Rosie moved into our ramshackle house 25 years ago, completely independent, and a fabulous support when we had school-aged children. A decade later, my parents threw their lot in with us, too. We bought a neglected and damp Edwardian pile around the corner, which had once been a care home. As my father’s Parkinson’s threatened to become more severe, we would need ramps, grab rails, widened doorways. And I would learn how to be a carer.

“Carer” is a tricky word. It’s a noun that brings with it a hint of transaction, of imbalance. The NHS defines it as anyone who looks after someone who “cannot cope without their support”, and clarifies: “The care they give is unpaid.” This definition is all the more uncomfortable if you are caring for someone you love.

First, I was supporting my mother caring for my father; then watching over her as she negotiated life without him; finally, after my Ma died, I became Granny Rosie’s full-time “extra pair of hands”, as she puts it. Each act has been one of love, but it has also been tough and distressing. It is challenging, caring for those who once cared for you, managing the physical and sometimes mental life without a loss of dignity, the tiredness and the loss of privacy. And it is endless. Being a carer is about meeting someone else’s needs, every single day, at all hours. If you can’t be there all the time, it’s about finding someone who can — a neighbour, a relative, a friend.

Many people, finding the relentless struggle impossible, have to leave their jobs. A spike in the number of people giving up work to care for family members was reported last year — 84% of them women. Most carers talk about feeling guilty whatever they do — that terrible disappointment on a beloved father’s face when the visit is over too soon, the falsely bright goodbye from a mother who is refusing to give in. The feeling, when you are caring for someone with dementia, when they can’t even recognise your face anymore.

On top of the emotional challenges are the practical ones, the financial ones. How do you agree with siblings over whether an ageing parent needs a residential home or a paid carer? Where do you turn, when you can afford neither to leave your job nor pay someone to care for a beloved relative? When there is so little state support on offer?

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Without unpaid carers, the NHS would collapse. There are 10.6 million of us in the UK, and we save the government £162 billion per year in England and Wales. (For context, in 2020-21, the NHS received an estimated £164 billion per year in funding.) Despite this, the Carer’s Allowance is only a measly £76.75 per week (up from last year’s £69.70). To qualify, you have to spend at least 35 hours a week caring for someone: a fulltime job. If an extra £7 a week seems paltry, consider the Carer’s Leave Act, which is about to come into force. It will give employees the right to take leave to provide care — unpaid — for a mere five days. But if carers withdrew their labour, the system would simply collapse. Hospital beds would be flooded, care homes would be unable to cope with the influx, the NHS would crack under the strain.

When the Dilnot Commission on Funding of Care and Support was published in 2011, one of its key recommendations was that there should be a cap placed on an individual’s contributions towards their own care. The figure was set at £35,000. The intention was to protect those who have spent their working lives paying National Insurance contributions from the sort of “extreme” care costs that would force them to sell their homes. The asset threshold for those in state-funded residential care should, it suggested, increase from £22,500 to £100,000. There should be greater integration between health and social care services, and better information for care users. The Commission was thorough, it was fair, and it achieved royal assent in 2015.

But nearly 13 years on — and despite the tough lessons taught by the pandemic — almost none of the Dilnot Commission’s key recommendations has been implemented. Cameron, May and Johnson all stalled. Theresa May changed the name of the Department of Health to the Department of Health and Social Care in 2018, as a nod to better integration. But, as in so many government departments, this one has seen a revolving door of ministers, who have made few lasting changes. Now, Britain’s care system is at breaking point. There is no fairness in who pays what; there is no plan for those who do not have children to step in and help, or those whose families are estranged or living too far away. As the NHS remains starved of funds — Rishi Sunak has just announced the “most radical” reform in NHS history: his plan to make £10 billion in savings — the situation is only worsening. In May, the Prime Minister killed off the Conservatives’ flagship social care plan.

Social care is not seen as a vote-winner. I’d hazard that this is at least partly because care is seen as a women’s issue. By the age of 46, women have a 50% chance of being a carer. Men don’t have equivalent odds until they are 57, which suggests that men mostly care for their partners, whereas women care for everyone. And though there are men actively campaigning in this field, the blunt fact is that the majority of carers, paid or unpaid, are women, and the vast majority of legislators are men. In September 2020, at the beginning of the period of local, tiered lockdowns, not a single woman attended Cobra meetings, and there was not one female nurse on the Sage Cobra team. If the Government is going to address the crisis in care, it needs to listen to those actually providing it. The trouble is we often don’t see the point in complaining. We just get on with it.

There is also a growing number of young carers looking after parents or siblings — the Children’s Society estimated in 2021 there might be as many as 800,000 carers between the ages of 5 and 17. If they have managed to stay in school, they are often alienated from their classmates because of the unpredictability of their lives. There are few advocating for this often invisible group of carers. Those that do, for instance the All-Party Parliamentary Group (APPG) on Young Carers and Young Adult Carers, have little power to effect change.

Carers are everywhere, hidden in plain sight. Most of us, even if we long for compassionate support from the Government, take on the role willingly, regardless of the consequences to ourselves. I am lucky: I didn’t have to give up my job to become a carer, but many have no choice, and find themselves pushed further to the margins of society. The current political narrative is that a valuable life is a “productive” one — one that makes the nation money. It belittles both those who give care and those who receive it. It ignores the fact that women and men who have spent their lives contributing to society deserve to be looked after, not seen as a burden, or a “trouble”.

It was a sobering affair. We discussed the public health measures with which we are all now familiar; the treatment of patients on intensive care; and the cold storage, burial and cremation of the bodies of the many dead.

It was a weird moment, for — as a parliamentary candidate before my first election, holed up in a cottage in Suffolk — I had written a history of the Black Death in the British Isles. I reflected then that however carefully scientists, doctors and officials planned for this event, historical experience suggested that the human reaction to pandemic disease is not always what utilitarians might expect.

Now the rehearsal has become real. We must contend with the greatest pandemic threat the world has seen for a century.

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Our first reaction is precisely that of our fourteenth century forebears — to assemble the basic facts: it came from the East; it travelled at terrifying speed, so fast it would strike a village or town almost as soon as news arrived that the pestilence was near; it killed rich and poor alike; and the Grim Reaper felled the young at the same rate as he did the old. By the time it departed, it would leave on average half the population dead.

Medieval men and women also knew perfectly well how the disease spread, even if modern historians choose to ignore them and impose their own epidemiology on events.

In an attempt to look afresh at the vector of this deadly pathogen, I worked with world-leading mathematical modellers of epidemics, using a super-computer to turn the varied information that did exist into a model that would best describe how the Black Death spread. (The same algorithms were subsequently used by the Chinese authorities to plan where they placed emergency medical supplies across China, in the event that bird flu reappeared.)

That model demonstrated that the Black Death was spread between people, most likely by touch and by breath, and not — as we have latterly been told — by rats jumping on and off ships. No other explanation can account for the terrifying speed with which it covered ground, from the Near East to the Mediterranean and western Europe, before making landfall on our own south coast. 3000 miles in just 18 months, in the age of the sailing ship, horse and cart.

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Explanations of the pandemic’s cause were more speculative. Country people noticed the wildly erratic weather, an unexplained mass mortality of livestock, and the birth of both children and animals terribly deformed; university astrologers looked to a malign conjunction of the stars.

These observations were all essentially pointing to the same thing: a dangerous imbalance in nature, a corruption that reflected the sinfulness of men and women. The only means by which every part of the world — the human included — could be put right was by God’s divine justice, and the purgative means was this cleansing pandemic.

We may smile at these crude attempts at explanation, products of a naïve pre-scientific age, but are we really any different? It takes seconds on social media to see people around the world linking the coincidence of Australian bushfires, global habitat destruction, climate-warming, air travel and this pandemic flu. Like the medieval stars, these are both portents and causes — evidence of a disequilibrium that neatly puts the pandemic into a comprehensible context.

And just as our fourteenth century forebears saw signs and reasons taper into one, so too can we find multiple explanations for why this has taken place: the hubristic fragility of global capitalism; “nature biting back”, as one mainstream Indian TV channel has it; or simply: “China”. Whether you are a member of the global metropolitan elite or a credulous boomer rube, there is a meta-explanation for this pandemic to suit your taste.

Despite our modernity, we still want to make sense of this pandemic by believing that it will somehow bend us back from our refractory ways. How many times have you heard that in our enforced isolation we will find pleasure in the simpler things in life, learn once again to value our families and rediscover a proper respect for the elderly and infirm? Has it not been divined that the newly clean air above Wuhan and Milan is the first step to the cleaner world we must now create? Just ‘imagine’ how this moment may be the opportunity to recast our economy and save the world.

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For those with a more apocalyptic cast of mind — and they are a constant proportion of us in any age — all this is further proof that we are entering an end time, where we fry in an earthly hell of our own creation. The most militant make public displays of their warnings, willing on the economic apocalypse: XR fanatics at the entrance of Downing Street are simply post-religious flagellants in not dissimilar dress.

Are things any different behind those famous gates? Modern government may be far more complex but the response is familiar. In 1349 the economy rapidly collapsed: workers who were not dead stayed at home for fear of infection, crops rotted in the fields and those willing to work would only do so at an extortionate rate.

Edward III — fabled in popular history, but a less appealing man the closer one inspects — was fortunate to be served by an extraordinarily capable treasurer, William Edington. In his hands, the Exchequer’s response was breathtaking in its innovation and scope. A royal ordinance was sent out fixing a maximum rate at which people could work, and infractions were prosecuted in special courts.

The receipts of the fines from these sessions were set against recent tax assessments, in recognition of the challenges that farms and businesses faced. The cost of manufactured goods was controlled by limiting the rates that craftsmen could charge, and to support prices — which had fallen — Edington undertook a massive recoinage, medieval quantitative easing on an industrial scale.

The precise target of these interventions may have been different from today’s Exchequer’s actions, but it had the same purpose: to maintain some sort of functioning economy through the disruption wrought by death after death after death.

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Some communities worked out what they had to do to limit the mortality. When the disease entered Milan, the authorities closed the gates and bricked the sick up in their own homes. It was brutal but it worked.

The English made half-hearted attempts in the same direction. The burghers of Gloucester, close to the first urban hotspot of Bristol, closed the city gates “believing that the breath of those who had lived among the dying would be infectious”. Only here it was too late. In London, the Corporation had to take action within weeks to control profiteering out of the run on gloves.

Without a remedy, villagers could rely only on the care of the church, which had a solemn responsibility to provide the last rites that would ease the journey of the soul from this world to the next. More even than modern-day medics, the efforts of so many medieval clergy were heroic, as they knew that their work gave them an odds-on chance of death. The dedication of so many priests to their crucial tasks meant that many parishes went through two, three and more clerics in a matter of months, each dead priest replaced in a matter of days so that the cure of souls would not be held back.

What was left was desolation. Villages half-emptied of peasants; weeds in the fields where a new crop should have stood. Already, however, rural society was reconstituting. Huge swathes of land had, through inheritance and forced sale, changed hands. People lost their families but gained a legacy.

Widowed men and women everywhere hastily remarried, desperate to maintain the security that marriage then ensured. In the near term, survivors had no option but to get back on their feet and make the best of the situation that they could. For some this meant making use of opportunities that had unexpectedly come their way, but for most the imperative was merely subsisting from one day to the next.

“Many changes,” wrote an Irish scribe a year after the pestilence, had passed. Indeed, they had — and they lasted some time. The labour market had been significantly disrupted; building projects had been put on hold; prices went down and then up; the frontier relationships within our four nations had been redefined.

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But over the years these changes ceased and then unwound. Some of those workers who had known the better pay they had enjoyed immediately after the Black Death bridled at the efforts of lords, parliament, judges and the king to return to the status quo ante — a memory that fired periodic outbursts of public anger, most famously in the Peasants’ Revolt. But by and large, the great arc of history was unbent by the Great Death.

For the medieval mind, this was a far easier outcome to comprehend than for us. In a pre-liberal worldview, one’s place in the world was divinely ordained, and change outside the turn of the seasons was neither inevitable nor expected.

It is a conclusion we find almost impossible to accept now — not just popularly, but as academic students too. Historians are biographers of an age, and like any biographer, we like to think our period was an agent of change. “Millions dead: things go on as before” makes for a poor quotation on the flyleaf of a new book.

And so the Black Death found itself posthumously responsible for changing almost everything: destroying feudalism, creating the middle classes, improving the lot of women, setting in motion the Reformation, ending the Decorated style of architecture and ushering in the Perpendicular, bringing forth our modern English tongue.

However, in as much as these developments did exist (and not all of them did) they all began long before the Great Death, whose effect on each was at most to accelerate an evolution that was already taking place.

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In truth, that was not the conclusion I had expected to reach when I set out to write about the Black Death, but after spending so much time with this greatest pandemic in history, it was the only judgement I could honestly make.

And now I am back in a cottage in Suffolk, isolated, this time with a family, working my way through the effects of an epidemic. So the wheel of life turns again, almost full circle.

For Michael Gove, who sits where I once did, this thought should be a comfort, as he wrestles with the effects of a pandemic for real. For while he and his colleagues carry the awesome responsibility of helping us all get through this crisis, he should not worry about remaking the world in its wake.

We have been here before. Our response shows that our natural instincts to make sense of our own story remain intact. This pandemic will bring nothing to an end, nor create anything anew. When historians look back in seven centuries’ time, they will hopefully divine the truth of our age: that we were already embarked upon great change — coping with an ever more interconnected world, the dismemberment of traditional community, huge structural changes in the nature of work, and our existential effort to cease the wanton destruction of our planet and manmade climate change — well before pandemic flu temporarily stopped everything in its tracks.

Those accounts will tell of how, in recovery, it was the strength of the human spirit, and the families and communities that we create, that enabled us not only to pick up where we left off but to make full use of the opportunities that this hiatus offered us. It will be a reminder to another time that change is evidence of life, not the dead hand of pandemic death.

The Scouring Angel: the Black Death in the British Isles is published by Vintage.