By now, it’s a familiar story, not least to the people who live here: people in Rhondda Cynon Taf are dying in proportionally greater numbers than anywhere else in the UK.

The area has consistently been one of the hardest hit, both in terms of the number of cases and the amount of deaths. And for many people, that can lead to a reflex reaction. It’s because people aren’t following the rules, they cry. But it’s not that simple.

As we move towards a full year of coronavirus restrictions it is important to ask why this particular part of South Wales has been so badly affected. As we have seen through the pandemic, anyone can catch coronavirus. So why has the virus been so devastating in RCT?

Firstly we need to establish how bad it has really been. This table shows the areas of the UK with the most deaths per 100,000 people. It shows RCT at the top, and there are Wales makes up five of the top eight worst-hit areas.

This table shows ONS data for the amount of deaths from Covid per 100,000 people in Wales only between March and December — again RCT is the very top (the numbers are slightly different to the table above because they cover different time periods)

The same is true for health boards and is even more stark, as this table shows:

And RCT, as well as the surrounding health board area, is a bit of an enigma when it comes to the rates of the virus. This is not because it has high rates, but because these rates have been consistently high.

This is not what has been seen in other areas. Aneurin Bevan had very high rates at the start of the outbreak, and so did Caerphilly when it became the first part of Wales to go into a local lockdown. But it also had periods of relatively low levels.

The same is true for Betsi Cadwaladr Health Board, which covers north Wales, an area which often seems to spike after the rest of Wales (the First Minister has indicated that this may be because of close links to the north west of England). However despite these spikes, the area has also seen low levels of the virus.

As you can see from this graph, the death rates in RCT are consistently the highest or second highest whereas other areas move around more:

Heather Lewis is a public health consultant working for Public Health Wales leads a specialist team in the Cwm Taf area which monitors and informs public health decisions on managing the virus there.

“It certainly feels as if we have been hit hard because there have been sustained high rates within the RCT and Cwm Taf area,” she said.

“Whereas other regions have peaks and troughs, as you would expect, in RCT there does seem to have been this sustained level of positivity. That, fortunately, is coming down since the most recent lockdown but before that there were sustained high levels which were really hard to get on top of.

“Initially it was people in care homes that were affected then after the summer period it moved into the younger age groups. There have been differences in who is affected but there has been a sustained high level.”

Why is RCT suffering such sustained high levels of Covid?

Some dismiss the problems seen in areas like Rhondda Cynon Taf as being mainly caused by people not following the rules. This is a gross over-simplification that underplays the efforts of the vast majority of people living in these areas.

Much closer to the truth is that people are dying on a larger scale in the RCT because they live in one of the most deprived parts of the UK. Perversely, the community spirit and support for one another may be playing a part in the large Covid rates.

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However, non-compliance has played its part. And while it might not be the reason for sustained community transmission, it did play a role in seeding the virus in these areas in the first place. There have been high profile incidences such as a club trip to Doncaster races which stopped in several pubs, and three RCT pubs given closure notices for not following rules. There have been similar instances in different parts of Wales.

“There have been some issues with non-compliance but I would say they are a minority,” said Heather Lewis.

“Back in the summer it was non-compliance that brought the virus into communities, definitely. I would say that at that point everybody had Covid fatigue. As soon as the restrictions were lifted people couldn’t wait to go on their holidays and they couldn’t wait to see one another again.

“There was definitely non-compliance. There was the trip to Doncaster, for example, and there were other examples. I would stress that there are only pockets of non-compliance. We did see a phenomena back in the summer with pub culture, where younger people would congregate together in pubs before the rule of four was so tightly enforced and we found then that we had some non-compliance.

“But it wasn’t wilful non-compliance, it was just young people having a few drinks and forgetting they had to socially distance. This was just around certain premises.

“We have had people who have gone on holidays in the summer and come back and had house parties where they have given it to everyone in house party. However, the vast majority of people from what I see are working really hard and making massive sacrifices to try and get the numbers under control. The small amount of rule breaking may be the reason the virus entered communities, but it is not the reason for the sustained high numbers or higher death rates.”

So if it isn’t rule breaking making the virus more widespread in RCT, what is it? According to Ms Lewis, there are number of entrenched societal issues that have created a perfect storm in the area.

Employment

Firstly, people in RCT are simply more likely to be in roles which require face to face interaction with others. Carers, supermarket workers, manual labourers – all those professions that we gladly clapped for months because the pandemic showed us just how essential they are. But it is the nature of these roles that you are more likely to catch Covid as you have more face to face contact with people.

Added to this you have the fact these jobs are, in the main, not well paid and often insecure, which leads to people feeling they cannot miss work.

“It just isn’t as simple when you have people on zero-hours contracts or low wages who feel it is very difficult for them to not go to work and also difficult to self-isolate because of the physical environment,” said Ms Lewis.

“If your primary concern is getting enough for rent, food and heating your house it is hard.”

Family ties

One of the great things about RCT is that sense of community.

Eighteen months ago, WalesOnline went to Penrhicwber in the Cynon Valley, where, according to official numbers, half of children grow up in poverty. But being officially classed as living in poverty doesn’t mean a lack of support.

And Ms Lewis says that the inherent closeness within communities means somewhere like RCT requires a greater behavioural change than somewhere with a more transient population like Cardiff.

“I was born in Rhondda Cynon Taff and I still live in Rhondda Cynon Taff. In the area where I was born everybody will know everybody. There are no secrets there unfortunately!” she says.

“You have social and family networks to look after one another, to look after each other’s children. Often multiple generations will live in the same street or town. “I can think of one street where, of the 20 houses, about seven of them are occupied by the same family. So you have that interaction and reliance with one another. So you go to your mother’s house and you feel safe there. So while in Tesco you will wear a mask and keep your distance you might not be as alert to those risks because you feel safe in that environment.”

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These ties are not just comforting, they are essential. With lower incomes it is hard to afford childcare while doing jobs that can’t be done from home. This means a reliance on grandparents and other relatives. This increases lines of transmission that means that community spread is harder to get on top of.

Housing

Even if you had 100% compliance with the rules, the nature of much of the housing in the Valleys means that the virus easily spread.

“There are a lot of terraced streets that are closely packed,” said Ms Lewis. “The houses are very small so families are very close together and it’s not as easy for them to self-isolate.”

Small and cramped housing is not just detrimental in terms of virus transmission, but also for those having to lockdown in close quarters. If you have multiple young people trying to home-school simultaneously it is far harder for them to continue their education, especially if there are having to share computers with siblings.

This WalesOnline investigation into the Butetown area of Cardiff showed how hard it is for people in close quarters to get through a sustained strict lockdown.

Mobility

“Car ownership is much lower in RCT than other places,” says Ms Lewis.

This has a number of impacts on the virus: firstly, people are more reliant on public transport which opens up more lines of transmission. Furthermore, people, especially the elderly, can be reliant on others giving them a lift in order to get, for example, to a doctor’s appointment. This mixing of vulnerable people with those who may well be asymptomatic is another way the virus can spread.

This inability to travel also poses an issue for healthcare planners with regard to testing. If people are not able to travel far, they may be unable to get a test (you wouldn’t want people with symptoms hopping on the bus). This means it is harder to get a handle on just how much Covid there is in the area.

Ms Lewis added: “If people haven’t got a car, where do you put a testing centre in order to make it accessible to lots of people?”

General ill health

Even if all these other factors that help the virus spread were not in place, RCT would still likely have more deaths than average.

“We know that those who live in the most deprived areas will have poorer health and lower life expectancy,” says Ms Lewis.

“If you look at RCT it has higher levels than average of heart disease, obesity, diabetes and stroke. All of the conditions that cause higher mortality, and RCT has it in spades.”

It’s important to note that RCT is not one homogenous area. There are differences across the county and it is perhaps clumsy to speak about it in generalities. Some parts have been hit harder than others but it is hard to know exactly because the data can be skewed if there is a care setting in the area.

Ms Lewis said: “There have been areas like for lower Rhondda that keep coming up. Tonyrefail is another one that keeps coming up. Penrhiwceiber and other parts of the Cynon Valley as well. There are areas which were not as significantly affected but sometimes the numbers get skewed if they have got a care home there, for example.”

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