June 25, 2021

expert reaction to Events Research Programme Report on Phase 1 findings

The government has published a report on the findings of the first phase of the Events Research Programme (ERP).

This Roundup accompanied an SMC Briefing.

Prof Paul Hunter, Professor in Medicine, UEA, said:

“The Events Research Programme Report is the keenly awaited report into several trial events run in late April and early May aimed at investigating whether such large events can be held safely. From reading the report the investigators were able to collect much useful information on the environment and human behaviour at events that will provide valuable insights to help plan the opening up of such events. But what this study is not able to do is tell us how risky opening up such events will be now for a number of reasons

1. This report covers just nine events, a mix of nightclub and indoor and outdoor musical and sporting events. So the chances that one of the venues would be part of a super-spreading event is low.
2. The requirement to provide a negative lateral flow test by itself would minimise any risk compared to subsequent events where such an entry requirement would not be in place.
3. The events all took place during late April early May when case numbers were low and we were seeing an average of just over 2,000 new cases per day compared to over 13,000 now.
4. The events took place at a time when the more infectious Delta variant made up about 11% of cases compared to around 97% now.
5. Only a minority of event participants submitted post event PCR tests (28% overall) ranging from, 13% to 66% depending on the event

“The report provides important insights into some human behavioural aspects including that “Contact-tracing found evidence of symptomatic individuals attending events despite instructions for participants with symptoms not to attend, and one case of an individual seeking multiple LFTs after a positive test to acquire a negative result” (page 36). The report did record 28 PCR positive cases of which 11 were considered potentially infected before an event and 17 at or after an event. The venue with the highest number of positives (the Circus Presents ‘The First Dance’ nightclub) only 7% of attendees returned both before and after PCR tests. Consequently the number of cases associated with this event may be much higher. Exploratory modelling of transmission risks at nightclubs suggested that primary transmissions in nightclubs could be reduced but not eliminated through testing on the day, the use of face coverings and through social distancing.

“Nevertheless some general conclusions seem to be valid, especially that such events were not risk free and that indoor events are generally more risky than outdoor events, though that is perhaps not that surprising a conclusion. But for people hoping that this study would show whether or not such events could be run safely (whatever the term ‘safely’ means in this context) this study does not provide unequivocal evidence either way. The fact that symptomatic individuals were still trying to gain access to these venues even when they were told not to and that they knew they would be screened is worrying when relying on personal discretion.”

Prof Jon Deeks, Professor of Biostatistics and head of the Biostatistics, Evidence Synthesis and Test Evaluation Research Group, University of Birmingham, said:

“The poor ability of lateral flow tests to detect SARS-CoV-2 infections has been a concern which has prevented recommendations for their use a tests-to-enable, such as for entering events where social distancing is not happening.   The Events Research Programme provides important data on their performance in these settings – and shows that they failed to identify most cases.

“Across the 10 events 51,319 lateral flow test results were reported of which only 10 were positive. One quarter of those attending also undertook a PCR test at or around the same time, which identified 11 individuals who attended events with false negative lateral flow results.  If the same rate of false negatives occurred in the three quarters not returning a PCR test, then the lateral flow test would have identified 10 out of 54 cases – less than one in five.  Whilst detecting some cases is better than none, allowing such a high proportion of people who are infected into events is not safe.

“Unlike now, the prevalence of Covid-19 was low when these events were held, which meant that little spread appeared to occur.  Given these data on the performance of the lateral flow test, continuing to run further and larger events where entry is only based on a negative test result, particularly where it is a self-report of a home test appears reckless. 

“More accurate tests are needed to make events safe, and fast and complete contact tracing will be essential to identify individuals in the outbreaks which seem likely to occur.” 

Prof Lawrence Young, Virologist and Professor of Molecular Oncology, Warwick Medical School, University of Warwick, said:

“None of this comes as a surprise. It has been evident for some time that crowded areas where people are in close proximity increase the risk of transmission. While low levels of infection associated with the Events Research Programme (ERP) are reported, the results are compromised by the low uptake of gold standard PCR testing both before and after the events. Coupled with the inaccuracy of lateral flow tests, these results provide little confidence that the larger events associated with the third phase of the ERP will provide any meaningful data. The ERP report highlights that ‘pinch points’ at outdoor events such as areas where attendees congregate as they enter or exit, toilets and refreshment zones carry greater risk of transmission. The ERP report also raises concerns about compliance in relation to the wearing of face coverings and social distancing particularly at large events when attendees were moving around or leaving the venue. The more transmissible delta variant is driving significant increases in rates of infection across the UK particularly in younger age groups who are not vaccinated. The mixing of these younger folk at mass events remains a significant concern. While full vaccination can protect against severe disease, it is less protective against transmission so in some cases it is still possible to catch and transmit the virus even when vaccinated. We still need to be cautious and stick with ‘hands, face, space, fresh air!”

https://www.gov.uk/government/news/government-publishes-events-research-programme-report

https://www.gov.uk/government/publications/events-research-programme-phase-i-findings

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

Prof Jon Deeks: “JD is an external advisor to the MHRA and the WHO, and leads the Cochrane reviews of the accuracy of tests for SARS-CoV-2 supported by funding from the Foundation for new Innovative Diagnostics.”

None others received.