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burnside-et-al-2023-covid-19-risk-mitigation-in-reopening-mass-cultural-events-population-based-observational-study-for.pdf (526.92 kB)

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

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posted on 2023-08-02, 15:51 authored by 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 CookMalcolm Cook, Ben M RobertsBen M Roberts, Eileen Gallagher, Kate Howell, Meera Chand, Robin Kemp, Matthew Boulter, Tom Fowler, Malcolm G Semple, Emer Coffey, Matt Ashton, The COVID-19 Genomics UK (COG-UK) consortium, Marta García-Fiñana, Iain E Buchan

Objectives: To understand SARS-CoV-2 transmission risks, perceived risks, and the feasibility of risk-mitigations from experimental mass cultural events before COVID-19 restrictions were lifted.

Design: Prospective, population-wide observational study.

Setting: Four events (two nightclubs; outdoor music festival; business conference) open to Liverpool City Region UK residents, requiring a negative lateral flow test (LFT) within the 36 hours before the event, but not requiring social distancing or face-coverings.

Participants: 12,256 individuals attending one or more event between 28th April and 2nd May 2021.

Main outcome measures: SARS-CoV-2 infections detected using audience self-swabbed (5-7 days post-event) PCR tests, with viral genomic analysis of cases, plus linked NHS COVID-19 testing data. Audience experiences were gathered via questionnaires, focus groups and social media. Indoor CO2 concentrations were monitored.

Results: 12 PCR-positive cases (likely 4 index; 8 primary or secondary), 10 from the nightclubs. Two further cases had positive LFTs but no PCR. 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.



National Institute for Health Research Applied Research Collaboration North West Coast

Medical Research Council (MRC)

National Institute of Health Research (NIHR) [grant code: MC_PC_19027]

Wellcome Sanger Institute



  • Architecture, Building and Civil Engineering

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Journal of the Royal Society of Medicine


SAGE Publications


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© The Royal Society of Medicine

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This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

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Dr Ben Roberts. Deposit date: 1 June 2023

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