Unity has not lasted long – and the rebellion is breaking out from the right. What started as carping about police officiousness is grumbling its way to deep dissent on the entire coronavirus lockdown policy. Reported conflict between Matt Hancock at Health and Rishi Sunak at the Treasury on its costs and benefits leak into the rightwing press in what begins to be a profound culture war – your money or your life.
It rises up in the Mail, Times and Telegraph. Here’s Jonathan Sumption taking up the cudgels in the Sunday Times: “As soon as scientists start talking about a month, or even three or six months, we are entering a realm of sinister fantasy in which the cure has taken over as the biggest threat to our society … Generations to come are being saddled with high levels of public and private debt. These things kill too.” The Mail on Sunday promotes critics who would let the virus rip: “Professor Graham Medley, the government’s chief pandemic modeller, said the only viable path through the health emergency would be to let people become infected so they are no longer vulnerable … Mounting unemployment, domestic violence and burgeoning mental health issues could be widespread if the normal functioning of society remains paralysed, Prof Medley forecast.”
Social democratic Sweden has become the unlikely beacon of the right’s hope, as the country refuses to lock down. Fraser Nelson writes in the Telegraph: “To Swedes, it’s the rest of the world engaging in a reckless experiment.” The conservative Swedish economist and Brussels thinktank chief Fredrik Erixon rails against the lockdown in the Spectator, quoting Orwell on self-censorship and the threat of totalitarianism. As Swedish corona cases rise they too may swerve, though if they stayed as they are they would act as the world’s control.
This attitude has spread from the usual rightwing exhibitionists and contrarians into comments by those such as Luke Johnson, chair of Risk Capital Partners and the Institute of Cancer Research. In the Sunday Times he says that with “an exaggerated fear of falling ill from coronavirus and dying – we have idled the nation and all become hypochondriacs”. He fears for the moral fibre of the nation: “The shutdown is helping to erode the work ethic of a generation.”
Expect this low rumble to build into a libertarian crescendo, despite polls showing the country massively in favour of life-saving isolation, with the Queen catching the national mood. The opposition questions the delays, dithering, disastrous lack of testing and the austerity-stricken unpreparedness of the public sector – but crucially not the lockdown itself. When it’s all over, when costs have been reckoned against deaths and the long-term social and economic damage assessed, we may know who was right, though with life-and-death stakes in this cultural rift, we cannot expect either side to admit defeat.
Before going to hospital, Boris Johnson asserted he had “a scientifically led, step by step action plan”. He didn’t, he has zigzagged, but at least that sounds sensible. Yet it’s hard to follow “the science” when epidemiologists fall out. Who’s right on the numbers and death toll, the Imperial College London alarmist or the Oxford University moderate? We do have a baseline for acceptable UK flu deaths: there was no outcry over the winter 2014-15 flu toll of 28,189. Any wise government would have been petrified by Imperial’s worst case warning of 510,000 dead if no action was taken. Now watch each side pick their scientists to suit their own cast of mind.
On the great question, the public wants no price put on lives: if asked, they want every cancer drug at any price even if it delays death for just a few months. People prefer everyday political decisions weighing life against money to be done through a glass darkly. Less money for the homeless, social care, poor families or maternity services leads directly to deaths, as has been forensically measured by Michael Marmot of the Institute of Health Equity. Poverty kills, infant deaths are rising for the first time in decades, and poorer women are dying younger – though that never worries the right. This economic shutdown will kill and harm: the Institute for Fiscal Studies and the Resolution Foundation show that the youngest, lowest paid and women will be most damaged. Cancer Research UK’s chief clinician, Professor Charles Swanton, warns that curable cancers will become inoperable as treatments stop. There is no avoiding trade-offs, though they can always be hidden. Casting off the lives of the old to save young futures looks brutal – but for the poorest old, lack of social care and day centres already curtails lives.
It is not just in a crisis that healthcare is rationed. Labour set up the admirable National Institute for Health and Care Excellence (Nice) to make that explicit: in treatment costs, one quality-adjusted life year (a qaly) is worth £30,000. Professor Gill Leng, the institute’s new head, was asked to produce rapid Covid-19 guidelines but, uniquely, “we were advised cost was not an issue”, she says. “Only what’s best for the service.” For adult critical care, Nice’s algorithm uses the clinical frailty scale, “a holistic approach”. Dementia is rightly included as an adverse frailty in the score card.
Will Nice ever evaluate in qalys whether the losses from a stricken economy were worth the gains in life years saved in the lockdown? That all depends, Leng says, on the quality of the data: she hopes someone is trying to evaluate it. For now, “the key question is exit, how do we get out of this?” Testing is vital, but she opposes releasing the lucky ones who are immune first. “In the end only solidarity, all in this together, will see us through.”
How odd that it’s the usually “patriotic” voices, the “blitz spirit” nostalgists on the right who are first to break that solidarity.
• Polly Toynbee is a Guardian columnist