Science framework for opening up group events

This paper is a response to a DCMS Commission to inform a research programme to be overseen by the DCMS Science Board focusing on opening events and venues with minimal transmission risk.

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assets.publishing.service.gov.uk/government/upl…
It was prepared by a Working Group organised by SAGE-EMG and DCMS that included participants in several SAGE subgroups (EMG, SPI-B, SPI-M) and others (Appendix B).
Summary -

Priority research questions, Principles for design and evaluation of pilots, and Best practice approaches for an events research programme.
Further details.
As well as being a fairly comprehensive biological study to identify infectious individuals, this is also a study of human behaviour and behavioural measures, and the relevant environment (sampling and airflow and ventilation systems etc).
Details on Environmental measures and research.
Details on Behaviours that affect risk of transmission at events and are being observed/measured.
On ethical concerns, important to note these pilot events are drawing upon Nuffield Council on Bioethics report on research *in global emergencies*, highlighting the ethical importance of learning, transparency, consent and community engagement, and equal moral value.
It notes that pilots should be subject to independent ethical scrutiny. Those running them should have access to ethics support and advice to enable the timely identification and addressing of emerging ethical concerns.
Again, public accusations by senior academics that an ethics committee is acting in a biased way & green lighting unethical trials are incredibly serious, and ones which I hope aren't being made lightly or just to sensationalise and oversimplify these complex issues on Twitter.
The remaining bits of the document cover the socio-economic rationale behind researching these events, details of COVID status certification for these events, and the published evidence which is relevant to these pilot studies.
Some comments from me - RE line highlighted here.

Prevalence is currently far lower than in February, and Liverpool currently has the lowest rates of any UK core city.

In addition, vaccination coverage is far higher than in Feburay also.
Also, prevalence estimates include symptomatic individuals, which were excluded from this event by pre-event symptom screening *using WHO definition.*

Pre-event negative LFDs further reduce the risk of infectious/infected individuals entering.
Expected prevalence in event group therefore extremely low.

The idea and claims that there were loads of infectious people at this event, or that the event will cause a significant rise in cases in the community, is not based on evidence or logic.
While there is an inherent risk with such a study, as there are in almost all medical studies, the event was extremely low risk, and importantly is lower risk than illegal raves or gatherings occurring elsewhere.

This of course feeds into ethical considerations.
I've then seen people say, well if there are no infected people at the event, how is it useful to study transmission.

When you read the framework, you realise this is not just some lazy self-test before an event to see what happens, as some have claimed...
I also find it troubling that ppl were happy for rather limited SAGE modelling to inform&essentially dictate policy & day-to-day life for a yr, w/ many sig collateral harms, some known, some unknown, w/ the assumption (poss correct) response was proportional & gave net-PH benefit
But now that an informed decision to study a relatively low-risk event with much risk mitigation in place & with sig potential for societal benefit both here & internationally, led by senior SAGE members, distinguished NIHR investigators, & local unis & PH teams is 'unethical.'
I'm a bit troubled as to peoples values when they consider this, essentially just young people having fun, unethical, but made no comments about ethics of the real-world experiment with unknown effectiveness and known significant harms which was school closures...
... workers having to work day in day out while non-practising academics were able to stay home and hold Zoom meetings, delivering food from kitchens and packages from warehouse workers, who died disproportionally to keep society, & the pleasures of life, functioning for you.
Did those workers consent to risking their lives, the lives of their families and friends, for you?

Did school children consent to losing their education, suffering great mental & physical harms, and possibly permanently damaging their life chances for your safety &/or values?
Did all young (and older) people consent to putting their lives on hold for a year, to losing friendships, relationships, jobs, livelihoods, and nearly all in-person social interactions to protect the vulnerable, the vast majority of whom have now been vaccinated.
This idea that every individual who may or may not be impacted or harmed by a clinical trial, a scientific study, a public health intervention, or government policy has to consent to it otherwise it is 'unethical' is quite simply just not based in any sort of reality.
Certainly, that is not what has happened over the past year.

National interventions where evidence of effectiveness & risk and net-benefit to society were not clear, wide-ranging & significant societal harms very clear...
& little done to study the implementation of interventions at a level that informs & improves future PH programmes & interventions were done.

Didn't hear much about ethics then, & certainly not from those now calling this pilot event unethical gov guinea pig experimentation.
What are the values of a society/individual when we say working at Amazon warehouses, in kitchens, delivery drivers, factories is 'essential' & ethical, but young people having fun social interactions in a very low prevalence city with high vacc coverage & much risk mitigation ->
-> as part of a compassionate, high-quality, locally-grounded Public Health implementation pilot programme, with significant potential for individual, community, national, & international benefit, is unethical guinea pig experimentation...?
This brings us to what Public Health actually is.
Public Health is the science & art of preventing disease and prolonging and improving quality of life through organized efforts & informed choices of society, organizations, communities & individuals.
Note that Public Health is much broader than infection control.

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

From @WHO constitution.
Also worth reading about implementation research, a growing but not well-understood field of health research that can contribute to more effective public health and clinical policies and programmes.

bmj.com/content/347/bm…
And some context & the evidence-base & rationale behind the Public Health work going on in Liverpool, which has already contributed valuably to the pandemic and is, imo, pioneering Public Health research, which the world can, and has, learn and benefit a great deal from.

End.

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More from @ScienceShared

4 May
@deeksj @vulpine2020 @TAH_Sci @AllysonPollock "The more common a disease is the greater the net benefit of testing" is quite an oversimplification imo.

There's a lot of complications, but it largely depends on what testing is trying actually to achieve.

1/
@deeksj @vulpine2020 @TAH_Sci @AllysonPollock Yes, at higher prevalence it will find more cases, and this may translate to more total infections prevented or lives saved, but the proportional impact on R(t) at high vs low prevalence likely not so different if uptake constant.

2/
@deeksj @vulpine2020 @TAH_Sci @AllysonPollock Also, it is unclear (& to me unlikely) whether UK's PCR testing when at the highest prevalence with slow turnaround had any kind of significant impact on transmission, or whether there was any net-benefit at all when the disease was more common.

3/
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1 May
Public health is a wide-ranging discipline, which has been defined as "the science and art of preventing disease”, prolonging life and improving quality of life through organized efforts and informed choices of society, organizations, communities and individuals.

1/ Image
Public Health is most probably the discipline of science that materially improves the lives of the most people around the world, striving to use evidence, expertise, and insight from all disciplines to improve the health and wellbeing of the population as a whole.

2/
The UK, and Liverpool in particular, has a long history of pioneering Public Health research and programmes, many of which have materially & significantly improved the lives of people in local communities & around the world.

ljmu.ac.uk/about-us/news/…
Read 29 tweets
1 May
Worth reading RE Liverpool events pilot.
news.liverpool.ac.uk/2021/04/07/uni… ImageImageImage
And some of the work published so far from Liverpool community testing pilot, which imo is pioneering Public Health work with mpact on local communities and far wider.

Should be applauded, not chastised.
Enhanced Lateral Flow Testing Strategies in Care Homes Are Associated with Poor Adherence and Were Insufficient to Prevent COVID-19 Outbreaks: Results from a Mixed Methods Implementation Study

papers.ssrn.com/sol3/papers.cf…
Read 9 tweets
29 Apr
Japan

Is

Not

an

Example

of

Elimination

Japan

Is

an

Example

of

Quite

Effective

Mitigation

I

Dislike

Misinformation

in

Medical

Journals

Especially

When

It's

Retweeted

by

so

many

leading

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Read 8 tweets
27 Apr
A recent letter was widely criticised.

While I am no fan of *some* of the signatories & their stances during the pandemic, nefarious connections or not, and I don't personally agree with the letter in its entirety...
I'm unsure if the actual content of the letter was quite so controversial as many are making out.

See the link here (bbc.co.uk/iplayer/episod…) at 18 minutes in for @jackiecassell thoughts on why vaccination means we should at least re-consider *how* we are doing public health.
Consent and support are far more desirable (and imo optimal) than restrictions and police enforcement.

At some point we will go back to public health by consent, at least I very much hope so. Whether that time is today, June 21st, or next year is of course worthy of debate.
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26 Apr
If a journalist came to me and asked me to give a comment on the technicalities of heart surgery, the complexities of recovering patients from myocardial infarction, how to run an intensive care unit, or other such like medical doctor things, I would politely decline.
I'm sure the vast majority of virologists/immunologists/ID experts/people with a degree in biology would appreciate it if certain medical doctors/political commentators did the same when asked to give comments on SARS-CoV-2 variants and vaccine escape...
I guess the most obvious follow up is, why are 'journalists' going to general medical doctors for comments on variants/viral evolution/immunology anyway...?
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