Living safely with COVID

The rush to declare the COVID-19 pandemic over in the United Kingdom was marked by government guidance issued on 21 February announcing the impending removal of the remaining legal restrictions on normal life while claiming to protect the most vulnerable and maintaining resilience. ¹ Lockdown regulations were to be replaced by the requirement on local authorities to manage outbreaks within pre-existing public health powers and resources, as they would with other communicable diseases; with the removal of legislation the burden was to be put on individuals to exercise personal responsibility to learn to ‘live with COVID’; and most testing and tracing was to be removed with almost immediate effect, although booster vaccinations were to remain available for older and more vulnerable cohorts and groups.

The announcement was met with scepticism by most of the medical establishment but to little effect, as concerns over the future of the economy came to trump those of public health. Paradoxically the guidance was shortly followed by news of the financial settlement for local public health teams which represented a significant reduction in real terms. The mood music created by the government and the mainstream media led rapidly to the general abandonment of mask wearing, personal spacing and other hygiene measures which had been so important in delaying the spread of the virus during the first wave of the pandemic in 2020. As far as the United Kingdom was concerned the pandemic was all over bar the shouting.

Ironically, the resounding success of COVID vaccine research and the subsequent implementation of the vaccination programme played into the hands of those who wished to ignore the lessons of history and most importantly of the environmental and social measures which had proved so effective in the years before virology and the advent of effective pharmaceuticals. We may yet rue this false path as we miss the opportunity to rediscover the importance of non-pharmacological measures in the years ahead and not least the vital links between effective public health and town planning and civic design.

For too long house builders and developers have paid scant regard for people’s wellbeing in good times and sanctuary in bad. The abandonment of Parker Morris’s housing standards in the 1980s can now be seen to have sidelined the importance of public health considerations. ² This was most cruelly exposed during the enforced lockdowns caused by COVID-19 that impacted most on the disadvantaged.³

Inadequate space in cramped apartments converted from industrial buildings, unsuited to home working and lacking even balconies to give access to fresh air; inflexible interiors that could not be adapted for self-isolation together with fixtures and fittings not fit for purpose for the maintenance of personal hygiene and the prevention of viral spread; lack of access to external green space for recreation and exercise, and for the socially disadvantaged, social interaction, were just some of the deficiencies exposed. At its most stark this was associated with much higher death rates among those living in overcrowded and unsatisfactory accommodation with shared facilities.

One might think that after everything that the population at large has been through during the past two years we might expect some political leadership addressing the vision of what the legacy of the pandemic might look like just as Lloyd George embraced ‘Homes For Heroes’ and Nye Bevan and his 1945 government went on to give us the NHS and the welfare state. ⁴ The elements of such a vision are fairly clear: safe neighbourhoods that facilitate community cohesion with ready access to green areas; a modal shift in transport towards walking and cycling; optimal opportunities for including physical activity in everyday routine; a new approach to streetscape including bio-secure public conveniences and drinking fountains together with a large-scale public housing programme incorporating 21st-century design specifications fit for family life and ageing population, and that are pandemic proof. We might dream.

Historical accounts of previous global disruptions from pandemics indicate that their social and political consequences may be wide ranging and unpredictable. In the aftermath of the COVID pandemic we need to rethink the way we live in our villages, towns and cities. So far we have been tempted with the vague offering of ‘levelling up’. With war raging once more in Europe and the threat of its global escalation, the impending arrival of tens of thousands of refugees displaced from Ukraine who must be fed and housed, and cases of COVID infection with new variants once again increasing at a worrying speed. Will we prove up to the task?