In the first week of April, as coronavirus cases in Scotland hit the 3,000 mark, 51-year-old Margaret* and her 76-year-old mother shared a jacket potato for dinner, at home in Renfrew, a town just outside Glasgow. Her mother's age and Margaret's multiple health conditions put them both in a high risk category for the virus; their restricted income – made up entirely of benefits – adds another layer of distress to an already anxiety-inducing situation.
"There's not a lot of space," says Margaret. "It's a one bedroom house, but we're making do." The local church has dropped off shopping while the pair self-isolate, but a broken fridge-freezer that Margaret can't afford to replace makes it difficult to store any fresh food. With no wifi or internet banking she's unsure how she'll access money in the short-term, and is reliant on rationing her phone data usage each day to access up-to-date information about the spread of coronavirus.
She is supported by the charity Poverty Alliance, but when I first spoke to her in early April she had received no official communications from the government, council or NHS. Six weeks on, despite proactively contacting her GP, social work and money advice services, Margaret has still received nothing, and says she is left feeling "very let down" by all agencies.
"A lot of my conditions are autoimmune in nature, and I've been hospitalised before for far less contagious viruses – flus and colds and things," she says. "If I do get it and it comes down to it, the ventilator's going to go to someone who's younger and fitter and more economically active. We won't be seen as a priority."
The west of Scotland is an unequal region. Its epicentre, Glasgow, is almost more like three cities: there's the de-industrialised and working class Glasgow – the Glasgow of shipyards, patter and slightly daunting pubs. The second is young and edgy, home to the Art School, a thriving music scene and international festivals, while the west end is affluent, leafy and middle class.
It is the first Glasgow that is most at risk from coronavirus: the Glasgow of poor pay, unemployment, high levels of respiratory disease and low levels of social capital. Many of its residents live in homes – including in a large number of peripheral housing estates – which are overcrowded and under-maintained, and are reliant on expensive public transport to access the amenities of the distant city centre.
Govanhill, in the south of the city, has long been vilified as a sink estate in terms that only thinly veil their racism and snobbery; in reality, it is a tight-knit community and Scotland's most ethnically diverse area, with at least 30 languages spoken, where students and young professionals live alongside migrant and multi-generational Glaswegian families. But its levels of deprivation are high, and it is characteristic of working-class communities that will struggle to deal with the impact of coronavirus: Govanhill is Scotland's most densely populated area, and much of its housing remains poor quality and overcrowded.
"Following government advice on social distancing is difficult for large families living in small private flats," says Sorana Goga, a Community Development Worker at Govanhill Community Trust. "And for those with limited literacy or English language skills, even getting the right information during this rapidly changing situation is difficult."
While the Community Trust has provided support and resources in multiple languages, a high migrant population brings other unique challenges. "In many cases, people are considering putting their lives and the lives of their families at risk, making dangerous journeys to their countries of origin, because of fear or a lack of money," continues Goga. "We’re advising them against making these journeys, but many feel they have no other option."
Coronavirus isn't just a health crisis, but a political one. In the west of Scotland, inequality simultaneously leaves its most deprived residents at high risk of the virus itself, and with little hope of weathering the political and economic storm it leaves behind. At the beginning of this month, figures from the Office for National Statistics showed a higher death rate in the most deprived areas of England and Wales. Just this week, similar analysis by the National Records of Scotland made the same link, with Inverclyde dubbed its "coronavirus capital", owing to a death rate that's double the national average.
High levels of deprivation here can be traced in large part back to political decisions which led to the dismantling of industries the area was particularly reliant on. "The region is still feeling the effects of that deindustrialisation," explains Ewan Gibbs, an economic historian at the University of Glasgow. "It's still poorer, unhealthier and more reliant on central government than elsewhere in the UK. The coronavirus crisis is hitting communities here that have already been made vulnerable by a longer set of crises."
"When governments have had to make large economic interventions in the past, Glasgow has disproportionately suffered," says Professor Chik Collins, an expert on early death in the west of Scotland. He points out that the city received a 23 percent reduction in total spending between 2010 and 2018. "The political fallout from coronavirus is a real worry here because there’s a high chance renewed austerity would hit us especially hard all over again."
Public health outcomes in Glasgow and the west of Scotland are notoriously bad, lagging behind nearby Edinburgh on almost every indicator. On average, a man born in Glasgow will die five years earlier than a man born on the same day 40 miles along the M8 motorway. Clinically, the city may be vulnerable to a disease that attacks the lungs, with a high level of smoking and the highest lung disease death rate in Britain.
It's impossible to talk about deprivation in Glasgow without considering the city’s high levels of homelessness and drugs deaths, of which there were 394 last year in the local NHS area. Supply chain issues mean the purity of heroin in the Glasgow market has decreased during the coronavirus outbreak, putting those who depend on it at greater risk of a bad batch – and at an increased chance of overdose when the purity increases again.
"For our clients, coronavirus is just another public health message on top of an already overwhelming list of public health messages," explains Collet O’Connor from charity Waverley Care’s street team, who highlights the low levels of digital literacy and access among the street population. "Many of them have a fatalistic attitude anyway; death isn’t the worst thing they’re thinking about. So I'm struggling to communicate the severity."
O'Connor describes a litany of issues for Glasgow’s drug-dependent street population: a fall in client numbers for sex-working women leaving them vulnerable to riskier transactions; a culture of sofa-surfing and communal living making it impossible to socially distance; those withdrawing from heroin having to manage their own dosage as methadone prescriptions are administered weekly instead of monthly.
On top of all this, she says, social distancing and isolation has compounded stigma and the sense of a two-tier society. "The only people left on the streets are those who inject drugs and sleep rough," she points out. "Usually they can blend into the hustle and bustle of the city, but now they feel like everyone knows exactly why they’re there."
A few miles away in Renfrew, while Margaret is able to isolate, she finds herself no less vulnerable to the unique ways a pandemic can tear through working class regions.
"It’s going to come down to communities to find those who’ve fallen through the net, because the government aren’t doing it and the councils aren’t doing it," she says. "I’m more resilient than most after everything else I’ve been through. Many others will struggle to get through it at all."
* Name has been changed.