Pubs and coronavirus - what does the evidence say?

Chris Whitty, the Chief Medical Officer, was lobbying MPs to close pubs in the North of England with a dodgy dossier that supposedly showed that a third of COVID-19 infections took place in pubs. Tellingly, he hasn't made this evidence public, but screenshots taken of one of his slides suggests that it is tenuous post hoc ergo propter hoc stuff. I wrote the following about the evidence on pubs and the coronavirus on Friday. You can download it as a briefing here.

 

The COVID-19 pandemic requires governments to balance health risks against social and economic wellbeing. The hospitality industry is Britain’s third biggest employer and has an annual turnover of £130 billion. It was effectively shut down for over three months during the lockdown from March 2020 at great expense to the industry and to HM Treasury. This briefing discusses the arguments for a further shutdown and the likely unintended consequences.

1. Flawed claims about infections in the hospitality sector

Scotland’s Chief Medical Officer justified closing pubs in many areas on the basis of data from NHS Test and Protect showing that 20-25% of infected individuals report having been in a hospitality venue (pub, restaurant, cafe, etc.) in the past week. However, he admits that this is not evidence that the individual was infected in a hospitality venue, nor that they infected others in the venue. Without knowing how many non-infected people visit pubs and restaurants each week, we cannot know whether visiting these venues makes it more or less likely that a person will catch the virus.

The most recent COVID-19 surveillance report for England found that the most common activity of people contacted by NHS Test and Trace in the week ending 27 September was ‘shopping’ (13.3%) followed by ‘eating out’ (13%). A smaller number of infected individuals reported engaging in an ‘activity event’ which includes ‘hospitality’ but also includes ‘arts entertainment or recreation’, ‘community and charity activities’, ‘public events and mass gatherings’, ‘teaching and education’, ‘transport’ and much more. The way the figures are presented makes it impossible to tell how many infected individuals visited pubs, but even if we assume that most of the ‘eating out’ and ‘hospitality’ took place in pubs, the number is likely to be below 20 per cent. Again, we do not know how this compares to the general population. It may be that pubgoers are less likely to be infected. 

According to the Telegraph, Chris Whitty has been lobbying MPs for pub closures on the basis that a larger proportion of infected people under the age of 30 report going to the pub as compared with older people. This only shows that young people are more likely to go to the pub in the current circumstances and is not evidence of widespread transmission in the hospitality sector.

More usefully, NHS Test and Trace has figures showing where infected people have had ‘close, recent contact [with other people] and places they have visited’. As the table below shows, the most common exposure, by far, is in the home. The hospitality sector is classified as ‘leisure/community’, a broad category that also includes ‘eating out, attending events and celebrations, exercising, worship, arts, entertainment or recreation, community activities and attending play groups or organised trips’. Despite the wide range of activities included in ‘leisure/community’, only around five per cent of individuals with the virus report having had close contact with other people in those settings. The amount of close contact in pubs must be even smaller.

2. Local restrictions on pubs have failed to reduce the infection rate

Analysis by the Labour Party shows that local ‘lockdowns’ have failed to reduce the spread of infection (Iacobucci 2020). The partial exception is Leicester where the infection rate fell initially but has since risen again (see table below from the British Medical Journal). 

Leicester and Bolton are of particular interest since they were both forced to close their pubs. Pubs reopened in Leicester on 3 August when there were 27 new cases per day. The infection rate then fell steadily to 13 cases per day in late August, but then began rising sharply in September and is currently at over 80 per day. The rise in cases does not correlate with the opening of the hospitality sector.

In Bolton, pubs were closed from 8 September when there were 88 new cases per day. Shutting down the hospitality sector has not reduced the infection rate which now stands at 109 cases per day.

Nationally, there was no surge in infections after pubs reopened on 4 July. The number of new cases reported remained below 1,000 a day in England throughout July and most of August and only began rising significantly in September. In Liverpool, Manchester and Newcastle, cases did not begin to spike until the second half of September, corresponding with the start of the new university year.

3. The 10pm ‘curfew’ failed to reduce the infection rate and may have made it worse 

 

The new closing time of 10pm for the hospitality sector has been accompanied by a further rise in the number infections, from an average of around 6,000 in England on the day it was introduced (24 September) to over 11,000 today.

The ‘curfew’ has led to impromptu mass gatherings in town centres and unnecessary crowding on public transport (see photo - taken at 10.10pm on 2 October on the London Underground). There is substantial anecdotal evidence that it has led to legal and illegal house parties as drinkers look for alternative venues to socialise. Informal gatherings of this kind lack the social distancing and other protections provided by the hospitality sector. It is likely that the ‘curfew’ has undermined respect for the law and led to increased transmission of the virus. 

4. The answer may lie in proper enforcement of existing control and mitigation measures in the hospitality sector 

When pubs reopened in early July, they were required to put in place comprehensive protocols around social distancing and other protective measures. Rather than fall back on lockdowns and other stringent restrictions, it may be time to revisit these measures, strengthen them based on lessons learnt, and ensure consistent enforcement.

Interventions that can stem the spread of COVID-19 in public venues are now better understood and have been tested. Face masks and shields, designated areas and physical distancing of tables, limits on the number of patrons and party sizes, and proper procedures for cleanliness and service have all proven their effectiveness. Heated outdoor areas can extend the season of open-air entertainment, and continued contact tracing can further mitigate potential infection. As noted by the Scotland’s Chief Medical Officer, ‘high compliance with all restrictions adopted and mitigating measures put in place will give us our best chance of suppressing the virus without having to implement the most stringent restrictions.’

Conclusion

There is very little evidence to suggest that pubs have been a significant factor in the recent rise in COVID-19 cases in the UK. Changes in the infection rate do not correlate with the reopening of pubs in early July, nor do they correlate with local pub closures in Leicester and Bolton. The 10pm closing time seems to have had no positive impact and has likely made the situation worse.

The hospitality sector already has to comply with increasingly rigid regulations, including social distancing, contact tracing and mandatory table service. Indeed, 85 per cent of pubgoers think their local is complying with, or exceeding, government guidelines. There is no reason to believe that they will not continue to do so.

A substantial majority of new infections appear to be taking place in private households. It is likely that further restrictions on the pub sector will lead to a further increase in illegal and unregulated private gatherings in the home where transmission of the virus is easier.