Exploring the scope of gatherings in the causation of COVID-19 outbreaks

COVID-19 and Gatherings

Authors

  • Saurabh RamBihariLal Shrivastava Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Tamil Nadu, India
  • Prateek Saurabh Shrivastava Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Tamil Nadu, India

DOI:

https://doi.org/10.54844/cai.2021.0046

Keywords:

COVID-19 pandemic, Gathering, World Health Organization

Abstract

The ongoing coronavirus disease – 2019 (COVID-19) pandemic has changed the dynamics of all sectors and has significantly impacted the functioning of the healthcare delivery system. The purpose of the current review was to explore the significance of gatherings in COVID-19 outbreaks and the strategies to be implemented prior to organize a gathering to minimize the potential risk of a COVID-19 outbreak. An extensive search of all materials related to the topic was carried out in the PubMed search engine and a total of 14 articles were selected. Keywords used in the search include COVID-19 and gathering in the title alone only. As COVID-19 infection spreads via close contact, a gathering of any size carries the definite potential to amplify the risk of transmission and initiate a new chain of disease outbreaks. In conclusion, the COVID-19 pandemic is far from being yet over, and the decision to organize a gathering has to be based on the risk evaluation, risk mitigation, and establishment of a risk communication strategy. Even with all this, zero risk does not exist, and the best approach will be to strictly implement all the prevention and control measures and be responsible in all the gatherings.

References

World Health Organization. Weekly operational update on COVID-19 - 30 November 2021; 2021. Available at: https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---30-november- 2021. Accessed November 4, 2021.

Limbachia J, Owens H, Matean M, Khan SS, Novak-Lauscher H, Ho K. Organizing a mass gathering amidst a rising COVID-19 public health crisis: lessons learned from a Chinese public health forum in Vancouver, BC. Cureus 2020;12:e12365. DOI: https://doi.org/10.7759/cureus.12365

World Health Organization. Holding gatherings during the COVID-19 pandemic: WHO policy brief, 2 August 2021. 2021. Available at: https://www.who.int/publications-detail-redirect/holding- gatherings-during-the-covid-19-pandemic-who-policy-brief-2- august-2021. Accessed November 5, 2021.

McCloskey B, Zumla A, Ippolito G, Blumberg L, Arbon P, Cicero A, et al. Mass gathering events and reducing further global spread of COVID-19: a political and public health dilemma. Lancet 2020;395:1096–1099. DOI: https://doi.org/10.1016/S0140-6736(20)30681-4

Saidan MN, Shbool MA, Arabeyyat OS, Al-Shihabi ST, Abdallat YA, Barghash MA, et al. Estimation of the probable outbreak size of novel coronavirus (COVID-19) in social gathering events and industrial activities. Int J Infect Dis 2020;98:321–327. DOI: https://doi.org/10.1016/j.ijid.2020.06.105

Hashim HT, Babar MS, Essar MY, Ramadhan MA, Ahmad S. The Hajj and COVID-19: How the pandemic shaped the world’s largest religious gathering. Am J Trop Med Hyg 2021;104:797–799. DOI: https://doi.org/10.4269/ajtmh.20-1563

Ebrahim SH, Ahmed Y, Alqahtani SA, Memish ZA. The Hajj pilgrimage during the COVID-19 pandemic in 2020: event hosting without the mass gathering. J Travel Med 2021;28:taaa194. DOI: https://doi.org/10.1093/jtm/taaa194

Furuse Y. Risk at mass-gathering events and the usefulness of complementary events during COVID-19 pandemic. J Infect 2021;82:e20–21. DOI: https://doi.org/10.1016/j.jinf.2020.11.040

Xin R, Skov-Petersen H, Zeng J, Zhou J, Li K, Hu J, et al. Identifying key areas of imbalanced supply and demand of ecosystem services at the urban agglomeration scale: A case study of the Fujian Delta in China. Sci Total Environ. 2021;791:148173. DOI: https://doi.org/10.1016/j.scitotenv.2021.148173

Che Mat NF, Edinur HA, Abdul Razab MKA, Safuan S. A singl mass gathering resulted in massive transmission of COVID-19 infections in Malaysia with further international spread. J Travel Med 2020;27:taaa059. DOI: https://doi.org/10.1093/jtm/taaa059

Schwartz NG, Moorman AC, Makaretz A, Chang KT, Chu VT, Szablewski CM, et al. Adolescent with COVID-19 as the source of an outbreak at a 3-week family gathering - Four States, June-July 2020. MMWR Morb Mortal Wkly Rep 2020;69:1457–1459. DOI: https://doi.org/10.15585/mmwr.mm6940e2

Lam HY, Lam TS, Wong CH, Lam WH, Mei ELC, Kuen YLC, et al. A superspreading event involving a cluster of 14 coronavirus disease 2019 (COVID-19) infections from a family gathering in Hong Kong Special Administrative Region SAR (China). Western Pac Surveill Response J 2020;11:36–40. DOI: https://doi.org/10.5365/wpsar.2020.11.1.012

Rocha ICN, Pelayo MGA, Rackimuthu S. Kumbh mela religious gathering as a massive superspreading event: Potential culprit for the exponential surge of COVID-19 cases in India. Am J Trop Med Hyg 2021;105:868–871. DOI: https://doi.org/10.4269/ajtmh.21-0601

Baraniuk C. Covid-19: People are gathering again, but can crowds be made safe? BMJ 2020;371:m3511. DOI: https://doi.org/10.1136/bmj.m3511

Domènech-Montoliu S, Pac-Sa MR, Vidal-Utrillas P, Latorre-Poveda M, Del Rio-González A, Ferrando-Rubert S, et al. “Mass gathering events and COVID-19 transmission in Borriana (Spain): A retrospective cohort study”. PLoS One 2021;16:e0256747. DOI: https://doi.org/10.1371/journal.pone.0256747

Zhang S, Yang Z, Wang M, Zhang B. “Distance-Driven” Versus“Density-Driven”: Understanding the role of “source-case” distance and gathering places in the localized spatial clustering of COVID- 19-A case study of the Xinfadi market, Beijing (China). Geohealth 2021;5:e2021GH000458. DOI: https://doi.org/10.1029/2021GH000458

Hsu CY, Chen YM, Su CW, Ku MS, Kim Y, Jensen T, et al. Preparedness for containing COVID-19 outbreak in mass religious gathering with non-pharmaceutical interventions (NPIs). J Formos Med Assoc 2021;120:S57–68. DOI: https://doi.org/10.1016/j.jfma.2021.04.017

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Published

2022-06-29

How to Cite

1.
Shrivastava SR, Shrivastava PS. Exploring the scope of gatherings in the causation of COVID-19 outbreaks: COVID-19 and Gatherings. Community Acquir Infect. 2022;9:3. doi:10.54844/cai.2021.0046

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Vol. 9 (2022)

Section

Review Article

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Mini Review

Exploring the scope of gatherings in the causation of corona virus disease 19 outbreaks


Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava

Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Tamil Nadu, India


The ongoing corona virus disease 19 (COVID-19) pandemic has changed the dynamics of all sectors and has significantly impacted the functioning of the healthcare delivery system. The purpose of the current review was to explore the significance of gatherings in COVID-19 outbreaks and the strategies to be implemented prior to organize a gathering to minimize the potential risk of a COVID-19 outbreak. An extensive search of all materials related to the topic was carried out in the PubMed search engine and a total of 14 articles were selected. Keywords used in the search include COVID-19 and gathering in the title alone only. As COVID-19 infection spreads via close contact, a gathering of any size carries the definite potential to amplify the risk of transmission and initiate a new chain of disease outbreaks. The findings of different studies have reported emergence of new outbreaks subsequent to a gathering in different nations. In addition, we cannot ignore the reality that any kind of gathering enhances the risk to strain the local health services. In conclusion, the COVID-19 pandemic is far from being yet over, and the decision to organize a gathering has to be based on the risk evaluation, risk mitigation, and establishment of a risk communication strategy. Even with all this, zero risk does not exist, and the best approach will be to strictly implement all the prevention and control measures and be responsible in all the gatherings.


Key words: COVID-19 pandemic, gathering, World Health Organization


Address for correspondence:

Dr. Saurabh RamBihariLal Shrivastava, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603108, Tamil Nadu, India. E-mail: drshrishri2008@gmail.com

Submitted: 07-12-2021 Revised: 30-12-2021

Accepted: 24-02-2022 Published: 29-06-2022

For reprints contact: reprints@sppub.org



The ongoing corona virus disease 19 (COVID-19) pandemic has changed the dynamics of all sectors and has significantly impacted the functioning of the healthcare delivery system. The global estimates depict that as of 28 November, in excess of 260 million confirmed cases and close to 5.2 million deaths have been attributed to the infection.[1] The very fact that the disease spreads from one person to another by means of close contact reinforces the need to maintain physical distancing and strictly adhere to the infection prevention and control measures.[2] The purpose of the current review was to explore the significance of gatherings in COVID-19 outbreaks and the strategies to be implemented prior to organize a gathering to minimize the potential risk of a COVID-19 outbreak.


An extensive search of all materials related to the topic was carried out in the PubMed search engine. Relevant research articles focusing on COVID-19 and gatherings published in the period 2020 to 2021 were included in the review. A total of 16 studies similar to current study objectives was identified initially, of which, two were excluded due to the unavailability of the complete version of the articles. Overall, 14 articles were selected based upon their suitability with the current review objectives and analyzed. Keywords used in the search include COVID-19 and gathering in the title alone only (viz. COVID-19 [ti] AND gathering [ti]; COVID-19 pandemic [ti] AND mass gathering [ti]). The articles published in only the English language were included in the review (Figure 1). The collected information is presented under the following sub-headings, namely Gathering, COVID-19 infection and gathering, COVID-19 outbreaks originating from gatherings, organizing gatherings during the COVID-19 pandemic, and additional considerations.


Figure 1
Figure 1: Flowchart for selection of research articles


Gatherings refer to the events wherein people aggregate with a specific intention for a fixed duration of time, and these can be either public or private events, planned or sudden events, or once a while or repetitive.[3,4] These gatherings have been observed in the domains of sports (cricket or football match, etc.), social (birthday or wedding, etc.), religious (temple or mosque, etc.), entertainment (theatres), cultural, political rallies or events, business meetings, health-related meetings, etc.[3,4,5] Upon a significant increase in the number of people attending the event, these are termed as mass gatherings, such as Olympics, Hajj pilgrimage, etc.[5,6,7] These events are often linked with international travel of the involved people, organization of events in different locations, and are of relatively long duration, which also has some kind of political or socioeconomic consequences.[3,4,5,6,7]


As COVID-19 infection spreads via close contact, a gathering of any size carries the definite potential to amplify the risk of transmission and initiate a new chain of disease outbreaks.[8] This is predominantly because of the conducive atmosphere (viz. high density and mobility of the people who have gathered) for the causative virus to spread, as people will be together for a longer duration, and that too close to each other.[4,5,6,7] In fact, the available evidence suggests that the risk of infection transmission significantly enhances with the duration of exposure, location (indoor > outdoor), and non-adherence with the standard prevention and control measures.[2,8] It is the need of the hour to employ the agglomeration scale and correlate the same with the occurrence of outbreaks and epidemics in heterogeneous settings.[9] More often than not, it has been reported that the chances of occurrence an outbreak of the COVID-19 infection significantly increases with agglomeration of susceptible individuals, more so in cases of urban settings.


The findings of a study done in Malaysia reported that close to 35% of the new cases were linked with the Sri Petaling gathering, a religious movement that was attended by more than 19,000 people from different nations in Kuala Lumpur in the month of March 2020.[10] Among the attendees, in excess of 1700 people were diagnosed with the new COVID-19 infection.[10] On a similar note, a COVID-19 outbreak was reported in the month of July – August 2020 in a long gathering, wherein from one index case, 11 additional cases were reported.[11] Similarly, a family cluster of 12 confirmed cases, along with two additional cases because of secondary transmission was reported in Hong Kong.[12] Even in India, many cases were reported from the Kumbh Mela in Uttar Pradesh, and it became a grave cause of public health concern.[13]


Acknowledging the threat related to the COVID-19 pandemic, most of the nations are still advocating restrictions on gatherings.[2] Even under circumstances where gatherings are permitted, due attention should be given to the standard infection prevention and control measures. These measures include practicing physical distancing (maintaining a distance of at least 1 meter) between people, covering the mouth & nose with masks, regular handwashing with soap & water or alcohol-based hand sanitizers, and avoiding crowded or poorly ventilated settings.[10,11,12,13,14,15] Further, all participants should be always reminded about the need to be responsible with an intention to not only safeguard their health, but even of the other people and the community at large.[2,7,8,10]


The agencies planning for organizing a gathering should adopt a risk-based approach, keeping in mind the attributes of the planned event.[2] This has to begin with risk evaluation, wherein the baseline risk of transmission of the infection is ascertained along with the preparedness of the health system to deal with a potential outbreak.[16] This has to be supported with risk mitigation measures, which essentially refers to the implementation of standard prevention measures and the logistics required for the same.[16] Finally, the organizers should also look to disseminate the required information about all the planned measures to everyone involved, justifying the need for each one of them. Regardless of the size of the gathering, it is always necessary that we should strongly adhere to the precautionary strategies and take efforts to minimize the potential risk, as the overall risk cannot be completely eliminated.[14,15,16,17] In this regard, we also have to plan for strategic testing, isolation of the confirmed cases, contact tracing and their quarantine, and intensifying immunization against the infection.[5,6,7]


Apart from the fact that the organization of gatherings amplifies the risk of transmission of the infection, we cannot ignore the reality that it also strains the local health services.[2] On the possibility of the emergence of a new chain of transmission, the health system has to be prepared to respond to the sudden demands, and there is a potential risk of interruption of the other health and essential delivery services. The decision to organize a gathering should also take into account the current status of the COVID-19 transmission on the global, regional, and local platform.[10,11,12,13]


In conclusion, the COVID-19 pandemic is far from being yet over, and the decision to organize a gathering has to be based on the risk evaluation, risk mitigation, and establishment of a risk communication strategy. Even with all this, zero risk does not exist, and the best approach will be to strictly implement all the prevention and control measures and be responsible in all the gatherings.


Source of funding

None declared.


Conflicts of interest

Prateek Saurabh Shrivastava is an Editorial Board Member of the journal. The article was subject to the journal’s standard procedures, with peer review handled independently of this editor and his research groups.


  1. World Health Organization. Weekly operational update on COVID-19 - 30 November 2021; 2021. Available at: https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---30-november-2021. Accessed November 4, 2021.
  2. Limbachia J, Owens H, Matean M, Khan SS, Novak-Lauscher H, Ho K. Organizing a mass gathering amidst a rising COVID-19 public health crisis: lessons learned from a Chinese public health forum in Vancouver, BC. Cureus 2020;12:e12365.DOI: 10.7759/cureus.12365
  3. World Health Organization. Holding gatherings during the COVID-19 pandemic: WHO policy brief, 2 August 2021. 2021. Available at: https://www.who.int/publications-detail-redirect/holding-gatherings-during-the-covid-19-pandemic-who-policy-brief-2-august-2021. Accessed November 5, 2021.
  4. McCloskey B, Zumla A, Ippolito G, Blumberg L, Arbon P, Cicero A, et al. Mass gathering events and reducing further global spread of COVID-19: a political and public health dilemma. Lancet 2020;395:1096–1099. DOI: 10.1016/S0140-6736(20)30681-4
  5. Saidan MN, Shbool MA, Arabeyyat OS, Al-Shihabi ST, Abdallat YA, Barghash MA, et al. Estimation of the probable outbreak size of novel coronavirus (COVID-19) in social gathering events and industrial activities. Int J Infect Dis 2020;98:321–327. DOI: 10.1016/j.ijid.2020.06.105
  6. Hashim HT, Babar MS, Essar MY, Ramadhan MA, Ahmad S. The Hajj and COVID-19: How the pandemic shaped the world’s largest religious gathering. Am J Trop Med Hyg 2021;104:797–799. DOI: 10.4269/ajtmh.20-1563
  7. Ebrahim SH, Ahmed Y, Alqahtani SA, Memish ZA. The Hajj pilgrimage during the COVID-19 pandemic in 2020: event hosting without the mass gathering. J Travel Med 2021;28:taaa194. DOI: 10.1093/jtm/taaa194
  8. Furuse Y. Risk at mass-gathering events and the usefulness of complementary events during COVID-19 pandemic. J Infect 2021;82:e20–21. DOI: 10.1016/j.jinf.2020.11.040
  9. Xin R, Skov-Petersen H, Zeng J, Zhou J, Li K, Hu J, et al. Identifying key areas of imbalanced supply and demand of ecosystem services at the urban agglomeration scale: A case study of the Fujian Delta in China. Sci Total Environ 2021;791:148173. DOI: 10.1016/j.scitotenv.2021.148173
  10. Che Mat NF, Edinur HA, Abdul Razab MKA, Safuan S. A single mass gathering resulted in massive transmission of COVID-19 infections in Malaysia with further international spread. J Travel Med 2020;27:taaa059. DOI: 10.1093/jtm/taaa059
  11. Schwartz NG, Moorman AC, Makaretz A, Chang KT, Chu VT, Szablewski CM, et al. Adolescent with COVID-19 as the source of an outbreak at a 3-week family gathering - Four States, June-July 2020. MMWR Morb Mortal Wkly Rep 2020;69:1457–1459. DOI: 10.15585/mmwr.mm6940e2
  12. Lam HY, Lam TS, Wong CH, Lam WH, Mei ELC, Kuen YLC, et al. A superspreading event involving a cluster of 14 coronavirus disease 2019 (COVID-19) infections from a family gathering in Hong Kong Special Administrative Region SAR (China). Western Pac Surveill Response J 2020;11:36–40. DOI: 10.5365/wpsar.2020.11.1.012
  13. Rocha ICN, Pelayo MGA, Rackimuthu S. Kumbh mela religious gathering as a massive superspreading event: Potential culprit for the exponential surge of COVID-19 cases in India. Am J Trop Med Hyg 2021;105:868–871. DOI: 10.4269/ajtmh.21-0601
  14. Baraniuk C. Covid-19: People are gathering again, but can crowds be made safe? BMJ 2020;371:m3511. DOI: 10.1136/bmj.m3511
  15. Domènech-Montoliu S, Pac-Sa MR, Vidal-Utrillas P, Latorre-Poveda M, Del Rio-González A, Ferrando-Rubert S, et al. “Mass gathering events and COVID-19 transmission in Borriana (Spain): A retrospective cohort study”. PLoS One 2021;16:e0256747. DOI: 10.1371/journal.pone.0256747
  16. Zhang S, Yang Z, Wang M, Zhang B. “Distance-Driven” Versus “Density-Driven”: Understanding the role of “source-case” distance and gathering places in the localized spatial clustering of COVID-19-A case study of the Xinfadi market, Beijing (China). Geohealth 2021;5:e2021GH000458. DOI: 10.1029/2021GH000458
  17. Hsu CY, Chen YM, Su CW, Ku MS, Kim Y, Jensen T, et al. Preparedness for containing COVID-19 outbreak in mass religious gathering with non-pharmaceutical interventions (NPIs). J Formos Med Assoc 2021;120:S57–68. DOI: 10.1016/j.jfma.2021.04.017

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