On June 25th, the UK government published the Phase I report of its Events Research Programme (ERP).
The ERP aims to explore how mass events can resume safely despite the ongoing pandemic. Phase I involved nine music and sports events, including two club nights in Liverpool organised by the promoter Circus. These ‘pilot raves’ had 3400 and 3700 attendees, who were required to have a negative lateral flow test result before entry. Various methods were used to gather data from these events.
In a previous post, I raised some critical questions about the pilot raves, and there is some more critical coverage here. In this blog post, I’ll review some of the report’s key points, focussing on the relevance to clubs due to my interest in dance music. I’ll end with some speculation about where things might be heading for clubs after the lockdown ends in England on 19th July.
The full ERP Phase I report is available here.
Contrary to popular belief, the ERP doesn’t seem to have been designed primarily to find out if mass events would lead to increased COVID transmission. It appears to have been more about examining risks and possible mitigations. The ERP Phase I used three sets of methods:
1. Environment studies, to assess the risks of airborne and surface COVID transmission. For example, measurements of carbon dioxide (CO2) were used to indicate levels of exhaled breath and ventilation, from which it is possible to gauge how likely events were likely to lead to airborne COVID transmission.
2. Behavioural studies, looking at how people reacted to the events. These included on site observations and video recordings, again focussing on risk factors such as overcrowding in particular areas. A survey and interviews were also carried out, but the nightclub pilots were not included in these methods.
3. Outbreak prevention and control studies . The aim here seems to have been to assess whether requiring negative lateral flow tests prior to entry was effective in reducing transmission risks. Methods included attempts to gather PCR tests (the most reliable COVID test available) from attendees before and after the events.
The ethics of these studies raise serious questions, as explored in depth here. For the purposes of this post, rather than go into those debates, I want to look at some key findings.
Key finding 1: (a lack of) evidence about transmission
The first point to emphasise is that the ERP has so far provided no robust information about whether the mass events led to increased COVID transmission. The outbreak prevention and control element has been inconclusive.
It’s worth labouring this point, because many of the headlines to date highlight the finding that only 28 attendees tested positive out of a total of 58,000. That figure is true, but also tells us nothing useful, because the percentage of attendees who took PCR tests was too small for any conclusions to be drawn.
The figure widely reported is that 15% of attendees took a PCR test after the events, which is a small sample, and there is no way of knowing if that sample is representative of attendees as a whole. For the two nightclub pilots, the figure was even lower: only 7% of night 1 attendees and 6% of night 2 attendees did PCR tests both before and after the events.
The report repeatedly makes this limitation clear:
“Phase I pilots were…insufficient in scale, scope and study designs to generate any direct evidence based on transmission data. Therefore, evidence on case numbers should be treated with caution.”
“these figures should be interpreted with extreme caution given the very low return rate of pre- and post-event PCR tests…the low prevalence at the time of the studies and the lack of a comparator group.”
When a scientific report advises “extreme caution” in interpreting its results, that is a polite way of saying: “these data can’t tell us much.”
It might be that the events led to no increase in cases, or a significant increase, or anything in between. We simply don’t know, based on the data. This basic point unfortunately seems to have been overlooked by much of the coverage in the dance music press. Journalists in the industry seem to have struggled to report accurately on the scientific dimension of the ERP – perhaps understandably, since their normal remit is predominantly cultural.
The report notes that no community outbreaks were traced to ERP events. It also states that exploratory modelling of transmission risks suggested that testing on the day could reduce COVID transmissions in nightclubs by between 37% and 71% depending on the scenario. These are encouraging signs that testing before entry can help to make clubs safer, but not firm evidence.
There is also a worrying (albeit unsurprising) detail buried in the data. PCR tests carried out prior to the events identified some positive cases where lateral flow tests had given a negative result. Extrapolating from that finding to the situation the UK will face when lockdown ends on July 19th, in which COVID will be much more prevalent in the community, clubs could require negative lateral flow tests prior to entry and still end up with infected people being admitted and causing outbreaks.
In summary, lateral flow tests are not a robust solution for keeping COVID out of clubs, and thus by extension neither is the NHS COVID Pass (see below).
Key finding 2: ventilation is crucial
One of the most relevant findings for night clubs comes from the environmental studies. CO2 monitors showed an area of concern in front of the stage in the Liverpool pilot raves:
“The area in front of the stage at the nightclub had a sustained CO2 reading of over 2000ppm (parts per million) on the first night and just under 2000ppm on the second. With attendees spending long periods of time in that area and doing aerobic activity, such a reading is a cause for concern and does not meet CIBSE COVID guidance.”
The guidance referred to here is from the Chartered Institution for Building Services Engineers (CIBSE), based on advice from the Scientific Advisory Group for Emergencies (SAGE). It suggests that CO2 levels over 2000ppm “must be improved”, 1500-2000ppm would be a “priority for improvement”, 800-1000ppm would indicate “good air quality”, and that areas used for aerobic activity should aim for concentrations below 800ppm.
To summarise in simplified terms: clubs present a high risk of airborne transmission, but that can be significantly reduced by better ventilation. This finding echoes some points made in a recent article in DJ Mag about how clubs can reopen safely.
The ERP report adds the caveat that “there was only one nightclub pilot…in an atypical warehouse setting where ventilation improvements could be made, so only limited inferences about the sector can be reliably made.” But is that setting really so atypical? How many clubs can you think of that you would describe as well ventilated?
This finding is useful because it identifies a possible risk factor for nightclubs, and indicates a solution, with clear guidelines available on what clubs should aim for with CO2 levels. The report points out other ways to reduce risks, such as reducing length of time spent in the area and crowd density, but those are impractical in a nightclub. Ventilation is something that can be done without ruining the experience.
The ERP report doesn’t make specific recommendations about how to improve ventilation. Presumably holding more events outdoors would help, along with increasing airflow and installing better ventilation systems in venues. Anecdotally, some venues appear to have addressed this issue, but it seems a missed opportunity that ventilation hasn’t been a more prominent part of the debates around COVID and dance music.
For a sector that has a track record of working on harm reduction around drug use, improving ventilation seems achievable. It could be an issue around which to lobby for government assistance. Nightclubs usually understand that it is important to have a good sound system. Could the same logic be extended to ventilation systems?
Some thoughts on what might happen next
The ERP has a phase 2 and 3 still to report. But the approach taken, of trying to gather evidence about transmission risks to inform future planning, might be rendered largely redundant in England because of the political situation.
The UK government has announced the removal of almost all formal restrictions on July 19th. It’s important to note that this lifting applies only to England, as the devolved administrations are all taking more cautious and gradual approaches. In England, clubs will be able to reopen, with no capacity limits or social distancing requirements. With case numbers currently doubling every fortnight or so, this strategy is a pivot to herd immunity in all but name. Public health measures are giving way to vague messages about ‘personal responsibility’, the need to ‘go slowly’ and ‘be cautious’.
The lifting of restrictions will happen in a context where the night time economy is in dire straits and desperate to reopen. After well over a year of enforced closure, the dance music industry is increasingly aligning with anti-lockdown movements in calling for the ‘freedom to dance’ without regard for the consequences on virus transmission. If you want an indicator of how the pandemic has realigned UK politics, look at how Sacha Lord, the night time economy adviser for Manchester’s staunchly Labour mayor, recently went on the talk radio show of right wing commentator Julia Hartley-Brewer, agreeing with her about the need for lockdown to end.
In this situation, it seems likely that many nightclubs in England will see the lifting of restrictions as a green light to reopen. As for preventing transmission, the government has issued guidance advising businesses to assess and reduce risks, such as by cleaning high touch surfaces, improving airflow in poorly ventilated areas, ensuring that staff and customers who are unwell do not enter a venue, and communicating these measures to staff and customers. The guidance advises high risk settings such as nightclubs to use the NHS COVID Pass as a condition of entry. The COVID Pass is awarded based on vaccination status or a recent negative test result. The test result can come from a PCR or a lateral flow test, which gives some cause for concern based on the ERP data about the effectiveness of lateral flow tests (see above).
The ventilation aspect of the guidance is broadly aligned with the ERP’s findings, but lacks detail. In any case, these measures are advisory rather than legally mandated. There are already signs of push back against the NHS COVID Pass from the night time industries lobby. The government says that it “reserves the right to mandate certification in certain venues at a later date if necessary”, following a repeated pattern throughout the pandemic of waiting for problems to arise and then looking for solutions after the fact, rather than taking a preventative approach.
It would therefore be unsurprising if nightclubs became a source of COVID outbreaks in coming months, regardless of the ERP’s findings or the government’s guidance. Would such outbreaks really be a problem? In short, yes. If a club has an outbreak and staff have to isolate or take sick leave, it will have to close again. More broadly, though the link between cases and deaths has been greatly weakened by the vaccination programme, allowing case rates to rise creates other difficulties: the conditions for mutation and a vaccine resistant strain, long COVID, intergenerational injustice as young people suffer the burden of disease, and exacerbating disadvantage for the vulnerable. There is also a huge question mark over what happens to essential services if infection rates go so high, and so many have to isolate, that key workers become unable to do their jobs.
Politically, lifting restrictions at this point might make sense for a Conservative government, whose voters tend to be older (and thus more likely to be vaccinated) and more driven by self-interest (and thus more likely to want individual freedom at the expense of protecting the vulnerable). What seems less clear is whether this strategy will work well for the dance music sector. If case rates continue to rise unchecked, there are a number of possible scenarios in which nightclubs in England might face another shutdown.