Now everybody sticks to the, uh to the measures that we have now.

Then way.

Think that by theme, Middle of February, then you know there really is the prospect off beginning the relax ation of some of these measures.

It seems so easy.

Just follow the rules.

But what we're realizing is it's far easier for some than for others.

If you're living comfortably working at home and you have a cough, there's every chance you'll go and get it tested.

Even just this a precaution.

But supposing, if you have no job security and cash is very tight, what are the chances you ignore that same cough?

Not everyone is able to work from home.

Not everyone is able to take time off work for self isolation, saving lives.

Restarting the economy.

Also nous estate addressing these inequalities.

Andi.

Given the varying the new variant, this might be the difference between a lock down.

Bringing are down below one or not, while headlines were focusing on the increased transmission potential of the new variant coronavirus.

Ah, Public Health England report was quietly released Ah, week before Christmas, Um pointed toe other factors that drive transmission at the heart of it was inequality.

It's highlighted factors including insecure public facing jobs without social distancing, overcrowded housing, chronic stress and pre existing health conditions a Z all contributing to an increased risk from covert.

The country applauded our NHS heroes last spring, but there are so many other essential workers keeping the country ticking through locked down in factories and food production, for example their essential.

But are they treated as such really precarious, essential workers who we have not thought about their position?

It all locked down widens inequality in two ways.

It's widens the difference in in how likely you are to be at risk on git like widens the inequality in whether you're actually ill.

In Toronto, they've looked at infection levels among essential workers, such as people working in public facing jobs such as shops, deliveries and also manufacturing and agriculture.

The Blue Line shows those infection rates amongst the communities with the fewest essential workers.

The Orange Line covers the middle third of communities on the Red line shows how infection is significantly higher among those communities with the highest number of thes workers.

Should we just accept that transmission will always be higher in some communities than in others.

On that lock down, maybe increasing that gap.

It's just what's happening is that they're reducing contact rate mawr amongst those folks that were already at lower risk and reducing it less amongst those folks that were at higher risk.

And thus we see those disparities just worsening.

And indeed, in the sense of actually reducing overall transmission, they can't work in the way that they've been designed.

There are over eight million essential workers in the UK who simply cannot work from home.

Blunt tools such as locked down with its associated trade offs can only work effectively if it stops transmission in the group's transmitting.

We drove covert infection rates right down last summer, but what experts have said is where the embers remained, hottest was in the deprived communities.

So what do you do about it?

I think we need to think about support proportionate to the risks off exposure, often individuals we need to think about additional layer off support for this advantage communities income relief.

At the moment, only one third of salary is recovered.

When you're off sick on, do we need to think about how we can incentivize sectors.

We need to think about whether to provide accommodation for people living in overcrowded housing or people don't who don't have a house to self isolate.

UK has one of the lowest proportions of pay covered by statutory sick pay in Europe.

A million's don't even qualify.

I think when we get into it, we understand that you know the sort of systematic and structural barriers that put folks at risk are really at the heart of effective interventions rather than this idea of blaming folks.

But but indeed, it's natural for us.

It's a society is just to blame individuals, I think, rather than tackling difficult and challenges issues.

Understandably, our politicians have spent a lot of time trying to make people doas, they've been told, but some are asking whether there has been enough effort thrown it people in those areas where, without help the virus is likely to thrive.

Deb Cohen, with that report, We invited the government on the program.

They declined, a spokesman told us.

They're doing everything they can to ensure their coronavirus support reaches those who need it most.

Joining me now is Rose Galahad, the professional lead for infection prevention and control at the Royal College of Nursing on Debate.

A hack a member of the independent Sage, formerly acting director of the Runnymede Trust on Good Evening to You both rose.

If I could just start with you Thio paint the picture for us, if you can, of what you're hearing.

It's like currently on your wards.

So what our members are telling us is that the pressure is absolutely relentless.

Our nurses and midwives, working in a way care, settings and care homes, have been working to support this pandemic now since March.

Andi, working in a pandemic is very much like running a marathon.

You need pace.

You need rest if you're going to reach the end.

But our members are sprinting and they are absolutely exhausted on it's a marathon in the sense that way, actually, don't know how long this could go on for me.

Nick heard figures.

I don't know if you heard that earlier that the laws will be in place until the end of March, which sounds like the beginning of April.

We've been told mid February.

Um, I wonder Zubaydah how you managed to get people to follow a set of rules when there are such severe economic consequences.

For some who are trying to do so well, that's absolutely the key point.

Emily, which is we have been saying from the very beginning.

Independent sage have been saying that in order to get people thio idea to rules, we need to help support them.

As you rightly pointed out at the beginning, This isn't just about will.

This is about being able too strict to stick to the to being able to a dear to the rules on.

We know, for instance, right from the beginning that black and ethnic minority people, people in deprived areas, were much more at risk.

For Kobe, 19, much more at risk was off severe illness on death because off the types of jobs that they were in because of the types of accommodation that they live in, because they're much more likely to live in overcrowded housing and so on.

Now all of these things matter.

But what also matters in this pandemic is stopping transmission on the way we stop transmission is to get people's self isolated on.

We've known from the beginning and throughout this pandemic that people in deprived areas that people in low paid jobs that black and ethnic minority people who are disproportionately in low paid jobs and insecure jobs have been less likely to afford to self isolate.

So let me ask you, what would you actually say to people in that position?

Would you say you have to You have to self isolate.

I know it's really hard, Um or would you understand that some people will have to break the rules and will have to go to work and obviously will live?

Maybe in multigenerational families where they can't make those kinds of decisions?

I wonder what message you would give out.

They shouldn't have to make that choice.

I mean, the whole point of the government is to help us in this pandemic is to protect us.

We know that black and ethnic minority people we know people in low paid jobs.

We know deprived areas have had to make difficult choices between going toe unsafe work on putting food on the table.

Now the government have been in the position to help them.

They've helped.

They would say to be fair, they would say they've given what 280 billion to protect the livelihoods of people and 50 million, um, toe help those on low incomes.

So I mean, the cash has been put there for this.

It's not been enough, as as it's as your colleague is rightly pointed out, that actually nearly two million people and not eligible for statutory sickness pay in this in this country because they don't earn enough.

Now, these those people are disproportionately and insecure.

Jobs are disproportionately in zero hour contracts.

Andi, that disproportionately women on this government haven't done enough.

They haven't given enough secretary sickness pay.

They've made the eligibility criteria very high on we know from the Liverpool Mass testing Dan card.

And the MP spoke about this, that in the Liverpool Mass testing pilot, only 4% of people in poorer areas came forward for the testing because they were too afraid of getting the result on that speakers they couldn't afford to self isolate.

So it matters.

Rose, let me turn to you because locked down is essentially a holding pattern for all of us.

Until we vaccinate everyone from what you've seen on on the front line.

Is the NHS being used efficiently for that.

Are you happy with the logistical process that's going on there?

Well, the vaccination program is a huge logistical challenge, but the plans are there.

Of course, we must remember that we've only just really received the Oxford vaccine, so it's early days now.

But there is a really commitment across the U.

K to get this to as many people as possible.

And GPS nurses in hospitals and other health care workers are all part off that we also know that there are many non healthcare workers that have signed up, such as volunteers through ST John's ambulance toe also help this effort.

But I would just also like to make the point that if this vaccination program is going to be successful, we do need to protect the vaccinators as well.

So as we have high rates of sickness and absence in the NHS and in the independent sector and care homes, what we can't have is our vaccinators off sick because they are self isolating or have co vid themselves.

It gets Dharma raised the point today that you know, if we are throwing everything at this which understandably we are, then we should probably be doing this round the clock, shouldn't we?

I mean, this should be a sort of a military strategy of getting every volunteer that's offered their name should be, you know, called up within 24 hours.

There are some people that you hear from who offer their services and have heard nothing for three weeks.

I wonder if you think it should have that sense now off.

If we're all staying at home for the most part, then then why aren't then?

Are we throwing everything at it 24 hours a day, seven days a week now?

So it's very much being approached like a military operation, and the military are supporting testing.

Aziz, You know, not everyone would want to accept an appointment 24 hours a day, and some people simply could not get to appointments 24 hours a day.

But certainly extended hours of flexibility is absolutely crucial to its success.

Zubaydah, Do you think that the way we're prioritizing is right at the moment?

Clearly, it's the vulnerable age demographics that are receiving the jab first.

Would you change that order?

Would you do it in socioeconomic or ethnic demographics?

Thio get priority access.

Well, I mean, would you mind?

First of all, can I just say one thing, which is where?

Focusing only on vaccination and only on lock down.

Justus, the prime minister has and independent sage would argue and have argued consistently that those men must not be the only two things.

They're not the only two things out of this pandemic.

What we also need to do is improve the contact tracing and the support for self isolation Now, in terms of priority for vaccination.

That's a really difficult question, because we know that that depends on multiple factors in multiple risk factors.

So the reason over eight year olds, for instance, are being prioritized for the vaccination is because age is a significant predictor off risk in covert 19.

Now, with ethnic minorities, it's much more difficult because there is no one gene for being black.

There is no one gene for being Asian, and it's not that one gene that the genetics that is making black and ethnic minority groups, or even people in deprived groups, you know it's those aren't the situations.

Those are the characteristics that are making them vulnerable.

So of course it needs much more care.

What I would say is if the government focused on the fine test tracing, isolate and support.

And it's the isolation and support the supported isolation that matters the most.

Then that is also going to get us out of this pandemic because that will suppress the virus.

And it will keep the virus down.

Those they very much indeed.

Thank you.

Thanks for joining us.