Perhaps the most surprising aspect of the British Covid-19 crisis is the extent to which the Scottish, Welsh and Northern Irish governments, and the English regions, allowed strategy to be decided by Westminster, delaying the implementation of public health measures until the first UK-wide lockdown was declared on 23 March 2020. Health and social care are devolved, and this national epidemic is not homogeneous. It has been and continues to be made up of hundreds, if not thousands, of outbreaks, each at a different stage, ongoing in different local areas throughout the country. England had its first confirmed case on 30 January, Wales on 28 February and Scotland on 1 March. Some areas – such as Rutland, Hartlepool, Blackpool, the Isle of Wight, Tyneside, Durham, Orkney, the Western Isles – had no reported cases until late March; and London in the second phase, until December 2020, had relatively few cases compared with other areas, such as the north-west and south-west, which had far fewer cases six months ago but now appear to have more cases.

Because infection is transmitted between individuals, local knowledge of both communities and their living circumstances and individuals is key not only for understanding and managing the risk of spread but also for putting in place protective measures.

We are all vulnerable to Covid-19, but income levels, housing, living conditions, ethnicity, age, overall health and gender are all significant factors in determining the impact of the virus on different people. The conclusion is clear: as well as a revised approach to the NHS, the United Kingdom also needs revised policies in social care, housing and poverty, and – perhaps most importantly of all – better understanding of the realities of living beyond the “Westminster bubble”.

Vulnerability

National lockdown in March 2020 emptied cities and streets of almost all people, the vast majority having retreated to their homes, where they awaited – with some trepidation – the government's daily press briefings. However, the reality is that the risk of dying or becoming seriously ill from Covid-19 is not the same for everyone in the country. We have also seen stark differences in infection rates and mortality between countries.