he lockdown was a nationwide policy: everyone was expected to follow the same rules. It has nevertheless exposed some stark inequalities. Elites have been able to endure the period in comfort, often in remote, spacious holiday homes. Those with office jobs have found themselves stuck in their flats, juggling restless children and Zoom meetings. And at the lower end of the income scale, there are people still showing up for their essential jobs as cleaners, delivery drivers and nurses, with scant childcare support and constant worry about exposure to the virus. These are tense times, with millions of us making sacrifices, some large, some small. Whether’s it’s cobbling together a home-schooling programme while ill yourself, being deprived of the support of extended family or missing a loved one’s funeral, the toll has been significant. It’s no surprise then, that news the prime minister’s chief adviser travelled from London to Durham with his family while lockdown measures were in place has set off a wave of fury. While the British people have been remarkably forgiving of special privileges for senior members of the government – such as access to priority testing and tracing for themselves and their families, and early medical support upon diagnosis – extending this to an exemption from lockdown rules feels like a step too far. From a public health perspective, though, the situation with Cummings presents three problems. First, and most obviously, it undermines the core message to stay at home. This is vitally important because the purpose of lockdown is to buy time to drive down the number of cases to a level that would allow a package of interventions – including testing and tracing, and isolation – to take over the job of suppressing the outbreak. If lockdown is interpreted flexibly, or lifted too early, or seen as a symbolic gesture alone, it becomes pointless. Second, Cummings’s actions give an unfortunate impression as far as exposing elderly people to the virus goes. According to Downing Street’s statement on the affair, he remained with his wife and children in a house near, but separate to, his family, including his mother and father. But to travel across the country to where his parents live inevitably erodes the strong message that precautions to protect older relatives are especially important, given that mortality increases with age. Third, Cummings travelled from London, an area that had a higher number of daily cases, and was ahead on the epidemic trajectory, to the north-east of England, which was less badly affected at the time, but which would soon become one of the hardest hits parts of the country. The lockdown measures were intended to prevent the spread of the virus from hotspots to less-exposed regions. Others advising on the pandemic response have had to resign for far less. This is not a left-right issue. Instead it is about right and wrong, and the government choosing to defend the actions of one of its leading figures over the public health message it has been pushing for the past eight weeks, and which is designed to save lives. Any undermining of that message could not come at a worse time: the UK is facing excess deaths of nearly 60,000, and has one of the highest death rates per capita in the world. There is no functioning test, trace and isolate system in place to take over the job of breaking chains of transmission and support the easing of lockdown. As other countries drive the virus to the margins and celebrate the reopening of shops, hairdressers, schools and businesses, the latest Office for National Statistics survey estimates 9,000 daily new cases in the UK. People are suffering from an incoherent public health response, a late and consequently unnecessarily long lockdown, and leaders losing sight of those they’re supposed to serve. While it might be psychologically appealing to believe the worst of the outbreak is behind us, early estimates from antibody tests, which provide a rough guide on what percentage of the population has been exposed, show most countries at under 10%, with cities slightly higher. The UK’s estimate is 5%, Spain 5% and Sweden 7%. This is nowhere near the level of exposure needed for population-wide natural “herd” immunity. Last week saw the largest number of daily new cases in the world, at 106,000, with outbreaks starting to take off in many low- and middle-income countries. The summer months must be used to think ahead, since the winter poses additional challenges. How can a second lockdown be avoided? How can more deaths be prevented? The clear lessons from east Asia are a robust test, trace and isolate system, close monitoring of hotspots such as care homes and hospitals, the protection of health and social care workers, border control and working towards a “new normal” involving face masks, temperature checks and distancing. Every single person in the world is now affected by this outbreak. How exactly they are affected has more to do with their government’s handling of the virus than anything else. Successful responses have not been correlated with country wealth, but rather with decisive political will and a clear strategy. Just compare the situations in the United States and Brazil with South Korea, Kerala in India, Greece, Vietnam and Senegal. Everything – whether it is schools reopening, the shielding of the elderly and vulnerable individuals, the viability of businesses, and families being able to see each other – depends on the ability of a government to contain this virus aggressively and quickly. Those of us who live in the UK need this government to succeed, but that requires it to focus all its efforts on public health planning, clear communication and retaining public trust – something made harder when a senior adviser appears to flout the rules. • Prof Devi Sridhar is chair of global public health at the University of Edinburgh