STA Q&A with Professor Jason Leitch – Minutes
STA Q&A with Professor Jason Leitch – Minutes
THURSDAY 24TH SEPTEMBER 2020
Professor Jason Leitch’s introductory comments opened with an apology to the sector followed by a short overview of the current situation with Covid-19 – this provided context to the Q&A session.
Firstly, Professor Leitch acknowledged that he didn’t understand the sector in the way that the members around the table did and that he can’t know how it feels like to be in their shoes, he noted however that he tried to understand and assured members that he was an advocate for the sector however he emphasised that his job was different from theirs but that didn’t mean that he wouldn’t face any of their tough questions.
Secondly, he recognised the impact that his role as Public health Advisor was having on the sector and acknowledged that it was very hard. He also noted that it was hard everywhere, in care homes, in families that have lost loved ones and across all segments. He noted that this feels different, that this was public health on a population scale, usually that would be obesity and smoking now it’s a viral disease that’s killed 1 million people around the world.
Background Context
- On Hogmanay 2019 the WHO declared a global public health emergency for a virus that didn’t have a name and now we call it SARS COV19
- 9 months later it’s killed 1 million people and it’s infected 31.5 million people (at least).
- 5 WHO regions of the world have an accelerating pandemic, including Europe which had 300,000 new cases last week, Africa is the only continent with a decreasing number but it is thought that is a testing issue and not a reality.
- Nearly everywhere is back to seeing hospitalisations, intensive care admissions and deaths. The UK is probably 4 weeks behind France unless we act and that is why action has been taken this week.
- Action was undertaken to adjust the main risk and the main risk is seen to be household transmissions, wherever those household are, whether there your own houses, other people’s houses or in other places such as hospitality, work places or halls of residence etc. Once the virus gets into your house it’s almost impossible not to infect everyone in your house so the only thing that can be done is to prevent those households mixing.
- The virus is still the same as it was in March, it’s an acute and horrible disease and we have learned that a certain proportion of people get a long term chronic disease which we didn’t previously know.
- The ‘hammer’ and the ‘dance’ are the two approaches being taken to address the pandemic.
– The initial, immediate measures to deal with the virus back in March was to shut everything down, this was the ‘hammer’ approach, the virus was unknown and it wasn’t clear what should be done, the only way to protect the public was to shut everything down – schools were closed for the first time in history.
– We are now in the ‘dance’ and this is much more difficult, we are trying to open but many countries are struggling to get this right. The dance is about opening as the route map progresses, slapping the outbreaks down but trying not to do it at a total population level and trying to do that gradually over time. - There are two weapons against this virus, Test & Protect and human behaviour until science and a vaccine can get us out the other end these are the only tools we have. In the meantime therefore we are relying on a gradual opening of the economy, test & protect and the app to get the positive cases off the streets and human behaviour helping us to get the numbers down.
- Finally, yesterday we announced the highest number of positive cases the country has ever had so we are accelerating again and that’s why radical steps over the last 24hrs-48hrs to try and close it down.
The questions for the session have been loosely structured around 4 key areas:
- Restrictions on the movement of people
- Social distancing guidelines
- Indoor meetings & events
- The future outlook
RESTRICTIONS ON THE MOVEMENT OF PEOPLE
Q1. With the hospitality sector facing further restrictions with the introduction of a curfew are there any figures indicating the R rate stemming from this particular sector? Are there not concerns that with the introduction of further restrictions this will only lead to increased non-compliance in other areas such has households? Is it not safer to be in the heavily regulated and controlled environment of our pubs, bars and restaurants?
A1. The exact clarity you seek is not currently available at the granular level that you will be looking for.
Let’s start with what the R number is, an average rate of infection from every positive case. When you restrict society for example with population measures, you restrict the average infection rate and the R number falls. The virus itself doesn’t change what you have changed is the interactions available to the virus. The virus wants to jump from household to household, it doesn’t even want to kill people it just wants to survive and it needs a new host to survive. Test & Protect, interviews every positive case so from the time symptoms start to the previous 48 hours Test & Protect will ask for your whereabouts and habits, where you’ve been and who you have met etc. It’s not possible to tell within that 48 hour period where you got the virus unless there is a known outbreak related to your whereabouts. If there are no known outbreaks then it’s a best guess for all of the places you were. We know from the numbers that the highest risk places are where people gather and that’s in people’s houses as well as other areas where groups get together such as hospitality and work places. If you can mitigate you make that less likely and the government makes choices about what to open in priority order and we have chosen to open schools, if you open schools that costs you R (e.g. 0.5 which is now ‘spent’), what do you open next? Contact sports for U12s that will cost you x. Where do you go next, you need to have supermarkets, oil & gas to keep the lights on, thereafter it becomes complex.
Q2.Recent Public Health England data for week 37 showed that only 34 out of 729 (4.66%) new cases were linked to food or restaurant settings. Is the hospitality sector being unfairly penalised given the lengths that businesses have gone to mitigate the risk of transmission?
A2. I believe that the vast majority of the industry is doing really well and are fully compliant with the guidelines. The only piece of the puzzle that is still difficult for industry and that I’m still worried about is household mixing. The distancing between households in the same booking, e.g. when two couples book for dinner they should be distanced, 1m, can’t sit at a normal table for 4. This is the only piece of the guidance that I think is not there yet for hospitality. Everything else is great and industry should be congratulated.
Q3. As we go forward with no doubt even more restrictions is there any possibility of reviewing the restrictions on background music and TV commentary? We understand the thought process behind it, but in reality our members have found it to have completely the opposite effect from what it was intended to do. With no focus of music or sports commentary, people are talking more, shouting to people a few tables away and moving about more.
A3. The last time this was looked at we were waiting on the industry coming back with a proposed solution, I’m not opposed to music it if it can be implemented, what I’m opposed to is loud noise that people have to shout over, take the point that silence can be just as bad so there is probably a happy medium to be found. If the industry can find a way of managing that then from a public health perspective I am not opposed to it. When we looked at this initially we struggled to find a way of doing that and ‘policing’ it.
Q4. To what extent is behavioural science factored in to the decision making process on lockdowns?
A4. At a UK level and Scotland level we have behavioural scientists on the advisory groups, the most well known is Steve Reicher, he sits on our scientific advisory group in Scotland, there is also SPI–B which is the scientific advisory group for behavioural science which is the UK based version, behavioural science is very prominent, e.g. just now with the outbreaks around universities he is helping us with the right messaging.
Q5. Would it not be better to ramp up enforcement of Guidance, rather than take a broad brush approach to restrictions on whole sectors of the economy? The Prime Minister has implied greater enforcement approach than what the First Minister has announced, do you see enforcement to be of greater importance now rather than expect the public to behave and act responsibly?
A5. A balance needs to be struck. I’d rather see compliance than enforcement and industry should lead that, I don’t want police in the restaurants or Environmental Health Officers standing in premises. Environmental health has a role, it has an escalation role and there may be cases when the Police have an escalation role but that should be minimal. Compliance, yes. Enforcement, only when required.
Q6. Over the last 48hrs there have been a number of changes in messaging around the self-catering situation as a result of the new restrictions that have been put on households, the business operators within the self-catering sector would greatly benefit from advance notice of any announcements of that type, the economic impact and the timing of the changes is very challenging. Can you also clarify the definition of a household, is it a household bubble?
A6. Apologies for the pace of these changes, sometimes the pace means that you don’t do things as well as they should be done.
The rule is, one household in a house, self-catering or your own house. The extended household, which in Scotland means a single person or a single person (parent) with kids can join with another household but they can’t do that selectively, they have to choose one extended household. Two other nuances to the household rules, kids who share houses between parents who no longer live together – the kids can be in either household at any time, non-cohabiting couples are exempt so they are allowed to come together.
All visitors to self-catering properties in Scotland need to follow the rules in Scotland (e.g. two households from Manchester (where the rules are different) would not be allowed to stay in a self-catering property in Scotland, however it works both ways, two household from Scotland could go to Manchester however people should be warned against this.
SOCIAL DISTANCING
Q7. A number of proposals have been put forward by ASVA requesting exemption from the 2m distancing rule for visitor attractions. This has already been provided to hospitality, retail and public transport and currently visitor attractions south of the border are operating under 1m guidance with no issues being reported. Is there a reason behind this or is there light at the end of the tunnel?
A7. There is some light, but, the numbers are bad, if the numbers were going in the right direction I’d be more enthusiastic about that question. That doesn’t mean that we rule it out. The exemptions for schools was one thing, the exemptions for public transport and hospitality was needed to allow them to do anything. The desire for 1m plus is understandable and we would look at it, but, with 2 days of the highest positive rates in last 7 months today is not the right day to look at it, but wouldn’t rule it out for museums or other attractions in the future. When you talk with officials it must be very clear what the mitigations are and what the risks and costs are.
Q8. There are proposals to change social distancing to 1m for outdoor tours, would this also be considered?
A8. Outdoors is an easier discussion. In a conversation about distancing, outdoors is better than indoors and kids are better than adults etc.
Q.9. For Marine Tourism the opportunity is now gone given the year is now over, so how does a sector establish what are the specific concerns regarding safe operations? How can we jointly develop a response to these concerns and jointly develop guidelines to satisfy/meet concerns? Keen to ensure everything is in place to allow the sector to reopen and recover quickly when the opportunity arises next year.
A9. We need to get to the point where we have public health professionals either inside the industry or able to advise your industry about what that might look like and then you need good links into the policy teams in government, which you have, and they should be able to help you put your guidance through Public health Scotland ‘mincer’ machine to make sure it applies. The process exists, the short cut would be getting public health advice in the room while you are doing it. There are local health protection teams and public health people inside your health boards, if you reach out to them you may be surprised how much they would help you.
Q10. Can the difference in risk between indoor and outdoor functionality be explained?
A10. Not sure this has been done as clearly as it should. Outdoors is significantly lower, from the viral perspective, outdoors is much less risky as the virus can’t hang about as long, it doesn’t settle as well on surfaces or people and it gets blown away, it doesn’t like humidity. In the winter we’re not sure what’s going to happen, no one has really had a winter with the virus yet, we don’t think it’s going to behave seasonally we think it’s just a factor of wind and being outdoors. People have caught the virus outside, but much less likely than indoors and therefore our guidance should reflect that.
INDOOR MEETINGS & EVENTS
Q11. A hotel is dealing with a 90th birthday party at the moment; the birthday lady say that if she died, under current rules she can have all her family gathered, but as she is still alive – and do not have any intention to get married at this moment, she cannot gather her family – despite having social distancing measures in place. How does this make sense?
A11. This comes down to total population risk vs individual risk. We have to live between two extremes, letting the virus go wild and people dying or lockdown like 23rd March and the economy dying, everything else is risk, if you think of a big bucket of risk, we cannot afford to let that bucket overflow or else we will be in exponential growth again and everything will shut. As you make decisions by sector you have to do it for the whole population, if I went to that ladies party the risk to me as an individual is tiny, but if the whole population gets to do that the risk is big – that’s the nature of public health and population health.
Q12. What is your thoughts and expectations on staging pilot events in the coming months, given the larger economic impact of the industry and that permission to stage pilot events in other industries has been granted.
A12. It is essential for these to happen at the appropriate moment, for sport, for business, for the conference centre. At the moment we have paused them partly because of how they will be perceived, (you can’t go to people’s houses but you can go to the golf) and partly for public health reasons because we don’t want to take extra risk if we don’t have to while we’re still keeping hospitality open and schools open. Pilot events will have to come back in order for us to understand how we open more broadly. I’m not ruling them out, just not sure of the timing of how we’re going to get there.
FUTURE OUTLOOK
Q13. Testing. What is the plan? If we were all to be tested every 4 days, would that solve this matter pre vaccine? Given the importance of international markets where do we sit with opening up international travel?
A13. There are 4 chances of getting out of this. The first and least likely is that the virus helps us, sometimes viruses can mutate and become less virulent – this is being monitored, but there is no sign of this happening. The second is we get treatments, just now we only have treatments for the seriously unwell and it’s not very good, we’ve got no treatment for mild cases, we’ve got nothing that prevents you going from mild to severe and we’ve got nothing that prevents you getting it. The third is a vaccine and it looks like the vaccine scientists will get us a vaccine because the virus isn’t changing and you need a stable virus that’s why you can’t vaccinate against the cold because it changes all the time. The fourth option is could you get a pregnancy style test every morning that you spat into a cup and you would get a red or green and it told you what you could do that day. The science does not yet exist but the principle is good. There are many drug companies and industry working on what that might look like. We’d need to know two things, it’s sensitivity and specificity – is the test telling you the right thing, we’re a long way from that and what does a green mean? If you’ve had covid how long do we let you have off? Just now you have 90 days before re-testing however around the world there are a number of people who have had it twice, who have had a slightly different strain of it second time around so it’s not impossible that you might be infectious if you catch it again even if you are not ill so you could still spread it. There are a lot of variables in the so called ‘moonshot’ testing plan.
Q14. Is the 15/90 minute test being trialed in Salford?
A14. It is but that is a PCR test, it’s the same test that we have just now but faster, this will help with hospital admissions, but what they won’t do is tell you what is happening tomorrow or happened yesterday, they are still a point in time and you can’t do them every day like the ‘moonshot’ proposal. What will happen is the test that takes 4 hours in the lab will become quicker and the test which is a bigger cartridge will become a smaller cartridge, but what we need is a better test. If you test the whole population today, 99% of positives will be false positives so that doesn’t help. The reason we don’t test arriving passengers is that the incubation period of the virus is 7-14 days, so you could test negative today but I couldn’t tell if you had the virus.
Q15. In addition to Test and Protect, should Orkney and other island destinations be resourced to actively test at all arrival points? And would this offer more protection to our vulnerable island communities?
A15. We’re going to look into it and we may use the islands as a trial. It depends on how much risk you are willing to take. It’s not ruled out but with the global prevalence we have it’s just something we’re not doing. Each country is choosing to do something different around the importation of people, New Zealand has shut its borders and in Australia all arrivals are quarantined in hotels under armed guard for 14 days.
Q16. How do you see quarantine restrictions evolving as we move into 2021?
A16. All options are on the table. As we learn more our response can be more precise rather than national. We didn’t want to take national restrictions this week but we felt the numbers were heading in the direction where we were forced to and the experience from Europe suggests that is the right thing to do. We thought very hard about whether we should exclude Orkney, Shetland and the Western Isles from recent national restrictions, they don’t have large numbers of cases, they do have some, the problem with doing that is that you would need to put a travel ban round the islands in order to stop the high prevalence areas reaching the low prevalence areas and that was felt, at this stage, not the right thing to do.
ADDITIONAL QUESTIONS SPECIFIC TO SELF CATERING SECTOR
Q17. A property has Tradesmen staying Monday-Friday and going home at the weekends, is this allowed?
A17. No, not sure whether this would have been allowed before the guidelines either. Tradespeople are allowed in people’s houses to work, but tradesmen using self-catering to live together, that’s not allowed.
Q18. Two Shepard huts with their own bathrooms – assuming two households can stay next door to each other?
A18. Yes
Q19. One person has a student vet staying with them in their home, there is an assumption that they can stay?
A19. Yes
Q20. A self-caterer who serves breakfast, can they have more than one household?
A20. Not if it’s in the one house. A hotel can have more than one household if there is social distancing. The recommendation is that you are sensible.
Q21. Self-caterers will have people who have arrived yesterday for a change in the rules on Friday, should they be sent home?
A21. No – use common sense
Q22. Can residents in hotels continue to enjoy hospitality after 10pm? Will the guidance that is due to be published address this?
A22. There are a number of nuanced areas which will feature in the updated guidance and hotel residents are one of them, the other one is the airports, 5am-10pm inside airport doesn’t work so there are some areas that need special attention and these are being looked at.
