Vulnerable communities under lockdown

If this week demonstrated anything, it is that tangible data is now being released supporting the theory that COVID-19 has further marginalised people who were marginalised in society before lockdown.

A government-ordered inquiry has found death rates of Covid-19 in England have been higher among people of black and Asian origin than any other ethnic group.

The Care Quality Commission released evidence this week on COVID 19 related deaths, that showed a 134% increase in the number of death notifications this year for people with learning disabilities and autism.

Last weekend, the government decided without any warning or scientific evidence that people who were vulnerable who had been shielding previously no longer were required to and encouraged society to return to work. Without suitable guidance this sent an avalanche of nervous callers to GP surgeries, community support lines and to human rights advocates like POhWER. The questions they were broadly asking support organisations included:

• Who made the decision I am no longer vulnerable to COVID 19 and on what basis?
• What should I be doing to protect myself against possible virus transmission?
• What precautions should I be taking to protect my loved ones who are vulnerable?
• How might I protect my employees returning to work? Where do I buy PPE? What PPE do I need?
• What role is Public Health taking to provide information, education to help me to understand my options?
• Should I be tested? How often? Which test?
• How will track and trace impact me and my ability to keep working?

People living with mental health, impairment or disability have been disproportionately disadvantaged due to COVID-19 because of barriers not fully considered or resolved in the UK’s COVID-19 response:

• Barriers to public information due to poor public health information accessibility.
• Difficulty with social distancing because of support needs requiring them to be within close proximity of others, physical necessity or because they are institutionalised.
• Lack of access to peers with shared ‘lived experience’ who can support during times of distress.
• Poor future planning to address pent-up demand for mental health and care services post-lockdown.
• Lack of understanding by local and central government on how to address gaps in information and services to ensure mainstreaming of requirements.
• Serious disruptions to the services they rely on.
• Additional factors placing them in position of further inter-sectional discrimination including race, sexual orientation, gender identity, digital exclusion, low income, education, religion, literacy.

What is the guidance for how vulnerable people protect themselves going forward?

There is a lack of a joined-up response, guidance that is incomplete and the finer details missing. The information is one-dimensional and not actionable on its own.

Releasing data without any context or real understanding to the circumstances of transmission, environments of transmissions or how other contributing factors (not exhaustive) like race, disability, age, pre-existing health conditions, employment environment or income makes it impossible to find solutions to how to protect vulnerable people.

The contact tracing application solution proposed by the government raises additional digital rights questions for vulnerable : (a) consent to access data about vulnerable people and protected characteristics (b) the effect of triggering daily alerts signalling danger on mental health and (c) how the government will communicate and contact people living with mental health, impairment or disability without knowing their access and communications preferences.

Encouraging the public to procure and wear Personal Protective Equipment (PPE) is not a ‘magic bullet’ as PPE only works if fitted properly, changed regularly and of the right standard. How is the general public expected to navigate PPE requirements on Amazon?

In the short-term, we need a more detailed analysis of this data to understand what drove further vulnerability into these communities. Public Health also has an immediate responsibility to provide practical advice on how people can ease out of lockdown unique to their own personal situations and how institutions can protect vulnerable people.

The government directive and guidance to date has been fragmented, relying solely on the medical model of health with no apparent consideration of the wider social health and care needs of the most vulnerable in the community. The NHS may well have been protected at a time was it was crucial to do so but social care support systems have been undermined and neglected.

We need government inquiries to not be delivered in silo or isolation, to consider prevailing inequality of people’s starting points pre-pandemic and to publish guidance which is people- or patient-centred. wider impacts of their guidance and consider what protections need to be in place to ensure a joined-up response protecting all vulnerable people

The siloed approach of assessing data in separate government departments for human rights, social care and the economy means vulnerable people are falling between the cracks in the system. You can’t study someone’s health and build a plan to protect them without understanding their wider needs. As an advocacy organisation we don’t know who is leading the response and how we could support reform and address gaps for our beneficiaries – do we report to the Care Quality Commission? The EHRC? The NHS CCG and Health Boards? The Local Authorities?