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

Girvan Burnside; Christopher P Cheyne; Gary Leeming; Michael Humann; Alistair Darby; Mark A Green; Alexander Crozier; Simon Maskell; Kay O'Halloran; Elena Musi; Elinor Carmi; Naila Khan; Debra Fisher; Rhiannon Corcoran; Jake Dunning; W John Edmunds; Kukatharmini Tharmaratnam; David M Hughes; Liora Malki-Epshtein; Malcolm Cook; Ben M Roberts; Eileen Gallagher; Kate Howell; Meera Chand; Robin Kemp; Matthew Boulter; Tom Fowler; Malcolm G Semple; Emer Coffey; Matt Ashton; COVID-19 Genomics UK (COG-UK) Consortium; Marta García-Fiñana; Iain E Buchan

doi:10.1177/01410768231182389

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

J R Soc Med. 2024 Jan;117(1):11-23. doi: 10.1177/01410768231182389. Epub 2023 Jun 23.

Authors

Girvan Burnside¹, Christopher P Cheyne¹, Gary Leeming¹, Michael Humann², Alistair Darby³, Mark A Green⁴, Alexander Crozier⁵, Simon Maskell⁶, Kay O'Halloran⁷, Elena Musi⁷, Elinor Carmi⁸, Naila Khan⁹, Debra Fisher⁹, Rhiannon Corcoran⁹, Jake Dunning¹⁰, W John Edmunds¹¹, Kukatharmini Tharmaratnam¹, David M Hughes¹, Liora Malki-Epshtein¹², Malcolm Cook¹³, Ben M Roberts¹³, Eileen Gallagher¹⁴, Kate Howell¹⁴, Meera Chand¹⁴, Robin Kemp¹⁵, Matthew Boulter¹⁴, Tom Fowler^{14

15}, Malcolm G Semple¹⁶, Emer Coffey¹⁷, Matt Ashton^{17

18}; COVID-19 Genomics UK (COG-UK) Consortium; Marta García-Fiñana¹, Iain E Buchan¹⁸

Affiliations

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.

Keywords: COVID-19; SARS-CoV-2 transmission; cultural events; mass gatherings; respiratory virus risk mitigation.

Publication types

Observational Study

MeSH terms

COVID-19 Testing
COVID-19* / epidemiology
COVID-19* / prevention & control
Carbon Dioxide
Humans
Prospective Studies
SARS-CoV-2
State Medicine
United Kingdom / epidemiology

Substances

Carbon Dioxide

Abstract

Publication types

MeSH terms

Substances

Grants and funding