A new policy paper published by the government has outlined what it calls “four types of evidence available to understand where transmission is occurring” in hospitality. The paper, published on 27 November, recognises that data in those four areas of evidence has “limitations,” but that all are “consistent in supporting the view that hospitality venues are a significant risk for transmission.” But in large part because the data cited is taken from overseas, the paper fails to explicitly say why “significant risk” hasn’t necessarily become a reality in the U.K.
The document is titled “transmission risk in the hospitality industry.” With some of the transmission metrics available to the hospitality industry indicating that in-premises transmission is comparatively low, the government has so far failed to sufficiently or effectively explain to those members that one of the reasons for this is that restrictions — of varying degrees — have been in place since March: After full closure, restaurants were restricted to reduced capacity and social distancing indoors, table-service only, (eventually) compulsory mask wearing, and the encouraging (by way of fewer restrictions) outdoor dining.
The information published has nevertheless angered members of the hospitality industry, some of whom have said the government has ignored the findings of its own scientific advisory groups and, they argue, continued to overlook the fact that transmission “isn’t happening in hospitality.” Part of the problem appears to be that the government has provided information as to why transmission could happen in hospitality without restrictions, when the same data could have been packaged thus: transmission in U.K. hospitality settings is likely low because it has enacted safety measures, as either recommended or mandated by the government.
Here’s a run down of the four areas of “evidence” the government has provided.
Problems associated with close-contact settings
1. Transmission risk in hospitality is based on a combination of environmental and behavioural factors, in which the social contact necessitated by certain venues means they are higher risk. The paper describes the nature of contact in those venues thus: “close, prolonged, indoors, face-to-face, in poorly ventilated and/or crowded spaces, or involve “loud” activities.” It summarises that “all [are] prevalent in the hospitality sector (but not unique to it).”
It also adds that alcohol consumption impacts the ability of customers to conform to distancing regulations: “The disinhibitory effects of alcohol are likely to exacerbate difficulties with social distancing,” the paper says.
For this, the government cites two papers from the Scientific Advisory Group for Emergencies (SAGE).
2. Analysis of the impact of tiers and national-level restrictions (SAGE 67, 12 November):
The paper says that “The general picture in the U.K. (and overseas) is that it has only been possible to get R (growth rate of coronavirus) consistently below 1 in places where there have been substantial restrictions on hospitality.”
It adds that SAGE analysis of tier restrictions and other interventions (beyond national lockdowns) found that virus spread shrunk in Tier 3/3+ in England, where severe restrictions were placed on hospitality. “All other interventions [where there were fewer restrictions on hospitality] were followed by a more mixed picture” as regards spread of the virus.
Superspreading in social settings
3.Data from epidemiological analysis of outbreaks (citing two pieces of analysis — SAGE 63, EMG/Nervtag) in Japan, China, South Korea, and Indonesia noted that their largest superspreading events “originated from pubs, clubs, restaurants, gyms and wedding venues.”
It goes on to observe that the “largest clusters in Hong Kong were associated with transmission in bars [...] in which face masks were not worn.”
Who is getting the disease and where are they getting it
4. Finally, the paper cites studies (SAGE 63, EMG/Nervtag papers) which looked for a “statistical correlation between activities/locations and infection and have found significant associations between hospitality and infection.”
It also cites a report from the American Center for Disease Control (CDC) which found that those infected with SARS-CoV-2 without known close contact with a person with confirmed COVID-19, case-patients were 2.8x more likely to report dining at a restaurant or 3.9x more likely to report going to a bar/coffee shop than were control participants.
While the virus doesn’t discriminate between nations, and there’s no epidemiological evidence to suggest that what’s been found in America, Hong Kong, or anywhere else couldn’t or wouldn’t happen in the U.K., the government’s presentation of its rationale has not done enough to convince the hospitality industry that it is acting in good faith. Emboldened by weekly Public Health England reports on Acute Respiratory Incidents that both credit hospitality for minute rates of transmission and don’t even come close to accounting for actual case numbers — restaurateurs, chefs, and publicans can continue to plausibly ask: why are there no studies taking evidence from venues in the U.K., which the government could cite? Oh, and where is that “world-beating” track-and-trace system designed to reduce the recourse to restrictions?
Maybe the government, busy though it has been today in deconstructing the substance of a Scotch egg, needs to get better, first at apps, and then at explaining why COVID-19 transmission is low in hospitality — and why it wants to ensure it stays that way.