COVID-19 risk mitigation in reopening mass cultural events: population-based observational study for the UK Events Research Programme in Liverpool City Region

Author:

Burnside Girvan1,Cheyne Christopher P1,Leeming Gary1,Humann Michael2,Darby Alistair3,Green Mark A4,Crozier Alexander5,Maskell Simon6,O’Halloran Kay7,Musi Elena7,Carmi Elinor8,Khan Naila9,Fisher Debra9,Corcoran Rhiannon9,Dunning Jake10,Edmunds W John11,Tharmaratnam Kukatharmini1,Hughes David M1,Malki-Epshtein Liora12,Cook Malcolm13,Roberts Ben M13,Gallagher Eileen14,Howell Kate14,Chand Meera14,Kemp Robin15,Boulter Matthew14,Fowler Tom1415,Semple Malcolm G16,Coffey Emer17,Ashton Matt1718ORCID,García-Fiñana Marta1,Buchan Iain E18ORCID,

Affiliation:

1. Deparment of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool L69 3GL, UK

2. Department of Psychology, University of Liverpool, Liverpool L69 7ZA, UK

3. Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK

4. Department of Geography and Planning, University of Liverpool L69 3BX, Liverpool, UK

5. Division of Biosciences, University College London, London WC1E 6BT, UK

6. Department of Electrical Engineering and Electronics, University of Liverpool, Liverpool L69 3BX, UK

7. Department of Communication and Media, University of Liverpool, Liverpool L69 7ZG, UK

8. Department of Sociology and Criminology, City University, London EC1V 0HB, UK

9. Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool L69 3BX, UK

10. Pandemic Sciences Institute, University of Oxford, Oxford OX3 7DQ, UK

11. Centre for Mathematical Modelling of Infectious Diseases and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK

12. Department of Civil, Environmental and Geomatic Engineering, University College London, London WC1E 6BT, UK

13. Building Energy Research Group, School of Architecture, Building and Civil Engineering, Loughborough University, Loughborough LE11 3TU, UK

14. Clinical and Public Health Group, UK Health Security Agency, London SW1P 3JR, UK

15. William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK

16. Department of Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK

17. Liverpool City Council, Liverpool L3 1AH, UK

18. Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool L69 3GB, UK

Abstract

Objectives To understand severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission risks, perceived risks and the feasibility of risk mitigations from experimental mass cultural events before coronavirus disease 2019 (COVID-19) restrictions were lifted. Design Prospective, population-wide observational study. Setting Four events (two nightclubs, an outdoor music festival and a business conference) open to Liverpool City Region UK residents, requiring a negative lateral flow test (LFT) within the 36 h before the event, but not requiring social distancing or face-coverings. Participants A total of 12,256 individuals attending one or more events between 28 April and 2 May 2021. Main outcome measures SARS-CoV-2 infections detected using audience self-swabbed (5–7 days post-event) polymerase chain reaction (PCR) tests, with viral genomic analysis of cases, plus linked National Health Service COVID-19 testing data. Audience experiences were gathered via questionnaires, focus groups and social media. Indoor CO2 concentrations were monitored. Results A total of 12 PCR-positive cases (likely 4 index, 8 primary or secondary), 10 from the nightclubs. Two further cases had positive LFTs but no PCR. A total of 11,896 (97.1%) participants with scanned tickets were matched to a negative pre-event LFT: 4972 (40.6%) returned a PCR within a week. CO2 concentrations showed areas for improving ventilation at the nightclubs. Population infection rates were low, yet with a concurrent outbreak of >50 linked cases around a local swimming pool without equivalent risk mitigations. Audience anxiety was low and enjoyment high. Conclusions We observed minor SARS-CoV-2 transmission and low perceived risks around events when prevalence was low and risk mitigations prominent. Partnership between audiences, event organisers and public health services, supported by information systems with real-time linked data, can improve health security for mass cultural events.

Funder

UK Government Department of Digital Culture Media and Sport

National Institute for Health and Care Research

UK Research and Innovation

Publisher

SAGE Publications

Subject

General Medicine

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