COVID-19 has made the social determinants of health painfully obvious. Social geographers like Danny Dorling have pointed out that the map of the three-tier system of Covid-19-related restrictions looks uncannily like “a depiction of the north-south divide.”

The north is, on average, poorer than the south. People are more likely to have jobs where they cannot work from home, and to live near to their extended family who provide childcare. These, along with other factors, mean that Covid-19 can spread more easily.

Currently, the government recommends that those with Covid-19 symptoms should self-isolate for ten days. A minority of people are following this. One study, not yet peer-reviewed, found that fewer than one in five people reported that they had adhered to the full self-isolation period, despite around 70 per cent having the intention to.

The researchers, led by first-author Dr Louise Smith at King’s College London, found that non-adherence was associated with factors such as “having a dependent child in the household, lower socioeconomic grade, greater hardship during the pandemic, and working in a key sector.” The team concluded that support and financial reimbursement would improve adherence.

According to the OECD, Britain’s mandatory sick pay system for the first four weeks of sick leave due to Covid-19 amounts to around 10 per cent of average earnings, compared to an average of over 60 per cent for similar countries.

The government have only introduced a one-off “self-isolation payment” of £500 for a subset of individuals, with bureaucratic hurdles to jump over. Without a doubt, low sick pay forces people to continue working and spreading Covid-19.

Refusing to increase statutory sick pay from £95.85 per week is a false economy: money paid out to those who are ill now results in smaller healthcare costs further down the road. This may be true under “normal” conditions, but it becomes blatantly obvious in a serious pandemic.

The economists Jonathan Portes and Daniel Howdon have used a simple calculation to estimate that increasing sick pay would easily pay for itself, even under conservative assumptions about the increase in the likelihood of self-isolation and infections prevented. They noted that the government has provided £12bn for the track and trace system, and increasing statutory sick pay would be “a rounding error in comparison.”

It is clear that many of the available levers within the government’s control are closed-off by ideology. Their ideology holds that increasing sick pay would encourage malingering. Providing the poorest with food during the school holidays would “nationalise children.” And providing a fair furlough scheme to northern communities alone would have been economically unsustainable—until a national extension of the scheme followed.

Yet refusals to use these limited levers can mask the fact that they are connected to a malfunctioning machine. We suspect that even if a Labour government were in charge, Britain would be faring worse in this crisis than other comparable countries.

Successive Conservative governments have degraded the institutions of central and municipal government; now, it appears the government simply lacks the ability to manage this crisis competently. Even if the spirit were willing, the flesh is weak. In consequence, ministers turn in panic and desperation to consultants.

This is the last-minute Christmas online-delivery model of government. Fiscal prudence is suspended. Money is thrown at the problem; it must be given to somebody, anybody, who claims their snake oil can do what government cannot.

Even those with an ideological commitment to the outsourcing of government duties should be outraged: this is only the facade of a free market. The National Audit Office examined £18bn of pandemic contracts, finding that £10.5bn were awarded without a competitive tender process.

Cronyism is merely a symptom, not a root cause, of a government throwing money away to mask a failure of the basic functions of the state at a time of crisis. The vastly outsourced “NHS” Test and Trace now has an annual budget of £22bn, with only 60 per cent or so of even known close contacts of those testing positive being reached by central call centres.

A government led by the ex-journalist and publicity hound Boris Johnson prefers to spend money in large, round sums on eye-catching projects, whether there is any evidence they are a good idea or not. This is the only possible way to make sense of projects like Operation Moonshot, reportedly costing a headline-worthy £100bn.

This huge figure, a staggering 77 per cent of the NHS’s annual revenue budget, was probably dreamt up independently of the underlying details: as the BMJ noted with a straight face, “[t]he figure is not broken down.”

Taking the government at their word, the plan is to increase testing capacity to 10 million tests a day and provide weekly testing for everyone. Sinisterly, those who tested negative would be provided with a digital “passport” proving their test status.

To be clear, this is madness. The plan is in direct contravention of decades of established guidelines on screening programmes and medical ethics. Experts have expressed unease about the idea of “immunity” passports showing that people have had the virus; “negative test” passports have been less discussed, because they are an even worse idea.

However, the same concerns apply: they would create a new layer of inequality using a potentially ineffective measure. This approach threatens privacy, undermines solidarity, compounds structural disadvantages, and sets an alarming precedent (although it should be stressed that border controls already make use of such biopolitical enforcement). Of course, incompetence may mean it never comes to pass.

Muir Gray, who was the director of the UK National Screening Committee, has written that spending so much money on “an unevaluated under-designed national programme leading to a regressive, insufficiently supported intervention [ie self-isolation]—in many cases for the wrong people—cannot be defended.”

If Operation Moonshot happens without changes to sick pay, we will be spending huge amounts of money to provide people with information which they may be unable to act on for economic reasons. This could be corrected at a fraction of the cost. 

We have a government eager to disclaim responsibility and put the burden of solving Covid-19 on “big science” and consultants. Better to haemorrhage public money in outsourcing, rather than admit defeat and start to repair the broken machinery of government.

Even if we could be convinced that mass screening is a good idea, it is ludicrous that the government are aiming for the moon when they can’t hit an open goal in front of them.