or some weeks now there has been a sense of inevitability about today’s announcement of substantial new restrictive measures affecting millions of people in England, as part of a new three-tier system. The plain fact is that the virus is out of control in many areas, and the growing level of infections has started to translate into hospital admissions and deaths, as Jonathan Van-Tam and colleagues set out at a briefing on Monday. Over the past few months the government has managed to create confusion and discord with a mixed bag of local restrictions. These seem to satisfy no one and, in terms of the overall picture, have proved to make only a limited contribution to reducing numbers of cases. In as much as the new tiered system will be clearer in which restrictions are being employed, and is to be implemented in response to a defined level of infection, it should be welcomed. However, it must be asked why the virus has been allowed to spiral out of control, and why simple measures such as reinstating the two-metre social distancing rule have not been applied. The government has completely failed to provide any form of strategic framework within which the tiered restrictions might have a role and, in particular, no explicit goal for where they want to get to in controlling the pandemic. It is a strong indication of public health failure when the only practical tool the government seems willing and able to use is crude social and economic restriction. In the absence of a strategy that commands confidence, how are people expected to maintain the hope that many jobs and businesses will have a future in the short or medium term? All this is before we even get to the very serious question of whether further restrictions of the type being implemented will lead to the virus being controlled. Data that emerged in September from Public Health England showed that even at the end of the previous national lockdown, the virus was still circulating in a significant number of local authorities across the north-west. If the last lockdown didn’t work, why is it expected that, in the absence of any other changes, the latest restrictions will? The local authorities where the virus was still circulating freely when the last lockdown was lifted share the characteristics of having deprived populations, overcrowded housing and a significant proportion of people from black and minority ethnic communities. If a map of lower life expectancy in local areas across England is placed alongside a map showing the areas that currently have a high incidence of Covid-19 infection, the similarity in distribution is startling. When this pandemic started at the beginning of the year, England was already facing a public health crisis. Since 2012, for the first time in more than 100 years, improvement in the life expectancy of the population of England has stalled. Indeed, for women in the most deprived areas, life expectancy has been falling. Covid-19 is a disease of poverty, even in a country as rich as the UK. It beggars belief that the government, after all these difficult months, still cannot understand that putting in place an effective system to find, test, trace, isolate and support (a framework known as FTTIS) right across England is absolutely vital. The only conclusion is that this failing is due to one of two things. It is either the absence of basic public health knowledge and experience at the heart of government alongside an inept advisory structure – or a deeply ingrained delusion that any major problem or catastrophe can best be resolved by pumping billions into a select number of private sector corporations. It may, however, be a calamitous mixture of both. Financial resources should be shifted into the communities that are suffering worst. The local level is the best place to mitigate the economic and social damage that is happening, as well as to put people to work tracking down and suppressing the virus in neighbourhoods and communities. If the measures that the government is putting in place do buy us some time, then this must on no account be squandered. Keeping the virus suppressed by a proper FTTIS system and by effective public health controls at ports and airports will be crucially important. It is shaping up to be a long and difficult winter. People need hope and support to keep their lives together; the latest announcements offer precious little of either. • Gabriel Scally is visiting professor of public health at the University of Bristol and a member of the Independent Sage committee