Leicester’s deputy mayor, Sarah Russell, sees a pattern in the latest data on the spread of coronavirus in the city. “We don’t get the peaks of other places but we take a longer time coming back down,” she says. In some parts of the country, it is a familiar problem.

Leaked analysis by the government’s Joint Biosecurity Centre (JBC) has found that low wages, cramped housing and the failures of the test-and-trace system have led to “stubbornly high” case rates in deprived areas such as parts of Leicester, Blackburn with Darwen and Bradford.

All three were above the English average of 194 new cases per 100,000 residents last week. Blackburn’s rate has not dropped below 200 since 30 September. Local politicians, doctors and community leaders say lockdown alone is not enough to contain the virus in these parts of the country.

Leicester

On 29 June, Leicester became the first English region to enter a local lockdown. In the previous two weeks, one in 16 of all positive cases in the UK were recorded in the city. The centre of the outbreak was reportedly in the east of the city, an area with tightly packed terraced housing where many black, Asian and minority ethnic (BAME) families live, often in intergenerational housing.

More than seven months later, Leicester’s case rates remain higher than the national average. It recorded almost 300 new cases per 100,000 residents in the week to 6 February.

Leicester authorities received limited data from test and trace in the summer, but a localised system set up on 7 December has made a big difference, Russell says. “It’s containing rather than stopping, but it’s absolutely better than test and trace. We were getting case data three, five or six days after a positive test. Now we get it after eight hours.”

The local system caters to local needs, she says. “[The tracers] speak a variety of languages, they’re able to offer support from dog walking to shopping.”

Russell emphasises that not everyone can afford to self-isolate when they are traced. The government’s £500 support grants for people self-isolating is largely reserved for those on benefits. The council’s discretionary grant system, set up for others who are struggling, was limited to £114,000, then increased to £184,000, and Russell says: “We could have spent that three times over.”

Precarious jobs also prevent some from isolating. “Some people are working three or four separate jobs. Two employers might be understanding [if someone needs to self-isolate], but the others won’t,” Russell says, adding that only once financial issues are resolved will cases fall and the local test system take effect. “We’ve got teams out on the doorsteps to root out every possible case. But there’s no point in doing lockdowns without enough financial support.”

Blackburn

Over the course of the pandemic, Blackburn has had more coronavirus cases per head of population than any local authority in the UK. The latest figures showed 302 new cases per 100,000 residents in a week.

Like Russell in Leicester, Blackburn’s Labour MP, Kate Hollern, sees a lack of financial support as the root cause. “I get letters all the time,” she says. “The real problem is the self-isolation payments. People were getting nervous of getting tested because they couldn’t afford to isolate.”

Blackburn with Darwen council ran out of discretionary grant funding in December, Hollern says, but the local health team has been “amazing”. In July, NHS test and trace was reaching less than half of contacts. Prof Dominic Harrison, the area’s director of public health, announced a local system on 4 August.

Now, Hollern hopes the vaccination rollout can unlock the region. She received her jab last Thursday. Blackburn Cathedral opened a mass testing centre on 18 January.

Faith leaders are seen as central to the vaccination efforts. Mauwana Rafiq Suri, the chair of the Lancashire Council of Mosques, is encouraging people of south Asian heritage to get their jabs, and he organised a webinar about vaccines with directors of public health, local GPs and others.

He says: “We had some issues with the younger generation trying to convince the elder generation to not take the vaccine because of all the misinformation and conspiracies online. We had to address that and give them the alternative.”

Thanks to this work, Hollern says, vaccine take-up among Blackburn’s BAME communities is good. Suri adds: “One good thing to have come out is the collaborative work: authorities have understood that faith organisations can help.”

Bradford

When Leicester was placed under local lockdown in July, Bradford was second in the list of towns with the highest case rates. Prof John Wright, director of the Bradford Institute for Health Research, referred to this list as a “league table of inequality”.

Though the region now has lower rates than Leicester and Blackburn, Wright says socioeconomic factors are keeping transmission rates stubbornly high. He describes coronavirus as an “occupational hazard”, saying: “It’s about the number of people who are low-paid workers or key workers here, taxi drivers or bus drivers.”

At Bradford Royal Infirmary, patients’ underlying health problems have worsened the impact of Covid: the city has higher than average rates of diabetes, heart disease and obesity.

Like experts in Leicester and Blackburn, Wright says NHS test and trace is not working because it “doesn’t understand context … If you don’t give proper support to allow people on the breadline to isolate, they can’t. They’ve got to find a way to feed their families.”

Trust is also a problem. “There’s a background of falling trust in government and, actually, NHS institutions [in Bradford]. The solution to that is locally developed grassroots movements,” Wright adds.

Laila Ahmed leads engagement for the Women’s Health Network, an almost 20-year-old community group whose 190 members work across Bradford’s Pakistani, Bangladeshi, African-Caribbean and white communities.

As well as providing their usual cancer care and mental health support, the network has used film clips to pass on accurate information about coronavirus in different languages.

Bradford’s approach has been well organised, Ahmed says, but “it’s impossible not to take onboard the previous 20 years of issues. When coronavirus landed here, it didn’t land on a blank slate.”

Inequality will continue to hold back efforts to contain the virus across the UK, Wright predicts. “These are deep structural issues,” he says. “There’s no lateral flow [test] or contact-tracing system that can combat these. The pandemic has shown the stark reality of social inequalities across the UK.”

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