Mass Gathering Events Research Articles

Observation of spectators’ mask-wearing behavior at a national basketball tournament

ABSTRACT Rationale/purpose Mass gathering events have resumed with the availability of SARS-CoV-2 vaccines. However, the pandemic is ongoing and such events potentially contribute to upsurges in COVID-19 cases. There is mounting evidence that public health mitigation strategies such as mask requirements, capacity restrictions, and physical distancing reduce transmission risk. However, evidence suggests imperfect compliance with these strategies. This study aimed to quantify spectators’ masking behaviors and identify correlates of mask-wearing during a major sporting event. Design/methodology/approach This study used a repeated cross-sectional design, in which trained observers used a web-based application to record counts of mask-wearing. Findings Overall, 74% of spectators observed correctly wore masks. Mask-wearing behavior was associated with presumed sex, location of the spectator, game competitiveness, and whether the teams playing originated from a state with an active mask mandate. Implications Understanding the factors associated with masking behavior may help venues prepare for future events and identify innovative and targeted strategies to promote compliance with public health mitigation measures. Contribution This study makes contributions to understanding how to manage public health risks during a high-profile sporting event, specifically by identifying spectator-, game-, venue-, and state-level factors associated with mask-wearing.

Association between two mass-gathering outdoor events and incidence of SARS-CoV-2 infections during the fifth wave of COVID-19 in north-east Spain: A population-based control-matched analysis.

SummaryBackgroundMany countries have resumed mass-gathering events like music festivals, despite the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreading. In this study, we aimed to assess the effect of two mass-gathering outdoor events, held during a peak of SARS-CoV-2 transmission, on COVID-19 incidence.MethodsThis was a retrospective, population-based control-matched analysis. The study population included attendees to two outdoor music festivals held in Catalonia (North-East Spain). The primary objective was to compare the incidence of COVID-19 within the 3-to-10 days following the event between attendees and a population-based control group.FindingsThe analysis included 18,275 and 27,347 attendees to the first and second festivals, respectively, and their corresponding controls. The post-festival 7-day cumulative COVID-19 incidence among attendees and controls was 4.14% (95% CI 3.86-4.44) vs. 1.69% (1.51-1.88) for the first festival (RR 2.46; 2.16-2.80), and 2.42% (2.35-2.61) and 1.10% (0.99-1.2) for the second festival (RR 2.19; 1.92-2.51). COVID-19 incidence among immunized individuals was also two-fold higher in attendees than in controls. Previous COVID-19 infection, vaccination, and adequate mask-wearing were significantly associated with a lower risk of COVID-19 infection after the events.InterpretationDespite the proven effectiveness of preventive measures such as Ag-RDT screening, mask-wearing and vaccination, caution should be taken when holding these events during a period of high community SARS-CoV-2 transmission.FundingCrowdfunding campaign YoMeCorono (https://www.yomecorono.com/) and the Generalitat de Catalunya.

Assessment of supplied water quality during mass gatherings in arid environments

Mass gathering events commonly encounter environmental challenges that necessitate assurance of water quality and food security. The current outbreak of the coronavirus disease 2019 (COVID-19) call for maintaining safe drinking water supply and providing assessment tools of drinking water quality to avoid contamination in water sources or distribution networks. Arid environmental conditions also add more stress on supplied water to mass gathering events. Herein, we assess the quality of the water supply (desalinated 95% and groundwater 5%) in Makkah city, Saudi Arabia during a mass gathering event in 2019 (9.6 million people) for religious purposes. Fifty five samples were randomly collected from nine different districts of Makkah city, analyzed for TDS, turbidity, pH, EC, free Cl2, Al, Cd, Pb, Cr, F, major ions, coliform and E.coli bacteria and were finally used to estimate the water quality index (WQI). Major ions, trace elements and heavy metals analyses show values below permissible limits in most of the samples, while a few samples show slightly higher values. No bacterial count found in any sample. WQI values of all fifty-five samples were below 50 and were identified as “excellent water”. The WQI variations could be attributed to the distribution network conditions rather than a direct impact of adding groundwater with uncontrolled chemical composition. The use of WQI to report the quality of water during mass gathering events to governmental authorities has been proved to be beneficial and should be applied for further mass gathering events worldwide.

Sanitary safety of the 2021 French Intensive Care Society medical conference: a case/control study

BackgroundIn-person mass gathering events (MGE) are returning after a period of restrictions, yet few prospective scientific evaluations of their safety are available.MethodsProspective observational study, including both attendees of the French Intensive Care Society (FICS) annual meeting held in Paris between June the 9th and June the 11th, 2021 and matched controls (healthcare professionals who stayed in the ICU during the conference). SARS-CoV-2 lateral flow test was performed on day 7. Follow-up occurred until day 21.ResultsOut of the 1824 healthcare professionals attending the congress (all of which fulfilled legal requirements: 7 days or more following a second dose of vaccine or a negative PCR test performed within less than 72 h), 520 (28.5%) agreed to participate. Follow-up data were received for 216 (41.5%) out of the 520 included attendees, and for 191 matched controls. No positive SARS-CoV-2 lateral flow test was reported in the attendees or in the matched controls. The probability of SARS-CoV-2 infection during the MGE was less than 1.7% in the attendees (95% confidence interval [0;1.7%]), less than 2% in the controls (95%CI [0;2%]) and the difference in probabilities of infection was less than 1.9% (95% CI [0;1.9%]).ConclusionDuring a low incidence period, in this population of congress attendees screened for SARS-CoV-2 by a lateral flow test at day 7, no positive cases could be documented, no concomitant infection occurred in the matched controls; suggesting no extra risk of infection during the MGE.Trial Registration: ClinicalTrial.gov, #NCT04918160.

The effects of super spreading events and movement control measures on the COVID-19 pandemic in Malaysia

This paper aims to develop an automated web application to generate validated daily effective reproduction numbers (Rt) which can be used to examine the effects of super-spreading events due to mass gatherings and the effectiveness of the various Movement Control Order (MCO) stringency levels on the outbreak progression of COVID-19 in Malaysia. The effective reproduction number, Rt, was estimated by adopting and modifying an Rt estimation algorithm using a validated distribution mean of 3.96 and standard deviation of 4.75 with a seven-day sliding window. The Rt values generated were validated using thea moving window SEIR model with a negative binomial likelihood fitted using methods from the Bayesian inferential framework. A Pearson’s correlation between the Rt values estimated by the algorithm and the SEIR model was r = 0.70, p < 0.001 and r = 0.81, p < 0.001 during the validation period The Rt increased to reach the highest values at 3.40 (95% CI 1.47, 6.14) and 1.72 (95% CI 1.54, 1.90) due to the Sri Petaling and Sabah electoral process during the second and third waves of COVID-19 respectively. The MCOs was able to reduce the Rt values by 63.2 to 77.1% and 37.0 to 47.0% during the second and third waves of COVID-19, respectively. Mass gathering events were one of the important drivers of the COVID-19 outbreak in Malaysia. However, COVID-19 transmission can be fuelled by noncompliance to Standard Operating Procedure, population mobility, ventilation and environmental factors.

Predicting medical usage rate at mass gathering events in Belgium: development and validation of a nonlinear multivariable regression model

BackgroundEvery year, volunteers of the Belgian Red Cross provide onsite medical care at more than 8000 mass gathering events and other manifestations. Today standardized planning tools for optimal preventive medical resource use during these events are lacking. This study aimed to develop and validate a prediction model of patient presentation rate (PPR) and transfer to hospital rate (TTHR) at mass gatherings in Belgium.MethodsMore than 200,000 medical interventions from 2006 to 2018 were pooled in a database. We used a subset of 28 different mass gatherings (194 unique events) to develop a nonlinear prediction model. Using regression trees, we identified potential predictors for PPR and TTHR at these mass gatherings. The additional effect of ambient temperature was studied by linear regression analysis. Finally, we validated the prediction models using two other subsets of the database.ResultsThe regression tree for PPR consisted of 7 splits, with mass gathering category as the most important predictor variable. Other predictor variables were attendance, number of days, and age class. Ambient temperature was positively associated with PPR at outdoor events in summer. Calibration of the model revealed an R2 of 0.68 (95% confidence interval 0.60–0.75). For TTHR, the most determining predictor variables were mass gathering category and predicted PPR (R2 = 0.48). External validation indicated limited predictive value for other events (R2 = 0.02 for PPR; R2 = 0.03 for TTHR).ConclusionsOur nonlinear model performed well in predicting PPR at the events used to build the model on, but had poor predictive value for other mass gatherings. The mass gathering categories “outdoor music” and “sports event” warrant further splitting in subcategories, and variables such as attendance, temperature and resource deployment need to be better recorded in the future to optimize prediction of medical usage rates, and hence, of resources needed for onsite emergency medical care.

Results of the enhanced COVID-19 surveillance during UEFA EURO 2020 in Germany.

Abstract In general, mass gatherings might pose a risk to the public health (PH). The UEFA EURO 2020 tournament (EURO 2020) was one of the first mass gathering events since the start of the coronavirus disease 2019 (COVID-19) pandemic in Germany. To allow early detection and response to any EURO 2020-associated impact on the COVID-19-related epidemiological situation, we initiated enhanced surveillance activities using the routine surveillance system in collaboration with the regional PH authority of Bavaria. Several preventive measures regarding the attendance of football matches and public viewing were implemented according to state regulations. We describe the results from the enhanced surveillance during the EURO 2020. In total, five cases who had attended a football match in the stadium of Munich, nine cases, who attended a football match in a stadium outside of Germany, and 123 cases in association with public viewing events were identified by enhanced surveillance. Concluding, the EURO 2020 seems to not have had a major impact on the COVID-19 pandemic development in Germany. Health measures for stadium visitors and the restriction of large public viewing events may have potentially contributed to the low case numbers detected, emphasising the need of appropriate PH surveillance and regulations to limit the potential risk to PH during mass gathering events.

Risk Assessment and Management at Mass Gathering Events: Case studies of Testing and Vaccination

Risk Assessment and Management at Mass Gathering Events: Case studies of Testing and Vaccination

Modelling and Improving the Passenger Evacuation Process in a Bi-Modal System with Bus and E-Hailing Modes after Mass Gathering Events

Modelling and Improving the Passenger Evacuation Process in a Bi-Modal System with Bus and E-Hailing Modes after Mass Gathering Events

Implementing Solution-focused Risk Assessment and Control for Mass Gathering Events

Implementing Solution-focused Risk Assessment and Control for Mass Gathering Events

The role of emergency medical services providers during mass gathering

Background: Mass gatherings are worldwide events, and the Hajj season is considered one of the significant mass gathering events that happen annually in Makkah city, Saudi Arabia. Medical preparation such as preparation for transportation, training, and medical staffing for mass gatherings at existing sites has been discussed. Aims: This study aimed to assess the role of emergency medical services (EMS) providers during Hajj Season 2019 and the preparedness of the EMS system through providers' perspectives. Settings and Design: A cross-sectional survey using a questionnaire has been conducted in Makkah during the Hajj season 2019, which took place in Mena valley and Arafat. Methods: Convenience sampling from two major institutions (the Saudi Red Crescent and the National Guards Hospital, EMS Department) was used. The inclusion criteria included emergency medical specialists and emergency medical technicians. Statistical Analysis Used: The data were analyzed using JMP. Data for continuous variables were presented as mean and standard deviation if normally distributed, otherwise median and interquartile range were used. Data for the categorical variables were presented as frequencies and percentages. Results: The majority of EMS providers were male in gender and almost half of them were emergency medical technicians with a diploma qualification. Most of them had specific training before Hajj such as basic life support. However, the majority reported the use of medications during transport and training are areas that require improvement. During Hajj, the majority of the EMS providers do ambulance decontamination. Busy shifts and lack of workforce were the main reasons for working more than 12 h per shift. Conclusions: This study offers important recommendations for improving the EMS system's preparedness during Hajj, which include more workforce coverage as well as improved providers' qualifications and level of training. Furthermore, this study provides a recommendation to change the scope of practice to treat and release in the majority of cases rather than unnecessarily transport to the hospital. This study urges the importance of collaboration between agencies to facilitate the EMS system.

FIFA World Cup 2022: What can we learn from the inspiring Tokyo 2020 Olympic Games held in COVID-19 times?

Preparation for the FIFA World Cup 2022 (WC2022) comes in the time of the COVID-19 pandemic. This study aims were to (i) provide a brief overview of the 2020 Tokyo Olympic and Paralympic games in the context of the COVID-19 pandemic, and (ii) highlight the potential challenges and opportunities central to the hosting of the FIFA WC2022. The organisation, public health policies and prevention protocols of the postponed 2020 Olympic/Paralympic Games (Tokyo July-August 2021), the infection rates during the event, as well as the upcoming WC2022 and its related preparations and challenges, were analysed. An unparalleled International Olympic Committee (IOC) effort, together with the Japanese government and people’s perseverance and drive, enabled the safe delivery of the Tokyo Olympic/Paralympic Games, which left a legacy beyond sport. This has been aided by the collection of critical data and lessons learnt throughout the games. The stringent public health policies and especially the tight bubble system for players and their respective delegations have certainly been the key components that ensured the successful containment of COVID-19 within the targeted population. One of the most significant lessons learned from the Tokyo 2020 Olympics is the improvement made in controlling COVID-19 in the context of mass gathering events. Strict infection control strategies to prevent future COVID-19 transmission during the FIFA World Cup 2022 are an immediate priority in Qatar and are constantly being prepared. The planned measures and health care strategies appear to be well adjusted to the risk, especially for the large anticipated number of visitors, and can provide sufficient guarantees to conduct relatively “safe” mega sports events.

Winning during a pandemic: epidemiology of SARS-CoV-2 during EURO2020 in Italy.

EURO2020 generated a growing media and population interest across the month period, that peaked with large spontaneous celebrations across the country upon winning the tournament. We retrospectively analysed data from the national surveillance system (indicator-based) and from event-based surveillance to assess how the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) changed in June-July 2021 and to describe cases and clusters linked with EURO2020. Widespread increases in transmission and case numbers, mainly among younger males, were documented in Italy, none were linked with stadium attendance. Vaccination coverage against SARS-CoV-2 was longer among cases linked to EURO2020 than among the general population. Transmission increased across the country, mainly due to gatherings outside the stadium, where, conversely, strict infection control measures were enforced. These informal 'side' gatherings were dispersed across the entire country and difficult to control. Targeted communication and control strategies to limit the impact of informal gatherings occurring outside official sites of mass gathering events should be further developed.

Eye of Devil: Face Recognition in Real World Surveillance Video with Feature Extraction and Pattern Matching

Abstract: People lost, people missing etc., these are the words we come across whenever there is any mass gathering events going on or in crowded areas. To solve this issue some traditional approaches like announcements are in use. One idea is to identify the person using face recognition and pattern matching techniques. There are several techniques to implement face recognition like extraction of facial features by using the position of eyes, nose, jawbone or skin texture analysis etc., By using these techniques a unique dataset can be created for each human. Here the photograph of the missing person can be used to extract these facial features. After getting the dataset of that individual, by using pattern matching techniques, there is a scope to find the person with same facial features in the crowd images or videos. Keywords: Face-Recognition, Image-Processing, Feature extraction, Video-Processing, Pattern-Matching.

Development of On-Site Medical System for Mass-Gathering Events During TOKYO 2020: Vulnerability Analysis Using Healthcare Failure Mode and Effect Analysis.

At mass-gathering events of the Olympic and Paralympic Games, a well-organized, on-site medical system is essential. This study evaluated the vulnerabilities of the prehospital medical system of the TOKYO 2020 Olympic and Paralympic Games (TOKYO2020) to propose corrections that can be generalized to other mass gatherings. The healthcare failure mode and effect analysis (HFMEA) was adopted to analyze vulnerabilities of the on-site medical system proposed by the organizing committee of TOKYO2020. Processes from detecting a patient on the scene to completing transport to a hospital were analyzed. Ten processes with 47 sub-processes and 122 possible failure modes were identified. HFMEA revealed 9 failure modes as vulnerabilities: misidentification of patient, delayed immediate care at the scene, misjudgment of disposition from the on-site medical suite, and inappropriate care during transportation to hospital. Proposed corrections included surveillance to decrease blind spots, first aid brochures for spectators, and uniform protocol for health care providers at the scene. The on-site medical system amended by HFMEA seemed to work appropriately in TOKYO2020.

Evaluation of Food Trucks' Hygiene During Mass Gathering Events.

During any event, food- and waterborne diseases represent a health risk, so food should be kept in a chilled state while being supplied in the trucks before distribution to consumers. The study aimed to evaluate temperature conditions, microbial contamination of food trucks, and their compliance to the basic local and international standards of food safety during a mass gathering event (pilgrimage). Fifty food trucks were evaluated for proper food storing and microbial contamination (load). A food truck inspection checklist was made to check if the trucks followed the standards of food safety and hygiene. The results showed that 90% of the trucks’ refrigerators were between 3 and 5°C. The number of total mesophilic and psychrotrophic bacteria in the contact surfaces varied between 1.93-6.16 (mean 4.0433) and 0.08-4.50 (mean 3.3340) log CFU (colony-forming units)/100 cm2, respectively. The studied food trucks met the standards of food safety and hygiene with a low mean level (45.2%), which was seen in monitoring thermometers/cold chain loggers, proper record of activities, proper disposal of food product waste, and proper practice of handwashing techniques. There were significant associations (p-value < 0.05) found between temperature readings and mesophilic microbial load. Efforts should be increased to reduce food loss by continuous monitoring of these trucks during mass gathering events.

Comparison of Unmanned Aerial Vehicle Technology versus Standard Practice of Scene Assessment by Paramedic Students of a Mass-Gathering Event.

The proliferation of unmanned aerial vehicle (UAV) technology has the potential to change the situational awareness of medical incident commanders' (ICs') scene assessment of mass gatherings. Mass gatherings occur frequently and the potential for injury at these events is considered higher than the general population. These events have generated mass-casualty incidents (MCIs) in the past. The aim of this study was to compare UAV technology to standard practice (SP) in scene assessment using paramedic students during a mass-gathering event (MGE). This study was conducted in two phases. Phase One consisted of validation of the videos and accompanying data collection tool. Phase One was completed by 11 experienced paramedics from a provincial Emergency Medical Services (EMS) service. Phase Two was a randomized comparison with 47 paramedic students from the Holland College Paramedicine Program (Charlottetown, Prince Edward Island, Canada) of the two scene assessment systems. For Phase Two, the paramedic students were randomized into a UAV or a SP group. The data collection tool consisted of two board categories: primary importance with 20 variables and secondary importance with 25 variables. After a brief narrative, participants were either shown UAV footage or the ground footage depending on their study group. After completion of the videos, study participants completed the data collection tool. The Phase One validation showed good consensus in answers to most questions (average 79%; range 55%-100%). For Phase Two, a Fisher's exact test was used to compare each variable from the UAV and SP groups using a P value of .05. Phase Two demonstrated a significant difference between the SP and UAV groups in four of 20 primary variables. Additionally, significant differences were found for seven out of 25 secondary variables. This study demonstrated the accurate, safe, and feasible use of a UAV as a tool for scene assessment by paramedic students at an MGE. No observed statistical difference was noted in a majority of both primary and secondary variables using a UAV for scene assessment versus SP.

Knowledge, Attitude, and Training of Health-Care Workers and Preparedness of Hospital Emergency Departments for the Threat of Communicable Diseases at Mass Gathering Events in Qatar: A Cross-Sectional Study.

This study aimed to assess the knowledge, attitude, and training of health-care workers (HCW), and their perception of the preparedness of hospitals for communicable disease (CD) threats during mass gathering (MG) events. This was a cross-sectional study conducted from June 1 to July 31, 2019, of doctors and registered nurses working in the emergency departments (EDs) of 5 main hospitals in Qatar. A self-administered online survey was used for data collection. The overall mean knowledge score about CD threat among study participants was 75.0% (SD ± 18.1). The majority of the participants had a favorable attitude toward CD preparedness during MG events. The participants achieved high scores in attending workshops on triaging, first aid, and infection control. Study participants as well had favorable perceptions about the current preparedness of their respective hospitals to respond to CD outbreaks in MG events. The participants were knowledgeable about the risk of CD outbreaks during MG events (eg, Federation of International Football Association (FIFA) World Cup games 2022) and had a favorable attitude and necessary training to respond to such outbreaks. Regular practice drills are necessary to ensure that all members of the workforce are knowledgeable of the necessary actions to take in emergent high-risk situations.

Conducting mass gathering events during the COVID-19 pandemic: a case study of Kumbh Mela 2021 as a potential 'super spreader event'.

Background: With the emergence of novel pathogens, there is a debate worldwide on the cancellation or conduction of mass gathering events.Methods: In the current COVID-19 pandemic, this study assesses the challenges in the conduction of the recently held Kumbh Mela mass gathering (MG) which took place from 14th January 2021-29th April 2021 at Haridwar, the capital city of the state of Uttarakhand, India. The correlation between increased cases of COVID-19 and the Kumbh Mela MG has been highlighted through statistical analysis and growth curves using the available data.Results: The Kumbh Mela-2021 emerged as a potential super spreader event with an increase from 37 cases per day to 144 cases per day (276%) in the COVID-19 cases in Haridwar. An increase from 138 to 480 cases per day (236%) and from 45 600 to 92 754 cases per day (92%) was noted in Uttarakhand and India respectively during this MG. A very strong correlation of ‘more than 0.99’ was seen between the number of cumulative cases of COVID-19 in Uttarakhand and Haridwar, and Haridwar and India during the Kumbh Mela in the third wave of the pandemic.Conclusions: The direct influence of Kumbh Mela on the increase in the number of COVID-19 cases is documented. Although, the socio-cultural, psychological, and economical advantages of MGs are considerable, in a developing nation like India organization of such events can be a huge health hazard. The lack of efficient implementation and observance of COVID-19 guidelines increase the necessity of cancellation of such MGs to prevent the outbreak of diseases. Thus, a well conducted risk assessment prior to the hosting of a MG event during a pandemic is required with strict application of precautionary measures during the event to prevent any superspreading events.

"Mass gathering events and COVID-19 transmission in Borriana (Spain): A retrospective cohort study".

Mass gathering events (MGEs) are associated with the transmission of COVID-19. Between 6 and 10 March 2020, several MGEs related to the Falles festival took place in Borriana, a municipality in the province of Castellon (Spain). The aim of this study was to estimate the incidence of COVID-19 and its association with these MGEs, and to quantify the potential risk factors of its occurrence. During May and June 2020, a population-based retrospective cohort study was carried out by the Public Health Center of Castelló and the Hospital de la Plana in Vila-real. Participants were obtained from a representative sample of 1663 people with potential exposure at six MGEs. A questionnaire survey was carried out to obtain information about attendance at MGEs and COVID-19 disease. In addition, a serologic survey of antibodies against SARS-Cov-2 was implemented. Inverse probability weighted regression was used in the statistical analysis. A total of 1338 subjects participated in the questionnaire survey (80.5%), 997 of whom undertook the serologic survey. Five hundred and seventy cases were observed with an attack rate (AR) of 42.6%; average age was 36 years, 62.3% were female, 536 cases were confirmed by laboratory tests, and 514 cases were found with SARS-CoV-2 total antibodies. Considering MGE exposure, AR was 39.2% (496/1264). A dose-response relationship was found between MGE attendance and the disease, (adjusted relative risk [aRR] = 4.11 95% confidence interval [CI]3.25-5.19). Two MGEs with a dinner and dance in the same building had higher risks. Associated risk factors with the incidence were older age, obesity, and upper and middle class versus lower class; current smoking was protective. The study suggests the significance of MGEs in the COVID-19 transmission that could explain the subsequent outbreak in Borriana.