It’s easy to assume that if influenza could be transmitted within the home, at school and at work, that the risk is exponential at a sports event or festival. Evidence has shown us that if restrictions on mass gatherings are implemented early on in pandemic, alongside other social distancing measures, can greatly reduce the risk of transmission. However, research conducted into virus transmission at mass gatherings is showing that there is varied evidence in the association of size with the transmission of influenza (Ishola and Phin, 2011). In the current climate, the banning of events seems to be based on size rather than any other factor, but is this the appropriate metric to measure? Is the risk of transmission greatly reduced by banning an event over 1,000 people but allowing one with 999 to go ahead?

Density and Duration

Reducing density and shortening duration at an event reduces the risk of transmission.

Research into public health at mass gatherings shows that it appears the type of event is key in assessing the level of risk to spreading influenza (Ishola and Phin, 2011). Events with high crowd densities (estimated at 5 or more per square metre) and where people lived close together for prolonged periods, for example, Hajj pilgrimage and large music festivals, displayed high rates of transmission (Memish et al, 2015). The authors even claim that the size of the event does not seem to be a critical factor. The higher transmission rates seem to be where contact continues outside of the event venue, such as accommodation; and events with campsites usually have sub-optimal hygiene facilities.  

Reducing density is usually the first policy implemented as we already know that social distancing works. Evidence tells us that cities implementing rapid and strict non-pharmaceutical measures including social distancing early on in a pandemic, recover quicker than cities that don’t (Correia et al, 2020). Reducing density and shortening duration at an event reduces the risk of transmission. 

Virus Hotspots

Recent studies indicate that the novel coronavirus can remain in aerosols for up to 3 hours and on plastic and stainless steel for up to 72 hours (Doremalen, 2020). However, the virus remains stable for around 180 minutes with decline after 3 hours (Lewis, 2020). Another study found the virus can last for up to 9 days (Kampf et al, 2020).  Transmission is also higher indoors compared to outdoors (Qian et al, 2020). This can enable spaces like hygiene facilities to become virus hotspots, regardless of how good a social distancing policy is. 

A previous study showcased the rate of transmission through UV light using a ‘fake virus’. After inoculating a bathroom faucet and exit door handle in an office, the resin spread to staff’s hands, face, phone and hair. 20 minutes after arriving home from work, the resin was then found on their keys, purses, doorknobs, countertops, kitchen appliances and light switches (Reynolds et al, 2005). This highlights how thorough and frequent hand washing is crucial to reducing transmission.

The fear of a pandemic can have worse implications than the virus itself

Honingsbaum, 2013

Fear and Behaviour

Researching the impact of previous pandemics such as the 1918 Spanish Flu and Ebola, academics and doctors stated that the fear of a pandemic can have worse implications than the virus itself (Honigsbaum, 2013) (Kolata, 2020). Negative emotions that result from a threat can be contagious, and fear can make the threat feel real (Bavel et al, 2020). There’s no event without our crowd and so, not only is our challenge in changing crowd behaviour in this climate, it’s instilling confidence to even attend an event in the first place. We know that emotions, rather than factual information, often drive our perception of risk and those who have favourable feelings towards an activity will judge its risk as low and benefits high (Slovic et al, 2004). An example of this is in a recent survey of festival attendees in the UK, Germany, France and the Netherlands, which indicated 82% of 110,000 felt confident attending a festival within one to six months of the lockdown being lifted (Parry, 2020). Those who want to attend events will still attend events. 

Then there is an element of ‘retraining’ the crowd. We have already been ‘taught’ to maintain social distance, to wash our hands frequently, to queue patiently to get into the local supermarket and to gladly allow key workers ahead of us. This has been accepted into our social parameters and we risk reputation and shame if we do not adhere.  Social norms differ across cultures and this has an impact on the risk of transmission.  For example, societies that promote individualism (North America, Western Europe) can have higher rates of transmission than through interdependent cultures (Asia), due to priority given to moral obligation over personal desires and punishment for deviance (Bavel et al, 2020). Furthermore, we all hold bias and often rely on heuristics (Kahneman, 2011). Therefore it is crucial to consider how your audience behaves, what fears and expectations they have, and what their perception of risk is when forming a ‘restart’ strategy.

Restarting Strategies

Risk is dynamic because humans are dynamic.

How does this information assist the events industry in getting back on its feet?  Considering the evidence, we can develop strategies that reduce the risk of transmission. For example; events could start with low densities, short durations and ensure welfare facilities are designed of high quality and frequently cleaned.

Alongside continued social distancing, what other actions can we take to reduce risk and increase safety? Focusing on virus hotspots, we’re seeing measures taken for restroom facilities including using touchless fixtures, propping doors open to minimise contact (not fire doors, unless automatic release system in place), using one way systems, and putting wastebaskets on exit (for those who use paper to avoid touching faucets) (Occupational Health & Safety, 2020). The Event Safety Alliance published a comprehensive guide to reopening venues safely and recommend strategies including electrostatic cleaning mist to spray over seats in between events (Adelman, 2020). User behaviour is changing too, for example, an American company that makes workplace bathrooms conducted a survey and found 91% customers now want touchless facilities, a statistic they’ve never seen before (Fisher, 2020). 

There is no one certified magic fixer here, but there is a lot we can do. Risk is dynamic because humans are dynamic. At 9 am after a thorough clean, your venue could be low risk in transmitting the virus. At 09:20 am your venue could become high-risk after 100 people were let in, mingle in the foyer and then all used the restroom. 

It is salient to remember virus transmission is one of many risks that can affect the health, safety and welfare of your staff and attendees. Whether or not we are experiencing a pandemic; constant vigilance, dynamic risk assessment and consistent action can reduce risk and keep our crowds safe at events.

References

Adelman, S. A. (2020) “The Event Safety Alliance Reopening Guide.” Event Safety Alliance.

Bavel, J. J. V., Baicker, K., Boggio, P. S., Capraro, V., Cichocka, A., Cikara, M., Crockett, M. J., Crum, A. J., Douglas, K. M., Druckman, J. N., Drury, J., Dube, O., Ellemers, N., Finkel, E. J., Fowler, J. H., Gelfand, M., Han, S., Haslam, S. A., Jetten, J., Kitayama, S., Mobbs, D., Napper, L. E., Packer, D. J., Pennycook, G., Peters, E., Petty, R. E., Rand, D. G., Reicher, S. D., Schnall, S., Shariff, A., Skitka, L. J., Smith, S. S., Sunstein, C. R., Tabri, N., Tucker, J. A., Linden, S. van der, Lange, P. van, Weeden, K. A., Wohl, M. J. A., Zaki, J., Zion, S. R. and Willer, R. (2020) “Using social and behavioural science to support COVID-19 pandemic response.” Nature Human Behaviour pp. 1–12.

Correia, S., Luck, S. and Verner, E. (2020) “Pandemics Depress the Economy, Public Health Interventions Do Not: Evidence from the 1918 Flu.” SSRN Electronic Journal.

Doremalen, N. van, Bushmaker, T., Morris, D. H., Gamble, A., Williamson, B. N., Tamin, A., Harcourt, J. L., Thornburg, N. J., Gerber, S. I., Lloyd-Smith, J. O., Wit, E. de, Munster, V. J. and Holbrook, M. G. (2020) “Aerosol and Surface Stability of SARS-CoV-2   as Compared with SARS-CoV-1.” New England Jourrnal of Medicine. (The New England Journal of Medicine), May.

Fisher, M. (2020) “Nature calls: Why public toilets are causing a lockdown easing dilemma.” Independent. [Online] 25th May. https://www.independent.co.uk/life-style/coronavirus-public-toilets-lockdown-easing-parks-homeless-a9526556.html.

Honigsbaum, M. (2013) “Regulating the 1918–19 Pandemic: Flu, Stoicism and the Northcliffe Press.” Medical History, 57(2) pp. 165–185.

Ishola, D. A. and Phin, N. (2011) “Could influenza transmission be reduced by restricting mass gatherings? Towards an evidence-based policy framework.” Journal of Epidemiology and Global Health, 1(1) pp. 33–60.

Kahneman, D. (2011) Thinking, Fast and Slow. St Ives: Penguin Books.

Kampf, G., Todt, D., Pfaender, S. and Steinmann, E. (2020) “Persistence of coronaviruses on inanimate surfaces and its inactivation with biocidal agents.” Journal of Hospital Infection, 104(3) pp. 246–251.

Kolata, G. (2020) https://www.nytimes.com/2020/05/10/health/coronavirus-plague-pandemic-history.html

Lewis, R. (2020) Coronavirus Stays in Aerosols for Hours, on Surfaces for Days. Medscape Medical News. [Online] https://www.medscape.com/viewarticle/926929_print.

Memish, Z. A., Assiri, A., Turkestani, A., Yezli, S., Masri, M. al, Charrel, R., Drali, T., Gaudart, J., Edouard, S., Parola, P. and Gautret, P. (2015) “Mass gathering and globalization of respiratory pathogens during the 2013 Hajj.” Clinical Microbiology and Infection, 21(6) pp. 571.e1-571.e8.

Occupational Health & Safety (2020) Five Restroom Upgrades to Improve Hand Washing and Minimize Germs. [Online] [Accessed on May 29th, 2020] https://ohsonline.com/Articles/2020/05/29/Five-Restroom-Upgrades-to-Improve-Hand-Washing-and-Minimize-Germs.aspx?Page=3.

Parry, A. (n.d.) After Lockdown Survey: 82% of festival-goers ready to return to live events. Event Industry News. [Online] [Accessed on May 31st, 2020] https://www.eventindustrynews.com/news/after-lockdown-survey-82-of-festival-goers-ready-to-return-to-live-events.

Qian, H., Miao, T., Liu, L., Zheng, X., Luo, D. and Li, Y. (2020) “Indoor transmission of SARS- Co V-2.” (MedRXiv), April.

Reynolds, K. A., Watt, P. M., Boone, S. A. and Gerba, C. P. (2005) “Occurrence of bacteria and biochemical markers on public surfaces.” International Journal of Environmental Health Research, 15(3) pp. 225–234.

Slovic, P., Finucane, M. L., Peters, E. and MacGregor, D. G. (2004) “Risk as Analysis and Risk as Feelings: Some Thoughts about Affect, Reason, Risk, and Rationality.” Risk Analysis, 24(2) pp. 311–322.

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