Is Euro 2020 a super spreader event?

 Is Euro 2020 a super spreader event?

The difference between the two ongoing football fests couldn’t be starker. While the players in the Copa America play their hearts out in echoing empty stadia, the Euro 2020 games are just as festive as ever, playing out in front of die-hard, (seems like an inappropriate word to use here, but I am going with it anyway) ostensibly Covid-free fans. As I watch the matches with a mixture of hope and envy, there’s this niggling feeling in the back of my mind that’s becoming increasingly difficult to ignore. Now, just to be clear, I am as eager as the next guy to be seduced by the allure of a Covid-free world. But are we really there yet? Is Europe going to see a new wave of infections? I know that precautions are being taken, but the sight of the Puskas Arena, packed to the brim, is deeply unsettling! So I thought I’d take a closer look.

 

A tale of eleven cities

One unintended consequence of Covid-19 is that it has democratised the UEFA Cup; countries and cities which have never hosted a match have now been given a chance. So we have a heterogeneous set host cities, spanning the entire geographic and figurative breadth of Europe, from Baku to Copenhagen. With this heterogeneity comes differences in the proportion of people fully immunised, different entry requirements, and a range of allowed capacities for the stadia. The table below summarises some of these differences.

 

City	Number of Group stage matches	Proportion of the population fully immunised (%)	Entry requirements for spectators*	Allowed stadium capacity (%)
Rome	3	29.5	T, V, or I	25
Baku	3	11.9	None	50
Copenhagen	3	31.4	T, V, or I	45
St. Petersburg	6	11.7	Temperature check	50
London	3	48.7	T#	25
Bucharest	3	23	T, V, or I	25
Amsterdam	3	31.6	T	33
Glasgow	3	48.9	None	25
Seville	3	33.9	None	30
Budapest	3	49.5	T, or V	100
Munich	3	35.4	T, V, or I	20

Proportion of the population vaccinated is for the respective countries. *Entry requirements: T - Negative test for COVID-19, usually RT-PCR, V - Proof of vaccination, I - Proof of immunity/convalescent status. # Only a negative lateral-flow test will do (RT-PCR test not sufficient). Data are from https://www.ispo.com/en/know-how/uefa-euro-2020-and-corona-these-rules-apply-fans, and https://ourworldindata.org/coronavirus

 

The red flags are obvious, and glaring! For one, 4 of the 11 venues do not need a negative Covid test, or proof of immunity, for stadium entry! A temperature check (required for entry into Krestovsky Stadium) is inaccurate, easily evaded, and provides no reassurance to anyone. Its uselessness seems to be equalled, only by its apparent indispensability around the world! Even where laboratory tests are required, authorities prefer the RT-PCR test. Unfortunately, it is not well appreciated that a negative RT-PCR test is not very useful and is not always good enough to rule out infection (a positive test has better value).  (https://www.bmj.com/content/bmj/369/bmj.m1808.full.pdf) Perhaps because of this limitation, authorities in London require a negative lateral flow test (and not a negative RT-PCR) for entry into Wembley. But these tests too vary in their sensitivity, and can be particularly poor in detecting infections among people without symptoms. (https://www.bmj.com/content/bmj/372/bmj.n823.full.pdf) Poor testing strategy combined with a large susceptible population (read Azerbaijan and Russia) surely does not bode well! And to top it all, St Petersburg hosted twice the number of matches as any other venue, in rather quick succession. The one bright spot is that most stadia were allowed to fill to less than 50% of their capacity (except for the Puskas Arena in Budapest). But hilariously enough, they also required fans to mask up and maintain “a minimum distance of 1.5 meters” between each other! Impractical idealism, that was inevitably, trampled upon by thousands of insouciant fans.

 

Super leagues and super spreaders

The games have been on for about 2 weeks now. Are there any signs of an emerging wave of infections? The number of daily Covid-19 cases appears to show a rising trend in 2 (St. Petersburg and Glasgow) of the 4 cities where there were no testing requirements. (Figure) An uptick in infections was also observed among Finnish fans returning from St. Petersburg. London too shows an increase in daily cases, but to be fair, the numbers were already rising over the weeks prior to the games. Budapest did not show an increase in cases, but the number of tests done per day showed a reducing trend, in contrast to all the other cities, where they increased.

 

Figure: Daily new COVID-19 cases in the St. Petersburg area and Scotland

Now, the link between the games and the increase in case numbers cannot be considered causal. There are too many factors, both known and unknown, at play here. Nevertheless, it would be foolish to ignore these trends. Given what we know about the virus, how it spreads, the emergence of the more infectious variants, and experience from similar events in other countries, it only makes sense to assume that putting a large number of people together in one place isn’t a good idea. Particularly when they have a tendency to vent frequently and uncontrollably. Testing may not pick up everyone who has the virus, and vaccinated individuals may be infected (particularly with the new variants) without showing signs of disease, and may pass on the virus to susceptible people around them. But, the die is cast, as they say. It seems that at least in the near-term, eternal vigilance is the price we have to pay for even a little joie de vivre.