At a government press conference last Wednesday, England’s deputy chief medical officer singled out one part of the north-west for praise. Sefton, said Dr Jenny Harries, had “done a brilliant job” dealing with rising cases of the variant first identified in India.
That day, eight people in the Merseyside local authority tested positive for Covid. Two weeks earlier, on 5 May, there had been 36 reported cases. The data was going in the right direction, said Harries.
Thirty-five miles east in Bolton, it was a different story. By Friday, cases there had soared to 321 per 100,000, giving it the highest infection rate in the UK, up from 82 per 100,000 on 1 May.
The demographic divide between the two places is illustrated by the fact Sefton council chose the Formby branch of Waitrose for a pop-up testing site. Bolton, meanwhile, parked its vaccine bus outside the Essa academy, where almost half of pupils qualify for free school meals and 80% of pupils do not have English as a first language.
Formby, where Sefton’s first cases of the India variant were detected, is one of the wealthiest parts of north-west England. Home to millionaires including the Liverpool manager Jürgen Klopp as well as a red squirrel sanctuary, it is part of the Harrington ward, where only 3% of children are on free school meals and life expectancy is above the national average. Ninety per cent of households have a spare bedroom, compared with 69% in England. More families there earn over £60,000 a year than under £39,000. In the 2011 census, only 2% of residents said they were black, Asian or minority ethnic (BAME).
But in parts of Rumworth in south Bolton, which at one point last week had a rolling case rate of 1,186 per 100,000, 93% of the population are of BAME background. About 10% of homes are overcrowded and net weekly income is £460 (£23,920 a year).
The link between deprivation and Covid infection rates is well-established. However unfair, it makes sense that keeping the virus in check is much easier in richer, whiter areas where people tend to put their elderly relatives in care homes rather than in the spare bedroom, and the bank of mum and dad pays for children to flee the nest.
“Where you have areas of your communities with a large proportion of people that are unable to work from home, with jobs that take them out of the house and into contact with other people, coupled with densely populated, terraced housing with multi-generational households it is really difficult,” said Lynn Donkin, the assistant director of public health for Bolton. “It’s difficult for people to isolate living like that, compared to being in a big detached house with two bathrooms.”
Margaret Jones, Sefton council’s director of public health, accepts that Formby’s relative affluence made it easier to control the new variant: “Where it’s occurred during our local authority is actually in one of the better off, more affluent areas of our borough, so the community that live there are very different from the other communities that have been affected,” she said.
Vaccine uptake in the affected area of Sefton was “very very high, both for first and second doses”, she added. Most of the recent cases were in young people who had not yet been invited for vaccination. Those who had to isolate could largely work from home.
Sefton has undoubtedly had a much easier pandemic. There were points last July when the borough had no Covid cases. Bolton has not had a day without at least one new infection being recorded since early March 2020. The arrival of the India variant was complicated by the fact that the district was already dealing with an outbreak of the South Africa variant when it arrived.
The local clinical commissioning group (CCG) announced last week it would “find reasons to vaccinate people” instead of turning them away. Hundreds of young people received their first Pfizer dose on the bus outside the Essa academy, many saying they did not seem to meet any of the criteria but were jabbed regardless.
“They made you fill out a form with my name, address and NHS number but no one asked if I had any conditions or if I was in an eligible group,” said student Farah Asghar, 21. Grady Lubaka, 30, also a student, said: “I got a text from my GP telling me to come here to get my vaccine. I’m quite surprised to be able to get it so early but I agree with the decision to offer it in areas that are spiking.”
But surge vaccination is an emergency, short-term measure. Addressing inequality will be the key to making sure places such as Rumworth are not always so much more vulnerable than people in Formby to future pandemics, said Donkin. “Not only has Covid exposed and really drawn more attention to those inequalities, it has exacerbated them and will continue to do so. I think we will all need to work together locally, regionally, nationally to address those inequalities.”