The autumn surge in COVID-19 has shown just how hard it is to suppress a highly infectious virus.
Sky data shows 50 areas in England have endured local restrictions since the national lockdown was lifted back in July.
But just one – Luton – has ever come out of restrictions, with local people praised by the prime minister in the House of Commons for following health guidance.
Just a day later the town was once again classified as an area of concern after another rise in cases.
Handwashing, masks and social distancing slow the spread of the virus, but they don’t seem to stop it.
Nationwide cases are rising, with the R number above one, indicating that the epidemic is growing exponentially.
But figures from Imperial College’s REACT study show there is huge variation across England.
In London the R number is estimated to be just below one. But in the North West, where people have been living with restrictions for many weeks, it is still 1.27.
And that shows up in the prevalence rates too.
The North West and North East have the highest rates in England, with around one in 100 people infected.
The South East has the lowest prevalence, with around one in 400 testing positive. London is inbetween, at one in 200.
A two-speed epidemic, for sure.
Young people have played a large part in the surge. One in 80 of those aged 18-24 tested positive in Imperial’s study.
That’s a worry because young adults are less likely to have symptoms yet are just as infectious.
But age doesn’t explain why the virus has been so concentrated in hotspots.
That’s much more to do with deprivation.
Poorer people live closer together, often in multi-generational households, and they tend to do more public-facing jobs. In other words, they are more likely to come into contact with the virus and then spread it through the community.
So, will the new three-tier system help?
Banning contact between households should make a difference in slowing the spread in hotspots.
But it needs good communication to win support, and a self-sacrificing public willing to give up all their normal social gatherings.
Even then, the underlying issues of deprivation will remain.
Large numbers of people told to self-isolate have continued to work because they have to put food on the table. Banning social contact won’t stop that.
The nationwide lockdown in the spring was a success because it was absolute. Our cities were ghost towns. The economy went into a coma.
It led to a rapid decline in the epidemic – the R number plummeted from around three to around 0.6 in a week.
This time there is more of a geographical patchwork.
As much of the economy as possible is being kept open. And in the inevitable trade-off between lives and livelihoods some people will feel hard done by.
At its most basic level, the science is simple. To bring the epidemic back under control you have to stop infected people meeting others who are susceptible to the disease.
But there is no evidence to draw on from the past and no manual that guarantees success.