Keep your 2m distance during the pandemic

Andrew Watterson, Rory O’Neill, Janet Newsham and Hilda Palmer critique the carelessness and incompetence of government policy and practice

The two-metre (2m) ‘social distance’ guidance during the pandemic lockdown soon became entangled in politics and economics rather than the science. It was weakened and then ditched in England on 4 July. It was ‘relaxed’ with caveats and warnings after 9 July rather than abandoned wholesale in Scotland. Public health and worker health were sidestepped in the process and parts of Britain and its economy were put at risk. Mainstream media were often easily manipulated, evidence was often ignored or lacking, scientists were silenced or out-manoeuvred and the precautionary principle was breached. English and Scottish politicians at times responded differently but in several respects the outcomes proved very similar. 2m was changed to 1m plus despite both the English Chief Medical Officer and Chief Scientific Advisor at the time repeatedly re-iterating the fact that 2m distance was significantly safer than 1m. Powerful reasons remain for restoring the 2m guidance in many places indoors for public and worker safety.

A successful media campaign was mounted over several weeks to reduce the 2m distancing guidance primarily based on a spurious argument that in 2020, the justification for 2m came from 1930s outdated research. The 1930s research ignored airborne transmission and, as 241 scientists indicated, current research shows potential inhalation for COVID-19 spread could be up to several metres (Clinical Infectious Diseases July 2020). The argument was not evidence-based but part of an extensive and well-thought strategy used primarily by politicians in England at the time and also by lobbyists in Scotland. The politicians ably supported by several economists and one sociologist filled the TV and radio air waves and newspaper columns south and north of the border, frequently unchallenged. Ian Duncan Smith made unevidenced judgements about epidemiology and argued the 2m guidance should be reduced. In Scotland, economists with links to the Scottish Government and no expertise in public health ramped up the media pressure to drop 2m. The campaigners argued the risks of economic damage from the lockdown outweighed the public health risks of 1m or 1m plus. Others argued mitigation measures would offset risks from reducing the 2m distance.

Yet, the evidence at the time the decision to reduce 2m was taken was either weak or did not exist to show such mitigation measures worked or could work in the future. These measures included as observing 1m distance, wearing masks, improved ventilation and cleaning in many workplaces and locations underpinned by effective test, track and trace schemes. Indeed, the opposite was true. In most circumstances neither mitigation nor effective test, track and trace were available. In many settings, employers had been actively discouraged from purchasing effective respirators, to reserve limited stocks for health care and social care settings. In other settings, like schools, mask use was actively discouraged and social distancing abandoned as a mitigating strategy

Scientific evidence from the 2020s, and not the 1930s and 1940s, indicated a strong case for supporting and even extending the 2-metre social distancing guidance in some circumstances (Environmental Health News 18 2020). Also, important gaps in our knowledge also emerged that justified adopting a precautionary policy when considering any changes in the 2m guidance. On 21 June 2020 the informed view was ‘until there is compelling evidence to the contrary, Independent SAGE advises against any reduction in social distancing in indoor settings’. It went further and noted the 1m reduction would ’not only lead to an increased physical transmission of infection …… [but] also undermine the psychological resolve we need to deal with the pandemic’. Significant risks from airborne and large droplet transmission were identified (Clinical Infectious Diseases July 2020, Physics of Fluids May 2020, International Journal of Environmental Research and Public Health April 2020). The ILO (2020) Canada and Spain supported 2m wherever possible. Evidence from clusters elsewhere supported more caution and the 2m figure. In addition, evidence from US workplace clusters stresses the importance of 2m physical distancing (Morbidity and Mortality Weekly Report 7 August 2020).

The decisions in England and Scotland to drop 2m for 1m/1m plus were supposedly based on rigorous reviews of the evidence by scientific groups and government advisors. They were not. The UK assessment was seriously deficient, neither a systematic review nor even a rapid review of the evidence on social distancing group was used to make the assessments and looks selective. There were at least a dozen scientific papers indicating caution on 1m when the UK review was considering the evidence that were not mentioned in the UK document. This is profoundly worrying for several reasons. The evidence indicates the politicians already appeared to have taken the decision on economic and political grounds prior to any reviews. The UK Government’s own assessment in June of the 2m evidence found ‘the evidence that the risk of transmission increases by 2-10 times at 1m compared to 2m and the potential for higher occupancy at 1m distancing will also increase risk if there are no mitigations’. The group looking at the principles upon which decisions were based additionally noted there was insufficient data in May 2020 carry out quantitative assessments of transmission risks to inform decisions about 2m or less.

The Scottish Government did not produce a ‘review’ of the 2m evidence but sought advice from its COVID-19 Advisory Group. The document produced contained even less evidence than that produced by the UK Government and only two of the papers cited dealt primarily with physical distancing and spatial matters. The Advisory Group drew on advice from the UK SAGE group as well as on other sources, seems to have fallen into the same trap as the UK Government ‘review’ and also appeared to accept absence of evidence as evidence of absence in its decision-making on risk, for example, with regard to schools and social distancing.

One of our leading behavioural scientists, Professor Steve Reicher (Guardian 24 June 2020) of the University of St. Andrews, observed that ‘research in the field of proxemics – the study of space and social interaction – shows that, in the UK, 1 metre is roughly the distance we ordinarily maintain with others. So, reducing it to 1m is akin to removing any restrictions from distancing, and hence functions as another signal of back to normal’. If compliance with mitigation measures – as well as the means to monitor, inspect and regulate those measures – is likely to be poor, then such a relaxation was very questionable. However, until the 10 August 2020 in Scotland they were non-statutory guidance measures to protect the public.

The Scottish Government adopted a welcome and far more cautious and gradual approach to easing lockdown than that in England in terms of policy changes, policy detail and language, and in terms of engaging and consulting with workers and employers. It undoubtedly sent out a stronger COVID-19 public health message and worked at managing expectations of coming out of lockdown much better. Nevertheless, it still reduced the 2m distance to 1m – in England it was 1m plus – and still appeared heavily reliant on UK scientific information that was either limited or simply flawed. Although at the moment, there have not been clusters on the scale of those in Leicester, the informed predictions of the behavioural scientists have sadly come to pass and social distancing, avoiding crowded spaces and other mitigation measures supposedly adopted to keep people safe have failed. This has resulted in clusters in call centres and bars in Scotland. Little attention has been paid to the fact that risks to the public from opening up the hospitality sector will add to the risks of workers in the sector too.

These are ‘live’ issues as occupational health and safety problems with a reduction of 2m to 1m have emerged in a variety of clusters not just in factories and call centres but also in bars and restaurants in Scotland. Effective monitoring, inspection and regulation to enforce even the 1m guidance has been almost non-existent (Greenock Telegraph 11 June 2020) but this is critical to effective social distancing by HSE, environmental health officers and the police.

Workplace reductions in the 2m guidance need to be based on sound evidence and demonstrate any control measures will be effective. The health and safety hierarchy should be applied by removing risks first, then using engineering controls and enhanced cleaning etc. PPE that is appropriate is a last resort. Evidence not only supports the 2m guidance but in some circumstances supports its extension (British Medical Journal May 2020, Lancet 1 June 2020, Guardian 12 June 2020). Any reductions in 2m guidance must be based on detailed, validated policies and procedures able to effectively protect vulnerable workers, children and the wider public. Current evidence continues to support the general importance of the combined use of social distancing, use of masks and other PPE and handwashing not removing or reducing parts of this strategy. This approach has been continually stressed by the Scottish Government. There must also be continued employment, wage protection and suspension of punitive sickness absence and performance management system, to encourage safe practices including self-isolation.

Those who run the risks of social distance changes should be fully involved and consulted about them at both workplace and national levels. At a time when we have reduced distancing, we are increasing potential contacts several fold, especially by pressing for a return to workplaces and schools. This strategy ignores the potential health, social and economic harm of a stop-start-repeat cycle driven by a desire to achieve a normality that cannot exist at this time. Often those making decisions about risk in Scotland rarely run them. The recent clusters continue to show why the risks to public health from the pandemic are still considerable for workers too. They indicate why it is so important for those working in risky settings to have a means to influence health and safety decisions such as the 2m guidance in the future. The Scottish Government has shown some commitment to Fair Work principles and consulting unions about guidance on health and safety issues relating to COVID-19. Whether it will be able to deliver on those promises in the future and improve worker health and safety and public health post-pandemic looks more problematic. This is especially the case when the managers of large Scottish estates and corporate lobbyists have surprisingly been given the task of preparing reports for the Scottish Government on economic recovery post-COVID-19 and economic policy that have marginalised and ignored worker health and safety.

• This article is an abridged version of ‘KEEP YOUR DISTANCE: Is two metres too far or not far enough to protect from COVID-19 and who benefits and who loses if it is reduced?’ by the same authors. It can and extensive references to further research can be found at http://www.hazardscampaign.org.uk/wp-content/uploads/2020/06/two-metre-commentary.pdf

Andrew Watterson is Professor of Health in the Occupational and Environmental Health and Public Health and Population Health research groups at the University of Stirling. Rory O’Neill is a visiting professor at the School of Law and Social Justice, University of Liverpool, the occupational health and workplace safety adviser to the International Trade Union Confederation (ITUC) and the editor of Hazards magazine www.hazards.org Janet Newsham is the chair of the National Hazards Campaign and Coordinator at Greater Manchester Hazards Centre. Hilda Palmer, a biologist and workers’ health and safety advisor, worked at Greater Manchester Hazards Centre for 33 years and is the facilitator of Families Against Corporate Killers.

References

Independent SAGE statement on 2m vs 1m social distance guidance in indoor settings https://www.independentsage.org/wp-content/uploads/2020/07/2m-vs-1m-guidance-Independent-SAGE-statement-June-21-3.pdf June 21 2020
ILO (2020) A safe and healthy return to work during the COVID-19 pandemic, 21 May 2020 https://www.ilo.org/global/topics/safety-and-health-at-work/resources-library/publications/WCMS_745549/lang–en/index.htm
Scottish Government (2020) COVID-19 Advisory Group: physical distancing advice. https://www.gov.scot/publications/covid-19-advisory-group-physical-distancing-advice/
UK Government (2020) Review of two metre social distancing guidance: Summary of review findings. https://www.gov.uk/government/publications/review-of-two-metre-social-distancing-guidance
UK Government (2020) Principles of understanding of transmission routes to inform risk assessment and mitigation strategies https://www.gov.uk/government/publications/principles-of-understanding-of-transmission-routes-to-inform-risk-assessment-and-mitigation-strategies-updated-14-may-2020

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