• 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, and Iain E Buchan.
• Deparment of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool L69 3GL, UK.
• J R Soc Med. 2024 Jan 1; 117 (1): 112311-23.

ObjectivesTo 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.DesignProspective, population-wide observational study.SettingFour 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.ParticipantsA total of 12,256 individuals attending one or more events between 28 April and 2 May 2021.Main Outcome MeasuresSARS-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.ResultsA 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.ConclusionsWe 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.

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