COVID-19 scientific evidence discussions concerning restrictions within hospitality sector: FOI release

Information requested

Any records relating to the scientific, statistical, or medical evidence related to public health controls on the spread of Covid-19 and how these relate to the hospitality sector, such as pubs and restaurants, at any point between the date of this request [4 November 2020] and 1 March 2020. We would like to limit our enquiry by restricting the document type to emails and meetings with Jason Leitch.

Response

Most of the information you have requested is available from the Scottish Government and UK government websites (see below). Under section 25(1) of FOISA, we do not have to give you information which is already reasonably accessible to you. If, however, you do not have internet access to obtain this information from the websites provided, then please contact me again and I will send you paper copies.

Attached is a copy of the remaining information requested.

We are aware how difficult this set of restrictions has been for businesses, employees and communities alike, and we do appreciate this has been a very daunting time for the many, many businesses that have been severely impacted by this pandemic.

The Scottish Government has not taken these decisions lightly. From May until October 2020 (when the new Strategic Framework was announced) the decisions on what sectors and activities to re-open on our route out of lockdown were guided by the principles set out in the Framework for Decision Making (Coronavirus (COVID-19): framework for decision making - further information - gov.scot (www.gov.scot)). Proposals were technically assessed using the best available evidence and analysis of their potential benefits and harms to health, the economy, and broader society to minimise overall harm and ensure transmission of the virus continues to be suppressed. This assessment process included oversight of the assessed health risks in different settings by the Chief Medical Officer and input from the other Chief Clinicians as appropriate.

Neither the Scottish Government, the Chief Medical Officer's Advisory Group nor SAGE have produced evidence papers on a sectoral basis. Instead we have used scientific evidence on transmission coupled with the social and economic benefits of particular sectors which Ministers have used to make decisions.

The restrictions we have put in place are based on evidence, we do not want to cause unnecessary harm to businesses, but we will take action to protect people from infection by SARS-CoV-2, leading to COVID-19. Some of the restrictions are aimed at venues where alcoholic beverages are consumed indoors, due to the changes in behaviour resulting from their consumption, such as reduced social distancing and talking more loudly, which can increase the risk of spreading the virus. The Scottish Government published the “Coronavirus (COVID-19): evidence paper - October 2020” on 7 October (Coronavirus (COVID-19): evidence paper - October 2020 - gov.scot (www.gov.scot)). This paper, from the Scottish Government's National Clinical Director (Jason Leitch), Chief Medical Officer (Gregor Smith) and Chief Nursing Officer (Fiona McQueen) and summed up evidence on infection trends, confirmed cases, hospital use and deaths, and how these vary across Scotland. This evidence paper was the summary of information provided to the National Clinical Director up to 7 October. The supporting documents for this evidence paper included the following SAGE paper:

• Transmission of SARS-CoV-2 and Mitigating Measures (publishing.service.gov.uk)

This paper explained that transmission of SARS-CoV-2 is most strongly associated with close and prolonged contact, suggesting that close-range direct person-toperson transmission (droplets) and indirect contact transmission (via surfaces and objects) are the most important routes of transmission. This paper explained that the risk of transmission depends on a number of factors which are common (but not unique to) the hospitality sector:

1. The highest risk for close-range transmission is when someone is face-to-face with an infectious person at a distance of 2m or less for a prolonged period. The risk increases with the amount of time spent in close proximity to the infectious person and with the reduction of distance. Risk at 2m face-to-face is around 10 times lower than the risk at 1m. A new meta-analysis paper of reported transmission suggests that the risk of transmission at 2m separation is approximately half that at 1m, although this does not consider the orientation or the mode of transmission. When people are side-to-side or behind one another risk is via aerosols and so is determined by the influence of ventilation; at 1m the exposure risks would be similar to 2m when face-to-face in an indoor environment.

2. Risk of contact transmission increases with the proximity to the infectious person (surfaces close by are more likely to be contaminated), the number of surfaces touched, virus survival on hands and surfaces, and higher frequency face touching behaviour. Frequent cleaning of hand touch surfaces and good hand hygiene reduce risk. Virus is not likely to survive for long periods of time on outdoor surfaces in sunlight, but may survive for more than 24 hours in indoor environments.

3. Risk of aerosol transmission is highest when people share poorly ventilated spaces where the viral aerosols can build up rather than being diluted and removed by the ventilation. Risk increases with time spent in the same shared air. Risk is generally higher closer to the infectious person, but beyond this close proximity the concentration of aerosols that a susceptible person will be exposed to depends on the ventilation in the room. Transmission by aerosol can happen at distances beyond 2m in the same enclosed space especially if the ventilation is poor and duration of exposure is sufficient. It is possible but unlikely that aerosol transmission can happen between people in different rooms (via ventilation systems). Aerosol transmission risk is considered to be very low outdoors due to high dilution of virus carrying aerosols and UV inactivation of the virus.

4. The amount of virus released by an infected person and its dispersion characteristics facilitates the transmission. Dispersion is governed by complex flow physics as described in previous EMG papers. Key factors include the type of respiratory activity (a sneeze generates the most particles, breathing and talking produce less), the velocity of the release (a cough or a sneeze is more violent than breathing or talking and hence the droplets can travel further and with higher momentum). Virus could also be introduced via nasal discharge through contamination on hands. The point at which the exposure occurs in the disease progression of the infected individual may also be important. There is evidence that viral shedding depends on the progression of the disease and may be highest the day prior to symptom onset. No viable virus has been recovered from air samples taken in hospitals from patients who generally are at a more advanced stage of infection. Viral RNA has only been recovered occasionally at low levels, although one study suggests it is higher for patients in the first week of illness. There is limited quantitative data yet to indicate how this varies between people.

5. Transmission may also be influenced by environmental conditions. The virus is stable on surfaces and in air under laboratory conditions that simulate indoor environments. The virus survives better under colder, drier conditions with survival times of hours to days. Experiments under simulated sunlight suggests that high exposure to UV in outdoor environments will reduce the survival time to the order of minutes, however this will depend on the time of year and the cloud cover.

The link between alcohol and restrictions was documented in a Business and Regulatory Impact Assessment (BRIA) which was shared with the National Clinical Director in late October and subsequently published in mid-November at: (The Health Protection (Coronavirus) (Restrictions and Requirements) (Local Levels) (Scotland) Regulations 2020 (legislation.gov.uk)) which focussed on the set of hospitality measures included within the Strategic Framework. Pages 5-7 feature a summary of the rationale for government intervention, based on the transmission risk
in hospitality settings. It includes a description of experience of using restrictions to hospitality to manage local outbreaks, for example in Aberdeen city in August. The BRIA also explains what happened to the R number around the time when hospitality opened up in the summer and includes links to the scientific evidence.

Decisions on what sectors and activities to re-open on our route out of lockdown are guided by the principles set out in our Strategic Framework: Coronavirus (COVID-19): Scotland's Strategic Framework - gov.scot (www.gov.scot). Proposals are technically assessed using the best available evidence and analysis of their potential benefits and harms to health, the economy, and broader society to minimise overall harm and ensure transmission of the virus continues to be suppressed. This assessment process includes oversight of the assessed health risks in different settings by the Chief Medical Officer and input from the other Chief Clinicians as appropriate.

Further information about the Scottish Government’s decision-making framework can be found in this paper published on 11 December Coronavirus (COVID-19): framework for decision making - assessing the four harms - gov.scot (www.gov.scot). This paper provides an overview of key analysis and evidence (and links to more detailed evidence) in support of decisions on how best to limit the effects of COVID-19.

In this document, we describe how the four harms approach works in practice and present evidence under each of the four harms to illustrate how we used the four harms to make decisions about levels, activities and restrictions through the Route Map process. On pages 16 to 18 you will find a summary of the science behind COVID-19. An important reference in this documents is the following: S0824_SARSCoV-2_Transmission_routes_and_environments.pdf (publishing.service.gov.uk). This paper contains three types of evidence to understand where transmission is occurring; each has limitations, but they are consistent in supporting the view that hospitality venues are a significant risk for transmission.

1. Mechanistic and wider data/evidence on risk factors: (SAGE 40, EMG/NERVTAG paper, SAGE 63): Transmission risk is associated with environmental and human factors: higher risk contacts are those that are close, last several hours, indoors, face-to-face, in poorly ventilated rooms, in crowded spaces and in noisy locations. These are all prevalent in the hospitality sector (but not unique to it). Physical distancing is likely to reduce due to the disinhibiting impact of alcohol.

2. Data from epidemiological analysis of outbreaks (SAGE 63, EMG/Nervtag paper): Japan, China, South Korea, and Indonesia noted that their largest superspreading events originated from pubs, clubs, restaurants, gyms and wedding venues. An analysis of 3,184 cases in Japan identified 61 case-clusters that were observed in healthcare and other care facilities, restaurants and bars, workplaces, and music events. The largest clusters in Hong Kong were associated with transmission in bars and at a wedding dinner, both locations in which face masks were not worn. At least 246 cases of coronavirus disease (COVID-19) have been linked to nightclubs in Seoul. A super-spreading event in Vietnam, including analysis using genomics, indicated 12 cases linked to transmission in a poorly ventilated bar, only four of whom had close contact with the index case.

3. Case-control and other association studies (SAGE 63, EMG/Nervtag paper): these studies look for a statistical correlation between activities/locations and infection and have found significant associations between hospitality and infection. A report from the US CDC found that those infected with SARS-CoV-2, without known close contact with a person with confirmed COVID-19, casepatients were 180% more likely to report dining at a restaurant (aOR = 2.8, 95% CI = 1.9–4.3) or 290% more likely to report going to a bar/coffee shop (aOR = 3.9, 95% CI = 1.5–10.1) than were control participants. In a study from China, where 391 cases and 1,286 of their close contacts were followed up, the secondary attack rate was twofold higher if dining was involved. According to a systematic review including papers published up to 3rd of July, the majority of pre-symptomatic transmission events involved dining in close proximity.

Overall, the key points about the evidence are as follows:

• The information shared with Jason Leitch is drawn from SAGE and sub-group papers and all relevant papers are publically available. Throughout the epidemic, having a clear route for synthesising scientific evidence and presenting that to Government has been important. To do this, scientific advice is provided by the Scottish Government COVID-19 Advisory Group, details of which can be found at Scottish Government COVID-19 Advisory Group - gov.scot (www.gov.scot). The Scottish Government is informed by SAGE, and its sub groups. Details can be found at: List of participants of SAGE and related sub-groups - GOV.UK (www.gov.uk). The latest publically available evidence from SAGE is here: Scientific Advisory Group for Emergencies - GOV.UK (www.gov.uk).

• Transmission risk is associated with environmental and human factors: higher risk contacts are those that are close, last several hours, indoors, face-to-face, in poorly ventilated rooms, in crowded spaces and in noisy locations. These are all prevalent in the hospitality sector (but not unique to it). Physical distancing is likely to reduce due to the disinhibiting impact of alcohol.

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FOI 202100146009 - Information requested

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