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Published 27 April 2020
The need to end the brutal lockdown is getting stronger every day. We have published our view on how it could be relaxed (here).
Whatever measures are taken, large scale social gatherings are likely to pose one of the biggest and persistent challenges for relaxing the lockdown.
The prime example is the Atalanta/Valencia football match, which was dubbed "Game Zero" due to its role in spreading Covid-19 in one of the worst affected regions in Italy.
In the UK there is some evidence that the Cheltenham Races and football matches between Liverpool / Atletico Madrid and Manchester United/Manchester City all led to relative increases in the mortality in the weeks that followed.*
These were all events with +50,000 people.
Other than virtual pub quizzes, what social activities might be safe to start considering?
The chart below shows the relative likelihood of being at an event with someone carrying the Covid-19 disease. It is almost sure that activities in the red region will have someone in attendance that is infected, but as the number of cases falls the activities that are possible increase. It will be a long time before we can start watching live football, unless you live in New Zealand.
Interesting as this is, it is hard to imagine communicating it clearly to larger audiences. But starting to think about how to manage and mitigate risk is the way forward - the prospect of a vaccine is low, and we need to accept that it is unlikely that we will return to "normal" for quite some time (if ever).
Identify closest hospital to major (sporting) event (matched Trust in list below)
Identify another hospital in the same region (comparator Trust in list below)
Scale deaths at comparator Trust by the ratio of beds at matched Trust - this tries to control for differences in the size of the two Trusts
Subtract scaled deaths at comparator Trust from matched Trust
This gives you an estimate of the excess daily deaths at the Trust that is local to the major event.
For example, for the Cheltenham races, the closest Trust is Gloucestershire. This is matched to Bristol, which is slightly smaller. So deaths at Bristol are scaled up a bit to make them more comparable to those at Gloucestershire.
The difference is calculated over time. As this is quite messy, we fitted a polynomial line of best fit to give the nice curve. For Cheltenham, this shows that there were over three extra deaths per day around 20-30 days after the Cheltenham races - this works in the context of the speed the disease spreads and manifests.
This is the list of comparator and matched Trusts:
1. Cheltenham Races: affected trust – Gloucestershire Hospitals NHS Foundation Trust (962 beds), reference trust – University Hospitals Bristol NHS Foundation trust (820 beds)
2. Champions League: affected trust – Liverpool University Hospitals NHS Foundation Trust (1600 beds), reference trust – Stockport NHS Foundation Trust (660 beds)
3. Manchester Derby: affected trust – Manchester University NHS Foundation Trust (2125 beds), reference trust – North West Anglia NHS Foundation Trust (1009 beds)