December 15, 2020

I can’t remember exactly where I was when I first heard the depressing news. I had somehow, in spite of all the rules making it almost more trouble than it was worth, managed to have a drink with another human being. And we may have been celebrating the fact that the vaccine had arrived, faster than anyone had dared to hope, more effective than we’d expected, and was now being put into the arms of vulnerable people, not just hundreds of thousands of volunteers on clinical trials.

But I do remember very clearly that when I heard that Health Person solemnly say that, vaccine or no vaccine, we would still be wearing masks and social distancing and so on for the next 18 months, my response was not fit to print.

Now, I’m no idiot. I know that a vaccine in a vial is as much use as those gym weights gathering dust under the bed. Vaccines don’t work till people are vaccinated with them. Getting them into the people at serious risk from Covid-19 will take a few months. We’re going to be firefighting till Easter, stoically trudging through the grim, dark, post-Christmas months before normal life can be resurrected with the Spring.

Then it will take more months to vaccinate the rest of us, not everyone perhaps, but enough to provide herd immunity. So no, I am not expecting Covid-19 to vanish overnight, just because a vaccine exists. And I do expect that some of the vulnerable population who can’t be vaccinated will still end up in hospital with it. And that, despite improvements in medical treatments, some of them will die.

But I also expect that the risk of death and serious illness from this novel disease will, by next summer, genuinely become comparable to seasonal influenza.

And that’s why I am worried about the way our relationship with the NHS has been reconfigured during this pandemic.

I regularly hear the voice of NHS Providers, the collective body representing NHS hospitals, mental health, community and ambulance services, in the media. On Sunday, they wrote to the Prime Minister, “urging extreme caution” over relaxing restrictions on everyday life, citing concerns about rising infection rates in some areas, and a potential shortage of hospital beds.

As they point out, “the NHS has been short of beds for each of the last five winters”. I have written before about the inability of our sainted NHS to cope with the annual surge in demand from cold weather and seasonal infections. Compared with our continental neighbours, the NHS is both inadequately funded and ineffective.

In October 2019, NHS Providers reported that 6 out of 10 Trusts were worried about their capacity to meet demand for services over the next 12 months, even before Coronavirus arrived. That report called for substantial investment in both health and social care services, and for ‘informed public debate’ on the future direction of the NHS.

If we ever get that informed public debate, it will happen in a very different context from the one that existed in 2019. In previous winters, when routine operations were cancelled, or acutely ill patients died on trolleys or in ambulances, the debate was about why the NHS failed to provide what we, the public who fund it and expect it to be there for us, needed. Now it is more likely to be about what we, the public, should be doing to reduce demand.

Public health bodies have long pointed to our unhealthy habits placing extra demands on the NHS, because our eating, drinking and smoking increased our risk from diabetes, cancer and heart disease. Excessive drinking is also blamed for placing extra strain on emergency services including paramedics and hospitals, mainly from drunken accidents and fights. This has reinforced calls from public health bodies to reduce opening hours, get people to sit down in pubs, and otherwise deter getting drunk.

Trying to change public behaviour to improve health and safety, and thereby reduce demand on health services, is nothing new. But the public has never before embraced such sweeping, compulsory restrictions on how we live.

Though trust in the Government’s Coronavirus measures is falling, along with willingness to adhere to rules that seem detached from either science or common sense, the majority of us still accept them, more or less. Well over half of us have changed our behaviour to reduce the spread of infection, washing our hands more, wearing masks and avoiding crowded places. Two thirds of Britons surveyed in November 2020 said they’d support a third national lockdown after Christmas if cases remained high. And, yesterday, a YouGov poll indicated that 65% of people think face coverings should be made compulsory in busy outdoor areas.

We must take these survey answers with a health-advice-breaking pinch of salt. Another survey said three quarters of us expected that most people would break restrictions to see people over Christmas, though of course only a quarter said they planned to do so themselves. In practice, many people use common sense when applying the rules to their own lives, making their own judgments about acceptable risks. But the principle that society must change around the limitations of the NHS, and not vice versa, is now entrenched in public discourse.

What happens when risks from Coronavirus become comparable to flu, and other seasonal respiratory illnesses? The 2014/5 winter was the worst since 2000 for excess winter deaths, which peaked at 15,000 per week in January 2015. The public was encouraged to take up influenza vaccines, and to wash hands and catch coughs and sneezes. No question of working from home, closing pubs and theatres, let alone sports stadiums or swimming pools.

Instead of strategies to reduce risk while keeping society running as much as possible, we responded to Coronavirus as if it were an existential threat, in whose teeth any measure was justified. When vaccines beat it back to a nasty disease like so many others that lie in wait for the vulnerable, will we know how to weigh risks to individual lives against the danger to public life?

I fear that, having once been sacrificed on the altar of the NHS and its limited capacity, our freedoms are no longer safe from the utilitarian knife. The same people telling us to shop alone, drink alone, and be in bed by eleven, to save lives from Coronavirus, will continue to make the same arguments over lesser risks.

If we accept pubs serving no alcohol, or alcohol only with a meal, or closing at ten, on the shaky ground that it reduces the spread of a virus, why not accept similar measures to take the strain of drunkenness off A&E departments every weekend? It can’t be coincidence that those rules fit so well with public health campaigners’ longstanding desire to wean us off our boozy nights out.

If we accept mandatory masks for Coronavirus, why not keep the rules for every flu season? And if masks, why not socially distanced theatres, reduced public transport capacity and more working from home? Once we have accepted that it’s our job to reduce demand on the NHS by limiting our lives, where will it end?

So the reason for drunken swearing behind my mask on that train home was not that I mind wearing a mask all that much. I wear a helmet for motorcycling, I take off my shoes for airport security, and if I have the flu I avoid friends on chemotherapy. Masks aren’t that big a deal.

But I want life to go back to normal. I want to meet people indoors, to laugh and drink, and watch performances, and take part in public meetings. I want to go into other people’s homes and have them come into mine. Lord knows, it’s the only thing that makes me get the vacuum cleaner out. And I don’t want to live another 50 years if I’m not allowed to hug anybody.

So once you’ve stuck that vaccine in the arms of the highest risk groups, you can take your 18 more months of social distancing, and stick them somewhere else.