, and this issue, is that when you have a virus, a communicable disease, it’s an immediate threat,” she says. “You feel fear about your immediate threat versus long term threats of chronic, non-communicable diseases. If you’re in London, and cases are rising in London, and your friends, neighbours, family, the environment you work in, they’re all worried about that, you subconsciously take on that threat yourself and so therefore you do focus on that.”
With Burnham and Rotheram predicting a widening of north-south economic inequality this winter, Sophie Harman, professor of international politics at QMUL, thinks communication is key: “People need to trust the government is taking action that will keep them safe, not that this is another example of London-based politicians trying to penalise parts of the country that have so often felt left behind.”
New analysis suggests that this could be more complicated than a strict north-south divide. Emails from Dominic Harrison, director of public health for Blackburn with Darwen, Lancashire, to the DHSC, which were leaked to The Sunday Times, aim to demonstrate that if you review the case rates across the country, some more economically deprived areas such as Blackburn with Darwen (212 cases per 100,000 but locked down with some wards at 60 per 100,000), Chorley (72) and Wolverhampton (56) have been placed back under more restrictive local measures earlier in their case rate trajectory.


Meanwhile, the figures show that wealthier areas with similar or higher case rates, such as Richmondshire, North Yorkshire (73 cases per 100,000), and some constituencies that voted Conservative in 2019 – Barrow-in-Furness (112), Darlington (110) and Wakefield (73) – have so far avoided local lockdowns, with all the negative economic impacts and questions around their effectiveness that follow. On October 4, Harrison tweeted: “Are you more likely to have social lockdowns earlier and for longer and at a lower confirmed case rate if you are northern, less wealthy, non conservative #localgov area? Check the data.”
Health secretary Matt Hancock has stated that infection rates are not the only data point used to decide which areas to place under restrictions and Johnson’s response last week to the allegation that the north-west is being treated “differently” to his London seat of Uxbridge and South Ruislip (44) was to say, “I appreciate… people want to see an iron consistency applied across the whole country.”
The government’s relationship with some parts of the media may also be adding to the perception of a disinterest in large swathes of England. In the north west metro mayors’ conference, Burnham admitted that he had “resorted to the media” to get the message out and journalists at regional newspapers are suggesting that Westminster needs to pay closer attention to their reporting going into winter. Reach PLC Devon and Cornwall published a piece titled “12 questions we wanted to ask Boris Johnson during his Exeter visit – but couldn’t” after its staff were shut out of the event this week in favour of national titles.
Geraldine Scott, Westminster correspondent for The Yorkshire Post, notes that it wasn’t just Greater Manchester requesting test and trace self isolation support payments (to compensate people for staying home from work while isolating), throughout the summer with no success. “Issues for the government are often raised in our patches first,” she says, “for example council leaders in Yorkshire have been calling for support payments for those who lose out on pay due to having to self-isolate for weeks, but only now is that getting national attention.”
Last week’s conference wasn’t the first north west metro mayors joint call this year but with the two mayors fed up with ad hoc meetings with Whitehall ministers, the tone felt a little more urgent. “It’s a plea really,” Burnham said during the call. “We are a bit frustrated, we just want solutions. We just want to work better with government, to protect our residents from what we can see is coming right at us. We’re not in a state of readiness.”
A day after Burnham described the town of Bolton as being “forgotten by national politicians”, Hancock’s response was to acquiesce and bring Bolton in line with the rest of Greater Manchester to reflect the regional picture. The calls for financial support for businesses under local lockdowns have also been heard, with £7 million allocated to local authorities. The remaining requests from the north west mayors going into winter, though, are focussed on shifting the UK’s highly centralised approach to the crisis with calls for local contact tracing, local furloughs and local shielding schemes, with the appropriate authority and funding. This is in contrast to Andy Preston, the mayor of Middlesborough, who has now backtracked over the claim he plans to “defy” the new restrictions and has been criticised for failing to produce a credible, local strategy.
Over the weekend both Keir Starmer and Burnham provided alternative five-point plans, both of which included requests for more regional powers. There are signs that Greater London is encountering some of the same problems as the north west too with more evidence for the weaknesses of a centralised Covid-19 response than any of the possible political biases.
Health experts are particularly concerned with the split between the centralised Test and Trace system and under-resourced local initiatives in England. As of the week beginning September 22, 42.6 per cent of contacts of positive cases in Greater Manchester were not reached by the centralised NHS Test and Trace scheme; in the Liverpool region, it was 38.4 per cent not reached the previous week (the most recent data available). Nationally, 71.3 per cent of contacts were reached in the week beginning September 17 (meaning 28.7 per cent were not). Indeed, similar numbers to the north west were reported in parts of London, in mid-September, such as Redbridge (47 per cent of close contacts not reached), Barking and Dagenham (46 per cent not reached) and Tower Hamlets (44 per cent not reached).
Burnham has launched a small pilot of local contact tracing with Greater Manchester Police and Fire and Rescue Services to try to fill the gaps but, then again, so has Hackney council with similar criticisms this week of the performance of the existing, privatised system. “This is not just a London and the rest issue, but No.10 and the rest,” says Harman. “I don’t think government communications with local authorities in London have been any better than they have in Gateshead or Manchester.”
Linda Bauld says she is sympathetic to the view that local government and directors of public health should be given more powers, particularly in England. She says the lack of local knowledge, control and involvement in decision making has disadvantaged areas such as Leicester, which struggled to get on top of the viral spread, post-lockdown.
“The classic example is test and trace,” she says. “Contracting out test and trace to large companies and having it in centralised call centres was a complete error. If you look at Germany, 400 small, local area community public health teams, connected to primary care, were given resources and authority to address issues in their locality through test and trace from the beginning. And they’ve done that really successfully.”
There may, in fact, be epidemiological reasons to treat business and transport hubs such as London slightly differently, or even to identify specific routes, origins and destinations with regards to local and regional restrictions, as Yale associate professor of health policy and economics Xi Chen has found in his modelling.
“Two types of cities should consider strong and early actions,” he says. “One: those cities are the Covid-19 epicentres, or geographically close to the epicentres, so that such origin cities have higher infection risks. And two: the destination cities are major metropolitans that can spill over to many other cities. London, NYC and Milan are all in this category.”
Could travel limits be the next battle between national and local politicians? There are currently travel restrictions in place in parts of Wales, and residents of Aberdeen were asked not to travel more than five miles for most of August. “Local restrictions are only going to work well if you have local travel restrictions as well,” says Bauld. “I think we’ve done it less than we should have but it’s quite an unpalatable thing for the UK. It’s been similar to our approach to air travel, we’re just not used to cutting ourselves off from other places.”
Both Steve Rotheram and Andy Burnham appear to be aiming to avoid local “circuit breaker” lockdowns being imposed on their areas without consultation in the coming weeks. “At every stage, I have to say we’ve been ahead of the government thinking,” said Rotheram. “You’re talking about 4.2 million people and I don’t think they can be ignored much longer.”
Sophie Charara edits WIRED Recommends. She tweets from @sophiecharara
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