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Covid 19: Widening divisions will take time to heal

BMJ 2021; 372 doi: (Published 14 January 2021) Cite this as: BMJ 2021;372:n96

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  1. Fiona Godlee, editor in chief
  1. The BMJ
  1. fgodlee{at}
    Follow Fiona on Twitter @fgodlee

We live in an ever more divided world. Divisions between rich and poor, privileged and vulnerable, were already growing before the pandemic. With the virus’s predilection for deprived and excluded communities, and the economic impacts of lockdown falling heaviest on people in already precarious financial positions, these social divisions have become starker still. But there is another divide: between those countries that got ahead of the virus at an early stage and those (the UK notable among them) that have been constantly on the back foot.

The lessons from New Zealand and Australia—to act before widespread community transmission—may have come too late for European countries struggling with second waves and third lockdowns.1 They must be learnt in time for the next pandemic, and meanwhile we have immediate challenges to face. Despite great advances in hospital care, deaths continue to rise, with the UK seeing the biggest year on year increase since 1940.2 More and younger people are being admitted to hospital, more people are living with long covid,3 and hospitals and general practices are stretched to breaking point, with absence resulting from illness and self-isolation adding to the strain on remaining staff.45

The vaccination programme is under way but will take months to reduce rates of infection, even with the UK’s controversial decision to delay second doses.6 Why were doctors and nurses not at the front of the queue? Vaccination of healthcare workers should be prioritised for safety and morale,7 and to reduce hospital acquired infection.8 Doctors have had varied experiences accessing the vaccine, with some travelling across the country to secure their first jab while others have been frustrated by no word from their employer.9 Please let us know if you are having difficulty getting vaccinated (

While vaccines and vaccinators continue their important task, there is other work to do, and we must press our governments to do it. Disastrously, there has been no sign of “systems thinking,”10 with even the basics—find, test, trace, isolate, and support—still largely undelivered.11 Blaming individuals for not following the restrictions serves only to hide the real frailties of government policy.12 Mass testing of asymptomatic people is being expanded despite no good evidence that it reduced cases in Liverpool.13 The role of asymptomatic spread may have been exaggerated,14 and community testing with lateral flow tests may increase rather than reduce transmission.15 Money being squandered on mass testing of asymptomatic people would be better spent on practical support for those unable to self-isolate, at the very least providing free accommodation and income support.13

The world’s health professionals will do all they can, but ever widening divisions will take time to heal.

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