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

Burnside, G., Cheyne, C., Leeming, G. , Humann, M., Darby, A., Green, M., Crozier, A., Maskell, S., O'Halloran, K., Musi, E., Carmi, E. ORCID: 0000-0003-1108-2075, Fisher, D., Corcoran, R., Dunning, J., Edmunds, J., Tharmaratnam, K., Hughs, D., Malki-Epshtein, L., Cook, M., Roberts, B., Gallagher, E., Howell, K., Chand, M., Kemp, R., Boulter, M., Fowler, T., Semple, M., Coffey, E., Ashton, M., Garc ıa-Fi~nana, M. & Buchan, I. (2023). COVID-19 risk mitigation in reopening mass cultural events: population-based observational study for the UK Events Research Programme in Liverpool City Region. Journal of the Royal Society of Medicine, doi: 10.1177/0141076823118238


To 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.

Prospective, population-wide observational study.

Four 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.

A total of 12,256 individuals attending one or more events between 28 April and 2 May 2021.

Main outcome measures
SARS-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.

A 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.

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.

Publication Type: Article
Additional Information: © The Royal Society of Medicine. This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( 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 (
Publisher Keywords: COVID-19, mass gatherings, cultural events, SARS-CoV-2 transmission, respiratory virus risk mitigation
Subjects: H Social Sciences > HA Statistics
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments: School of Policy & Global Affairs > Sociology & Criminology
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