As the U.K. Prepared to go into nationwide lockdown this spring, Raj Bhopal, 67, an emeritus professor of public health at the University of Edinburgh, decided to come out of retirement and go back to work.
His 35-year-old son Sunil, a pediatric public health doctor, chair of the International Child Health Group, and an academic at the University of Newcastle and the London School of Hygiene and Tropical Medicine, also saw his job shift—he was heading back into hospitals to prepare for a wave of patients infected with COVID-19.
The U.K.’s pandemic hasn’t gone like they expected. In the months since, father and son have become academic collaborators, publishing a piece on mortality rates for children as a result of the virus. They’ve also both become outspoken critics on the lack of detail in the U.K.’s lockdown and reopening strategy, arguing that it doesn’t acknowledge the impact on some of society’s most vulnerable members: children, migrants, and the homeless.
They’re now calling for a more “honest” conversation about the risks and tradeoffs of emerging from lockdown.
This interview has been edited for brevity and clarity.
Coins2Day: What have the past several months been like for you?
Raj: I’ve been retired nearly two years. And when this happened, I thought, well, this is my field. I know a lot about epidemiology, public health, infections. So I couldn’t just keep my feet up. I usually just work one leisurely day a week, and I decided to put myself back to work.
So I’ve been pretty busy. And it’s been very stressful because it’s not just the work, it’s following the news, and the mismatch between what I would expect to be happening.
I’ve been in public health since 1983. This is my second pandemic. I was there right at the beginning of the AIDS pandemic. I remember the feelings then, and now to come back to it a second time around and watching what’s going on in the world and the sense of great unease as to how badly it’s being handled. It’s been, I think for myself, I would have to say it is very stressful. And yet I recognize that I’m one of the most privileged people around.
Raj, what was the moment when you decided, “I’ve got to start working again”?
Raj: About 10 days before the lockdown was announced in Scotland, I could see things were beginning to move. Because I’m a chess player, and our chess club locked down about 10 days before the Scottish government announced a lockdown. And the golf club also started to communicate with each other. And I realized the public was way ahead of our politicians.
[The chess club] knew I’m a public health academic doctor. So they were asking me questions, and I was answering the questions according to the official guidance I was reading in my journals. And very shortly I realized that what I was reading was wrong, and that the public was ahead of me. And then I thought: I need to get on top of this. I can’t just rely upon what I’m hearing on the news. I can’t just rely upon the summaries in the journals like the BMJ. I have to understand this disease for myself. Probably around about the 15th of March, I realized that something terrible was about to happen.
Sunil: As the pandemic transitioned here in the U.K., I was asked to come out of my academic role and out of my community-facing role where I normally see children at home, and purely work in the accident and emergency department. It was a big change for me professionally. We were are all really scared because we didn’t know what was going to happen. We thought there was a pretty reasonable possibility that our children’s accident and emergency [units] were going to be full of sick kids. We were really, really worried about it. And we can talk about how that panned out, but essentially we’ve not seen that. We’ve not seen A&Es full of really, really sick children. We’ve seen actually children not being brought to hospital, which is its own concern. We’re still trying to unpick the reasons behind that, but it’s been quite a strange period for me as a children’s doctor.
Sunil, particularly for children, as we were going into the lockdown in the U.K., what were your concerns about the other health impacts this might have?
Sunil: It was quickly apparent to those of us in the children’s sector that it was going to exacerbate problems that already existed for children—particularly children at risk of abuse and neglect, on that end of the spectrum, but actually for all children. And we know that these periods, whether it’s early life or adolescence, whatever it is, that whole period of childhood is so crucial to children’s lifelong well-being. We really don’t have the luxury of messing it up. What was worrying to me and to others was that we weren’t hearing anything about it particularly from government. I watched those political briefings here in the U.K. Every day, looking for some acknowledgement of what was happening to children. Putting children away, hiding them away at home, it’s different to keeping adults away. I don’t think that was acknowledged. And I really struggled to find a sense that the government were thinking deeply and clearly about this.
Raj, when did you start to see that this might have an outsize impact on minority communities in the U.K.?
Raj: I taught my undergraduate and postgraduate students for 35 years in public health. We always start with the most underprivileged people first. If we can solve the problem for them, we can solve it for the whole of society, but if we solve it for the privileged people, we don’t solve it for the whole society. And my first concern was about the beggars on the streets. I had noticed a lot of beggars in the streets during the lockdown, and I wrote to our public health agency to say that we need to do something about getting the beggars off the streets, because they’re in danger themselves and also to other people. So where are they going to go? In fact, I said to a beggar, “You shouldn’t be on the streets.” And he said to me, “You tell that to our government.”
And then I thought to myself: Who’s going to be the greatest risk is going to be the undocumented migrants because they have no recourse to public funds. People don’t know where they are. They tend to work in very difficult circumstances, usually in the restaurant trade, caring for people. No one will notice or think about them. So those are the first two groups.
Then of course, I knew that ethnic large groups do tend to have varying problems. We needed to study them. I wasn’t quite sure what was going to happen, but I knew that with this particular virus, and most viruses, most infections, they affect people who live in overcrowded households, overcrowded work settings, large families.
And I also was worrying about places of worship. I know for my own community—I’m a Sikh—I go to the Gurdwara. It’s busy. The men shake every single person’s hand. That’s the culture. And I also have been to mosques, and I know what it’s like to go to a church on a Sunday. So I was worrying about these sorts of places.
I wanted to get your thoughts on the recent protests.
Sunil: I think what we have to recognize is that there are all sorts of causes of inequality and hardship, and COVID is one of those. And it’s brought such huge amounts of difficulty to our country, to the globe. But it’s not the only one. And racism is another one, and it’s a really important one. And it’s really important that we continue to fight on all of these different fronts to keep things moving.
That’s part of what my argument is about children—that in the super important focus on COVID, we can’t just forget all the other things that are going on. It’s about considering things in the whole. And one of the things I learned from my dad growing up—as a child and through my career—is that you approach all problems taking a lens that is all encompassing, and that’s a real public health approach. And it’s really, really difficult to do.
Raj: [On the protests], I think the people have spoken. They have said to us very clearly, some things matter even more than health. Justice. Injustice. Racism. The way we organize our societies. These things matter more than our health. And indeed, health is not the most important thing. Even as a public health doctor, I have to admit health is not the most important thing.
[For example], I’ve been talking to my family and saying that if I was given the choice between being unemployed or getting COVID-19, and I was under 50, I’ll have COVID-19 any day, rather than being made unemployed. If I’m over 50 I don’t want to get COVID-19—I take the risk of being unemployed.
What do you think of the U.K. Government’s reopening strategy?
Sunil: Society has to decide: What does it value? That we get the economy moving is incredibly important. So they’re going to make decisions that might seem a little bit strange to people who really are desperate to see a particular person in their life, their uncle, aunt, grandparents, whatever, you know. You see this on social media all the time: Why is the Premier League football opening, but I still can’t see so-and-so?
I think that government should be really explicit about why it’s choosing these things and allow and encourage conversations about what’s important to people. Children get missed. Young people get missed because they don’t have a voice. They struggled to raise it themselves. They’re not thinking about these groups.
I think that the crucial thing is that a variety of voices are heard—those who are voiceless or powerless. Some of those groups we’ve talked about today. The homeless, people from minority ethnic groups, children, you can go on.
Raj: I think what we all have to remember is that health and wealth are very closely intertwined. If you’re wealthy, you’re definitely healthy. If you’re poor, your health is much worse. Health and unemployment are closely interrelated.
So getting that balance right is extremely difficult. I’m so glad I’m not a politician. Easier to be a public health doctor and a public health academic at these times because our job is to supply the information or maybe supply the analysis that will help people make the decisions. Making the decisions is very difficult.
In my view, we should have acted in January. Even February was too late. Acting in March was definitely too late. But that’s okay, that’s all history now. We have to think about the future, not the past, and the retrospectoscope, as I like to call it, it’s a wonderful instrument—but it was never invented. So it’s very easy to look back with hindsight and say, We should have done that. Maybe we can learn the lessons for the future.
We’ve got to think about what do we do now. And the answer is we can’t stay in lockdown much longer, but I would like a more honest debate about the pros and cons of various things. I’d like to see the evidence. And it’s very hard to get the evidence from government. [The government’s] not intending to publish its evidence.
And I think there should be a more public debate about what’s going on. Some people will prefer to take the risk; some people prefer to take no risks. We should be giving people more of an individual choice on how to act.
Of course, we have to work collectively as a society to minimize the risk in society, but we can’t be in lockdown for a year. We can’t be in lockdown for five years. Because the idea that this is all going to go away is not right. We’re not going to get a very effective treatment that’s going to solve the problem. We’re all hoping for a vaccine, but the experience of vaccines for infections of this kind is not good. We have to be hopeful. We have to be optimistic. But we also have to be realistic.
