On Saturday 7 March, 24 hours before hundreds of thousands of people rallied across Spain to mark International Women’s Day, and 9,000 faithful Vox supporters arrived in Madrid for a far-right jamboree, authorities in the northern region of La Rioja were taking some difficult decisions.
That weekend, not quite three weeks ago, Spain had confirmed just 430 coronavirus cases. After 60 of those were traced to a funeral in the neighbouring Basque country, La Rioja’s regional government ordered the quarantining of entire blocks of a neighbourhood in the small town of Haro.
Health workers, who account for about 14% of the country’s coronavirus victims, are complaining about a lack of basic protective equipment; a Madrid ice rink has been converted into a makeshift morgue; and the capital’s flagship conference centre has gone from hosting the Cop25 climate conference to sheltering the sick as it is repurposed into an enormous field hospital.
For some of those 18 days, life continued as normal – tables and chairs began to recolonise pavements outside bars and cafes, and parks began to fill with picnickers as winter faded away.
Even as parts of Haro were being quarantined that Saturday afternoon, Fernando Simón, the head of Spain’s centre for health emergencies, said people had to make up their own minds about the risk from coronavirus if they joined the International Women’s day parades. “If my son asks me whether he can go, I’d tell him to do what he wants,” he told a press conference.
And so the marches went ahead, as did Vox’s huge meeting in Madrid and countless sporting fixtures. Three Spanish cabinet ministers – all of whom marched that Sunday – have contracted the virus, as has Begoña Gómez, wife of the Spanish prime minister. Vox’s leader and its secretary general also tested positive.
Worry hit Madrid on 11 March when, with 1,646 cases confirmed, regional government ordered all nurseries, schools and universities to close, as well as galleries, including the world-famous Prado.
Similar measures soon followed elsewhere and, on the evening of 12 March, the Catalan government ordered about 70,000 people in four municipalities in the Barcelona region to remain in their homes for two weeks after a steep increase in cases in the area.
As pressure on the government of the prime minister, Pedro Sánchez, mounted, toilet paper was frantically stockpiled, larders and freezers were filled, and the streets of central Madrid emptied. Then, a week after the Haro lockdown, the inevitable finally happened: Sánchez ordered an initial two-week lockdown.
For many in Spain, both living and dead, the national lockdown came too late. This week, which is becoming grimmer by the day, began with the defence minister revealing that soldiers drafted in to help tackle the outbreak by disinfecting residential homes had found a number of elderly people abandoned and dead in their beds.
In a country that takes justified pride in its family bonds, its conviviality and its national health service, these are bleak and sobering days.
But if, between the long hours of home-schooling, the phoning of friends, the bingeing on box sets and the fixating on recipes, people are wondering what exactly has happened and why, Spain’s doctors are not among them.
The pandemic did not drop out of a clear blue sky, they say – look at China, at South Korea and, far closer to home, at Italy. Then look back at Spain and remember that it is a country still suffering the effects of the 2008 economic crash and its attendant cuts.
Each night at 8pm, people gather on their patios and balconies to acknowledge the efforts of the country’s health workers. For a couple of minutes, while the applause bounces around each barrio, the fear is forgotten, elbowed out by gratitude and solidarity.
But when the ritual thanks are no longer needed, the clamour for answers will be just as loud and insistent.
An anti-racism protest in Montreal has been declared illegal after police said projectiles were thrown at officers.
Thousands of people gathered in front of police headquarters in downtown Montreal on Sunday to protest racial violence and police brutality in light of the recent killing of George Floyd in Minneapolis, Minn.
Windows were smashed, fires were set and the situation degenerated into a game of cat-and-mouse between pockets of protesters and police trying to disperse them.
The officers used pepper spray and tear gas.
The killing of Floyd on May 25 sparked a series of protests in several cities across the United States since his death.
The Montreal rally organizers said the demonstration is to show solidarity with American anti-racism activists, but added that it is also an opportunity to express anger at the killing of racialized people in Quebec and elsewhere in Canada at the hands of police.
A statement from The Black Coalition of Quebec said the group stands with protesters and that Montreal is not free of racial injustice and violence from the city’s police officers.
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The demonstration began at 5 p.m. in Quartier des Spectacles outside the Montreal police headquarters on Saint-Urbain Street.
Montreal police spokesperson Raphael Bergeron told Global News police could not yet comment on whether they would fine protesters who don’t respect physical distancing measures.
Organizers said they will encourage distancing between demonstrators to mitigate the spread of COVID-19.
They also asked that those who attend wear a face covering.
As protesters flood streets across the country, officials worry that they could be spreading the virus.
Mass protests over police violence against black Americans in at least 75 U.S. cities have spurred concern that the gatherings will seed new outbreaks.
Speaking on CNN, Atlanta’s mayor, Keisha Lance Bottoms, said she was concerned that the protests could increase infections in communities of color, which are already being disproportionately hit by the disease. Death rates among black Americans are double those of whites, and the economic toll of lockdowns has also inflicted disproportionate economic pain.
“I’m extremely concerned we are seeing mass gatherings,” Ms. Bottoms said. “We’re going to see the other side of this in a couple of weeks.”
Larry Hogan, the Republican governor of Maryland, echoed those concerns. Mr. Hogan told CNN the gatherings of “thousands of people jammed in together in close proximity” could lead to a spike in cases.
Dr. Ashish Jha, a professor of global health at Harvard’s T.H. Chan School of Public Health, urged protesters to take safety precautions, including wearing face masks and practicing social distancing.
On the CBS program “Face the Nation” on Sunday, Dr. Scott Gottlieb, the former commissioner of the Food and Drug Administration, noted that Minnesota had seen an uptick in cases before the protests. He also predicted that the protests would ignite chains of transmission.
“This country isn’t through this epidemic,” he said. “This is continuing to expand, but at a much slower rate, but it’s still expanding.”
Dr. Theodore Long, who is leading New York City’s contact tracing efforts with its public hospitals agency, urged anyone who had been involved in the demonstrations to get tested for the virus.
The outbreak has inflicted disproportionate health and economic tolls on black and Latinocommunities.
“To have corona, and then this — it’s like a gut shot,” said Jimmy Mills, a barber in a working-class area of Minneapolis.
The protests could affect planned reopenings. Mayor Carlos Gimenez of Miami-Dade County said on Sunday that the unrest had prompted him to keep local beaches closed, rather than reopening on Monday as scheduled.
This week, as global coronavirus cases pass six million, many nations are entering a pivotal period, giving students, shoppers and travelers more freedom to return to some sense of normalcy after months under lockdown.
Greece, seeking to bolster its crucial tourism sector, announced one of the more aggressive reopening plans. After initially announcing on Friday that it would allow entries from 29 countries whose outbreaks were mostly contained, it shifted to allow flights from all countries.
From June 15 to June 30, the Greek foreign ministry said on Saturday, the flights will go to Greece’s two largest airports, in Athens and Thessaloniki. Passengers from the 29-nation list, including Germany, Australia and South Korea, will be subject to random tests. Those flying in from countries deemed by the European Union Aviation Safety Agency to have a high risk of virus transmission will be tested.
As of July 1, all Greek airports will reopen to international flights, with random screening for all passengers. Arrivals by sea will be allowed as of July 1, also subject to random testing.
In Britain, more stores will be allowed to open starting Monday, and small groups from different households can meet outdoors. Primary schools will openin England with new social-distancing rules and spaced seating. The government also gave the green light for professional sports to resume under strict protocols, according to government guidelines published on Saturday.
Other countries are creating “travel bubbles,” allowing visitors from nations with low infection rates.
Norway and Denmark will allow leisure travel between the two countries, excluding Sweden, where coronavirus infections are higher. Norway will also allow entry to business travelers from the other Nordic countries from Monday, the government said.
But in Spain, Prime Minister Pedro Sánchez said on Sunday that he would ask Parliament for a sixth and final extension to the state of emergency, allowing his central government to keep control over the lockdown in Madrid, Barcelona and other parts of the country until June 21.
Mr. Sánchez told a news conference that Spain needed to “immediately” recover its tourism sector, but that quarantine rules for outside visitors would be kept in place until July 1. “We cannot throw away all the work that we have done,” he said.
Congregations emerge from quarantine to celebrate the Pentecost and to call for change.
In communities from the Deep South to California, congregations that had been sequestered for months ventured forth at a social distance on Sunday in search of comfort, prayer and political expression.
With their sick and elderly at home and their nation wracked by the pandemic, evangelical congregations across California violated state health rules in the name of unity.
“Outside the confines of these walls we hear the sound of a very broken world,” Samuel Rodriguez, the pastor of a church in Sacramento, said.
At least a dozen evangelical churches in California made a coordinated return to church timed to Pentecost, a holy day particularly tied to fundamentalist worship. Some in that group were also seeking to pressure the state’s Democratic governor, Gavin Newsom, into dropping a 100-person cap on church attendance that the state had enacted to curb the spread of the disease.
Supporters acknowledged the legal and health risks, but said their congregants’ spiritual health would suffer if they delayed their return to public worship.
“It’s been terrible, an unimaginable tide of grief,” said the Rev. W. Franklyn Richardson, the senior pastor at Grace Baptist Church in Mount Vernon, N.Y., said of the moment. Mr. Richardson, who is African-American, noted that during the worst of the pandemic, he was making three to five condolence calls a day.
Still, he said, the church has not, and cannot, abdicate its central role in pushing for positive change. “I think the church has to help make sure it is a wake up call,” he said of the unrest. “The church has had to be a safety net for a society that has ignored the community.”
Nicaragua has resisted imposing lockdown rules. Now the virus appears to be raging through the country.
Nicaragua is one of the last countries to resist adopting strict measures to curb the spread of the virus. It never closed its schools. It did not shutter businesses. Throughout the pandemic, the government not only allowed mass events — it organized them.
Long lines have formed at hospitals, and pharmacies have run out of basic medicines. Families of people who die of respiratory illnesses are being forced to hold “express burials” at all hours of the night, for fear of contagion.
Health organizations are struggling to get accurate case numbers. Testing is limited and controlled by the government. Doctors and activists are bracing for disaster, just two years after antigovernment uprisings against President Daniel Ortega turned violent.
Facing withering criticism, the government released a report last Monday stating that critics were trying to sow chaos, and that the vast majority of people in the country, the second-poorest in the hemisphere, could not afford to lose work under a strict lockdown.
Elena Cano said her 46-year-old son, Camilo Meléndez, the facilities manager at the National Assembly building, died on May 19 from “unusual severe pneumonia,” after trying to get medical care several times.
“The whole world has to understand the truth of the crime that our government is committing,” she said.
The N.B.A. was planning to start up again in late July. The N.H.L. announced a playoff tournament would take place through the summer. Major League Baseball was continuing negotiations with its players for a shortened season. The N.F.L. was moving toward opening training facilities. Soccer leagues for both men and women in North America were working toward finalizing plans for summer tournaments. Top-tier soccer leagues in England, Italy and Spain announced they would resume play in June.
After months filled with pessimism, hesitation, quiet planning and uncertainty about whether major sports would happen again in 2020, nearly every sport was preparing to come back, provided that work agreements with players could be negotiated and that public health authorities raised no objections.
With reopening plans underway in all 50 states and with elected officials and the public anxious for business activity to resume, league officials had a growing sense that there would be minimal opposition if they moved ahead with plans.
Also, people who work closely with the leagues and team owners said, the financial consequences of not returning, potentially billions of dollars in losses across the leagues, made trying to come back vital.
Pope Francis appeared in person on Sunday to bless a gathering of the faithful in Saint Peter’s Square for the first time since the coronavirus exploded in Italy and the government imposed a national lockdown in March.
“Today since the square is open we can return,” he said to a scattered audience that applauded as he approached an open window of his private study. “It is a pleasure.”
Francis recited the Regina Coeli prayer and gave his blessing to the crowd.
“You know that from a crisis such as this we will not be the same as before,” he said. “Let’s have the courage to change in order to be better than before.”
The pope began reciting the Angelus prayer from the Library of the Apostolic Palace on March 8 because of the pandemic. “It is a bit strange this Angelus prayer today,” he said then, “with the pope ‘caged’ in the library. But I can see you. I am close to you.”
Earlier Sunday, the pope celebrated a Mass in St. Peter’s Basilica in front of a limited number of worshipers. In his homily, he urged people to fight three enemies: narcissism, victimhood and pessimism, saying that they “prevent us from giving ourselves” during the pandemic.
Most tenants have been able to pay their rent, but those in smaller buildings are struggling more.
Since April, U.S. landlords have looked to the first of the month fearing that tenants would stop paying their rent. For the most part, that has not happened. Despite a 14.7 percent unemployment rate and millions of new jobless claims each week, collections are only slightly below where they were last year, when the economy was booming.
How can this be? Part of the answer is a little negotiation and a lot of government money. The $2 trillion CARES Act, which backstopped household finances with stimulus checks and extended unemployment benefits, has kept many tenants current on their monthly balances. At the same time, many landlords have reduced rents or are partly or completely forgiving overdue payments.
At the same time, many of the numbers showing only a slight dip skew toward higher-end buildings. Other surveys show that buildings with poorer tenants have lower collection rates.
And deferrals and partial payments appear to be increasing: Apartment List, a rental listing service, said 31 percent of respondents failed to make the full May payment on time, up from a quarter the month before. Hoping for a swift recovery, many landlords are telling tenants they can pay later, knowing this often won’t happen.
The rate of those who have been able to continue paying rent is unlikely to remain stable without a swift and robust recovery, which is becoming increasingly unlikely, or without another big injection of government money, which Senate Republicans say will not happen anytime soon.
American households were struggling with rent long before the economy went into free fall, and there are signs — from an increase in partial payments to surveys that show many tenants are putting rent on their credit cards and struggling to pay for essentials like food — that this pressure is building.
For years, jet service providers have ferried executives and wealthy leisure travelers who pay high fees for the privacy and security. Now, with business travel curtailed, those same companies are shifting to meet rising demand from people worried about getting on a commercial flight.
Over the Memorial Day weekend, one of the busiest travel times in the United States in years past, traffic in the private jet industry was 58 percent of the volume from the same time last year, according to Argus, a company that tracks aviation data. But commercial flights fared worse, plunging to 12 percent of the 2019 level.
Five weeks ago, private flights had fallen to 20 to 25 percent of what they were the same time last year, said Doug Gollan, the founder of Privatejetcardcomparisons.com, a research site for consumers. “Now to be back to 60 percent of pre-Covid levels shows the people who have access to private travel are getting back out there,” he said.
NetJets, the largest private jet operator in the world, is seeing a rush in interest from new customers, said Patrick Gallagher, its president.
“May is on track to be the best month of new customer relationships that we’ve seen in the past 10 years,” Mr. Gallagher said.
Companies that carved out a niche with private international flights are also reporting an increase. Thomas Flohr, founder and chairman of VistaJet, which has longer-range jets, said the company’s refueling landings in Anchorage, a major stop for transcontinental flights to Asia, were up 250 percent since the pandemic began.
Thousands of maskless vacationers flocked to the Maryland town of Ocean City this weekend as the Greater Washington region began to emerge from a coronavirus lockdown.
As Gov. Larry Hogan of Maryland has emphasized, the state is at Phase 1 of his “Roadmap to Recovery,” which includes restrictions to keep the virus from spreading. Among them are a requirement that face coverings be worn inside businesses.
But at the Quiet Storm Surf Shop, a clerk folding T-shirts said, “We make them optional.” On the boardwalk outside, a police officer said that the problem was that merchants have to enforce the mask order, but many are reluctant to alienate their first summer customers.
Not all of the tourists were nonchalant about the restrictions. Sitting on a wall dividing the boardwalk from the beach, Kelly and Dan Goddard, who live in a Baltimore suburb, were wearing masks. Their children were sporting tie-dyed cloth ones sewn by relatives.
“There are a lot of unknowns and not a lot of real clear guidance,” Mr. Goddard said. “But I don’t think people realize how serious things are, or they don’t care.”
Patrick Kingsley, an international correspondent, and Laetitia Vancon, a photojournalist, are driving more than 3,700 miles to explore the reopening of the European continent after coronavirus lockdowns. Read all their dispatches.
PRAGUE — To attend her first play in more than two months, Marie Reslova, a prominent Czech theater critic, drove into Prague, headed to a large vegetable market, parked next to a convertible sports car and switched off her engine.
Soon, actors from the Czech National Theater strode onto a platform a few yards from Ms. Reslova’s windshield.
The play had begun. And she hadn’t even left her car.
The Czech Republic enforced tighter restrictions than most European countries to combat the coronavirus pandemic. For several weeks, Czechs were barred even from jogging without a mask. Even after the government eased that restriction, masks were still mandatory in most other public contexts.
But the country also loosened the lockdown earlier than most — and that has made it a laboratory for how arts and culture can adapt to a context in which some restrictions on social life have been lifted, while others remain in place.
The drive-in theater at Prague’s vegetable market was an ambitious example. To circumvent restrictions on public gatherings, audience members watched plays, concerts and comedy from behind their steering wheels — in a monthlong program that ended with a variety act by the National Theater last Sunday evening, attended by Ms. Reslova.
Across Europe, drive-ins have become a familiar means of circumventing pandemic restrictions. By default, cars keep their occupants socially distanced, leading even nightclub owners and priests to set up drive-in discos and churches.
President Trump told reporters on Saturday that he was postponing a Group of 7 meeting scheduled to be held in the United States next month. Earlier Saturday, Chancellor Angela Merkel of Germany had said she would not attend in person, citing concerns about the coronavirus.
Mr. Trump also said he wanted to invite Russia to rejoin the group.
Making the announcement while returning from the SpaceX launch in Florida, the president said he also planned to invite Australia, India and South Korea to the summit, with an adviser adding that the idea was to bring together traditional allies to discuss China. He said he now wanted to hold the meeting in September.
“I don’t feel that as a G7 it properly represents what’s going on in the world. It’s a very outdated group of countries,” Mr. Trump said. But his intention to unilaterally invite Russia — which was indefinitely suspended in March 2014 after the annexation of Crimea — is certain to inflame other member nations.
In March, with the coronavirus spreading around the world, Mr. Trump said that the June summit would take place virtually. But he changed plans this month, saying he might invite the participating leaders to Washington as a demonstration of a return to normalcy.
Australia said on Sunday that it would welcome an official invitation, and a government spokesman told reporters that Prime Minister Scott Morrison and the United States had made contact to discuss the matter.
Did that donation reach those who need it?
As U.S. unemployment claims exceed 40 million and those filing them grow more desperate, an altruistic instinct has emerged among some people who are more financially secure. Yet the sheer breadth of the pain is almost overwhelming, and the appeals are widespread.
So what is the best way to give money to those who require it for food, shelter and other necessities?
Sites and services like GoFundMe can connect donors with real people, but they may lack vetting of recipients, their back stories or their plans. They also may not make it possible to be identified or anonymous based on the preference of a giver or a beneficiary.
Donors with large amounts to give may want to use tax deductions to increase what they can afford to donate but may not be able to get them through one-off cash transfers.
Two of Islam’s holiest sites reopen to worshipers.
Throngs of Muslim worshipers returned to formal services in Israel and Saudi Arabia on Sunday as two of Islam’s holiest sites reopened for the first time since being closed more than two months ago because of the coronavirus.
At the Aqsa Mosque in Jerusalem, Islam’s third-holiest site, worshipers entering the compound for dawn prayers were greeted by officials who took their temperatures, distributed masks and implored them to follow social distancing guidelines.
“We are depending on your heedfulness,” Omar Kiswani, the mosque’s director, said through a loudspeaker system.
Ibrahim Zaghed, 25, an unemployed resident of Jerusalem, wept as he laid down hisprayer mat. “Today is no different than a holiday,” said Mr. Zaghed, who was not wearing a mask. “I feel like a complete person again.”
The compound, which Jews revere as their holiest site and refer to as the Temple Mount, is often at the center of tensions between Israelis and Palestinians.
In Saudi Arabia, the government said that 90,000 mosques across the kingdom had reopened on Sunday, including parts of the Prophet’s Mosque in Medina, considered Islam’s second-holiest site. The most revered site in Islam, the Kaaba in Mecca, remains closed.
Imam Kiswani of the Aqsa Mosque, who estimated that about 3,000 people participated in the prayers on Sunday, said that while most followed social-distancing guidelines, some needed to exercise “greater attentiveness.”
Manal Balala, 50, a housekeeper from Jerusalem who was wearing a mask and gloves, was overjoyed as she socialized with her friends after prayers.
“I feel like my soul has been restored,” she said.
Reporting was contributed by Antonio de Luca, Dave Taft, Umi Syam, Alfonso Flores Bermúdez, Frances Robles, Alexander Villegas, Patricia Mazzei, Niki Kitsantonis, Roni Caryn Rabin, Raphael Minder, Karen Zraick, Conor Dougherty,Mark Landler, Stephen Castle, Ron Lieber, Paul Sullivan, Emma Bubola, Jack Healy, Dionne Searcey,Patrick Kingsley, Sharon Otterman, Elizabeth Williamson, Elian Peltier, Yonette Joseph, Hannah Beech, Maggie Haberman, Mike Ives, Aimee Ortiz, Suhasini Raj, Adam Rasgon, Kai Schultz and Derrick Bryson Taylor.
Every Thursday at 8pm, millions of Britons have opened their front doors or stood on balconies to applaud the NHS. The ritual has been a weekly expression of gratitude to medical workers, and national pride in a state-run health service said to be the envy of the world.
“Let’s not forget,” Boris Johnson said in early March, near the start of the coronavirus crisis, “we already have a fantastic NHS, fantastic testing systems and fantastic surveillance of the spread of disease.”
Yet those who have experienced the government’s emerging testing and tracing operations for Covid-19 have had limited contact with the NHS. Instead, Britons with symptoms are directed to a network of 50 drive-through testing centres, set up by management consultants at Deloitte.
Upon arrival, patients are marshalled not by NHS staff, but workers in hi-vis jackets supplied by outsourcing companies, such as Serco, G4S, Mitie and Sodexo. Those who cannot make the drive have received postal test kits, processed by the private diagnostics company Randox and delivered by Amazon.
When contact tracing to stop the spread of the virus finally moved up the agenda in late April, the health and social care secretary, Matt Hancock, said the job would be done with an as–yet unproven NHS app. The app has been developed by private firms for NHSX, the technology wing of the health service, which is also responsible for a Covid-19 government data operation involving tech companies Palantir, Faculty, Amazon, Google and Microsoft.
On Thursday the government finally launched its long-awaited NHS Test and Trace Service. But despite the name, many of the 25,000 contact tracers tracking those potentially exposed to Covid-19 and advising them to self-isolate will be working not for the NHS, but rather the outsourcing firms Serco and Sitel.
The government’s reliance on private contractors during the public health emergency comes after a decade of public sector reorganisation, marketisation and deep cuts to services and local government in England. The Guardian has interviewed dozens of public health directors, politicians, experts in infectious disease control, government scientific and political advisers, NHS leaders and emergency planners about the years leading up to the pandemic.
They described how an infrastructure that was once in place to respond to public health crises was fractured, and in some places demolished, by policies introduced by recent Conservative governments, with some changes going as far back as Labour’s years in power.
“The undermining of our responsiveness to a pandemic was one of my major concerns,” said Gabriel Scally, a professor of public health at the University of Bristol and a former regional director of public health in the NHS for almost 20 years. “There has been a destruction of the infrastructure that stops England coping with major emergencies. It absolutely explains why you’re now seeing private companies being brought into these functions.”
Councils left in the dark
Local authorities are the Cinderellas of government, their work often overlooked. But in the middle of a public health crisis, counties, districts and boroughs traditionally become the foot soldiers of national response. Few have been as badly hit as the east London borough of Newham, the local authority with the highest Covid-19 mortality rate in England and Wales.
Yet Newham’s director of public health, Jason Strelitz, was left in the dark at the start. He had no official notification that the virus had arrived in his area in mid-March, and only found out when he logged on to the government’s public coronavirus tracker web page to make his daily check on the declared numbers. Strelitz did not know who in Newham had Covid-19, where they had been tested, or which part of the borough they came from.
“We’re really concerned about the way national testing has been set up,” Strelitz said. “We still don’t have a clear picture of who is being tested in our area nor of the extent of community transmission in Newham.”
In normal times, a Public Health England (PHE) representative would be expected to contact Strelitz’s environmental health teams if a case of a notifiable disease was found in the area that needed following up, enabling them to set to work tracing contacts and containing an outbreak. But the government had just abandoned community testing and tracing so local authorities were not being contacted at that point.
Newham is among the most deprived boroughs in the country. Like all the public health directors interviewed by the Guardian, Strelitz has deep knowledge of the characteristics of his patch that make its health inequalities so stark and its residents so vulnerable to the disease. About 30,000 people have been identified by the council as being at high risk – many of them over 70, living alone and isolated.
Even now, with large-scale community testing resumed, Strelitz said he was not receiving useful test data from the centralised, privately contracted operation created by Hancock. He also has concerns about the contact-tracing operation being set up.
In addition to the contact-tracing app, the government has once more turned to outsourcing companies, including Serco and Sitel, to recruit and train 25,000 contact tracers. Working on a salary just above minimum wage, the majority will have no medical training. Using scripts, they will contact those who have tested positive, trace people they have been in contact with, and advise them on how to isolate.
“Contact tracing is a sensitive issue – I’m not sure how well it can be done with a remote call centre with no understanding of people’s local context,” Strelitz said.
Dominic Harrison, the director of public health for Blackburn and Darwen, has similar concerns. Speaking earlier this month he said there was “a huge disconnect” between different branches of government, with some functions of the local public health system having been disabled in recent years.
“People like environmental health officers, community and neighbourhood teams, youth services workers – the people who you could deploy in a crisis, who already know where the vulnerable are and how to reach them – those were the kind of staff they used during 2009 swine flu to work closely with the NHS, but they have been lost,” Harrison said.
The Labour leader of Nottingham city council, David Mellen, said Conservative ministers had spent so many years shrinking the state locally “they have forgotten what local authorities can do”. Nottingham has had its central government support grant cut by 80% since 2013 and, like many other councils, no longer has reserves for emergencies such as coronavirus. The Ministry of Housing, Communities and Local Government has made an emergency grant of £3.2bn to councils for Covid-19 costs, which the communities secretary, Robert Jenrick, has defended as fair and generous. Mellen disagrees. Nottingham, he said, had been given £19.8m as its share of the exceptional grant, but had already spent well over £12m extra on Covid-19 while losing at least £19m in revenue because of the lockdown.
A Department of Health and Social Care (DHSC) spokesperson did not dispute that cuts to central government grants could have had an impact on local public health networks. However, she pointed to the £3.2bn emergency funding for councils, which she said was in addition to an increase of £2.9bn in councils’ core spending power this year. “Protecting the public’s health is, and has always been, a priority for the UK government,” she said.
A decade of austerity
Next month, Britain will mark an anniversary many Conservative ministers would rather forget. Shortly after 12.30pm on 22 June 2010, George Osborne stepped up to the dispatch box as chancellor of the new coalition government and announced the longest and deepest period of cuts to public service spending since the second world war.
Ushering in a new age of austerity to a raucous Commons, Osborne outlined £81bn of cuts over five years. His aim was twofold: to eliminate the government’s budget deficit and to reduce its debt as a share of GDP. The emergency budget would, he said, bring the country back from the brink of ruin. “It pays for the past. It plans for the future. And it protects the most vulnerable in our society,” Osborne told MPs.
It was the prime minister, David Cameron, who had the previous year introduced the notion of “the age of irresponsibility giving way to the age of austerity”. He said he expected the public spending cuts would be permanent as the private and voluntary sectors stepped in to deliver public services better than the state could. Some government departments would be cut by a third and most public sector workers would have to accept a pay freeze.
Along with welfare, some of the most brutal reductions were imposed on local government in England as Osborne transferred the political risk of austerity to councils. Over the next decade, local authorities had 60% of their funding from central government cut, according to the Local Government Association. At the same time their ability to increase council tax, to try to replace the lost revenue, was capped. The cuts fell disproportionately on those authorities with the poorest populations.
Cameron promised he would “cut the deficit, not the NHS” and Osborne ringfenced its budget. It got cash increases, but these were less than 1% a year, and failed to keep pace with growing demand from an ageing population.
Approximately 32,000 overnight beds have been lost from hospitals in England in just over a decade, including some lost under Labour. Allyson Pollock, a professor of public health at Newcastle University, points out that the number of beds lost is roughly the same as the beds the NHS had to scramble to free up for Covid-19 patients.
When the coronavirus spread to Europe earlier this year, the UK ranked 24th among European countries for its numbers of critical care beds, with 6.6 per 100,000 population, compared with Germany, which topped the league with 29.2 per 100,000.
Two years after Osborne’s announcement, with austerity beginning to bite, the then health secretary, Andrew Lansley, embarked on a complete market-oriented restructuring of the NHS. Despite Cameron’s pre-election promise that there would be no more pointless, disruptive top-down reorganisations, critics argue that Lansley’s 2012 Health and Social Care Act did just that.
Labour had done its fair share of subjecting the NHS to upheaval. Its programme of building new hospitals under the private finance initiative required other hospital and community health services to close, and shrank bed numbers to help cover the high annual fees to private companies. It accelerated changes brought in by the Conservatives to mimic a market, and created NHS trusts that could operate as semi-autonomous corporate bodies. By 2006, Labour’s reorganisations had created 152 primary care trusts (PCTs). Overarching priorities were set by regional strategic health authorities and the Department of Health.
But every area still had a Public Health Observatory, which included infectious disease control teams. Under government pandemic plans, each had to identify rapid response teams for testing and tracing, and these were activated during the swine flu outbreak in 2009.
Health authorities also had consultants in communicable disease control appointed at senior level on a par with NHS hospital consultants. An independent public body, the Health Protection Agency (HPA), provided specialist support on the threat of emerging diseases. There were critics of the structures, but in planning for emergencies there was, at least, a clear chain of command and control. “Labour started the process of fragmenting public health but it was at least still integrated with communicable disease control and the NHS,” Pollock said.
Lansley’s legislation did away with much of that. He abolished PCTs and strategic health authorities. Instead, existing public health structures were stripped out of the NHS and redistributed, along with their budgets and staff. In a dramatic shift, local authorities were given responsibility for public health for their areas, with larger ones being required to appoint a director of public health.
“They took a perfectly well-functioning public health system and fractured it,” said Julie Hotchkiss, a PCT director with responsibility for emergency pandemic response who moved to York city council during the changes. She said it took her a year to work out where her infectious disease control nurses had gone. “No one knew and there was no one to ask.”
Dr Jeanelle de Gruchy, the president of the Association of Directors of Public Health, argues it was right for local authorities to have a key role in tackling health inequalities, which tend to relate to people’s living circumstances and socio-economic status. She regards the transfer of public health to local authorities as “incredibly important and positive”. But she adds: “It’s a very big job and the transition came at a time of cuts to the public sector, not just to local government, although those were huge.”
Lansley’s act also created an entirely new agency that has been at the centre of the response to the coronavirus outbreak: Public Health England. It was given two primary responsibilities: improving health and reducing inequalities by tackling “lifestyle” diseases, such as obesity; and protecting the public from infectious diseases and environmental hazards.
The HPA, which had previously taken a lead on infectious disease control, was folded into PHE. Martin McKee, a professor of European public health at the London School of Hygiene and Tropical Medicine, argues the result of all these new arrangements was “a hugely weakened and fragmented public health system with consequences writ large in Covid-19”.
The DHSC rejected the suggestion that the system was fragmented and that changes had affected the government’s ability to respond. Lord Lansley did too. He told the Guardian that an independent review of the public health changes from 2013 published by the the King’s Fund thinktank in January, “concluded that they were the right reforms, but were not supported subsequently by the right level of resources”. Combating health threats, such as pandemics, was “no more or less fragmented” after 2013, Lansley said, and the problem was not the new structures or moving public health to local government but money. “Our intention was for a real-terms increase in public health budgets alongside those for the NHS, but this was not followed through from 2015 onwards,” he said.
The ringfenced annual grant for public health from central government to local authorities – currently about £3.2bn – has been cut by a cumulative £850m in real terms since 2015-16, according to the King’s Fund review.
During his two-decade career in government, Scally had been involved in emergency responses for swine flu, foot and mouth, BSE, and the fuel crisis. For previous epidemics, he said, the government took “a public health approach; go in quick and hard, test, trace, isolate, throw everything at it”. But, he said, “the whole system was demolished” by Lansley’s changes, which led him to resign.
He then worked as an adviser for Labour’s former shadow health secretary, Andy Burnham, who is now the mayor of Greater Manchester. Burnham recalls Scally constantly warning him as Lansley’s bill was going through parliament that “we were losing pandemic preparedness”.
Testing time for Public Health England
No branch of government appears to have received more flak over its handling of the Covid-19 outbreak than Public Health England. The government’s chief scientific adviser, Sir Patrick Vallance, suggested it had failed to expand testing at the right moment. Its top executive has been criticised by leading public health experts, such as Prof Anthony Costello of University College London, for being “invisible”.
Even before the outbreak, the agency was a target of complaints from across the spectrum. Leftwing critics have accused PHE of failing to be tough enough in its role of promoting better health. The right has accused it of being the instrument of a nanny state with a bloated budget. PHE has had precious few political friends. But even those who might be natural allies – like Prof John Ashton, the former regional director of public health for north-west England – suggest it has “had a bad Covid war”.
Some of this might be down to bad luck. Its chief executive, Duncan Selbie, caught the virus along with key advisers in Westminster, and its director of health protection, Prof Paul Cosford, has cancer and has been self-isolating, although both have been working throughout.
However, there have also been structural challenges. The Lansley act created an agency that lacked independence from government, in contrast to its predecessor, the HPA. That has led to suspicions that some PHE decisions were politically influenced, such as the varying guidance on what kind of personal protective equipment (PPE) was needed for frontline staff treating Covid-19 patients. In late March, PHE said a lower specification of protective gowns than previously advised could be used, leading unions to accuse it of basing decisions on shortages of PPE, rather than evidence. This month, it downgraded the type of masks NHS workers should use “as a pragmatic approach for times of severe shortage”.
PHE disputes that it was slow off the mark, and Selbie points out that it rolled out the details for its first diagnostic test in January, making it “the fastest deployment of a novel test in recent UK history”. It says the guidance on PPE has been misunderstood: it was offering a solution in the event of extreme shortages.
“Our track record speaks for itself,” a PHE spokesperson said. “During 2018-19 alone, we responded to more than 10,000 disease outbreaks and emergencies across England, including meningitis, measles, E coli and the first ever UK case of monkeypox. Our flu vaccination programme grows every year and cases of TB have fallen to the lowest level since records began.” They said that far from being invisible, Selbie had been at the coalface, helping to advise government on its decision-making.
The DHSC spokesperson cited a positive report by the International Association of National Public Health Institutes, which described PHE as a “strong, capable, coordinated, united and efficient public health agency”. The report only examined PHE and not the public health systems devolved to local authorities. The same report pointed out that “there is scope for greater clarity in the responsibilities of PHE’s local partners”.
In its defence, PHE has had to absorb disparate functions since its creation in 2013. And it too has been struck by austerity: a public health source said PHE’s operational budget sustained a 40% real-terms cut between 2013 and 2019.
It was PHE that initially had responsibility for testing, tracing and advising isolation for those who became infected. It was a huge and complicated task, but one the World Health Organization has made clear from the outset was the single most important thing countries could do to suppress the disease. The government’s decision to abandon large-scale testing and tracing on 12 March remains one of its most controversial decisions.
PHE says it reprioritised limited resources rather than abandoning tracing completely. “When the lockdown began, our contact-tracing resource was refocused on to complex outbreaks in care homes, prisons and immigration centres,” Selbie said. “The good news is, now that we have testing capacity in place and are working towards recovery, we can start mass contact tracing through the NHS test and trace programme.
“PHE’s contact tracing during the ‘‘contain’ phase of the pandemic bought several weeks of time for the government and the NHS to prepare for what was to come, and has undoubtedly saved lives,” he said.
Greg Clark, the chair of the Commons science and technology select committee, accused PHE of choosing to “concentrate” tests in its own limited number of labs rather than expanding capacity rapidly by using university and private labs, as the Germans and South Koreans had done, even though the need for mass testing was “identifiable from the beginning”. PHE responded by blaming the DHSC, saying it was responsible for decisions on testing policy.
The DHSC spokesperson said: “Although Britain had a world-class pharmaceutical industry, it did not have the existing diagnostic base necessary to test hundreds of thousands of people each week for a new virus.” She said the government had more than doubled the capacity of NHS and PHE laboratories since early March, with more than 3m tests carried out by mid-May, and that anyone with symptoms could now book a test.
The government boasts that its new Test and Trace programme will mobilise an “army” of contact tracers. But in the two months leading up to 12 March, PHE’s team resembled no more than a small platoon. The Guardian has established it consisted of just 70 staff in its field services, 120 in local health protection teams, and 20 specially recruited clinical staff. In total, the contact tracing operation to manage the pandemic consisted of just 210 people.
Documents released on Friday by the government’s Scientific Advisory Group on Emergencies (Sage) suggest the contact-tracing operation initially only envisaged the need to deal with a handful of cases a week. Minutes from an 18 February meeting of the group said: “Currently PHE can cope with five new cases a week (requiring isolation of 800 contacts).” The minutes added: “Modelling suggests this capacity could be increased to 50 new cases a week (8,000 contact isolations) but this assumption needs to be stress-tested with PHE operational colleagues.”
Rather than ramp–up capacity, the government scientists instead agreed in the same meeting they would need data “to feed into trigger points for decisions on when the current monitoring and contact-tracing approach is no longer working”. The minutes added: “When there is sustained transmission in the UK, contact tracing will no longer be useful.”
PHE told the Sunday Telegraph that the reference to five cases a week was based on a modelling of how it would cope with imported cases of Covid-19 – and it was certain it had capacity to track and trace more cases at that time. “The model used an assumption of five importation events per week in the initial phase,” a PHE spokeswoman said. “This means five imported cases and subsequent cases that may arise as a consequence of those imported cases; the modelling considered the associated contacts for both. Modelling stated that the number of contacts could be managed by PHE.”
However, two days later, at another Sage meeting, the advisers acknowledged “individual cases could already have been missed” and again discussed when it would be appropriate to abandon the nascent operation. Appearing to acknowledge such a move would be controversial, the minutes said: “Any decision to discontinue contact tracing will generate a public reaction – which requires consideration with input from behavioural scientists.”
By the time community tracing was shelvedin mid–March, PHE had “contact traced” only 3,500 people who were likely to have been in close proximity with infected people on flights, cruises or other places where there were known outbreaks. Of those, only 3% tested positive for Covid-19 and were advised to self-isolate.
In other words, PHE had managed to identify and warn about 100 people with Covid-19 who might otherwise have spread the disease – a tiny fraction of the infected people. Vallance said there were 5,000 confirmed Covid cases when the community testing and tracing programme stopped, but epidemiologists at Imperial College London estimated 1.8 million people in Britain were infected by the end of March.
William Hanage, a professor of infectious disease epidemiology at Harvard University, said the numbers of PHE staff dedicated to contact tracing in Britain in the weeks leading up to mid-March was shocking. “I am sure that the people involved in this programme worked incredibly hard, and I have the utmost respect for them, tasked with doing this in the face of a global pandemic,” he said. “But it beggars belief to see these numbers held up as adequate.”
The elusive 100,000 target
On 2 April, three weeks after capacity had been overwhelmed and PHE had abandoned testing in the community, Hancock announced a five-pillar testing plan. He pledged to scale up the country’s testing capacity to reach a target of 100,000 tests a day by the end of the month.
But the architecture created in the postwar years to respond to pandemics was no longer standing. In the past, the Public Health Laboratories Service had been tasked with disease control, and with coordinating support and advice to the NHS and others. In 2003, Labour folded it into the HPA. Fifty PHLS labs that existed two decades ago have been merged with hospital labs or “consolidated” by successive governments to make efficiency savings. As of January this year, just eight laboratories remained under direct PHE control, along with 122 NHS labs in England.
Hancock expected hospital labs testing patients and staff and PHE to make up 25,000 of the ambitious 100,000 target. For the other 75,000 he turned to the private sector. Deloitte, one of the big four accountancy firms, was asked to set up a network of 50 drive-through rapid testing centres, and yet more private companies, such as Serco, Sodexo, Mitie and G4S, would operate and manage the day-to-day running of them.
A lab network to process the tests was also established. Deloitte was again given the coordinating role in the creation of new Lighthouse labs in Milton Keynes, Glasgow, Belfast and Cheshire and a further facility in Cambridge, with day-to-day running entrusted to a coalition of private and public partners, including universities and drug companies.
But Hancock’s 2 April announcement made no mention of one of the main purposes of testing: tracking or tracing.
The Guardian soon received reports from people trying to get tested of chaos at some sites, with results going astray, dangerously leaking swab samples arriving at labs, queues of more than three hours and symptomatic people being unable to book a test or told to make round trips of more than 100 miles to test centres. Many still report results taking seven to 10 days to arrive – too long to be useful for quarantine purposes – but the DHSC maintains that 97% of test results are obtained within 48 hours.
In the last week of April, the government changed its criteria for counting tests to include ones that had been dispatched, even if they had not been received, returned or processed. The date of 30 April came and Hancock missed his 100,000 target; the number of tests conducted that day was 81,611. But the next day, on 1 May, he appeared to smash it, as 122,347 tests were recorded in government data. The magic number had, by Hancock’s own admission, included nearly 30,000 postal tests sent out but not yet analysed. By 3 May the number was back down to 76,496, and the government would fail to meet its target for the next seven days, before getting back on track on 11 May.
For Chris Hopson, the chief executive of NHS Providers, which represents foundation trusts in England, Hancock’s single-minded focus on reaching an arbitrary number cost the country another precious month. “Too much of April was wasted by focusing on the 100,000 tests by 30 April target at the expense of other aspects of a clear strategy,” he said. “The testing strategy, if there was one, got hijacked on the basis of just meeting that target when there were lots of other things that needed to be done.”
Hopson said the saga also illustrates the danger of trying to control testing from the centre. “We need to be ready to do test, track and trace in every part of the country. That can only be done effectively with greater local control.”