The principles behind this phase of the Covid response are not new.
Public health departments across the country – at one time experts hidden in the NHS, now back in local authorities – follow the granular movement of a contagious disease in their area and stamp on it, as they have done for many decades.
In this case it might mean a coronavirus outbreak in a school, factory or care home leading to the building being quickly closed down, a deep clean carried out and everyone told to stay at home.
Or, in a more tricky scenario, it could mean spotting that an uptick in infections has suddenly appeared in a corner of their area’s map – around some particular streets, say. In theory that might then lead to people in that area being asked to self isolate, aimed at containing the spread to the wider population. Perhaps local bars and playgrounds would shut down temporarily, with public health messaging targeted at the community in question.
The science behind it is precise but the principle isn’t new. Speak to anyone in public health – including environmental health – and they will tell you the same thing. This is what they do with food poisoning outbreaks, with a spike in sexually transmitted diseases, with measles or TB.
If you’ve watched the TV dramatisation about the Skripal poisonings in Salisbury, you’ll know that’s also exactly what the director of public health in Wiltshire did in order to stop a deadly Novichok attack ripping through the population. (She had to send Whitehall civil servants packing at one point in order to get on with it.)
Going back to the 19th Century, medical officers of health for municipalities such as Manchester were in charge of suppressing outbreaks of the Victorian diseases plaguing dirty water supplies or overcrowded, unsanitary housing.
So public health directors are steeped in this kind of scenario. And in this case their expertise is also crucial to avoiding a second 21st Century mass shutdown of the economy.
Yet they have been denied the tools they need.
From early-May onwards, as we’ve covered extensively, they were unable to access any data from tests carried out in privately-run testing labs procured by the government.
After the looming local lockdown of Leicester became apparent, suddenly parts of that information did begin flowing. From the week of June 21 onwards, public health directors started getting some data – partial postcodes showing roughly where those with the virus lived, albeit only provided on a weekly basis.
But for the experts tasked with out-running the virus, it isn’t enough.
They don’t need to know roughly where the people are; they need to know exactly where they are and who they are. This is precisely the information they would have during an outbreak of any other ‘notifiable’ disease – in other words any communicable illness, such as TB or meningitis, where cases in their area have to legally be reported to them.
Despite them apparently being owed that information legally, it has not been forthcoming.
Today, Greater Manchester’s mayor Andy Burnham revealed patience has run out. The former health secretary has written to the current holder of that post, Matt Hancock, on behalf of public health directors here to demand the figures are handed over.
The situation simply makes no sense, when these experts can get the information in any other comparable circumstance.
“The government have cited patient confidentiality as the reason why they are not providing that data to local authorities,” he said.
“That is outwith the norms when it comes to the procedures for notifiable diseases. The normal procedure is if there is a notifiable disease, that the director of public health in the relevant local authority would be given all of the data, including patient details.
“So this system that is running is not consistent with the way we’ve always handled notifiable diseases.”
To put it even more succinctly: of course public health directors can be trusted with patient data. It’s their job.
Burnham is unusual within England in that he has a political platform outside London, so is able to voice the argument.
But this applies to everywhere currently trying to keep a lid on the virus, including Leicester. Today that city’s mayor also wrote to the health secretary, making similar points to those Andy Burnham made at the weekend: he has only half the ethnicity data he needs, for example, and nothing about where those with Covid are working.
In Greater Manchester, for what it’s worth, only 10-30pc of ethnicity data is coming through about a disease known to affect BAME people more severely.
At the weekend Matt Hancock tried to suggest the region merely needed the help of his own experts in interpreting the limited data he has provided, a suggestion that caused a collective intake of break in public health departments here.
But this isn’t, as one official here says, a story unique to the region.
“This is not a Greater Manchester thing,” they say. “This is national. The Secretary of State is trying to present it as ‘Greater Manchester is wide of the mark’. But we’ve been through this with them again and again.”
Part of the issue in this pandemic may be the light in which public health has been seen in recent years, perhaps decades.
Back in the 19th Century, Manchester’s medical officer of health was a big deal.
You can see that from the original architectural plans for Manchester town hall, unearthed in 2016. The status of their designated office showed the post was of social and political importance, on a line with the police chief. These officers were tasked with keeping a lid on the sorts of diseases that were running rife at the time through the city’s dirty water supplies and overcrowded housing – the latter in some parts of the world, including in this country, now a key risk for Covid outbreaks.
But times moved on and communicable diseases fell down the list of political concern. In the 20th Century, those powerful health officers were subsumed into the NHS and then returned to local government in 2013, just as the drastic cuts to town halls under austerity began to bite. As a result there is an uneasy sense locally that Whitehall, including the Department of Health and Social Care, doesn’t quite understand what they do.
A couple of weeks ago, for example, Matt Hancock told the House of Commons that ‘clusters’ of cases – which he defines as those in one specific setting – will be dealt with by local authorities, but anything wider than that will be passed around through some kind of complicated national chain that may eventually find its way back to the public health director. Eventually. Perhaps.
Yet public health departments need the data as it happens, so they can predict what will happen next. This shouldn’t be about reacting to existing to outbreaks, they point out, but preventing new ones.
“If you’ve got real-time personal data, you can identify the contacts, you can think about where the person is working and the social circumstances and you can take preventative measures to stop an outbreak,” points out one official.
“But they are thinking about reacting to it when it’s already happening, rather than thinking about how we’re going to stop it happening in the first place – which is crucial to saving lives, preventing hospital admissions and keeping the economy going.
“Aren’t we supposed to be all about saving the NHS?”
To use one obvious example, Greater Manchester started identifying all its meat packing plants a couple of weeks ago and has been working with them proactively on measures to ensure the infection never happens. They don’t want it to be a thing. The principle isn’t difficult.
Yet for whatever reason, Whitehall has decided those experts who have spent a career thinking about these questions cannot be trusted with the information they need. It must be hoarded and protected, even as the virus floats about with no respect for governmental tiers.
Nobody knows whether central government will change tack. But plenty at local level, where people really do know about how public health works, sense the underlying cause.
“This is about culture,” says one senior local figure of ministerial and civil service attitudes towards local government and public health departments, “and control.”
The life-or-death question for millions of people is whether that means controlling a lethal virus, or just clinging on to meaningless fiefdoms.